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1.
J Sci Med Sport ; 2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33640263

RESUMO

OBJECTIVES: Low muscular strength is a risk factor for current and future adverse health outcomes. However, whether levels of muscular strength persist, or track, and if there are distinct muscular strength trajectories across the life course is unclear. This study aimed to explore muscular strength trajectories between childhood and mid-adulthood. DESIGN: Prospective longitudinal study. METHODS: Childhood Determinants of Adult Health Study participants had their muscular strength (right and left handgrip, shoulder extension and flexion, and leg strength measured by hand-held, shoulder and leg-back dynamometers, and a combined strength score) assessed in childhood, young adulthood and mid-adulthood. The tracking of muscular strength was quantified between childhood and mid-adulthood (n=385) and young- and mid-adulthood (n=822). Muscular strength trajectory patterns were identified for participants who had their muscular strength assessed at least twice across the life course (n=1280). RESULTS: Levels of muscular strength were persistent between childhood and mid-adulthood and between young- and mid-adulthood, with the highest tracking correlations observed for the combined strength score (childhood to mid-adulthood: r=0.47, p<0.001; young- to mid-adulthood: r=0.72, p<0.001). Three trajectories of combined muscular strength were identified across the life course; participants maintained average, above average, or below average levels of combined muscular strength. CONCLUSIONS: Weak children are likely to become weak adults in midlife unless strategies aimed at increasing muscular strength levels are introduced. Whether interventions aimed at increasing muscular strength could be implemented in childhood to help establish favourable muscular strength trajectories across the life course and in turn, better future health, warrant further attention.

2.
Mult Scler ; : 1352458521994557, 2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33591218

RESUMO

BACKGROUND: While employment rates have increased in people with multiple sclerosis (PwMS), little is known about the longitudinal trends of work productivity. OBJECTIVE: To describe the longitudinal patterns of work productivity and examine the factors associated with annual change of work productivity of PwMS. METHODS: Study participants were employed participants of the Australian MS Longitudinal Study (AMSLS) followed from 2015 to 2019 with at least two repeated measures (n = 2121). We used linear mixed models to examine if the within-individual variations in MS symptoms are associated with changes in work productivity. RESULTS: The mean annual change in work productivity between 2015 and 2019 was -0.23% (SD = 18.68%). Not the actual severity of symptoms but rather the changes in severity of symptoms that are associated with change in work productivity in the same year. In a multivariable model, every unit increase in mean annual change in 'pain and sensory symptoms', 'feelings of anxiety and depression', and 'fatigue and cognitive symptoms' were independently associated with 2.43%, 1.55% and 1.01% annual reductions in work productivity, respectively. CONCLUSION: Individual changes in work productivity are largely driven by the changes in symptom severity rather than the absolute severity. Stabilising/improving MS symptoms might improve work productivity.

3.
BMC Musculoskelet Disord ; 22(1): 40, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413273

RESUMO

BACKGROUND: To describe demographic and clinical factors associated with the presence and incidence of depression and explore the temporal relationship between depression and joint symptoms in patients with symptomatic knee osteoarthritis (OA). METHODS: Three hundred ninety-seven participants were selected from a randomized controlled trial in people with symptomatic knee OA and vitamin D deficiency (age 63.3 ± 7.1 year, 48.6% female). Depression severity and knee joint symptoms were assessed using the patient health questionnaire (PHQ-9) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively, at baseline and 24 months. RESULTS: The presence and incidence of depression was 25.4 and 11.2%, respectively. At baseline, having younger age, a higher body mass index (BMI), greater scores of WOMAC pain (PR: 1.05, 95%CI:1.03, 1.07), dysfunction (PR: 1.02, 95%CI:1.01, 1.02) and stiffness (PR: 1.05, 95%CI: 1.02, 1.09), lower education level, having more than one comorbidity and having two or more painful body sites were significantly associated with a higher presence of depression. Over 24 months, being female, having a higher WOMAC pain (RR: 1.05, 95%CI: 1.02, 1.09) and dysfunction score (RR: 1.02, 95%CI: 1.01, 1.03) at baseline and having two or more painful sites were significantly associated with a higher incidence of depression. In contrast, baseline depression was not associated with changes in knee joint symptoms over 24 months. CONCLUSION: Knee OA risk factors and joint symptoms, along with co-existing multi-site pain are associated with the presence and development of depression. This suggests that managing common OA risk factors and joint symptoms may be important for prevention and treatment depression in patients with knee OA. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01176344 . Anzctr.org.au identifier: ACTRN12610000495022 .

