Sleep as a mediator of the relationship between social class and health in higher education students.

A substantial body of research indicates that higher education students from lower social class backgrounds tend to have poorer health than those from higher social class backgrounds. To investigate sleep as a potential mediator of this relationship, online survey responses of students from five large Australian universities, one Irish university and one large Australian technical college were analysed in three studies (Study 1 N = 628; Study 2 N = 376; Study 3 N = 446). The results revealed that sleep quality, sleep duration, sleep disturbances, pre-sleep worries and sleep schedule variability mediated the relationship between social class and physical and mental health. Sleep remained a significant mediator when controlling for related variables and other mediators. Thus, the findings suggest that sleep partly explains social class differences in health. We discuss the importance of addressing sleep issues among students from lower social class backgrounds.

Mood profiles of amateur triathletes: Implications for mental health and performance.

Moods have been shown to be predictive of athletic performance and a reflection of mental health status. The aims of our study were (a) to compare pre-race mood scores of triathletes with population norms; (b) to compare pre-race mood scores of triathletes grouped by gender and age bands; (c) to explore whether six distinct mood profile clusters reported in the literature were evident among triathletes and their respective prevalence; (d) to determine if pre-race mood scores predicted triathlon performance; and (e) to interpret our findings in terms of the risk of mental health issues for triathletes. Participants were 592 age-group triathletes (also referred to as recreational or amateur triathletes) who completed the Brunel Mood Scale pre-race and recorded their time goal for the race. Mean mood scores deviated significantly from population norms, with Tension and Vigor scores at the 55th and 54th percentile, respectively, and Depression, Anger, Fatigue, and Confusion scores between the 42nd and 46th percentile. Females reported higher Tension scores than males (p < 0.001), and those in the 18-25 years and 26-35 years age bands reported higher Tension scores than those in the 46-55 years age band (p < 0.008). Using k-means cluster analysis, six distinct mood profiles were identified, the distribution of which approximated the general population, except for a low prevalence of very negative profiles. Mean scores for Depression and Anger were exceptionally low and only 1.5% of triathletes, compared to the normal prevalence of ~5%, reported an "inverse Everest" profile, which is associated with elevated risk of psychopathology. Mood scores did not predict triathlon performance, assessed by finish time as a percentage of time goal. Results showed an association between triathlon participation and psychological well-being. Findings will inform future investigations of mood responses among triathletes and provide a relevant point of reference for applied practitioners who work with triathletes.

Metacognitions in heterosexual, bisexual, and homosexual men: with or without premature ejaculation and erectile dysfunction.

BACKGROUND: Premature ejaculation (PE) and erectile dysfunction (ED) are prevalent sexual problems, with evidence to suggest variation across sexual orientation. Contributing factors have traditionally been divided into organic and psychological categories. While limited research has found support for the influence of metacognitive beliefs, these studies did not investigate potential differences in sexual orientation. AIM: The current study aimed to investigate the differences in metacognitive beliefs in men with or without PE and/or ED and whether these varied according to sexual orientation. METHOD: A sample of 531 men was recruited (65 met criteria for PE only, 147 for ED, 83 with PE and ED, and 236 healthy controls). Within this sample, 188 men identified as heterosexual, 144 as bisexual, and 199 as homosexual. Participants completed a cross-sectional online survey consisting of psychometric measures. RESULTS: Participants with PE and ED were significantly higher in cognitive confidence, thoughts concerning uncontrollability and danger, and need to control thoughts than PE only, ED only, and healthy controls. Furthermore, the PE only group was significantly higher than healthy controls for cognitive confidence, with the ED significantly higher for thoughts concerning uncontrollability and danger. There were no significant differences between differing sexual orientations for men with/or without PE and/or ED. CONCLUSIONS: Congruent with previous research, metacognitive beliefs play a role in PE and/or ED, although this is not exclusive to sexual orientation. The findings highlight that assessment and intervention regarding metacognitive beliefs may be beneficial for men of all sexual orientations with PE and/or ED.

