The number of years lived with obesity and the risk of all-cause and cause-specific mortality

Background The role of the duration of obesity as an independent risk factor for mortality has not been investigated. The aim of this study was to analyse the association between the duration of obesity and the risk of mortality.

Methods A total of 5036 participants (aged 28–62 years) of the Framingham Cohort Study were followed up every 2 years from 1948 for up to 48 years. The association between obesity duration and all-cause and cause-specific mortality was analysed using time-dependent Cox models adjusted for body mass index. The role of biological intermediates and chronic diseases was also explored.

Results The adjusted hazard ratio (HR) for mortality increased as the number of years lived with obesity increased. For those who were obese for 1–4.9, 5–14.9, 15–24.9 and ≥25 years of the study follow-up period, adjusted HRs for all-cause mortality were 1.51 [95% confidence interval (CI) 1.27–1.79], 1.94 (95% CI 1.71–2.20), 2.25 (95% CI 1.89–2.67) and 2.52 (95% CI 2.08–3.06), respectively, compared with those who were never obese. A dose–response relation between years of duration of obesity was also clear for all-cause, cardiovascular, cancer and other-cause mortality. For every additional 2 years of obesity, the HRs for all-cause, cardiovascular disease, cancer and other-cause mortality were 1.06 (95% CI 1.05–1.07), 1.07 (95% CI 1.05–1.08), 1.03 (95% CI 1.01–1.05) and 1.07 (95% CI 1.05–1.11), respectively.

Conclusions The number of years lived with obesity is directly associated with the risk of mortality. This needs to be taken into account when estimating its burden on mortality.

Comparing external and internal dorsal-spine bands to interpret the age and growth of the giant lantern shark, Etmopterus baxteri (Squaliformes: Etmopteridae)

The giant lantern shark, Etmopterus baxteri, is taken as bycatch of commercial fisheries that operate in deepwater off southeastern Australia. Bands on the second dorsal spine were used to obtain age estimates. The number of bands on the external surface of the spine and within the inner dentine layer increased with animal length. Most spines had more bands on the external surface, and the rate of band formation was significantly different between the external surface and the inner dentine layer. Females had a maximum of 57 external bands and 26 internal bands, while males had up to 48 external bands and 22 internal bands. Age estimates from external bands suggest maturity (A ₅₀) at 20 years for males and 30 years for females. Internal band age estimates suggest maturity at 10.5 years for males and 11.5 years for females. Although there is a large discrepancy between these two preliminary (i.e., unvalidated) age estimates, they both suggest that E. baxteri is a long-lived and late maturing species that is likely to be susceptible to over fishing.

The inverse relationship between number of steps per day and obesity in a population-based sample - the AusDiab study

Background:
Physical activity (PA) is inversely associated with obesity but the effect has been difficult to quantify using questionnaires. In particular, the shape of the association has not yet been well described. Pedometers provide an opportunity to better characterize the association.

Methods:
Residents of households over the age of 25 years in randomly selected census districts in Tasmania were eligible to participate in the AusDiab cross-sectional survey conducted in 1999–2000. 1848 completed the AusDiab survey and 1126 of these (609 women and 517 men) wore a pedometer for 2-weekdays. Questionnaire data on recent PA, TV time and other factors were obtained. The outcomes were waist circumference (in cm) and body mass index (BMI) (kg/m2).

Results:
Increasing daily steps were associated with a decline in the obesity measures. The logarithmic nature of the associations was indicated by a sharper decline for those with lower daily steps. For example, an additional 2000 steps for those taking only 2000 steps per day was associated with a reduction of 2.8 (95% confidence interval (CI): 2.1,4.4) cm in waist circumference among men (for women; 2.2 (95% CI: 0.6, 3.9 cm)) with a baseline of only 2000, steps compared to a 0.7 (95% CI 0.3, 1.1) cm reduction (for women; 0.6 (95% CI: 0.2, 1.0)) for those already walking 10 000 steps daily. In the multivariable analysis, clearer associations were detected for PA and these obesity measures using daily step number rather than PA time by questionnaire.