4.
Maturitas ; 143: 81-88, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33308641

RESUMO

OBJECTIVES: To examine the associations of childhood adiposity with menopausal symptoms in women aged 45-49 years. STUDY DESIGN: National population-based cohort study of 334 girls prospectively followed from childhood (aged 11-15) through to midlife (aged 45-49). Childhood overweight and obesity were defined by international age- and sex-specific standards for body mass index (BMI), and abdominal obesity was defined as waist/height ratio≥0.5. MAIN OUTCOME MEASURES: Vasomotor symptoms (VMS), vaginal dryness, total menopausal symptoms and domain-specific symptoms (somatic, psychological and urogenital) were measured during 2018-19 using the Menopause Rating Scale (MRS) and classified as none, mild, moderate or severe. RESULTS: The prevalence of mild, moderate and severe VMS was 24.0 %, 9.0 % and 3.9 %, and of vaginal dryness was 12.6 %, 4.8 % and 2.4 %. No significant associations of childhood overweight/obesity or abdominal obesity with VMS or vaginal dryness were found after adjustment for childhood age, follow-up length, smoking, socioeconomic status and diet quality. Childhood overweight/obesity was associated with increased risks of more severe total (RR:1.17, 95 % CI:1.02-1.36), psychological (RR:1.19, 95 % CI:1.04-1.35) and urogenital (RR:1.29, 95 % CI:1.14-1.46) symptoms measured using the MRS. Associations with childhood abdominal obesity were mostly stronger with more severe total (RR:2.19, 95 % CI:1.48-3.23), somatic (RR:1.52, 95 % CI:1.15-2.02), psychological (RR:1.21, 95 % CI:1.04-1.42) and urogenital (RR:2.11, 95 % CI:1.39-3.20) symptoms. CONCLUSIONS: Childhood adiposity was not associated with increased risks of more severe VMS or vaginal dryness in women aged 45-49 years. Childhood adiposity, especially abdominal obesity, was associated with more severe total, somatic, psychological and urogenital symptoms. However, the association between these symptoms and menopause is not established.


Assuntos
Menopausa , Obesidade Abdominal/epidemiologia , Obesidade Pediátrica/epidemiologia , Adiposidade , Adolescente , Austrália/epidemiologia , Criança , Estudos de Coortes , Feminino , Doenças Urogenitais Femininas/epidemiologia , Humanos , Menopausa/psicologia , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários
5.
Mult Scler ; 26(12): 1550-1559, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33063620

RESUMO

BACKGROUND: More work is needed to understand the burden of comorbidities in people with multiple sclerosis (MS). OBJECTIVE: To assess prevalence of 30 comorbidities and impacts of comorbidities on employment outcomes in a working-aged MS cohort. METHODS: Participants were from the Australian MS Longitudinal Study (n = 929). Information on specific comorbidity was obtained (whether or not each was present, doctor-diagnosed, limited their activities and being treated). RESULTS: Comorbidities most frequently reported to limit activities were osteoarthritis (51%), migraines (40%), anxiety (33%), depression (29%) and allergies (18%). Mean MS-related work productivity loss in past 4 weeks was 1.3 days for those without comorbidities and 2.5 days for those with any comorbidity. The annual population costs of work productivity loss were highest for people with depression, allergies, anxiety, migraines and osteoarthritis. Higher number of comorbidities was associated with more work productivity loss and a higher likelihood of not working. These associations were substantially reduced after adjustment for MS symptom severity. CONCLUSIONS: Comorbidities substantially impact employment outcomes and these effects were mainly mediated through MS symptom severity. This suggests that optimal and simultaneous management of comorbidities may be a viable strategy to reduce MS symptom severity, which in turn could improve employment outcomes.

