The relationship between chronic disease self-efficacy and nutritional status, functional ability and quality of life in older adults at risk of hospital readmission

Background and significance: Older adults with chronic diseases are at increasing risk of hospital admission and readmission. Approximately 75% of adults have at least one chronic condition, and the odds of developing a chronic condition increases with age. Chronic diseases consume about 70% of the total Australian health expenditure, and about 59% of hospital events for chronic conditions are potentially preventable. These figures have brought to light the importance of the management of chronic disease among the growing older population. Many studies have endeavoured to develop effective chronic disease management programs by applying social cognitive theory. However, limited studies have focused on chronic disease self-management in older adults at high risk of hospital readmission. Moreover, although the majority of studies have covered wide and valuable outcome measures, there is scant evidence on examining the fundamental health outcomes such as nutritional status, functional status and health-related quality of life. Aim: The aim of this research was to test social cognitive theory in relation to self-efficacy in managing chronic disease and three health outcomes, namely nutritional status, functional status, and health-related quality of life, in older adults at high risk of hospital readmission. Methods: A cross-sectional study design was employed for this research. Three studies were undertaken. Study One examined the nutritional status and validation of a nutritional screening tool; Study Two explored the relationships between participants. characteristics, self-efficacy beliefs, and health outcomes based on the study.s hypothesized model; Study Three tested a theoretical model based on social cognitive theory, which examines potential mechanisms of the mediation effects of social support and self-efficacy beliefs. One hundred and fifty-seven patients aged 65 years and older with a medical admission and at least one risk factor for readmission were recruited. Data were collected from medical records on demographics, medical history, and from self-report questionnaires. The nutrition data were collected by two registered nurses. For Study One, a contingency table and the kappa statistic was used to determine the validity of the Malnutrition Screening Tool. In Study Two, standard multiple regression, hierarchical multiple regression and logistic regression were undertaken to determine the significant influential predictors for the three health outcome measures. For Study Three, a structural equation modelling approach was taken to test the hypothesized self-efficacy model. Results: The findings of Study One suggested that a high prevalence of malnutrition continues to be a concern in older adults as the prevalence of malnutrition was 20.6% according to the Subjective Global Assessment. Additionally, the findings confirmed that the Malnutrition Screening Tool is a valid nutritional screening tool for hospitalized older adults at risk of readmission when compared to the Subjective Global Assessment with high sensitivity (94%), and specificity (89%) and substantial agreement between these two methods (k = .74, p < .001; 95% CI .62-.86). Analysis data for Study Two found that depressive symptoms and perceived social support were the two strongest influential factors for self-efficacy in managing chronic disease in a hierarchical multiple regression. Results of multivariable regression models suggested advancing age, depressive symptoms and less tangible support were three important predictors for malnutrition. In terms of functional status, a standard regression model found that social support was the strongest predictor for the Instrumental Activities of Daily Living, followed by self-efficacy in managing chronic disease. The results of standard multiple regression revealed that the number of hospital readmission risk factors adversely affected the physical component score, while depressive symptoms and self-efficacy beliefs were two significant predictors for the mental component score. In Study Three, the results of the structural equation modelling found that self-efficacy partially mediated the effect of health characteristics and depression on health-related quality of life. The health characteristics had strong direct effects on functional status and body mass index. The results also indicated that social support partially mediated the relationship between health characteristics and functional status. With regard to the joint effects of social support and self-efficacy, social support fully mediated the effect of health characteristics on self-efficacy, and self-efficacy partially mediated the effect of social support on functional status and health-related quality of life. The results also demonstrated that the models fitted the data well with relative high variance explained by the models, implying the hypothesized constructs under discussion were highly relevant, and hence the application for social cognitive theory in this context was supported. Conclusion: This thesis highlights the applicability of social cognitive theory on chronic disease self-management in older adults at risk of hospital readmission. Further studies are recommended to validate and continue to extend the development of social cognitive theory on chronic disease self-management in older adults to improve their nutritional and functional status, and health-related quality of life.

Practical physical activity measurement in youth : a review of contemporary approaches

Background: The accurate evaluation of physical activity levels amongst youth is critical for quantifying physical activity behaviors and evaluating the effect of physical activity interventions. The purpose of this review is to evaluate contemporary approaches to physical activity evaluation amongst youth. Data sources: The literature from a range of sources was reviewed and synthesized to provide an overview of contemporary approaches for measuring youth physical activity. Results: Five broad categories are described: self-report, instrumental movement detection, biological approaches, direct observation, and combined methods. Emerging technologies and priorities for future research are also identified. Conclusions: There will always be a trade-off between accuracy and available resources when choosing the best approach for measuring physical activity amongst youth. Unfortunately, cost and logistical challenges may prohibit the use of "gold standard" physical activity measurement approaches such as doubly labelled water. Other objective methods such as heart rate monitoring, accelerometry, pedometry, indirect calorimetry, or a combination of measures have the potential to better capture the duration and intensity of physical activity, while self-reported measures are useful for capturing the type and context of activity.