Interpretation:
Pedometer measures of activity indicate that the inverse association between recent PA and obesity is logarithmic in form with the greatest impact for a given arithmetic step number increase seen at lower levels of baseline activity. The findings from this study need to be examined in prospective settings.

Functional capacity and quality of life in middle-age men and women with high and low number of metabolic risk factors

It is not clear if men and women with high numbers of risk factors (HiMF) for metabolic syndrome (MetS) have impaired capacities to perform activities of daily living (ADL's) and lower quality of life (QoL) in the absence of symptomatic heart disease. Our results indicate that in women there is a correlation between the number of risk factors and the capacity to perform ADL's and QoL. This was not evident for men. These findings may partly explain why women tend to consult healthcare practitioners earlier in the disease process than men.

Probability distributions of number of children and maternal age at various order births using age-specific fertility rates by birth order

In this study, a simple analytical framework to find the probability distributions of number of children and maternal age at various order births by making use of data on age-specific fertility rates by birth order was proposed. The proposed framework is applicable to both the period and cohort fertility schedules. The most appealing point of the proposed framework is that it does not require stringent assumptions. The proposed framework has been applied to the cohort birth order-specific fertility schedules of India and its different regions and period birth order-specific fertility schedules, including the United States of America, Russia, and the Netherlands, to demonstrate its usefulness.

Living healthier for longer: comparative effects of three heart-healthy behaviors on life expectancy with and without cardiovascular disease

BACKGROUND: Non-smoking, having a normal weight and increased levels of physical activity are perhaps the three key factors for preventing cardiovascular disease (CVD). However, the relative effects of these factors on healthy longevity have not been well described. We aimed to calculate and compare the effects of non-smoking, normal weight and physical activity in middle-aged populations on life expectancy with and without cardiovascular disease.

METHODS: Using multi-state life tables and data from the Framingham Heart Study (n = 4634) we calculated the effects of three heart healthy behaviours among populations aged 50 years and over on life expectancy with and without cardiovascular disease. For the life table calculations, we used hazard ratios for 3 transitions (No CVD to CVD, no CVD to death, and CVD to death) by health behaviour category, and adjusted for age, sex, and potential confounders.

RESULTS: High levels of physical activity, never smoking (men), and normal weight were each associated with 20-40% lower risks of developing CVD as compared to low physical activity, current smoking and obesity, respectively. Never smoking and high levels of physical activity reduced the risks of dying in those with and without a history of CVD, but normal weight did not. Never-smoking was associated with the largest gains in total life expectancy (4.3 years, men, 4.1 years, women) and CVD-free life expectancy (3.8 and 3.4 years, respectively). High levels of physical activity and normal weight were associated with lesser gains in total life expectancy (3.5 years, men and 3.4 years, women, and 1.3 years, men and 1.0 year women, respectively), and slightly lesser gains in CVD-free life expectancy (3.0 years, men and 3.1 years, women, and 3.1 years men and 2.9 years women, respectively). Normal weight was the only behaviour associated with a reduction in the number of years lived with CVD (1.8 years, men and 1.9 years, women).

CONCLUSIONS: Achieving high levels of physical activity, normal weight, and never smoking, are effective ways to prevent cardiovascular disease and to extend total life expectancy and the number of years lived free of CVD. Increasing the prevalence of normal weight could further reduce the time spent with CVD in the population.

Menopausal stage and age and perceptions of body image

The aim of This study was to investigate the association between menopausal stage and age and women's perception of their body image. Females from a community sample (n = 304. age range from 35 to 65 years) volunteered to complete a structured questionnaire which contained the Multidimensional Body Self Relations Questionnaire (MBSRQ) and the Stunkard Body Shape Figure Scale. One hundred and twenty women were premenopausal, 76 women were perimenopausal and 108 were postmenopausal. The effects of age and menopausal stage could not be separated in ratings of appearance evaluation, fitness evaluation, current, ideal and societal ratings of the Stunkard Body Shape Figure Scale. Premenopausal women (who were likely to be younger) had more positive ratings of appearance evaluation and fitness evaluation than menopausal women (who were likely to be older). Women who were premenopausal nominated smaller figures from the Stunkard Body Shape Figure Scale for ratings of the current, ideal and societal body shape than women who were perimenopausal and postmenopausal. The implications of these findings as they relate to women as they progress through the menopausal transition and as they become older is discussed.

