The relationship between abdominal obesity and depression in the general population : a systematic review and meta-analysis

Obesity has been widely regarded as a public health concern because of its adverse impact on individuals’ health. Systematic reviews have been published in examining the effect of obesity on depression, but with major emphasis on general obesity as measured by the body mass index. Despite a stronger effect of abdominal obesity on individuals’ physical health outcomes, to our best knowledge, no systematic review was undertaken with regard to the relationship between abdominal obesity and depression. This paper reports the results of a systematic review and meta-analysis of cross-sectional studies examining the relationship between abdominal obesity and depression in a general population. Multiple electronic databases were searched until the end of September 2009. 15 articles were systematically reviewed and meta-analyzed. The analysis showed that the odds ratio of having depression for individuals with abdominal obesity was 1.38 (95% CI, 1.22–1.57) as compared to those who are not obese. Furthermore, it was found that this relationship did not vary with potential confounders including gender, age, measurement of depression and abdominal obesity, and study quality.

Body composition and its relationship to metabolic risk factors in Asian children

Obesity is a major public health problem in both developed and developing countries. The body mass index (BMI) is the most common index used to define obesity. The universal application of the same BMI classification across different ethnic groups is being challenged due to the inability of the index to differentiate fat mass (FM) and fat�]free mass (FFM) and the recognized ethnic differences in body composition. A better understanding of the body composition of Asian children from different backgrounds would help to better understand the obesity�]related health risks of people in this region. Moreover, the limitations of the BMI underscore the necessity to use where possible, more accurate measures of body fat assessment in research and clinical settings in addition to BMI, particularly in relation to the monitoring of prevention and treatment efforts. The aim of the first study was to determine the ethnic difference in the relationship between BMI and percent body fat (%BF) in pre�]pubertal Asian children from China, Lebanon, Malaysia, the Philippines, and Thailand. A total of 1039 children aged 8�]10 y were recruited using a non�]random purposive sampling approach aiming to encompass a wide BMI range from the five countries. Percent body fat (%BF) was determined using the deuterium dilution technique to quantify total body water (TBW) and subsequently derive proportions of FM and FFM. The study highlighted the sex and ethnic differences between BMI and %BF in Asian children from different countries. Girls had approximately 4.0% higher %BF compared with boys at a given BMI. Filipino boys tended to have a lower %BF than their Chinese, Lebanese, Malay and Thai counterparts at the same age and BMI level (corrected mean %BF was 25.7�}0.8%, 27.4�}0.4%, 27.1�}0.6%, 27.7�}0.5%, 28.1�}0.5% for Filipino, Chinese, Lebanese, Malay and Thai boys, respectively), although they differed significantly from Thai and Malay boys. Thai girls had approximately 2.0% higher %BF values than Chinese, Lebanese, Filipino and Malay counterparts (however no significant difference was seen among the four ethnic groups) at a given BMI (corrected mean %BF was 31.1�}0.5%, 28.6�}0.4%, 29.2�}0.6%, 29.5�}0.6%, 29.5�}0.5% for Thai, Chinese, Lebanese, Malay and Filipino girls, respectively). However, the ethnic difference in BMI�]%BF relationship varied by BMI. Compared with Caucasians, Asian children had a BMI 3�]6 units lower for a given %BF. More than one third of obese Asian children in the study were not identified using the WHO classification and more than half were not identified using the International Obesity Task Force (IOTF) classification. However, use of the Chinese classification increased the sensitivity by 19.7%, 18.1%, 2.3%, 2.3%, and 11.3% for Chinese, Lebanese, Malay, Filipino and Thai girls, respectively. A further aim of the first study was to determine the ethnic difference in body fat distribution in pre�]pubertal Asian children from China, Lebanon, Malaysia, and Thailand. The skin fold thicknesses, height, weight, waist circumference (WC) and total adiposity (as determined by deuterium dilution technique) of 922 children from the four countries was assessed. Chinese boys and girls had a similar trunk�]to�]extremity skin fold thickness ratio to Thai counterparts and both groups had higher ratios than the Malays and Lebanese at a given total FM. At a given BMI, both Chinese and Thai boys and girls had a higher WC than Malays and Lebanese (corrected mean WC was 68.1�}0.2 cm, 67.8�}0.3 cm, 65.8�}0.4 cm, 64.1�}0.3 cm for Chinese, Thai, Lebanese and Malay boys, respectively; 64.2�}0.2 cm, 65.0�}0.3 cm, 62.9�}0.4 cm, 60.6�}0.3 cm for Chinese, Thai, Lebanese and Malay girls, respectively). Chinese boys and girls had lower trunk fat adjusted subscapular/suprailiac skinfold ratio compared with Lebanese and Malay counterparts. The second study aimed to develop and cross�]validate bioelectrical impedance analysis (BIA) prediction equations of TBW and FFM for Asian pre�]pubertal children from China, Lebanon, Malaysia, the Philippines, and Thailand. Data on height, weight, age, gender, resistance and reactance measured by BIA were collected from 948 Asian children (492 boys and 456 girls) aged 8�]10 y from the five countries. The deuterium dilution technique was used as the criterion method for the estimation of TBW and FFM. The BIA equations were developed from the validation group (630 children randomly selected from the total sample) using stepwise multiple regression analysis and cross�]validated in a separate group (318 children) using the Bland�]Altman approach. Age, gender and ethnicity influenced the relationship between the resistance index (RI = height2/resistance), TBW and FFM. The BIA prediction equation for the estimation of TBW was: TBW (kg) = 0.231�~Height2 (cm)/resistance (ƒ¶) + 0.066�~Height (cm) + 0.188�~Weight (kg) + 0.128�~Age (yr) + 0.500�~Sex (male=1, female=0) . 