The relationship between stress and the symptomatology of fibromyalgia

Fibromyalgia is an unexplained but often debilitating syndrome, characterised primarily by widespread pain. This thesis provides direct evidence that physical and emotional stress exacerbates pain, fatigue and other symptoms of Fibromyalgia and supports the assertion that symptoms may be related to disordered stress-response mechanisma in the human brain. The professional portfolio presents four clinical case studies that demonstrate the utility of Acceptance and Commitment Therapy (ACT) in the psychotherapeutic treatment of people with chronic illness.

The impact of violent video-games on cognition, affect and personality

This research investigated the impact of playing violent videogames. Aggressive or anxious responses were most likely: when the player perceived the violence in the games to be extreme, when the player experienced a heightened sense of becoming 'absorbed' into the game, and during a relatively brief exposure to the game. The portfolio explores the use of manualised interventions in psychology research and practice. Four illustrative case studies regarding the efficacy and effectiveness of adapting manualised interventions for clients with chronic health conditions are presented.

Body image in adolescent girls

This study investigated the Tripartite Influence Model of body image and eating disturbance in adolescent females. The model was found to be a satisfactory representation of the social, cultural and individual factors proposed to promote body dissatisfaction, dieting and bulimic behaviours in 14 to 18 year old girls. The portfolio presents four case situations in which the specialist knowledge of a clinical psychologist has shown to be beneficial to pediatric patients, their families, and medical staff at a major metropolitan hospital.

PTSD symptomatology in children and adolescents : treatment development and evaluation

This thesis developed, implemented and evaluated a cognitive-behavioural group treatment programme for children and adolescents experiencing symptoms of PTSD (Post-traumatic stress disorder). Results of the study indicate that symptoms of sleep disturbance and flashbacks, reduced markedly in the participants, providing a useful tool in reducing synptoms experiences by individuals exposed to trauma. The Professional portfolio presents four case studies that demonstrate the clinical application of the affect of chronic illness on the psychological adjustment of the sufferer and their families.

The neuroanatomical correlates of subjective wellbeing following head injury

The thesis found results supporting the involvement of the Right Frontal area of the brain in the subjective wellbeing (SWB) of individuals. Additional results suggested SWB is dependent upon Core Affect, itself dependent upon the Right Parietal area of the brain. These results provide evidence that SWB and Core Affect are based upon a neurological substrate. The portfolio investigated the association between chronic medical conditions and anxiety disorders, and how the occurence of anxiety issues can affect overall psychological adjustment to illness.

A hypothesised model of disordered eating in overweight women

This thesis found that predicted risk factors for disordered eating were similar for overweight and non-overweight women. However, overweight women reported more stigmatisation and body shame, had a higher risk for developing an eating disorder, and were twice as likely to be diagnosed with a subclinical/clinical eating disorder than non-overweight women. The portfolio presents four case studies demonstrating the considerations and challenges of psychologically assessing and treating individuals with chronic health conditions.

Reducing adverse events in older Australians taking newly released drugs

The number of older Australians with one or multiple chronic diseases is increasing. This thesis presents a model to assist in identifying current older patients with multiple illnesses and taking multiple medications who are at risk of experiencing an adverse drug reaction if they are prescribed a newly released drug.

Adults with arthritic conditions and care-seeking in an attachment framework

This thesis investigated the role of care-seeking amongst adults with arthritis, using an attachment framework to help explain the inconsistent results of previous studies in regard to psychological adjustment to a chronic illness. The results highlight the importance of attachment processes in partially influencing care-seeking and coping strategies that shape psychological adjustment. The portfolio addresses the frequent co-occurence of depression with chronic medical disorders. This impacts the ability for chronic, medically ill adults to engage in self-management strategies. Four case studies are presented.

Body weight and weight loss : are health messages reaching their target?