Physiotherapists' views, perceived knowledge, and reported use of psychosocial strategies in practice.

Background: Research has addressed the usefulness of psychosocial strategies within physiotherapy, as part of a biopsychosocial model. A lack of current research in Australia concerning the views of physiotherapists, from a range of practice areas, regarding a variety of strategies, suggests the need for broader exploration. Methods: This research employed a cross-sectional survey asking Australian physiotherapists (n = 251) to rate their perceived importance and perceived benefits of psychosocial strategies; perceived positive effects on rehabilitation outcomes and adherence; confidence in applying strategies, and perceived benefits of further training. Data were analyzed using descriptive statistics, Crosstabs with Chi-Squared Tests of Contingencies and Spearman's Rank-Order Correlations. Results: Physiotherapists reported that having knowledge of such strategies was important and considered them beneficial for practice. Respondents rated highly their perceived knowledge about goal setting and positive reinforcement, both of which were reported as most used in practice. Approximately one quarter of physiotherapists reported using cognitive behavioral therapy and motivational interviewing. Physiotherapists communicated a lack of confidence to apply psychosocial strategies in their practice, and desired further training. Conclusion: Physiotherapists could benefit from tailored instruction regarding psychosocial strategies at a level appropriate to, and within their scope of practice. This could enhance their practice from a biopsychosocial perspective, subsequently improving outcomes for their patients.

Psychosocial strategies for physiotherapy: A qualitative examination of physiotherapists' reported training preferences.

Physiotherapists report using a range of psychosocial strategies in their practice, yet, barriers to implementation include lack of time, limited knowledge, and minimal training. This research aimed to establish what training physiotherapists have had with regards to psychosocial strategies, why they think they would benefit from more training, what training they want, and delivery preferences. Content analysis of answers to four open-ended, online survey questions collected from Australian physiotherapists (N = 208) was conducted. Physiotherapists reported having minimal training specific to psychosocial strategies. Physiotherapists reported wanting training in assessment and management of psychosocial issues, and practical application of specific psychosocial strategies. Didactic and interactive training delivered by experts who understand the psychosocial needs of their patients, and the constraints of physiotherapy practice was preferred. These findings suggest that training in psychosocial strategies at the undergraduate level and continued professional development are necessary. Specifically, training in the assessment and management of psychosocial factors, and in referral processes is warranted, and should be applicable and appropriate for rehabilitation settings. Training should be both didactic and interactive as outlined in the proposed framework.

Successfully treating refugees' post-traumatic stress symptoms in a Ugandan settlement with group cognitive behaviour therapy.

BACKGROUND: High rates of post-traumatic stress disorder (PTSD) are documented within refugee populations. Although research supports effectiveness of trauma-focused cognitive behaviour therapy (TF-CBT) among Western populations, little research exists for its efficacy among refugees living in camps and settlements in developing nations. AIMS: To investigate whether a culturally sensitive, group-based TF-CBT programme (EMPOWER) delivered in a Ugandan refugee settlement effectively reduced refugees' post-traumatic stress symptoms (PTSS), and whether sociodemographic factors, trauma characteristics, or PTSS severity related to programme completion or treatment outcomes. METHOD AND RESULTS: Data linkages were conducted on information provided by 174 Congolese refugees living in a Ugandan settlement (mean age = 33.4 years, SD = 11.7; 49% male). Using a quasi-experimental design, participants who initially completed the intervention (n = 43) delivered across nine 90-minute sessions, reported significant reductions in self-reported PTSS with a large effect size. The delayed treatment group (n = 55) also reported significant treatment gains once they received the intervention. Participants who completed the programme reported significantly greater initial PTSS severity than those who dropped out, while no sociodemographic factors, trauma characteristics or PTSS were associated with better treatment outcomes. DISCUSSION: A culturally sensitive, group-based TF-CBT programme delivered in a refugee settlement meaningfully reduces refugees' PTSS severity and is equally effective for all participants, with the highest retention rates found among those in greatest need of treatment. Programmes such as this, with capacity to treat hundreds of people simultaneously, represent highly cost-effective, accessible, disseminable and effective treatment for PTSS among refugees living in humanitarian settings in developing nations.