0.316�~Ethnicity (Thai ethnicity=1, others=0) �] 4.574, and for the estimation of FFM: FFM (kg) = 0.299�~Height2 (cm)/resistance (ƒ¶) + 0.086�~Height (cm) + 0.245�~Weight (kg) + 0.260�~Age (yr) + 0.901�~Sex (male=1, female=0) �] 0.415�~Ethnicity (Thai ethnicity=1, others=0) �] 6.952. The R2 was 88.0% (root mean square error, RSME = 1.3 kg), 88.3% (RSME = 1.7 kg) for TBW and FFM equation, respectively. No significant difference between measured and predicted TBW and between measured and predicted FFM for the whole cross�]validation sample was found (bias = �]0.1�}1.4 kg, pure error = 1.4�}2.0 kg for TBW and bias = �]0.2�}1.9 kg, pure error = 1.8�}2.6 kg for FFM). However, the prediction equation for estimation of TBW/FFM tended to overestimate TBW/FFM at lower levels while underestimate at higher levels of TBW/FFM. Accuracy of the general equation for TBW and FFM compared favorably with both BMI�]specific and ethnic�]specific equations. There were significant differences between predicted TBW and FFM from external BIA equations derived from Caucasian populations and measured values in Asian children. There were three specific aims of the third study. The first was to explore the relationship between obesity and metabolic syndrome and abnormalities in Chinese children. A total of 608 boys and 800 girls aged 6�]12 y were recruited from four cities in China. Three definitions of pediatric metabolic syndrome and abnormalities were used, including the International Diabetes Federation (IDF) and National Cholesterol Education Program (NCEP) definition for adults modified by Cook et al. and de Ferranti et al. The prevalence of metabolic syndrome varied with different definitions, was highest using the de Ferranti definition (5.4%, 24.6% and 42.0%, respectively for normal�]weight, overweight and obese children), followed by the Cook definition (1.5%, 8.1%, and 25.1%, respectively), and the IDF definition (0.5%, 1.8% and 8.3%, respectively). Overweight and obese children had a higher risk of developing the metabolic syndrome compared to normal�]weight children (odds ratio varied with different definitions from 3.958 to 6.866 for overweight children, and 12.640�]26.007 for obese children). Overweight and obesity also increased the risk of developing metabolic abnormalities. Central obesity and high triglycerides (TG) were the most common while hyperglycemia was the least frequent in Chinese children regardless of different definitions. The second purpose was to determine the best obesity index for the prediction of cardiovascular (CV) risk factor clustering across a 2�]y follow�]up among BMI, %BF, WC and waist�]to�]height ratio (WHtR) in Chinese children. Height, weight, WC, %BF as determined by BIA, blood pressure, TG, high�]density lipoprotein cholesterol (HDL�]C), and fasting glucose were collected at baseline and 2 years later in 292 boys and 277 girls aged 8�]10 y. The results showed the percentage of children who remained overweight/obese defined on the basis of BMI, WC, WHtR and %BF was 89.7%, 93.5%, 84.5%, and 80.4%, respectively after 2 years. Obesity indices at baseline significantly correlated with TG, HDL�]C, and blood pressure at both baseline and 2 years later with a similar strength of correlations. BMI at baseline explained the greatest variance of later blood pressure. WC at baseline explained the greatest variance of later HDL�]C and glucose, while WHtR at baseline was the main predictor of later TG. Receiver�]operating characteristic (ROC) analysis explored the ability of the four indices to identify the later presence of CV risk. The overweight/obese children defined on the basis of BMI, WC, WHtR or %BF were more likely to develop CV risk 2 years later with relative risk (RR) scores of 3.670, 3.762, 2.767, and 2.804, respectively. The final purpose of the third study was to develop age�] and gender�]specific percentiles of WC and WHtR and cut�]off points of WC and WHtR for the prediction of CV risk in Chinese children. Smoothed percentile curves of WC and WHtR were produced in 2830 boys and 2699 girls aged 6�]12 y randomly selected from southern and northern China using the LMS method. The optimal age�] and gender�]specific thresholds of WC and WHtR for the prediction of cardiovascular risk factors clustering were derived in a sub�]sample (n=1845) by ROC analysis. Age�] and gender�]specific WC and WHtR percentiles were constructed. The WC thresholds were at the 90th and 84th percentiles for Chinese boys and girls, respectively, with sensitivity and specificity ranging from 67.2% to 83.3%. The WHtR thresholds were at the 91st and 94th percentiles for Chinese boys and girls, respectively, with sensitivity and specificity ranging from 78.6% to 88.9%. The cut�]offs of both WC and WHtR were age�] and gender�]dependent. In conclusion, the current thesis quantifies the ethnic differences in the BMI�]%BF relationship and body fat distribution between Asian children from different origins and confirms the necessity to consider ethnic differences in body composition when developing BMI and other obesity index criteria for obesity in Asian children. Moreover, ethnicity is also important in BIA prediction equations. In addition, WC and WHtR percentiles and thresholds for the prediction of CV risk in Chinese children differ from other populations. Although there was no advantage of WC or WHtR over BMI or %BF in the prediction of CV risk, obese children had a higher risk of developing the metabolic syndrome and abnormalities than normal�]weight children regardless of the obesity index used.