6.
BMJ Glob Health ; 5(9)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32994229

RESUMO

INTRODUCTION: Prior studies have revealed the increasing prevalence of obesity and its associated health effects among ageing adults in resource poor countries. However, no study has examined the long-term and economic impact of overweight and obesity in sub-Saharan Africa. Therefore, we quantified the long-term impact of overweight and obesity on life expectancy (LE), quality-adjusted life years (QALYs) and total direct healthcare costs. METHODS: A Markov simulation model projected health and economic outcomes associated with three categories of body mass index (BMI): healthy weight (18.5≤BMI <25.0); overweight (25.0≤BMI < 30.0) and obese (BMI ≥30.0 kg/m2) in simulated adult cohorts over a 50-year time horizon from age fifty. Costs were estimated from government and patient perspectives, discounted 3% annually and reported in 2017 US$. Mortality rates from Ghanaian lifetables were adjusted by BMI-specific all-cause mortality HRs. Published input data were used from the 2014/2015 Ghana WHO Study on global AGEing and adult health data. Internal and external validity were assessed. RESULTS: From age 50 years, average (95% CI) remaining LE for females were 25.6 (95% CI: 25.4 to 25.8), 23.5 (95% CI: 23.3 to 23.7) and 21.3 (95% CI: 19.6 to 21.8) for healthy weight, overweight and obesity, respectively. In males, remaining LE were healthy weight (23.0; 95% CI: 22.8 to 23.2), overweight (20.7; 95% CI: 20.5 to 20.9) and obesity (17.6; 95% CI: 17.5 to 17.8). In females, QALYs for healthy weight were 23.0 (95% CI: 22.8 to 23.2), overweight, 21.0 (95% CI: 20.8 to 21.2) and obesity, 19.0 (95% CI: 18.8 to 19.7). The discounted total costs per female were US$619 (95% CI: 616 to 622), US$1298 (95% CI: 1290 to 1306) and US$2057 (95% CI: 2043 to 2071) for healthy weight, overweight and obesity, respectively. QALYs and costs were lower in males. CONCLUSION: Overweight and obesity have substantial health and economic impacts, hence the urgent need for cost-effective preventive strategies in the Ghanaian population.

7.
Artigo em Inglês | MEDLINE | ID: mdl-32991774

RESUMO

ISSUE ADDRESSED: Physical activity is lower and rates of preventable common diseases are higher in regional/rural than urban Australia. Active commuting (walking/bicycling to get from one place to another) may benefit health through increased physical activity, but most evidence of its correlates come from urban studies. This study aimed to investigate associations between active commuting, socio-demographic characteristics, behaviours, total physical activity and health in a regional/rural Australian state. METHODS: This study used data from the 2016 Tasmanian Population Health Survey, a representative cross-sectional self-report survey of 6,300 adults in Tasmania, Australia. Logistic regression modelling investigated associations between socio-demographic, behavioural and health characteristics and past week active commuting frequency. RESULTS: In multivariable models, being younger, having tertiary qualifications, living in a socio-economically advantaged area, being physically active, having a healthy body mass index and good/excellent self-rated health were associated with engaging in more active commuting. Inner regional dwellers were no more likely than outer regional dwellers to actively commute after covariate adjustment. CONCLUSION: Strategies to promote active commuting in regional/rural areas might consider targeting older adults, those less educated, those living in socio-economically disadvantaged areas, those less physically active, those with poorer health and those with higher body mass index. Research could further investigate why these groups appear to be less active for commuting purposes. SO WHAT?: Increasing physical activity and active commuting may help to reduce rates of preventable common diseases in regional/remote areas.