The Impact of COVID-19 on Staff Working Practices in UK Horseracing.

Due to COVID-19, horseracing was required to cease all activity in March 2020; however, little is known about the pandemic's impact on staff working practices. This study investigated the impact of COVID-19 on staff working practices during the initial lockdown phases. An online survey about working conditions during lockdown was answered by 287 participants. Chi-squared tests for independence and binary logistic regression (BLR) analysis was undertaken. A total of 53.7% (n = 154) of staff were working during lockdown. Pandemic-specific workplace changes were reported as effective by 87.8% (n = 115) of staff. Flat grooms reported workplace changes as less effective (χ2 (52, n = 131) = 92.996, p < 0.001). A total of 67.2% (n = 193) of staff were positive about job security. Trainers and grooms were significantly less likely to report jobs as secure (χ2 (52, n = 287) = 75.653, p < 0.05). The findings suggest that most of the racing industry positively received changes made by their employers to tackle the pandemic, and for staff still working during lockdown, their health and safety was prioritised. Continued development of employee support structures to promote job security and workforce stability is advised, which will minimise the disruption of staff changes on the care and welfare of the horses.

Mental toughness and self-efficacy of elite ultra-marathon runners.

Minimal research has examined psychological processes underpinning ultra-marathon runners' performance. This study examined the relationships between mental toughness and self-efficacy with performance in an elite sample of ultra-marathon runners competing in the 2019 Hawaiian Ultra Running Team's Trail 100-mile endurance run (HURT100). The Mental Toughness Questionnaire (SMTQ) and the Endurance Sport Self-Efficacy Scale (ESSES) were completed by 56 elite ultra-marathon runners in the HURT100 (38 males, 18 females; Mage = 38.86 years, SDage = 9.23). Findings revealed mental toughness and self-efficacy are highly related constructs (r(54) = 0.72, p < 0.001). Mental toughness and self-efficacy did not significantly relate to ultra-marathon performance (mental toughness and self-efficacy with Ultra-Trail World Tour (UTWT) rank F(2, 53) = 0.738, p = 0.483; mental toughness and self-efficacy with likelihood would finish the HURT100 χ2 = 0.56, p = 0.756; mental toughness and self-efficacy with HURT100 placing and time F(2, 53) = 1.738, p = 0.186 and F(2, 30) = 2.046, p = 0.147, respectively). However, participants had significantly and meaningfully higher mental toughness (M = 45.42, SD = 4.26, medium and large effect sizes) than athletes from other sports previously published. Our interpretation is that these results taken in conjunction, suggest a threshold of mental toughness that performers require to be of the standard needed to be able to prepare for and compete in elite ultra-marathon events such as the HURT100; once this mental toughness threshold is met, other factors are likely to be more influential in determining elite level ultra-marathon performance.

A Comparison of V̇O 2 , and Muscle and Prefrontal Cortex Tissue Oxygen Extraction between Short and Long-term Aerobically Trained Men Aged 40 - 60 Years.

This study was designed to compare systemic O2 utilization (V̇O2), and changes in tissue O2 extraction [deoxyhemoglobin (ΔHHb)] in the vastus lateralis (VL), gastrocnemius (GAST) and pre-frontal cortex (PFC) tissue; between aerobically short-term trained (STT) and long-term trained (LTT) older men (40 - 60 yr) who were matched for current training load. On separate occasions, 14 STT and 14 LTT participants completed ramp incremental (RI) and square-wave constant load (SWCL) tests on a cycle ergometer. In LTT compared to STT; (i) V̇O2 was higher during the RI (p > 0.001) and SWCL (p > 0.001) tests, (ii) ΔHHb in the GAST was greater in SWCL (p = 0.011); and (iii) ΔHHb in the PFC was greater at 90% GET during SWCL (p = 0.011). The additional years of training in LTT compared to STT (LTT 17.50yr ± 6.94yr vs STT 1.68yr ± 0.31yr) were associated with higher V̇O2peak, and sub-GET V̇O2, and ΔHHb in the GAST and PFC at sub-GET exercise, despite there being no difference in current training volume.