Supply chain sustainability : a relationship management approach moderated by culture and commitment

This paper explores the nature of relationship management on construction projects in Australia and examines the effects of culture, by means of Schwarz’s value survey, on relationships under different contract strategies. The research was based on the view that the development of a sustainable supply chain depends on the transfer of knowledge and capabilities from the larger players in the supply chain through collaboration brought about by relationship management. The research adopted a triangulated approach in which quantitative data were collected by questionnaire, interviews were conducted to explore and enrich the quantitative data and case studies were undertaken in order to illustrate and validate the fi ndings. The aim was to investigate how values and attitudes enhance or reduce the incorporation of the supply chain into the project. From the research it was found that the degree of match and mismatch between values and contract strategy impacts commitment and the engagement and empowerment of the supply chain.

Some empirical results for neo-Piagetian reasoning in novice programmers and the relationship to code explanation questions

Recent research on novice programmers has suggested that they pass through neo-Piagetian stages: sensorimotor, preoperational, and concrete operational stages, before eventually reaching programming competence at the formal operational stage. This paper presents empirical results in support of this neo-Piagetian perspective. The major novel contributions of this paper are empirical results for some exam questions aimed at testing novices for the concrete operational abilities to reason with quantities that are conserved, processes that are reversible, and properties that hold under transitive inference. While the questions we used had been proposed earlier by Lister, he did not present any data for how students performed on these questions. Our empirical results demonstrate that many students struggle to answer these problems, despite the apparent simplicity of these problems. We then compare student performance on these questions with their performance on six explain in plain English questions.

Evolving a relationship for cross-cultural participatory innovation

Participatory design prioritises the agency of those who will be most affected by design outcomes. However in cross cultural innovation involving indigenous and non-indigenous communities there is much work to do to develop the cross cultural innovation practices that can best bring together different skills, perspectives and ways of knowing in order to realise the aspirations of indigenous peoples. In this short paper we outline a work-inprogress method based upon relationship development and reciprocity over practical, tangible and culturally appropriate activities. We argue that in a cross-cultural setting the participatory innovation process must be part of a larger relationship building process. The paper centres around a proposed design project with a remote indigenous community on the Groote Eylandt archipelago. A project proposal has evolved from a relationship built through ecological work between scientists and the local community to study native populations of animal species. We describe the context and history and our proposed approach to engaging indigenous knowledge in design.

