Measuring the economic impact of falls prevention interventions

The objective of this paper is to assess the appropriateness of available health economic models and concepts in the development of a best practice model to assess community based multifactorial falls prevention programs. To this end, a critical review and synthesis of contemporary published and unpublished  methodological approaches to economic evaluation of health initiatives in general and falls prevention initiatives in particular, has been carried out. The review  indicates that costs, time and utility all need to be taken into consideration when economically evaluating a falls prevention program.

A recommended approach that takes into account a full consideration of relevant costs and benefits associated with falls prevention programs is outlined. This approach can help demonstrate the true relative efficacy of preventing falls over the treatment of their consequences.

Gender differences in motor skill proficiency from childhood to adolescence : a longitudinal study

Students' proficiency in three object control and three locomotor skills were assessed in 2000 (M age = 10.06 years, SD = 0.63) in New South Wales, Australia and in 2006-07 (M age = 16. 44 years, SD = 0. 64). In 2006-07, 266 students, 138 girls (51.9%) and 128 boys (48.1%), had at least one skill reassessed. Boys were more object control proficient than girls. Childhood object control proficiency significantly predicted (p =. 001) adolescent object control proficiency ([r.sup.2] = .39), and, while gender was significant (p = .001), it did not affect the relationship between these variables (p = .53). Because childhood object control proficiency is predictive of subsequent object control proficiency, developing skills in childhood is important.

Promoting a team ball game (Lifeball) to older people : who does this game attract and who continues?

Issue addressed: To describe the demographic and health-related characteristics (physical activity, self-reported health status, quality of life and falls history) of older people who enroll in a team-based game, Lifeball, and examine associations between continuation and participant characteristics. Reasons for stopping, participants' perceptions of the game and changes in health-related characteristics over 12 months were examined.

Methods: Telephone surveys were conducted with a cohort of Lifeball players at: baseline, soon after commencing playing and 12 months later.

Results: At baseline, participants were aged 40 to 96 years (mean 67). Most were female (84%), in good to excellent health (86%) and reported being sufficiently (>150 minutes per week) physically active (69%). Almost half (43%) were still playing 12 months later (continuers). Continuers were more likely to perceive Lifeball had helped them to: feel fitter and healthier (91%); improve their social life (73%); and be more active (53%). No significant changes in continuers' physical activity, self-reported health status and quality of life measures were reported. The main reason for stopping playing was illness/injury unrelated to Lifeball.

Conclusions: Lifeball mainly appealed to healthy, active older people.

A reverse pathway? Actual and perceived skill proficiency and physical activity

Purpose: Motor skills are considered a prerequisite to physical activity, yet the relationship may be reciprocal and perceived sports competence might mediate associations.
Methods: In 2006/2007, 215 adolescents completed motor skill proficiency (Get Skilled Get Active), perceived sport competence (Physical Self-Perception Profile) and physical activity assessments (Adolescent Physical Activity Recall Questionnaire) as part of the Physical Activity and Skills Study. Using AMOS (Version 7.0), reciprocal relationships were examined between motor skill (object control and locomotor) and moderate to vigorous physical activity (MVPA). Both models were then run in different versions to understand the role of perceived sports competence as a potential mediator.
Results: Mean age was 16.4 yr (SD = 0.6), 51.6% (111/215) were females. A reciprocal relationship between object control and MVPA and a one-way relationship from MVPA to locomotor skill was found. When perceived sports competence was examined as a mediator, the best-fitting model versions explained 16% (R² = 0.16)
MVPA variation, and 30% object control (R² = 0.30), and 12% locomotor skill variation (R² = 0.12) (reverse relationship). Perceived sports competence partially mediates the relationship between object control proficiency and physical activity for both directions and fully mediates the relationship between physical activity and locomotor skill; but only when locomotor skill is the outcome.
Conclusions: If the relationship between object control skill and physical activity is viewed as a ‘‘positive feedback loop,’’ skill development and increasing physical activity should simultaneously be targeted in physical activity interventions. Increasing perceived sport competence should also be an intervention focus.

Adolescents' perception of the relationship between movement skills, physical activity and sport