8.
J Neurol ; 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32880072

RESUMO

BACKGROUND: Little is known about the relative contribution of comorbidities in predicting the health-related quality of life (HRQoL) of people with Multiple Sclerosis (PwMS). OBJECTIVE: To determine the associations between the number of and individual comorbidities and HRQoL and estimate the relative contribution of different comorbidities on HRQoL. METHODS: Cross-sectional analysis of data on self-reported presence of 30 comorbidities and HRQoL from the Australian MS Longitudinal Study (AMSLS) participants (n = 902). HRQoL was measured using the Assessment of Quality of Life-8 Dimensions (AQoL-8D). Linear regression and general dominance analysis were used. RESULTS: Higher number of comorbidities was associated with lower HRQoL (p trend p < 0.01). Comorbidities accounted for 18.1% of the variance in HRQoL. Mental health and musculoskeletal disorders were the strongest contributors to lower HRQoL. Of individual comorbidities, systemic lupus erythematosus (SLE) [ß = - 0.16 (- 0.27, - 0.05)] and depression [ß = - 0.15(- 0.18, - 0.13)] were most strongly associated with overall HRQoL, depression [ß = - 0.14(- 0.16, - 0.11)] and anxiety [ß = - 0.10 (- 0.13, - 0.07)] with psychosocial HRQoL, and SLE [ß = - 0.18 (- 0.29, - 0.07)], rheumatoid arthritis [ß = - 0.11 (- 0.19, - 0.02)] and hyperthyroidism [ß = - 0.11 (- 0.19, - 0.03)) with physical HRQoL. CONCLUSION: Comorbidities potentially make important contributions to HRQoL in PwMS. Our findings highlight groups of and individual comorbidities that could provide the largest benefits for the HRQoL of PwMS if they were targeted for prevention, early detection, and optimal treatment.

9.
Mult Scler ; : 1352458520954167, 2020 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-32880529

RESUMO

BACKGROUND: No studies have assessed changes in employment survival in multiple sclerosis (MS) populations over recent decades, including the introduction of disease-modifying therapies (DMTs). OBJECTIVES: To evaluate factors associated with leaving employment due to MS; to assess whether the risk of leaving employment has changed over recent decades in Australia, stratified by MS phenotype. METHODS: We included 1240 participants who were working before MS diagnosis. Information on employment status, reasons for leaving employment and year of leaving were collected. Data were analysed using competing risk survival analysis. RESULTS: Males, progressive MS, lower education level and older age at diagnosis were associated with a higher sub-distribution hazard of leaving employment. Compared to the period before 2010, the sub-distribution hazard during 2010-2016 for relapsing-remitting multiple sclerosis (RRMS) was reduced by 43% (sub-distribution hazard ratio (sHR) 0.67, 95% confidence interval (CI): 0.50 to 0.90), while no significant reduction was seen for primary-progressive multiple sclerosis (PPMS) (sHR 1.25, 95% CI: 0.72 to 2.16) or secondary-progressive multiple sclerosis (SPMS) (sHR 1.37, 95% CI: 0.84 to 2.25). CONCLUSION: Males, people with progressive MS and those of lower education level were at higher risk of leaving employment. The differential changed risk of leaving employment between people with different MS phenotype after 2010 coincides with the increased usage of high-efficacy DMTs for RRMS.