The relationships between migration, social support and social integration on quality of Life

Past research indicates that humans have a remarkable ability to maintain normal levels of subjective wellbeing despite adverse objective circumstances. This suggests that such wellbeing may be held under homeostatic control. This paper investigates some of the potential factors
that may contribute to this homeostatic mechanism, in response to the major life event of migration. Three groups were examined: Persian immigrants to Australia (Persian- Australians), non-Persian Australians, and Persians residing in Iran. A total of 330 subjects were recruited. A notable finding was that all three groups did not differ in regard to subjective wellbeing, despite the Persian-Australians being a minority ethnic group in Australia, and the Persians having significantly lower objective life quality. The Persian-Australians who migrated at an older age reported lower subjective quality of life, while the number of years of residence in Australia did not appear to be related to the extent of social integration. Subjective life quality was, however, related to subjective social support for the Australian and Persian samples, and to reciprocality of support for the Persian-Australians.

Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes : modeled lifetime analysis

OBJECTIVE--To estimate the cost-effectiveness of surgically induced weight loss relative to conventional therapy for the management of recently diagnosed type 2 diabetes in class VII obese patients.

RESEARCH DESIGN AND METHODS--This study builds on a within-trial cost-efficacy analysis. The analysis compares the lifetime costs and quality-adjusted life-years (QALYs) between the two intervention groups. Intervention costs were extrapolated based on observed resource utilization during the trial. The proportion of patients in each intervention group with remission of diabetes at 2 years was the same as that observed in the trial. Health care costs for patients with type 2 diabetes and outcome variables required to derive estimates of QALYs were sourced from published literature. A health care system perspective was adopted. Costs and outcomes were discounted annually at 3%. Costs are presented in 2006 Australian dollars (AUD) (currency exchange: 1 AUD = 0.74 USD).

RESULTS--The mean number of years in diabetes remission over a lifetime was 11.4 for surgical therapy patients and 2.1 for conventional therapy patients. Over the remainder of their lifetime, surgical and conventional therapy patients lived 15.7 and 14.5 discounted QALYs, respectively. The mean discounted lifetime costs were 98,900 AUD per surgical therapy patient and 101,400 AUD per conventional therapy patient. Relative to conventional therapy, surgically induced weight loss was associated with a mean health care saving of 2,400 AUD and 1.2 additional QALYs per patient.

CONCLUSIONS--Surgically induced weight loss is a dominant intervention (it both saves health care costs and generates health benefits) for managing recently diagnosed type 2 diabetes in class IBI obese patients in Australia.

Does baiting influence the relative composition of the diet of foxes?

The changes in the diet of foxes (Vulpes vulpes) in the Jervis Bay Region was assessed following a long-term baiting program by analysing the composition of fox faecal excreta (scats). In all, 470 fox scats were collected between April and August 2003 from two baited sites, Booderee National Park (BNP) and Beecroft Peninsula, and from two unbaited sites in the southern and northern parts of Jervis Bay National Park (SJBNP and NJBNP respectively). Diet was compared between these sites and mammalian diet was also compared from scats collected before baiting in 1996 and after baiting in 2000 at Beecroft Peninsula and in 2001 at Booderee National Park. In 2003, the most common species consumed by foxes was the common ringtail possum (Pseudocheirus peregrinus), except at unbaited NJBNP, where the swamp wallaby (Wallabia bicolor) was the most frequent dietary item. Significant dietary differences were found between unbaited and baited sites, with the long-nosed bandicoot (Perameles nasuta) and P. peregrinus featuring more in the diet of foxes from the baited sites. Marked increases in the frequency of occurrence of P. peregrinus and P. nasuta in fox scats occurred from before baiting through to after baiting. Relative fox abundance, as indexed by the number of scats collected per kilometre, was lowest in Booderee, followed by Beecroft, then SJBNP, with NJBNP having the highest relative abundance of foxes. We suggest that baiting did affect the diet of foxes on both peninsulas and that the dietary changes across baiting histories were intrinsically related to an increase in abundance in some taxa as a result of relaxed predator pressure following sustained fox control. However, the lack of unbaited control sites over the whole study precludes a definitive conclusion.