Objective: To investigate lay peoples’ knowledge of health risks of overweight, accuracy of self-perception of body weight and perceived benefits of weight loss. Method: A nine item questionnaire was administered to a cross sectional survey of adults in metropolitan shopping centres, height and weight were measured. Results: Two hundred and nine (57% female) adults completed the survey. Thirty eight percent had a healthy BMI (18.5-24.9), 38% were overweight (BMI 25-29.9) and a further 22% were obese (BMI>30). However only 46% perceived themselves ‘overweight’, 50% considered themselves ‘just about right’ and 4% considered themselves ‘underweight’. Of those with a BMI of 25 or greater 28% considered their weight ‘just about right’. Over 80% thought ‘being overweight’ was ‘likely’ or ‘very likely’ to be a risk factor for cardiovascular disease, hypertension, diabetes and stroke; however 20% of overweight or obese individuals did not think their health would improve if they lost weight. Conclusion: A significant proportion of overweight or obese individuals do not accurately perceive their body weight and do not recognise the health advantages of weight loss despite recognising excess body weight as a risk factor for chronic diseases. Implications: Increasing the awareness of an individual’s BMI and promoting the benefits of modest weight loss maybe two underutilized strategies for population level weight control.

The quality and outcomes framework reduces disparities in health outcomes for cardiovascular disease

Jamie Robinson, the Berkeley health economist, famously remarked in 2001 that ‘the three worst ways to pay doctors are salary, capitation and fee-for-service.’ Different financial incentives produce different clinical and service outcomes, sometimes perversely.1 In 2004, the UK government introduced pay for performance (P4P) for general practitioners, the Quality and Outcomes Framework (QOF). Its introduction was associated with the general trend in the National Health Service away from placing implicit trust in doctors and more active monitoring of their performance. One-quarter of GP pay can be earned from achieving scores on 147 indicators.2 These indicators were acceptable to doctors because the majority are evidence-based clinical outcome measures for 10 chronic diseases. Others relate to patient access and satisfaction, and practice organisation.

Oleocanthal, a natural anti-Inflammatory compound in extra virgin olive oil

Recent research on the olive oil phenolic, oleo canthal has led to speculation that it may confer some of the health benefits associated with a traditional Mediterranean diet. Oleocanthal produces a peppery, stinging sensation at the back of the throat similar to that of the non-steroidal anti-inflammatory drug (NSAID), ibuprofen. This led to the hypothesis that the perceptual similarity between oleocanthal and ibuprofen may indicate similar pharmacological properties. Subsequent studies have proved the hypothesis and oleocanthal was shown not only to inhibit inflammation in the same way as ibuprofen does, but it was found to be substantially more potent than this NSAID. It is important to note that inflammation has been demonstrated to playa significant role in the development of a number of chronic diseases, such as cardiovascular disease (CVD) and certain types of cancers. Therefore, as a result of dietary feeding with olive oil as a part of the traditional Mediterranean diet, a reduction in inflammation produced by oleocanthal is speculated to be the potential mechanism that is partially responsible for the health benefits associated with this dietary pattern. This review summarizes the current knowledge on oleocanthal, in tenns of its physiological and sensory properties, as well as a discussion on the factors that have the ability to affect oleocanthal concentrations in extra virgin olive oils (EVOOs).

Health professionals' and dietetics practitioners' perceived effectiveness of fruit and vegetable parenting practices across six countries

Fruit and vegetable intake may reduce the risk of some chronic diseases. However, many children consume less-than-recommended amounts of fruit and vegetables. Because health professionals and dietetics practitioners often work with parents to increase children's fruit and vegetable intake, assessing their opinions about the effectiveness of parenting practices is an important step in understanding how to promote fruit and vegetable intake among preschool-aged children. Using a cross-sectional design, collaborators from six countries distributed an Internet survey to health and nutrition organization members. A self-selected sample reported their perceptions of the effectiveness of 39 parenting practices intended to promote fruit and vegetable consumption in preschool-aged children from May 18, 2008, to September 16, 2008. A total of 889 participants (55% United States, 22.6% Mexico, 10.9% Australia, 4.4% Spain, 3.3% Chile, 2.2% United Kingdom, and 1.6% other countries) completed the survey. The fruit and vegetable intake–related parenting practices items were categorized into three dimensions (structure, responsiveness, and control) based on a parenting theory conceptual framework and dichotomized as effective/ineffective based on professional perceptions. The theoretically derived factor structures for effective and ineffective parenting practices were evaluated using separate confirmatory factor analyses and demonstrated acceptable fit. Fruit and vegetable intake–related parenting practices that provide external control were perceived as ineffective or counterproductive, whereas fruit and vegetable intake–related parenting practices that provided structure, nondirective control, and were responsive were perceived as effective in getting preschool-aged children to consume fruit and vegetables. Future research needs to develop and validate a parent-reported measure of these fruit and vegetable intake–related parenting practices and to empirically evaluate the effect of parental use of the parenting practices on child fruit and vegetable consumption.