10.
J Neurol ; 2020 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-32880720

RESUMO

BACKGROUND: Little is known about the change in prevalence of comorbidities during the disease course of people with multiple sclerosis (MS) and whether the prevalences vary by MS onset type. OBJECTIVE: To calculate the change in prevalence of comorbidities between symptom onset and the time of study, to compare the prevalences of comorbidities with those in the Australian population at the time of study and to examine onset-type differences. METHODS: Comorbidity data from 1518 participants of the Australian MS Longitudinal Study and Australian population comparator data (2014-2015 National Health Survey) were used. The change in prevalence between time points and prevalence ratios (PR) at the time of study (crude, age and sex adjusted, and stratified by onset type) was calculated. RESULTS: Comorbidities were common, and those with the largest increases in prevalence between MS symptom onset and the time of study were depression (+ 26.9%), anxiety (+ 23.1%), hypertension (+ 21.9%), elevated cholesterol (+ 16.3%), osteoarthritis (+ 17.1%), eye diseases (+ 11.6%), osteoporosis (+ 10.9%) and cancer (+ 10.3%). Compared to the general population and after age and sex adjustment, participants had a significantly higher prevalence for 14/19 comorbidities at the time of study. The associations were strongest for anaemia, cancer (both PR > 4.00), anxiety, depression, migraine (all PR > 3.00), psoriasis and epilepsy (both PR > 2.00). No significant differences were seen by onset type. CONCLUSION: Comorbidities are common at MS symptom onset and increase with MS duration. Having MS may thus contribute to accrual of comorbidities. This emphasises the importance of optimal screening for and management of comorbidities in early MS and throughout the disease course.

11.
Mult Scler ; : 1352458520958369, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32924841

RESUMO

BACKGROUND: The symptoms that have the largest impact on health-related quality of life (HRQoL) in people with multiple sclerosis (MS) may vary by MS phenotype (relapsing-remitting MS (RRMS), secondary progressive MS (SPMS) and primary progressive MS (PPMS)). Knowing these symptoms assists in symptom management. OBJECTIVE: To examine the associations between 13 common MS symptoms and HRQoL in the total sample and stratified by MS phenotype. METHOD: The study included 1985 participants. HRQoL was measured with two multi-attribute utility instruments: assessment of quality of life with eight dimensions (AQoL-8D) and European quality of life with five dimensions and five levels for each dimension (EQ-5D-5L). Multivariable linear regression was used to identify the symptoms that had the largest impact on the HRQoLs. RESULTS: Feelings of depression, pain, fatigue, and feelings of anxiety were most strongly associated with AQoL-8D and EQ-5D-5L. Walking difficulties additionally contributed to reduced EQ-5D-5L. The strongest single predictors in the multivariable analyses were feelings of depression or pain for AQoL-8D and walking difficulties for EQ-5D-5L, irrespective of MS phenotype. CONCLUSION: The strongest single predictors for the AQoL-8D and EQ-5D-5L were feelings of depression, pain and walking difficulties, irrespective of MS phenotype. Reducing these symptoms may have the largest impact on improving HRQoL in all MS phenotypes of people with MS.

12.
J Neurol ; 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32876720

RESUMO

BACKGROUND: More research is needed to understand the contribution of comorbidities to MS symptomatology. OBJECTIVES: To examine the dose-response relationship between the number of comorbidities and severity of MS symptoms and to assess the relative contribution of comorbidity groups and individual comorbidities to the severity of each symptom. METHODS: We surveyed 1223 participants of the Australian MS Longitudinal Study for the presence of 30 comorbidities and the severity of 13 MS symptoms (0-10 scale). The associations between comorbidities and symptoms were assessed using negative binomial regression. The relative contributions of comorbidities to the severity of symptoms were assessed using general dominance analysis. RESULTS: Higher number of comorbidities was most strongly associated with a higher severity of pain and feelings of anxiety and depression (ratios of means ≥ 0.12 per comorbidity increase). Comorbidities explained between 3.7% (spasticity) and 22.0% (feelings of anxiety) of the total variance of symptom severity. Mental health and musculoskeletal disorders contributed most strongly to the severity of the most common symptoms in MS. CONCLUSIONS: Our findings support that early recognition and optimal management of comorbidities, particularly of mental health and musculoskeletal disorders, could have a positive impact on the severity of symptoms of people with MS.