Providing sporting experiences for children in Out of School Hours Care (OSHC) environments : sport and physical activity participation and intentions

The Out of School Hours Sports Program (OSHSP) aimed to provide structured sporting experiences and community links to local clubs for children in Out of School Hours Care (OSHC). The OSHSP involved 17 State Sporting Associations (SSAs), 71 OSHC Services and local club representatives. This study explored children's participation in sport in and outside the OSHSP and parental intention for participation in sport in and outside the OSHSP. Surveys were received from 211 children (76 girls and 125 boys; mean age = 7.9 years, S.D. = 1.7) and their parents/guardians (37.9% response rate). OSHC is characterised by freedom of choice of participation in activities by children. The OSHSP was used to provide an opportunity to choose to participate in a sport while attending OSHC. At the OSHC Services surveyed, between 7.1 and 100% of the children attending OSHC chose to participate in the OSHSP. Of those children who chose to participate, 85% were participating in a sport, usually a different sport to the one offered in the OSHSP. This participation was largely club-based (49.8%), most often once a week for training and competition (55.2%). Parental intentions for children's participation in the OSHSP sports varied with respect to the number of years attending the OSHSP, where children played and trained in their main sport, and how many times a week a child played and trained in their main sport. Older children tended to play and train for sport more times per week and had been attending the OSHC for more years than younger children.

Aspects of the biology of the abalone Haliotis laevigata and Haliotis scalaris

The abalone Haliotis laevigata Donovan is commercially exploited in southern Australia; Haliotis scalaris Leach is a smaller, noncommercial species. This thesis describes the early life history of both species and other aspects of the fishery biology of H. Iaevigata required for fishery management. Both abalone species recruit onto a crustose coralline substratum variously from spring to winter. After settlement the growth rate of both species Is linear for a number of years (1 .7mm/month for H. Iaevigata and 1.1mm/month for H. scalaris) . Crustose coralline algae are the main food during the first year of life but thereafter the diet switches largely to drift algae and seagrass. Survival of newly-settled cohorts differed between years and between species. Overall, it appeared to be density Independent at low densities but density-dependent at high densities, Recruitment strength (measured at 2-1/2 - 3 years of age) and natural mortality of adults in a closed population was measured over 17 years at West I. There were sequences of strong and weak recruitments, but no relationship with presumed spawning stock size was apparent. Adult natural mortality rates ranged from 0.02 to 0.86 and were strongly density dependent. Stingrays were a major, and octopuses a minor, cause of mortality. The fecundity of H. Iaevigata was investigated at a number of sites and was adequately described by linear regressions of fecundity on total weight. Fecundity ratios and growth rate differed between sites and fecundity appears subject to phenotyplc and genotypic variation. The short and long term movement of H. laevigata was also examined, !n short term studies sexually mature Individuals aggregate during the spawning season but disperse randomly at other times of the year. In the longer term the amount of movement depends on availability of crevice space and size. Movement is also directional and, at one site, was toward that of the approaching swell. A method is described for estimating density of abalone by using a free-range search technique and adjusting for individual variation in power and efficiency of different divers and in differing degrees of habitat heterogeneity. The method is useful for estimating recruitment strength and density of abalone in surveys of abalone stocks.

Cashmere production and fleece attributes associated with farm of origin, age and sex of goat in Australia