The role and regulation of MAFbx/atrogin-1 and MuRF1 in skeletal muscle atrophy

Skeletal muscle atrophy occurs in many chronic diseases and disuse conditions. Its severity reduces patient recovery, independence and quality of life. The discovery of two muscle-specific E3 ubiquitin ligases, MAFbx/ atrogin-1 and Muscle RING Finger-1 (MuRF1), promoted an expectation of these molecules as targets for therapeutic development. While numerous studies have determined the conditions in which MAFbx/atrogin-1 and MuRF1 mRNA levels are regulated, few studies have investigated their functional role in skeletal muscle. Recently, studies identifying new target substrates for MAFbx/atrogin-1 and
MuRF1, outside of their response to the initiation of muscle atrophy, suggest that there is more to these proteins than
previously appreciated. This review will highlight our present knowledge of MAFbx/atrogin-1 and MuRF1 in skeletal muscle atrophy, the impact of potential therapeutics and their known regulators and substrates. Finally, we will comment on new approaches that may expand our knowledge of these two molecules in their control of skeletal muscle function.

Molecular mechanisms of inflammation : anti-inflammatory benefits of virgin olive oil and the phenolic compound oleocanthal

Chronic inflammation is a critical factor in the pathogenesis of many inflammatory disease states including cardiovascular disease, cancer, diabetes, degenerative joint diseases and neurodegenerative diseases. Chronic inflammatory states are poorly understood, however it is known that dietary habits can evoke or attenuate inflammatory responses. Popular methods to deal with inflammation and its associated symptoms involve the use of non steroidal anti-inflammatory drugs, however the use of these drugs are associated with severe side effects. Therefore, investigations concerned with natural methods of inflammatory control are warranted. A traditional Mediterranean diet has been shown to confer some protection against the pathology of chronic diseases through the attenuation of proinflammatory mediators and this has been partially attributed to the high intake of virgin olive oil accompanying this dietary regime. Virgin olive oil contains numerous phenolic compounds that exert potent anti-inflammatory actions. Of interest to this paper is the recently discovered phenolic compound oleocanthal. Oleocanthal is contained in virgin olive oil and possesses similar anti-inflammatory properties to ibuprofen. This pharmacological similarity has provoked interest in oleocanthal and the few studies conducted thus far have verified its anti-inflammatory and potential therapeutic actions. A review of the health benefits of the Mediterranean diet and antiinflammatory properties of virgin olive oil is presented with the additional emphasis on the pharmacological and anti-inflammatory properties of the phenolic compound oleocanthal.

Assessing free-living physical activity using accelerometry : practical issues for researchers and practitioners

Physical activity is an integral component of a healthy lifestyle, with relationships documented between physical activity, chronic diseases, and disease risk factors. There is increasing concern that many people are not sufficiently active to benefit their health. Consequently, there is a need to determine the prevalence of physical activity engagement, identify active and inactive segments of the population, and evaluate the effectiveness of interventions. The aim of the present study was to identify and explain a number of methodological and decision-making processes associated with accelerometry, which is the most commonly used objective measure of physical activity in child and adult research.

Specifically, this review addresses:
(a) pre-data collection decisions,
(b) data collection procedures,
(c) processing of accelerometer data, and
(d) outcome variables in relation to the research questions posed.

An appraisal of the literature is provided to help researchers and practitioners begin field-based research, with recommendations offered for best practice. In addition, issues that require further investigation are identified and discussed to inform researchers and practitioners of the surrounding debates.

Overall, the review is intended as a starting point for field-based physical activity research using accelerometers and as an introduction to key issues that should be considered and are likely to be encountered at this time.