Movement skill competence is important to organised youth physical activity participation, but it is unclear how adolescents view this relationship. The primary aim of this study was to explore adolescents’ perception of the relationship between movement skills, physical activity and sport, and whether their perceptions differed according to extent of participation in organised physical activities. We recruited 33 (17 male) Grade 11 and 12 students (aged 16 to 18) from two secondary schools in Australia. Focus groups were allocated according to whether or not students participated in organised physical activity, where ‘organised activity’ was defined as activity which involved regular classes, training or competition, was reasonably structured or formal, or had a teacher, instructor or coach. There were three all-male ‘organised’ groups, one mixed-gender ‘organised’ group and one all-female ‘not-organised’ group. Students were asked about their attitudes towards physical activity and sport, the relationship between childhood skill proficiency and later physical activity and their perceptions of the appropriate time taken to learn movement skills. Group discussions lasted for approximately 50 minutes, were recorded and were then transcribed verbatim. Transcripts were read using a constant comparison method, in which quotes were continually compared to other quotes. A thematic analysis was conducted in which the transcripts were analysed inductively. Participation in organised sport had no bearing on opinions regarding whether lack of childhood skill development would negatively impact latter participation. It did, however, subtly influence opinions regarding whether skill could be successfully acquired later in life. When asked whether not having well-developed skills as a child would negatively impact on participation in sport/physical activity later in life, the response was mixed, but this was not related to their involvement in organised sport or activities. Students who believed early skill proficiency related to subsequent activity thought this was due to skill ability and motivation. An alternate view was that subsequent activity did not need to be based on skill proficiency; also, one’s environment might change, resulting in differing opportunities/constraints. Students felt skills could be learnt at any time in life (dependent on motivation), but that learning skills at a younger age would be easier and that skills learnt later would not be as developed. Fear of failure was identified as a barrier to learning when older. We conclude that motivation towards participation in sport and physical activity is affected by adolescents’ perception of their own movement skill ability. Therefore, developing children’s actual and perceived movement skills may help to increase adolescent physical activity. Since those with intrinsic achievement orientations were not as inclined towards organised activity, we may also need to provide physical activity options that resonate with intrinsic achievement motivations.

Cardiovascular prevention model from Kenyan slums to migrants in the Netherlands

Cardiovascular diseases (CVD) are the main cause of morbidity and mortality worldwide. As prevention and treatment of CVD often requires active screening and lifelong follow up it is a challenge for health systems both in high-income and low and middle-income countries to deliver adequate care to those in need, with efficient use of resources.We developed a health service model for primary prevention of CVD suitable for implementation in the Nairobi slums, based on best practices from public health and the private sectors. The model consists of four key intervention elements focusing on increasing awareness, incentives for promoting access to screening and treatment, and improvement of long-term adherence to prescribed medications. More than 5,000 slum dwellers aged ≥35 years and above have been screened in the study resulting in more than 1000 diagnosed with hypertension and referred to the clinic.Some marginalized groups in high-income countries like African migrants in the Netherlands also have low rates of awareness, treatment and control of hypertension as the slum population in Nairobi. The parallel between both groups is that they have a combination of risky lifestyle, are prone to chronic diseases such as hypertension, have limited knowledge about hypertension and its complications, and a tendency to stay away from clinics partly due to cultural beliefs in alternative forms of treatment, and lack of trust in health providers. Based on these similarities it was suggested by several policymakers that the model from Nairobi can be applied to other vulnerable populations such as African migrants in high-income countries. The model can be contextualized to the local situation by adapting the key steps of the model to the local settings.The involvement and support of African communities' infrastructures and health care staff is crucial, and the most important enabler for successful implementation of the model in migrant communities in high-income countries. Once these stakeholders have expressed their interest, the impact of the adapted intervention can be measured through an implementation research approach including collection of costs from health care providers' perspective and health effects in the target population, similar to the study design for Nairobi.

Chemical composition and fermentation characteristics of elephant grass silage with biodiesel industry co-products

The objective of this research was to evaluate the effect of three concentrations (3, 6, and 9%) of forage turnip (Raphanus sativus) and physic nut (Jatropha curcas) cakes on dry matter, crude protein, ether extract, neutral detergent fiber, acid detergent fiber, lignin, acid detergent insoluble nitrogen neutral detergent insoluble nitrogen contents, in vitro dry matter digestibility, pH values and concentrations of N-NH3 in elephant grass silages. It was used an entirely randomized design in factorial arrangement [(2x3)+1]. Experimental PVC silos were used and ensiled material was kept for 62 days. The addition of cakes increased the dry matter contents (P<0.05). The fibrous fractions were reduced (P<0.05) with the inclusion of cakes during the grass ensilage and the CP contents increased (P<0.05). The forage turnip cake provided the same pH and N-NH3 values in ideal levels and the physic nut, added to 9%, increased those values (P<0.05). IVDMD was reduced (P<0.05) when the cakes were added. These co-products can be used in small amounts for elephant grass ensilage in order to provide improvement in chemical and fermentation characteristics of the silages. Nevertheless, physic nut cake shows limitations for its use in animal feeding due to the presence of toxic compounds, making necessary studies for their identification and elimination.