An exploration of physiotherapists' perceived benefits and barriers towards using psychosocial strategies in their practice.

BACKGROUND: This study aimed to determine what physiotherapists perceive are the benefits of using psychosocial strategies in their own practice, and whether perceived barriers extend beyond practitioner and contextual barriers. METHODS: Content analysis of two open-ended questions was conducted. Australian physiotherapists (n = 206) provided written comments. RESULTS: Three key categories of benefits emerged: patient benefits, shared patient and physiotherapist benefits, and physiotherapist benefits. Patient benefits included improved rehabilitation experience, improved patient wellbeing and improvement of psychosocial responses. Specifically, increased patient enjoyment, improved self-management and improved understanding of the links between their physical and psychological health. Therapeutic alliance appeared as a shared patient and physiotherapist benefit, with specific reference to enhanced partnerships and improved patient-centred practice. Physiotherapist benefits comprised of improved needs assessment and occupational benefits such as reduced load. Three key categories of physiotherapist barriers, contextual barriers, and patient barriers emerged. Time, knowledge, confidence, lack of expertise, and limited formal training, were the main barriers, specifically a lack of practical training, and for more complex strategies. Physiotherapists acknowledged patient barriers such as patient resistance, lack of understanding, and complex mental health needs. CONCLUSIONS: These findings contribute novel information with regard to the benefits and barriers of psychosocial approaches from a physiotherapist perspective. Physiotherapists may benefit from further support in their use of psychosocial approaches, to emphasize the benefits for their own practice. Furthermore, to potentially reduce patient barriers and improve outcomes, patient education concerning a biopsychosocial model of care could be valuable.

Exploring physiotherapists' considerations regarding the use of psychosocial strategies in practice.

OBJECTIVES: To investigate what factors physiotherapists consider when deciding whether to use psychosocial strategies with their patients and what factors they consider when choosing a specific approach. METHODS: Content analysis of two open-ended questions contained within a cross-sectional survey was conducted. Australian physiotherapists (N = 201) provided written comments. RESULTS: Textual data were subjected to content analysis. Two key categories emerged: practitioner considerations and patient considerations. Subcategories included physiotherapist factors, practice environment, patient biological factors, patient psychological factors, and patient social factors. When contemplating the use of psychosocial strategies, physiotherapists' responses aligned with a biopsychosocial perspective. The most common consideration overall was patient attitudes. Physiotherapists reflected on which specific psychosocial strategies they perceived were beneficial for a particular patient based on their presentation. Scope of practice was a minor factor in their decision-making process, as physiotherapists considered their knowledge, confidence, and skill base more frequently. CONCLUSION: Physiotherapists incorporate a biopsychosocial framework in their assessment of patients with regard to potential use of psychosocial strategies. Physiotherapists displayed language that reflected a developed understanding of psychological and social issues with respect to their patients' presentation. Nonetheless, selection of psychosocial strategies was predominantly based on experience, success with an approach, perceived knowledge, skill, and confidence, as opposed to evidence-based efficacy of such strategies. These findings have implications for the training of physiotherapists. Desired outcomes are enhancing management of patients based on a biopsychosocial approach and ensuring inclusion of appropriate, relevant, and evidence-based psychosocial strategies within their accepted scope of practice.

Occupational therapists' perceptions of psychosocial strategies for clients with Parkinson's disease.