13.
BMC Musculoskelet Disord ; 21(1): 533, 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778082

RESUMO

BACKGROUND: Hip effusion-synovitis may be relevant to osteoarthritis (OA) but is of uncertain etiology. The aim of this study was to describe the cross-sectional and longitudinal associations of hip effusion-synovitis with clinical and structural risk factors of OA in older adults. METHODS: One hundred ninety-six subjects from the Tasmanian Older Adult Cohort (TASOAC) study with a right hip STIR (Short T1 Inversion Recovery) Magnetic Resonance Imaging (MRI) on two occasions were included. Hip effusion-synovitis CSA (cm2) was assessed quantitatively. Hip pain was determined by WOMAC (Western Ontario and McMaster Universities Osteoarthritis) while hip bone marrow lesions (BMLs), cartilage defects (femoral and/or acetabular) and high cartilage signal were assessed on MRI. Joint space narrowing (0-3) and osteophytes (0-3) were measured on x-ray using Altman's atlas. RESULTS: Of 196 subjects, 32% (n = 63) had no or a small hip effusion-synovitis while 68% (n = 133) subjects had a moderate or large hip effusion-synovitis. Both groups were similar but those with moderate or large hip effusion-synovitis were older, had higher BMI and more hip pain. Cross-sectionally, hip effusion-synovitis at multiple sites was associated with presence of hip pain [Prevalence ratio (PR):1.42 95%CI:1.05,1.93], but not with severity of hip pain. Furthermore, hip effusion-synovitis size associated with femoral defect (ßeta:0.32 95%CI:0.08,0.56). Longitudinally, and incident hip cartilage defect (PR: 2.23 95%CI:1.00, 4.97) were associated with an increase in hip effusion-synovitis CSA. Furthermore, independent of presence of effusion-synovitis, hip BMLs predicted incident (PR: 1.62 95%CI: 1.13, 2.34) and worsening of hip cartilage defects (PR: 1.50 95%CI: 1.20, 1.86). While hip cartilage defect predicted incident (PR: 1.11 95%CI: 1.03, 1.20) and worsening hip BMLs (PR: 1.16 95%CI: 1.04, 1.30). CONCLUSIONS: Hip effusion-synovitis at multiple sites (presumably reflecting extent) may be associated with hip pain. Hip BMLs and hip cartilage defects are co-dependent and predict worsening hip effusion-synovitis, indicating causal pathways between defects, BMLs and effusion-synovitis.

14.
Sports Med ; 2020 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-32813182

RESUMO

BACKGROUND: Although low child and adult grip strength is associated with adverse cardiometabolic health, how grip strength across the life course associates with type 2 diabetes is unknown. This study identified the relative contribution of grip strength measured at specific life stages (childhood, young adulthood, mid-adulthood) with prediabetes or type 2 diabetes in mid-adulthood. METHODS: Between 1985 and 2019, 263 participants had their grip strength measured using an isometric dynamometer in childhood (9-15 years), young adulthood (28-36 years) and mid-adulthood (38-49 years). In mid-adulthood, a fasting blood sample was collected and tested for glucose and glycated haemoglobin (HbA1c). Participants were categorized as having prediabetes or type 2 diabetes if fasting glucose levels were ≥ 5.6 mmol or if HbA1c levels were ≥ 5.7% (≥ 39 mmol/mol). A Bayesian relevant life course exposure model examined the association between lifelong grip strength and prediabetes or type 2 diabetes. RESULTS: Grip strength at each time point was equally associated with prediabetes or type 2 diabetes in mid-adulthood (childhood: 37%, young adulthood: 36%, mid-adulthood: 28%). A one standard deviation increase in cumulative grip strength was associated with 34% reduced odds of prediabetes or type 2 diabetes in mid-adulthood (OR 0.66, 95% credible interval 0.40, 0.98). CONCLUSIONS: Greater grip strength across the life course could protect against the development of prediabetes and type 2 diabetes. Strategies aimed at increasing muscular strength in childhood and maintaining behaviours to improve strength into adulthood could improve future cardiometabolic health. The Association Between Grip Strength Measured in Childhood, Young- and Mid-adulthood and Prediabetes or Type 2 Diabetes in Mid-adulthood.