The relationship between academic library usage and educational performance in Kuwait

University libraries play an important role in contributing to student and faculty members’ academic achievement. This study examines perceptions of university library usage to consider factors that influence achievement of students, academics and administrators. A thorough review of relevant literature examined approaches to determining user satisfaction of students and faculty, and factors that influence library usage. It highlighted the value of usage on educational performance. It enabled development of a theoretical framework leading to the Factors of Academic Library Usage (FALU) model, which was developed to investigate the effect of usage factors. FALU was tested in Kuwait university libraries. The study used validated questionnaires from 792 students, 143 academics and 121 administrators to measure five library factors. Interviews were conducted across the three University libraries. The findings are useful in measuring the correlation between the current academic library usage and educational performance.

Points of convergence and divergence : normative, institutional and operational relationships between R2P and POC

As an international norm, the Responsibility to Protect (R2P) has gained substantial influence and institutional presence—and created no small controversy—in the ten years since its first conceptualisation. Conversely, the Protection of Civilians in Armed Conflict (PoC) has a longer pedigree and enjoys a less contested reputation. Yet UN Security Council action in Libya in 2011 has thrown into sharp relief the relationship between the two. UN Security Council Resolutions 1970 and 1973 follow exactly the process envisaged by R2P in response to imminent atrocity crimes, yet the operative paragraphs of the resolutions themselves invoke only PoC. This article argues that, while the agendas of PoC and R2P converge with respect to Security Council action in cases like Libya, outside this narrow context it is important to keep the two norms distinct. Peacekeepers, humanitarian actors, international lawyers, individual states and regional organisations are required to act differently with respect to the separate agendas and contexts covered by R2P and PoC. While overlap between the two does occur in highly visible cases like Libya, neither R2P nor PoC collapses normatively, institutionally or operationally into the other.

A phenomenological model for the structure-composition relationship of the high Tc cuprates based on simple chemical principles

A simple phenomenological model for the relationship between structure and composition of the high Tc cuprates is presented. The model is based on two simple crystal chemistry principles: unit cell doping and charge balance within unit cells. These principles are inspired by key experimental observations of how the materials accommodate large deviations from stoichiometry. Consistent explanations for significant HTSC properties can be explained without any additional assumptions while retaining valuable insight for geometric interpretation. Combining these two chemical principles with a review of Crystal Field Theory (CFT) or Ligand Field Theory (LFT), it becomes clear that the two oxidation states in the conduction planes (typically d8 and d9) belong to the most strongly divergent d-levels as a function of deformation from regular octahedral coordination. This observation offers a link to a range of coupling effects relating vibrations and spin waves through application of Hund’s rules. An indication of this model’s capacity to predict physical properties for HTSC is provided and will be elaborated in subsequent publications. Simple criteria for the relationship between structure and composition in HTSC systems may guide chemical syntheses within new material systems.

The relationship between self-reported animal fear and ERP modulation : Evidence for enhanced processing and fear of harmless invertebrates in snake- and spider-fearful individuals

The present study used ERPs to compare processing of fear-relevant (FR) animals (snakes and spiders) and non-fear-relevant (NFR) animals similar in appearance (worms and beetles). EEG was recorded from 18 undergraduate participants (10 females) as they completed two animal-viewing tasks that required simple categorization decisions. Participants were divided on a post hoc basis into low snake/spider fear and high snake/spider fear groups. Overall, FR animals were rated higher on fear and elicited a larger LPC. However, individual differences qualified these effects. Participants in the low fear group showed clear differentiation between FR and NFR animals on subjective ratings of fear and LPC modulation. In contrast, participants in the high fear group did not show such differentiation between FR and NFR animals. These findings suggest that the salience of feared-FR animals may generalize on both a behavioural and electro-cortical level to other animals of similar appearance but of a non-harmful nature.

China and the "Responsibility to Protect" (R2P) : the implications of the Libyan intervention

The emerging principle of a “responsibility to protect” (R2P) presents a direct challenge to China's traditional emphasis on the twin principles of non-intervention in the domestic affairs of other states and non-use of military force. This paper considers the evolution of China‟s relationship with R2P over the past ten years. In particular, it examines how China engaged with R2P during the recent Libyan crisis, and considers what impact this conflict may have first, on Chinese attitudes to R2P, and second, on the future development and implementation of the doctrine itself. This paper argues that China‟s decision to allow the passage of Security Council resolution 1973, authorising force in Libya, was shaped by an unusual set of pragmatic considerations, and should not be viewed as evidence of a dramatic shift in Chinese attitudes towards R2P. More broadly, controversy over the scope of NATO's military action in Libya has raised questions about R2P‟s legitimacy, which has contributed to a lack of timely international action in Syria and Yemen. In the short term at least, this post-Libya backlash against R2P is likely to constrain the Security Council‟s ability to respond decisively to other civilian protection situations.