Psychological strategies are a promising adjunct to pharmacological treatment for symptoms, including depression and anxiety associated with Parkinson's disease. In this study, we investigated perceptions and reported behaviors of occupational therapists regarding the use of psychosocial strategies during their practice with clients with Parkinson's disease. The results of a cross-sectional online survey (n = 115 occupational therapists) demonstrated that the majority of participants (83%) reported using psychosocial strategies with their clients living with Parkinson's disease, with goal setting the most frequent. Almost all occupational therapists (99.1%) reported that it was moderately to extremely important to have knowledge about psychosocial strategies for practice with clients living with Parkinson's disease, and 96.5% rated it important to be able to offer these strategies in practice with their clients living with Parkinson's disease. The majority (91.3%) felt incorporating psychosocial strategies into their practice was moderately to extremely beneficial, and 93.9% reported that psychosocial strategies have a moderate-to-extremely positive effect on Parkinson's disease management outcomes. These findings have important implications for the education and training of occupational therapists working with clients living with Parkinson's disease to help ensure the best possible outcomes for people with Parkinson's disease.

A systems approach to understanding the identification and treatment of sport-related concussion in community rugby union.

AIM: The aim of the present study was to utilise a systems thinking approach to explore the perceived responsibilities for identifying and treating concussion held by different actors across the community rugby system (e.g., players, coaches, parents, medics, referees, and management), as well as their role-specific concussion management strategies. METHODS: A systems approach was taken to assess what different stakeholders within rugby systems perceive their roles to be regarding concussion identification and treatment. Through an online survey, 118 members of the amateur (community) rugby union system were asked about their role-specific concussion management responsibilities and strategies. Respondents included players, parents, medics, coaches, club managers, administrators, and volunteers. RESULTS: The majority of respondents indicated that they were able to identify the symptoms of rugby-related concussion, however, only medics stated their responsibility to use formal concussion assessments (e.g., SCAT2). A smaller number of the respondents indicated that they were involved in treating concussion within their current role/s (majority of which were medics). CONCLUSIONS: This study illustrated that the current challenges in the identification and treatment of rugby-related concussion in community sport may be due to role/responsibility confusion and possible overreliance on field-side medics. These findings offer insight into the possible limitations of the current concussion management guidelines and may offer empirically based direction for future revisions.

The Effect of Short- and Long-Term Aerobic Training Years on Systemic O2 Utilization, and Muscle and Prefrontal Cortex Tissue Oxygen Extraction in Young Women.

Buzza, G, Lovell, GP, Askew, CD, and Solomon, C. The effect of short- and long-term aerobic training years on systemic O2 utilization, and muscle and prefrontal cortex tissue oxygen extraction in young women. J Strength Cond Res 33(8): 2128-2137, 2019-This study aimed to determine if systemic O2 utilization (VO2) and tissue oxygen extraction (deoxyhemoglobin [HHb]) in the vastus lateralis (VL), gastrocnemius (GAST), and prefrontal cortex were different during exercise between short-term trained (STT, 6-24 months) and long-term trained (LTT, >5 years) young women while controlling for current training load. Thirteen STT and 13 LTT participants completed ramp incremental (RI) and square-wave constant load (SWCL) tests on a cycle ergometer. In LTT compared with STT: (a) VO2 was higher during the RI (p = 0.024) and SWCL (p = 0.001) tests; (b) HHb in the VL (p = 0.044) and GAST (p = 0.027) was higher in the RI test; and (c) there were significant group × intensity interactions for VO2 in the SWCL test. The additional years of aerobic training in LTT compared with STT (LTT 7.1 ± 1.9 vs. STT 1.5 ± 0.4 years) resulted in higher VO2 and HHb in the VL and GAST. These results indicate that in young women, independent of current training load, systemic VO2 and peripheral muscle O2 extraction during exercise continues to increase beyond 24 months of aerobic training.

Nutrition Risk Measured Online in Community-Living Older Australians.