Degradação ruminal de silagem de capim-elefante com adição de vagem de algaroba triturada

This research was carried out to evaluate the ruminal degradation of dry matter (DM), crude protein (CP) and neutral detergent fiber (NDF) of silages of elephant grass (Pennisetum purpureum) cutting in 70; 90 and 110 days after regrowth with inclusion of 0; 5; 10 and 15% of mesquite (Prosopis juliflora) meal, based on natural matter in a completely randomized design, in split plot arrangement. Samples of silages were incubated in the rumen of two Jersey cows for 3; 6; 12; 24; 48; 72 and 96 h, and the bags at time "zero" were only washed with water to determine the soluble fraction. There was not interaction (P> 0.05) incubation time x inclusion of mesquite pods x cutting age of the grass for DM degradability, there was only interaction (P <0.05) between these factors for CP and NDF degradability. The most effective DM degradability (42.54%) was observed for 15% inclusion of mesquite pods. The effective CP degradability was higher (69.04%) for elephant grass silage with 70 days after regrowth with 15% of mesquite pods. The inclusion of mesquite pods in elephant grass silages improve DM, CP and NDF degradability, while increment of the age after regrowth result in reduction of this parameters.

Determinação do teor de extrato etéreo de grãos de oleaginosas através de diferentes processamentos

The objective of this work was to determine the ether extract content of peanut and canola seeds, with extraction in Soxhlet apparatus and with three types of processing: grinding in ball mill type; maceration in mortar and grind into micro mill after maceration in mortar. Data were analyzed in an entirely randomized design with 3 treatments and 12 replicates, submitted to variance analysis and the means were compared using Tukey test (P<0.05) with routines of the SAS statistical package. The largest percentage of ether extract was obtained in the treatment which the peanuts were subjected to a greater number of extractions (56.43%), and all treatments presented different results(P <0.05). In canola grains, it was observed that the extraction with the method of grinding in ball mill and the method of sequential extraction (macerate + ground in micro mill) were statistically similar (43.52 and 42.35% respectively), and these methods were more efficient (P <0.05) to extract the ether extract than the treatment in which the grains were only macerated. For peanut grains it was concluded that the most efficient method was the sequential one and to the canola grain, it can be used only a grinding mill as samples processing witch will be submitted to ether extract extraction.

Glicerina bruta na dieta de bovinos de corte confinados: Efeito sobre o hemograma

The aim of this study was to evaluate the hemogram in cattle fed crude glycerin. 30 Nellore steers, were used for blood sampling, which were done each 28 days. The animals were confined for 103 days and were fed with five diets containing 0, 7.5, 15, 22.5 and 30% crude glycerin based on dry matter, formulated in a forage:concentrate ratio of 30:70. Corn silage was used as forage and the concentrate was composed by corn grain, soybean hulls, sunflower meal, glycerin, limestone, dicalcium phosphate and salt. The experimental design was a randomized block with five treatments. Orthogonal contrasts were used to determine the linear, quadratic, cubic effects and gliceryn treatments × the control one. There was no treatment effect (P>0,05) on blood concentrations of erythrocytes, hematocrit, basophils, eosinophils, band neutrophils and lymphocytes, but were linearly effect on the concentrations of platelets, hemoglobin and monocytes (P=0.009, P=0.001 and P=0.043, respectivelly), and cubic effect on the concentrations of total leukocytes and segmented neutrophils (P=0.008 and P=0.004, respectivelly). Diets for beef cattle, with forage:concentrate ratio of 30:70 added with crude glycerin promote changes in the erytrhogram and leucogram of these animals.

Glicerina bruta em dietas para bovinos da raça Nelore confinados

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Consumo e digestibilidade de dietas contendo fontes energéticas associadas ao farelo de girassol ou ureia em novilhos confinados

Objetivou-se avaliar o consumo e a digestibilidade total e parcial de dietas utilizando milho, casca de soja e polpa cítrica associados ao farelo de girassol ou ureia em novilhos confinados. Foram utilizados quatro novilhos ½ Aberdeen Angus vs. ½ Nelore, providos de cânulas no rúmen e duodeno, com 18 meses de idade e 360 kg de peso médio inicial. As dietas foram constituídas por duas fontes energéticas (milho grão e polpa cítrica) associadas a duas fontes nitrogenadas (ureia e farelo de girassol), totalizando quatro tratamentos, numa proporção volumoso:concentrado de 40:60. O delineamento utilizado foi o quadrado latino com quatro tratamentos e quatro períodos de 21 dias cada. O consumo médio diário de matéria seca foi influenciado (p < 0,05) entre as dietas, e o maior valor foi atribuído à dieta milho e farelo de girassol. A digestibilidade aparente de todos os componentes, exceto da proteína bruta, foi maior (p < 0,05) para as dietas com polpa cítrica. Não houve efeito (p > 0,05) entre as dietas para as digestibilidades ruminal e intestinal. A utilização de coprodutos na alimentação animal não prejudicou a digestibilidade das dietas, sendo indicados como ingredientes de elevado potencial de utilização em dietas para bovinos de corte.

Crude glycerin in diets for feedlot Nellore cattle

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A utilização de glicerina em dietas para bovinos altera a microbiota ruminal

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)