Differences in cashmere production and fleece attributes associated with farm of origin, age and sex were quantified for commercial Australian cashmere goat enterprises. From 11 farms in four states, 1147 does and 97 wethers were monitored, representing 1- to 13-year-old goats. Individual clean cashmere production ranged from 21 to 389 g, with a mean ± standard deviation value of 134 ± 62 g. The mean cashmere production of 2-year-old does from different farms varied from 69 to 225 g and averaged 141 g. Mean ± s.d. greasy fleece weight was 394 ± 123 g, clean washing yield was 90.8 ± 4.1%, clean cashmere yield 33.4 ± 9.4%, cashmere fibre diameter 16.4 ± 1.6 µm, fibre curvature 48 ± 8.7 degrees/mm and staple length 8.7 ± 2.1 cm. There were large, commercially significant differences between farms for clean cashmere weight, mean fibre diameter and other attributes of cashmere. These were much larger than the effects of age and sex. Farm and age accounted for 42 to 67% of the variation in clean cashmere production, mean fibre diameter, fibre curvature, staple length and clean washing yield. Farm of origin affected clean cashmere yield, accounting for 24% of the variation. Sex of the goats had only a minor effect on the staple length of cashmere. The responses to age of clean cashmere weight, mean fibre diameter and the inverse of fibre curvature are very similar. Generally, cashmere production and mean fibre diameter increased with age. For the majority of farms, cashmere fibre curvature declined in a curvilinear manner with increases in age of goat. There were large differences in cashmere staple length from different farms, with means ranging from 7 to 12 cm. Between 1 and 2 years of age, the staple length of cashmere demonstrated a constant proportional increase. At ages older than 2 years, staple length either declined or increased by less than 1 cm with age, depending on the farm of origin. This study demonstrates that there are large gains in productivity that can be achieved from Australian cashmere goats. A better understanding of on-farm factors that influence cashmere production would enable all producers to optimise their production systems.

The effect of resistance training on functional capacity and quality of life in individuals with high and low number of metabolic risk factors

OBJECTIVE—There are limited data on the effects of resistance training on the capacity to perform activities of daily living (ADLs) and quality of life (QoL) for individuals with a high number of metabolic risk factors (HiMF). In this study, we examined the effect of resistance training on the capacity to perform ADLs and QoL in individuals with HiMF and compared any benefits with individuals with a low number of metabolic risk factors (LoMF).

RESEARCH DESIGN AND METHODS—Fifty-five untrained individuals, aged 50.8 ± 6.5 years, were randomized to four groups: HiMF training (HiMFT), HiMF control, LoMF training (LoMFT), and LoMF control. At baseline and after 10 weeks of resistance training, participants underwent anthropometric measurements and assessments of aerobic power (Vo2peak), muscle strength, capacity to perform ADLs, and a self-perceived QoL questionnaire. A repeated-measures ANOVA was used to examine the effect of training over time among groups.

RESULTS—Training increased lean body mass in both HiMFT (P = 0.03) and LoMFT (P = 0.03) groups. Total fat content and Vo2peak improved in the LoMFT group only. Muscle strength improved in both training groups (P < 0.01). Time to complete ADLs was reduced by 8.8% in the LoMFT group (P < 0.01) and 9.7% in the HiMF group (P < 0.01). Only the HiMFT group reported improvement in QoL.

CONCLUSIONS— Resistance training improved muscle strength and the capacity to perform ADLs in individuals with HiMF and LoMF. Resistance training improved QoL for the HiMF group, and this result was independent of changes in body fat content or aerobic power. Longer training regimens may be needed to improve QoL in individuals with LoMF.

The impact of age at onset of bipolar I disorder on functioning and clinical presentation

Objectives: Recent studies have proposed the existence of three distinct subgroups of bipolar 1 disorder based on age at onset (AAO). The present study aims to investigate potential clinical and functional differences between these subgroups in an Australian sample.

Methods: Participants (n = 239) were enrolled in the Bipolar Comprehensive Outcomes Study (BCOS), a 2-year longitudinal, observational, cross-sectional study. Assessment measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAMD21), Clinical Global Impressions Scale (CGI-BP), SF-36, SLICE/Life Scale, and the EuroQol (EQ-5D). Participants were also asked about their age at the first major affective episode.

Results: Three AAO groups were compared: early (AAO < 20, mean = 15.5 ± 2.72; 44.4% of the participants); intermediate (AAO 20–39, mean = 26.1 ± 4.8; 48.14% of the participants) and late (AAO > 40, mean = 50.6 ± 9.04; 7.4% of the participants). Higher rates of depression, suicidal ideation and binge drinking were reported by the early AAO group. This group also reported poorer quality of life in a number of areas. The early AAO group had a predominant depressive initial polarity and the intermediate group had a manic predominance.

Conclusion: Early AAO is associated with an adverse outcome.