Many community-living older adults experience the condition of malnutrition and the causes are complex and multi-factorial. This study examined nutrition risk in a sample of community-living older Australians (n = 77, age ≥65 years) using an online, self-administered survey consisting of two validated questionnaires (SCREEN II and SF-12). We found a significant relationship between health status and nutrition risk; those with higher self-rated health status had lower nutrition risk. Forty percent of the participants were categorized at high nutritional risk, 26% at moderate nutritional risk and 34% not at nutritional risk. The most common nutrition risk factors were: (i) weight perception (perceiving weight to be more than it should); (ii) food avoidance; (iii) low intake of milk, milk products and alternatives; and (iv) finding meal preparation a chore. Many nutrition-risk factors were consistent with population survey data highlighting the need for greater awareness of nutritional requirements for healthy ageing.

A graduated food addiction classification approach significantly differentiates obesity among people with type 2 diabetes.

This study examined a graduated severity level approach to food addiction classification against associations with World Health Organization obesity classifications (body mass index, kg/m2) among 408 people with type 2 diabetes. A survey including the Yale Food Addiction Scale and several demographic questions demonstrated four distinct Yale Food Addiction Scale symptom severity groups (in line with Diagnostic and Statistical Manual of Mental Disorders (5th ed.) severity indicators): non-food addiction, mild food addiction, moderate food addiction and severe food addiction. Analysis of variance with post hoc tests demonstrated each severity classification group was significantly different in body mass index, with each grouping being associated with increased World Health Organization obesity classifications. These findings have implications for diagnosing food addiction and implementing treatment and prevention methodologies of obesity among people with type 2 diabetes.

A graduated food addiction classifications approach significantly differentiates depression, anxiety and stress among people with type 2 diabetes.

AIMS: To examine differences in depression, anxiety, and stress across people with type 2 diabetes mellitus (t2d) classified according to a four level processed food addiction (PFA) severity indicator dichotomy. METHODS: Four hundred and eight participants with a t2d diagnoses completed an online survey including the Yale Food Addiction Scale (YFAS) and the DASS-21. Based on YFAS symptom counts participants were classified as either: non-PFA; mild-PFA; moderate-PFA; or severe-PFA. RESULTS: Multivariate, λ=0.422, F(9,978.51)=46.286, p<0.001, np2=0.250, and univariate analyses of variance demonstrated that depression F(3,408)=159.891, p<0.001, np2=0.543, anxiety F(3,408)=127.419, p<0.001, np2=0.486, and stress scores F(3,408)=129.714, p<0.001, np2=0.491, significantly and meaningfully increased from one PFA classification level to the next. Furthermore, the proportion of participants with more severe classifications of depression χ2 (12)=297.820, p<0.001, anxiety χ2 (12)=271.805, p<0.001, and stress χ2 (12)=240.875, p<0.001, were significantly higher in the more severe PFA groupings. CONCLUSION: For people with t2d, PFA is an important and meaningful associate of depression, anxiety, and stress, and that the adopted four level PFA severity indicator dichotomy is valid and useful.

A knock to the system: A new sociotechnical systems approach to sport-related concussion.

Broader contextual factors that influence concussion management have tended to be overlooked. To address this, the present study used a sociotechnical systems approach to identify perceived responsibilities and applied strategies for three domains of concussion management (i.e., prevention, identification and treatment). Participants were 118 members of the community rugby union system in Australia (69.2% male). Participants from throughout the rugby system (e.g., players, parents, coaches, club management) were asked open-ended questions about their perceived responsibilities and the strategies they use for concussion management. It was found that (a) proper training, technique correction and education were recurrent prevention themes; (b) the majority of key stakeholders felt that they could consistently identify concussion; however, medical aids (medics) were the only system actors who stated a responsibility to use standardised concussion assessment measures and (c) less than one third of the respondents indicated their involvement in treating concussion. This study identifies specific junctures in the system that prevents effective concussion management strategies. A sociotechnical systems approach improves the understanding of concussion prevention, and management beliefs and behaviours.