Children physical activity correlates and parent physical activity do not have a strong association with physical activity amongst adolescents

Background: Physical activity is a key modifiable behavior impacting a number of important health outcomes. The path to developing chronic diseases commonly commences with lifestyle patterns developed during childhood and adolescence. This study examined whether parent physical activity and other factors correlated with physical activity amongst children are associated with self-reported physical activity in adolescents. Methods: A total of 115 adolescents (aged 12-14) and their parents completed questionnaire assessments. Self-reported physical activity was measured amongst adolescents and their parents using the International Physical Activity Questionnaire for Adolescents (IPAQ-A), and the International Physical Activity Questionnaire (IPAQ) respectively. Adolescents also completed the Children’s Physical Activity Correlates (CPAC), which measured factors that have previously demonstrated association with physical activity amongst children. To examine whether parent physical activity or items from the CPAC were associated with self-reported adolescent physical activity, backward step-wise regression was undertaken. One item was removed at each step in descending order of significance (until two tailed item alpha=0.05 was achieved). Results: A total of 93 (80.9%) adolescents and their parents had complete data sets and were included in the analysis. Independent variables were removed in the order: perceptions of parental role modeling; importance of exercise; perceptions of parental encouragement; peer acceptance; fun of physical exertion; perceived competence; parent physical activity; self-esteem; liking of exercise; and parental influence. The only variable remaining in the model was ‘liking of games and sport’ (p=0.003, adjusted r-squared=0.085). Discussion: These findings indicate that factors associated with self-reported physical activity in adolescents are not necessarily the same as younger children (aged 8-11). While ‘liking of games and sport’ was included in the final model, the r-squared value did not indicate a strong association. Interestingly, parent self-reported physical activity was not included in the final model. It is likely that adolescent physical activity may be influenced by a variety of direct and indirect forms of socialization. These findings do support the view that intrinsically motivated themes such as the liking of games and sport take precedence over outside influences, like those presented by parents, in determining youth physical activity behaviors. These findings do not suggest that parents have no influence on adolescent physical activity patterns, but rather, the influence is likely to be more complex than physical activity behavior modeling perceived by the adolescent. Further research in this field is warranted in order to better understand potential contributors to successful physical activity promotion interventions amongst young adolescents.

Beyond here-and-now : extending shared physical experiences to shared conceptual experiences

For robots to use language effectively, they need to refer to combinations of existing concepts, as well as concepts that have been directly experienced. In this paper, we introduce the term generative grounding to refer to the establishment of shared meaning for concepts referred to using relational terms. We investigated a spatial domain, which is both experienced and constructed using mobile robots with cognitive maps. The robots, called Lingodroids, established lexicons for locations, distances, and directions through structured conversations called where-are-we, how-far, what-direction, and where-is-there conversations. Distributed concept construction methods were used to create flexible concepts, based on a data structure called a distributed lexicon table. The lexicon was extended from words for locations, termed toponyms, to words for the relational terms of distances and directions. New toponyms were then learned using these relational operators. Effective grounding was tested by using the new toponyms as targets for go-to games, in which the robots independently navigated to named locations. The studies demonstrate how meanings can be extended from grounding in shared physical experiences to grounding in constructed cognitive experiences, giving the robots a language that refers to their direct experiences, and to constructed worlds that are beyond the here-and-now.

No cure for curiosity: Linking physical and digital urban layers

Although mobile phones are often used in public urban places to interact with one’s geographically dispersed social circle, they can also facilitate interactions with people in the same public urban space. The PlaceTagz study investigates how physical artefacts in public urban places can be utilised and combined with mobile phone technologies to facilitate interactions. Printed on stickers, PlaceTagz are QR codes linking to a digital message board enabling collocated users to interact with each other over time resulting in a place-based digital memory. This exploratory project set out to investigate if and how PlaceTagz are used by urban dwellers in a real world deployment. We present findings from analysing content received through PlaceTagz and interview data from application users. QR codes, which do not contain any contextual information, piqued the curiosity of users wondering about the embedded link’s destination and provoked comments in regards to people, place and technology.

Perceptions of physical versus virtual design studio education

While the studio environment has been promoted as an ideal educational setting for project-based disciplines associated with the art and design, few qualitative studies have been undertaken in a comprehensive way, with even fewer giving emphasis to the teachers and students and how they feel about changing their environment. This situation is problematic given the changes and challenges facing higher education, including those associated with new technologies such as online learning. In response, this paper describes a comparative study employing grounded theory to identify and describe teachers’ and students’ perceptions of the physical design studio (PDS) as well as the virtual design studio (VDS) of architectural students in an Australian university. The findings give significance to aspects of design education activities and their role in the development of integrated hybrid learning environments.