The nature of juristic paradigms : exploring the theoretical and conceptual relationship between adversarialism and therapeutic jurisprudence

Problem solving courts appear to achieve outcomes which are not common in mainstream courts. There are increasing calls for the adoption of more “therapeutic” and “problem solving” practices by mainstream judges in civil and criminal courts in a number of jurisdictions, most notably in the United States and Australia. Currently, a judge who sets out to exercise a significant therapeutic function is quite likely to be doing so in a specialist court or jurisdiction, outside the mainstream court system, and, arguably, from outside the adversarial paradigm itself. To some extent, his work is tolerated but marginalized. But do therapeutic and problem solving functions have the potential to define, rather than complement, the role of judicial officers? The basic question addressed in this paper is, therefore, whether the judicial role could evolve to be not just less adversarial, but fundamentally non-adversarial. In other words, could we see--or are we seeing--a paradigm shift not just in the colloquial, casual sense of the word, but in the strong, worldview changing sense meant by Thomas Kuhn?

Exploring ethical dilemmas for principals arising from role conflict with school counsellors

Acting in the best interests of students is central to the moral and ethical work of schools. Yet tensions can arise between principals and school counsellors as they work from at times opposing professional paradigms. In this article we report on principals’ and counsellors’ responses to scenarios covering confidentiality and the law, student/teacher relationships, student welfare and psychological testing of students. This discussion takes place against an examination of ethics, ethical dilemmas and professional codes of ethics. While there were a number of commonalities among principals and school counsellors that arose from their common belief in education as a moral venture, there were also some key differences among them. These differences centred on the principals’ focus on the school as a whole and counsellors’ focus on the welfare of the individual student. A series of recommendations is offered to assist principals to navigate ethical dilemmas such as those considered in this article.

The introduction of an interactive teaching and learning activity (TLA) in class and its relationship to students’ learning-outcomes

In the university education arena, it is becoming apparent that traditional methods of conducting classes are not the most effective ways to achieve desired learning outcomes. The traditional class/method involves the instructor verbalizing information for passive, note-taking students who are assumed to be empty receptacles waiting to be filled with knowledge. This method is limited in its effectiveness, as the flow of information is usually only in one direction. Furthermore, “It has been demonstrated that students in many cases can recite and apply formulas in numerical problems, but the actual meaning and understanding of the concept behind the formula is not acquired (Crouch & Mazur)”. It is apparent that memorization is the main technique present in this approach. A more effective method of teaching involves increasing the students’ level of activity during, and hence their involvement in the learning process. This technique stimulates self- learning and assists in keeping these students’ levels of concentration more uniform. In this work, I am therefore interested in studying the influence of a particular TLA on students’ learning-outcomes. I want to foster high-level understanding and critical thinking skills using active learning (Silberman, 1996) techniques. The TLA in question aims to promote self-study by students and to expose them to a situation where their learning-outcomes can be tested. The motivation behind this activity is based on studies which suggest that some sensory modalities are more effective than others. Using various instruments for data collection and by means of a thorough analysis I present evidence of the effectiveness of this action research project which aims to improve my own teaching practices, with the ultimate goal of enhancing student’s learning.

Prevalence of malnutrition risk and its relationship with risk factors of hospital re-admission in older adults

Background: Risk of malnutrition in older people continues to be a global problem. Malnutrition is often unrecognized and under-treated across health care settings and may result in undesirable health consequences, impaired recovery from illness and a poorer quality of life. Aim: This study aimed to determine the prevalence of malnutrition risk in a sample of older people at high risk of hospital re-admission. The association between risk factors of hospital re-admission and risk of malnutrition were also explored. Methods: One hundred and twenty five hospitalised patients aged 65 years and older at risk of hospital readmission (24% male, 76% female, mean age 77 ± 6 years) were recruited from a tertiary metropolitan hospital in Australia. The valid and reliable Malnutrition Screen Tool (MST) was employed to screen for malnutrition risk. It consists of two questions related to recent weight loss and appetite. Results: Prevalence of older adults at risk of malnutrition was 27.4%. Risk of malnutrition was not associated with age, gender and living arrangement. However, among risk factors of hospital readmission, lack of social support (χ2 = 4.18, N = 125, p = 0.028), and fair –poor self-rating of health (χ2 = 4.13, N = 125, p = 0.042) were statistically significant associated with risk of malnutrition. Conclusion: Risk of malnutrition in older people continues to be a concern in health care, and increasing psycho social support may help shed light on reducing risk of malnutrition.