15.
Acta Neurochir (Wien) ; 162(9): 2271-2282, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32607744

RESUMO

BACKGROUND: Women are over-represented in aSAH cohorts, but whether their outcomes differ to men remains unclear. We examined if sex differences in neurological complications and aneurysm characteristics contributed to aSAH outcomes. METHODS: In a retrospective cohort (2010-2016) of all aSAH cases across two hospital networks in Australia, information on severity, aneurysm characteristics and neurological complications (rebleed before/after treatment, postoperative stroke < 48 h, neurological infections, hydrocephalus, seizures, delayed cerebral ischemia [DCI], cerebral infarction) were extracted. We estimated sex differences in (1) complications and aneurysm characteristics using chi square/t-tests and (2) outcome at discharge (home, rehabilitation or death) using multinomial regression with and without propensity score matching on prestroke confounders. RESULTS: Among 577 cases (69% women, 84% treated) aneurysm size was greater in men than women and DCI more common in women than men. In unadjusted log multinomial regression, women had marginally greater discharge to rehabilitation (RRR 1.15 95% CI 0.90-1.48) and similar likelihood of in-hospital death (RRR 1.02 95% CI 0.76-1.36) versus discharge home. Prestroke confounders (age, hypertension, smoking status) explained greater risk of death in women (rehabilitation RRR 1.13 95% CI 0.87-1.48; death RRR 0.75 95% CI 0.51-1.10). Neurological complications (DCI and hydrocephalus) were covariates explaining some of the greater risk for poor outcomes in women (rehabilitation RRR 0.87 95% CI 0.69-1.11; death RRR 0.80 95% CI 0.52-1.23). Results were consistent in propensity score matched models. CONCLUSION: The marginally poorer outcome in women at discharge was partially attributable to prestroke confounders and complications. Improvements in managing complications could improve outcomes.

16.
Mult Scler ; : 1352458520943087, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32701031

RESUMO

BACKGROUND: Dietary patterns and their association with subsequent clinical course have not been well studied in early multiple sclerosis (MS). OBJECTIVES: To describe dietary patterns in people in 5 years following first clinical demyelination and assess associations with MS conversion and relapse. METHODS: This study included baseline food frequency questionnaire dietary intake (entry to the Ausimmune Study) and 5-year follow-up; iterated principal factor analysis was applied. MS conversion and relapse risks were assessed by Cox proportional hazards models, adjusted for age, sex, study site, education, body mass index (BMI), smoking and omega-3 supplement use. RESULTS: In cases with a first clinical diagnosis of central nervous system (CNS) demyelination, we identified three major dietary patterns, 'Prudent', 'High-Vegetable' and 'Mixed', explaining 43%, 37% and 24% of diet variance in dietary intake, respectively. Fruits, vegetables, fish, wholegrains and nuts loaded highly on the Prudent pattern, starchy vegetables and legumes on the High-Vegetable pattern, and meats and alcohol on the Mixed pattern. Diet factor scores were not associated with MS conversion risk. Those with baseline Prudent scores above the median had significantly lower relapse risk (adjusted hazard ratio = 0.54, 95% confidence interval (CI) 0.37, 0.81) with some evidence of a plateau effect. CONCLUSION: Prudent diet factor score above the median was prospectively associated with lower relapse risk in the 5 years following the first clinical demyelinating event.