The relationship between listening and other language skills in International English Language Testing System

Listening comprehension is the primary channel of learning a language. Yet of the four dominant macro-skills (listening, speaking, reading and writing), it is often difficult and inaccessible for second and foreign language learners due to its implicit process. The secondary skill, speaking, proceeds listening cognitively. Aural/oral skills precede the graphic skills, such as reading and writing, as they form the circle of language learning process. However, despite the significant relationship with other language skills, listening comprehension is treated lightly in the applied linguistics research. Half of our daily conversation and three quarters of classroom interaction are virtually devoted to listening comprehension. To examine the relationship of listening skill with other language skills, the outcome of 1800 Iranian participants undertaking International English Language Testing System (IELTS) in Tehran indicates the close correlation between listening comprehension and the overall language proficiency.

Community wide interventions for increasing physical activity

Not having enough physical activity leads to poorer health. Regular physical activity can reduce the risk of chronic disease and improve one's health and well being. The lack of physical activity is a common and growing health problem. To address this, 25 studies have used improvement activities directed at communities using more than one approach in a single program. When we looked at the available research, we observed that there was a lack of good studies which could show whether this approach was or wasn't beneficial. For example, some research studies claimed that community wide programs improved physical activities and other studies did not. It was not possible to determine what might work. Future research is needed with improved designs, measures of outcomes and larger samples of participants.

How important is length? : mechanical testing and measurement of a cemented, polished, tapered femoral implant

Total hip arthroplasty (THA) has a proven clinical record for providing pain relief and return of function to patients with disabling arthritis. There are many successful options for femoral implant design and fixation. Cemented, polished, tapered femoral implants have been shown to have excellent results in national joint registries and long-term clinical series. These implants are usually 150mm long at their lateral aspect. Due to their length, these implants cannot always be offered to patients due to variations in femoral anatomy. Polished, tapered implants as short as 95mm exist, however their small proximal geometry (neck offset and body size) limit their use to smaller stature patients. There is a group of patients in which a shorter implant with a maintained proximal body size would be advantageous. There are also potential benefits to a shorter implant in standard patient populations such as reduced bone removal due to reduced reaming, favourable loading of the proximal femur, and the ability to revise into good proximal bone stock if required. These factors potentially make a shorter implant an option for all patient populations. The role of implant length in determining the stability of a cemented, polished, tapered femoral implant is not well defined by the literature. Before changes in implant design can be made, a better understanding of the role of each region in determining performance is required. The aim of the thesis was to describe how implant length affects the stability of a cemented, polished, tapered femoral implant. This has been determined through an extensive body of laboratory testing. The major findings are that for a given proximal body size, a reduction in implant length has no effect on the torsional stability of a polished, tapered design, while a small reduction in axial stability should be expected. These findings are important because the literature suggests that torsional stability is the major determinant of long-term clinical performance of a THA system. Furthermore, a polished, tapered design is known to be forgiving of cement-implant interface micromotion due to the favourable wear characteristics. Together these findings suggest that a shorter polished, tapered implant may be well tolerated. The effect of a change in implant length on the geometric characteristics of polished, tapered design were also determined and applied to the mechanical testing. Importantly, interface area does play a role in stability of the system; however it is the distribution of the interface and not the magnitude of the area that defines stability. Taper angle (at least in the range of angles seen in this work) was shown not to be a determinant of axial or torsional stability. A range of implants were tested, comparing variations in length, neck offset and indication (primary versus cement-in-cement revision). At their manufactured length, the 125mm implants were similar to their longer 150mm counterparts suggesting that they may be similarly well tolerated in the clinical environment. However, the slimmer cement-in-cement revision implant was shown to have a poorer mechanical performance, suggesting their use in higher demand patients may be hazardous. An implant length of 125mm has been shown to be quite stable and the results suggest that a further reduction to 100mm may be tolerated. However, further work is required. A shorter implant with maintained proximal body size would be useful for the group of patients who are unable to access the current standard length implants due to variations in femoral anatomy. Extending the findings further, the similar function with potential benefits of a shorter implant make their application to all patients appealing.

A CAD interface for GEANT4

Often CAD models already exist for parts of a geometry being simulated using GEANT4. Direct import of these CAD models into GEANT4 however,may not be possible and complex components may be diffcult to define via other means. Solutions that allow for users to work around the limited support in the GEANT4 toolkit for loading predefined CAD geometries have been presented by others, however these solutions require intermediate file format conversion using commercial software. Here within we describe a technique that allows for CAD models to be directly loaded as geometry without the need for commercial software and intermediate file format conversion. Robustness of the interface was tested using a set of CAD models of various complexity; for the models used in testing, no import errors were reported and all geometry was found to be navigable by GEANT4. Funding source: Cancer Australia (Department of Health and Ageing) Research Grant 614217