Insomnia subtypes characterised by objective sleep duration and NREM spectral power and the effect of acute sleep restriction: an exploratory analysis.

Insomnia disorder (ID) is a heterogeneous disorder with proposed subtypes based on objective sleep duration. We speculated that insomnia subtyping with additional power spectral analysis and measurement of response to acute sleep restriction may be informative in overall assessment of ID. To explore alternative classifications of ID subtypes, insomnia patients (n = 99) underwent two consecutive overnight sleep studies: (i) habitual sleep opportunity (polysomnography, PSG) and, (ii) two hours less sleep opportunity (electroencephalography, EEG), with the first night compared to healthy controls (n = 25). ID subtypes were derived from data-driven classification of PSG, EEG spectral power and interhemispheric EEG asymmetry index. Three insomnia subtypes with different sleep duration and NREM spectral power were identified. One subtype (n = 26) had shorter sleep duration and lower NREM delta power than healthy controls (short-sleep delta-deficient; SSDD), the second subtype (n = 51) had normal sleep duration but lower NREM delta power than healthy controls (normal-sleep delta-deficient; NSDD) and a third subtype showed (n = 22) no difference in sleep duration or delta power from healthy controls (normal neurophysiological sleep; NNS). Acute sleep restriction improved multiple objective sleep measures across all insomnia subtypes including increased delta power in SSDD and NSDD, and improvements in subjective sleep quality for SSDD (p = 0.03), with a trend observed for NSDD (p = 0.057). These exploratory results suggest evidence of novel neurophysiological insomnia subtypes that may inform sleep state misperception in ID and with further research, may provide pathways for personalised care.

Older adults' time in sedentary, light and moderate intensity activities and correlates: application of Australian Time Use Survey.

OBJECTIVES: Understanding how older adults spend their time between active and sedentary activities is an important aspect of healthy ageing. This study examined the time spent in all-domains of sedentary, light and moderate intensity physical activities in old age and identified high-risk groups. DESIGN: A cross-sectional analysis of Australian 2006 Time Use Survey. METHODS: Participants comprised non-working older adults with at least one 24-h time use diary (n=992). Primary activities were recoded by activity domain and intensity. Multivariate logistic regression analyses were used to calculate the odds ratios of having high sedentary time, low light-intensity physical activity (LIPA), and being insufficiently active (<30 min/day of moderate-to-vigorous physical activity, MVPA) by sociodemographic variables. RESULTS: Older adults spent 223 and 121 min/day of their waking time in LIPA and MVPA, respectively, mostly (88%) attributed to household chores. One third of participants spent ≥600 min/day in sedentary activities, 63% spent ≥180 min/day in LIPA, 85% achieved sufficient levels of MVPA by all domains, but only 30% of participants by the leisure/transport domains. Neither age nor socio-economic indicators were associated with insufficient MVPA. Marital status and living arrangement were significant correlates of low MVPA and LIPA but moderated by gender. The only correlate of high sedentary time (>10 h/day) was disability or long-term health condition. CONCLUSIONS: The majority of older Australians are sufficiently active when considering all domains. Household domain is the main source of LIPA and MVPA. In old age, prolonged sitting is associated with disability. Marital status and living arrangements can be used to identify physically inactive seniors.

Thirteen-year trends in child and adolescent fundamental movement skills: 1997-2010.

PURPOSE: The objective of this study is to describe 13-yr trends in children's fundamental movement skill (FMS) competency. METHODS: Secondary analysis of representative, cross-sectional, Australian school-based surveys was conducted in 1997, 2004, and 2010 (n = 13,752 children age 9-15 yr). Five FMS (sprint run, vertical jump, catch, kick, and overarm throw) were assessed using process-oriented criteria at each survey and children's skills classified as competent or not competent. Covariates included sex, age, cardiorespiratory endurance (20-m shuttle run test), body mass index (kg·m), and socioeconomic status (residential postcode). RESULTS: At each survey, the children's FMS competency was low, with prevalence rarely above 50%. Between 1997 and 2004, there were significant increases in all students' competency in the sprint run, vertical jump, and catch. For boys, competency increased in the kick (primary) and the overarm throw (high school), but among high school girls, overarm throw competency decreased. Between 2004 and 2010, competency increased in the catch (all students), and in all girls, competency increased in the kick, whereas competency in the vertical jump decreased. CONCLUSIONS: Overall, students' FMS competency was low especially in the kick and overarm throw in girls. The observed increase in FMS competency in 2004 was attributed to changes in practice and policy to support the teaching of FMS in schools. In 2010, competency remained low, with improvements in only the catch (all) and kick (girls) and declines in vertical jump. Potentially, the current delivery of FMS programs requires stronger positioning within the school curriculum. Strategies to improve children's physical activity should consider ensuring children are taught FMS to competency level, to enjoy being physically active.

Investigating the media power of a population health monitoring survey: case study of the NSW Schools Physical Activity and Nutrition Survey (SPANS).

OBJECTIVE: To examine the extent and nature of news coverage of a government-funded population monitoring survey of children and the potential implications of this coverage for public health advocacy. METHODS: Case study of the NSW Schools Physical Activity and Nutrition Survey (SPANS), a population monitoring survey of school-aged children's weight and weight-related behaviours, conducted in 1997, 2004 and 2010. Printed news items from all Australian newspapers between January 1997 and December 2011 mentioning the survey findings were identified from the Factiva database and a descriptive analysis of the content conducted. RESULTS: Overall, 144 news items were identified. The news angles focused mainly on physical activity/sedentary behaviour; overweight/obesity and nutrition; however these angles changed between 1997 and 2011, with angles focused on physical activity/sedentary behaviour increasing, compared with overweight/obesity and nutrition angles (p=0.001). Responsibility for obesity and weight-related behaviours was most frequently assigned to parents and food marketing, and the most common solutions were policy strategies and parental/child education and support. CONCLUSIONS: Population health surveys are newsworthy and when coupled with strategic dissemination, media can contribute to communicating health issues and interpreting findings in ways that are relevant for consumers, policy makers and stakeholders. Implications : This case study emphasises the news value of government-funded population surveys, while providing a cautionary note about media focus on individual studies rather than a larger body of research evidence.

Prevalence and correlates of low fundamental movement skill competency in children.

OBJECTIVE: To describe the demographic and health-related characteristics of school-aged children with low competency in fundamental movement skills (FMS). METHODS: Cross-sectional representative school-based survey of Australian elementary and high school students (n = 6917) conducted in 2010. Trained field staff measured students' height, weight, and assessed FMS and cardiorespiratory endurance (fitness). Information on students' demographics and physical activity was collected by questionnaire. RESULTS: Overall, the prevalence of students with low motor skill competency was high. Girls with low socioeconomic status (SES) were twice as likely to be less competent in locomotor skills compared with high SES peers. Among boys, there was a strong association between low competency in FMS and the likelihood of being from non-English-speaking cultural backgrounds. There was a clear and consistent association between low competency in FMS and inadequate cardiorespiratory fitness. For boys, there was a clear association between low competency in object-control skills and not meeting physical activity recommendations. Conversely, the odds of being inactive were double among girls who had low competency in locomotor skills. CONCLUSIONS: Low competency in FMS is strongly associated with lower cardiorespiratory fitness and physical activity levels in children and adolescents. The characteristics of students with competency in FMS differ by gender and skills types and show that interventions need to target girls from low SES backgrounds and boys from non-English-speaking cultural backgrounds. The high prevalence of low competency in FMS among Grade 4 students indicates that FMS interventions need to start during the preschool and early school years.

Reduction of diabetes risk in routine clinical practice: are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis.

BACKGROUND: The clinical effectiveness of intensive lifestyle interventions in preventing or delaying diabetes in people at high risk has been established from randomised trials of structured, intensive interventions conducted in several countries over the past two decades. The challenge is to translate them into routine clinical settings. The objective of this review is to determine whether lifestyle interventions delivered to high-risk adult patients in routine clinical care settings are feasible and effective in achieving reductions in risk factors for diabetes. DATA SOURCES: MEDLINE (PubMed), EMBASE, CINAHL, The Cochrane Library, Google Scholar, and grey literature were searched for English-language articles published from January 1990 to August 2009. The reference lists of all articles collected were checked to ensure that no relevant suitable studies were missed. STUDY SELECTION: We included RCTs, before/after evaluations, cohort studies with or without a control group and interrupted time series analyses of lifestyle interventions with the stated aim of diabetes risk reduction or diabetes prevention, conducted in routine clinical settings and delivered by healthcare providers such as family physicians, practice nurses, allied health personnel, or other healthcare staff associated with a health service. Outcomes of interest were weight loss, reduction in waist circumference, improvement of impaired fasting glucose or oral glucose tolerance test (OGTT) results, improvements in fat and fibre intakes, increased level of engagement in physical activity and reduction in diabetes incidence. RESULTS: Twelve from 41 potentially relevant studies were included in the review. Four studies were suitable for meta-analysis. A significant positive effect of the interventions on weight was reported by all study types. The meta-analysis showed that lifestyle interventions achieved weight and waist circumference reductions after one year. However, no clear effects on biochemical or clinical parameters were observed, possibly due to short follow-up periods or lack of power of the studies meta-analysed. Changes in dietary parameters or physical activity were generally not reported. Most studies assessing feasibility were supportive of implementation of lifestyle interventions in routine clinical care. CONCLUSION: Lifestyle interventions for patients at high risk of diabetes, delivered by a variety of healthcare providers in routine clinical settings, are feasible but appear to be of limited clinical benefit one year after intervention. Despite convincing evidence from structured intensive trials, this systematic review showed that translation into routine practice has less effect on diabetes risk reduction.

Quality improvement activities associated with organisational capacity in general practice.

BACKGROUND: Clinical audit is recognised worldwide as a useful tool for quality improvement. METHODS: A feedback report profiling capacity for chronic disease care was sent to 97 general practices. These practices were invited to complete a clinical audit activity based on that feedback. Data were analysed quantitatively and case studies were developed based on the free text responses. RESULTS: Eighty-two (33%) of 247 general practitioners participated in the clinical audit process, representing 57 (59%) of 97 general practices. From the data in their feedback report, 37 (65%) of the 57 practices recognised the area most in need of improvement. This was most likely where the need related to clinical practice or teamwork, and least likely where the need related to linkages with other services, and business and finance. Only 25 practices (46%) developed an action plan related to their recognised area for improvement, and 22 (39%) practices implemented their chosen activity. Participating GPs judged that change activity focused on teamwork was most successful. DISCUSSION: The clinical audit process offered participating GPs and practices an opportunity to reflect on their performance across a number of key areas and to implement change to enhance the practice's capacity for quality chronic disease care. The relationship between need and action was weak, suggesting a need for greater support to overcome barriers.