17.
JAMA ; 323(15): 1456-1466, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32315057

RESUMO

Importance: A proof-of-principle study suggested that intravenous zoledronic acid may reduce knee pain and the size of bone marrow lesions in people with knee osteoarthritis, but data from large trials are lacking. Objective: To determine the effects of intravenous zoledronic acid on knee cartilage volume loss in patients with symptomatic knee osteoarthritis and bone marrow lesions. Design, Setting, and Participants: A 24-month multicenter, double-blind placebo-controlled randomized clinical trial conducted at 4 sites in Australia (1 research center and 3 hospitals). Adults aged 50 years or older with symptomatic knee osteoarthritis and subchondral bone marrow lesions detected by magnetic resonance imaging (MRI) were enrolled from November 2013 through September 2015. The final date of follow-up was October 9, 2017. Interventions: Intravenous infusion with either 5 mg of zoledronic acid in a 100-mL saline solution (n = 113) or a placebo saline solution (n = 110) at baseline and 12 months. Main Outcomes and Measures: The primary outcome was absolute change in tibiofemoral cartilage volume assessed using MRI over 24 months (the minimum clinically important difference [MCID] has not been established). Three prespecified secondary outcomes were change in knee pain assessed by a visual analog scale (0 [no pain] to 100 [unbearable pain]; MCID, 15) and the Western Ontario and McMaster Universities Osteoarthritis Index (0 [no pain] to 500 [unbearable pain]; MCID, 75) over 3, 6, 12, 18, and 24 months and change in bone marrow lesion size over 6 and 24 months (the MCID has not been established). Results: Of 223 participants enrolled (mean age, 62.0 years [SD, 8.0 years]; 52% were female), 190 (85%) completed the trial. Change in tibiofemoral cartilage volume was not significantly different between the zoledronic acid group and the placebo group over 24 months (-878 mm3 vs -919 mm3; between-group difference, 41 mm3 [95% CI, -79 to 161 mm3]; P = .50). No significant between-group differences were found for any of the prespecified secondary outcomes, including changes in knee pain assessed by a visual analog scale (-11.5 in the zoledronic acid group vs -16.8 in the placebo group; between-group difference, 5.2 [95% CI, -2.3 to 12.8]; P = .17), changes in knee pain assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (-37.5 vs -58.0, respectively; between-group difference, 20.5 [95% CI, -11.2 to 52.2]; P = .21), and changes in bone marrow lesion size (-33 mm2 vs -6 mm2; between-group difference, -27 mm2 [95% CI, -127 to 73 mm2]; P = .60) over 24 months. Adverse events were more common with zoledronic acid than with placebo (96% vs 83%, respectively) and consisted mainly of acute reactions (defined as symptoms within 3 days of administration of infusion; 87% vs 56%). Conclusions and Relevance: Among patients with symptomatic knee osteoarthritis and bone marrow lesions, yearly zoledronic acid infusions, compared with placebo, did not significantly reduce cartilage volume loss over 24 months. These findings do not support the use of zoledronic acid in the treatment of knee osteoarthritis. Trial Registration: anzctr.org.au Identifier: ACTRN12613000039785.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Doenças da Medula Óssea/tratamento farmacológico , Cartilagem Articular/efeitos dos fármacos , Osteoartrite do Joelho/tratamento farmacológico , Ácido Zoledrônico/uso terapêutico , Idoso , Conservadores da Densidade Óssea/administração & dosagem , Medula Óssea/patologia , Doenças da Medula Óssea/complicações , Doenças da Medula Óssea/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/patologia , Falha de Tratamento , Ácido Zoledrônico/administração & dosagem
18.
Chemosphere ; 244: 125537, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32050337

RESUMO

Understanding exposure to air pollution during extreme events such as fire emergencies is critical for assessing their potential health impacts. However, air pollution emergencies often affect places without a network of air quality monitoring and characterising exposure retrospectively is methodologically challenging due to the complex behaviour of smoke and other air pollutants. Here we test the potential of roof cavity (attic) dust to act as a robust household-level exposure proxy, using a major air pollution event associated with a coal mine fire in the Latrobe Valley, Australia, as an illustrative study. To assess the relationship between roof cavity dust composition and mine fire exposure, we analysed the elemental and polycyclic aromatic hydrocarbon composition of roof cavity dust (<150µm) from 39 homes along a gradient of exposure to the mine fire plume. These homes were grouped into 12 zones along this exposure gradient: eight zones across Morwell, where mine fire impacts were greatest, and four in other Latrobe Valley towns at increasing distance from the fire. We identified two elements-barium and magnesium-as 'chemical markers' that show a clear and theoretically grounded relationship with the brown coal mine fire plume exposure. This relationship is robust to the influence of plausible confounders and contrasts with other, non-mine fire related elements, which showed distinct and varied distributional patterns. We conclude that targeted components of roof cavity dust can be a useful empirical marker of household exposure to severe air pollution events and their use could support epidemiological studies by providing spatially-resolved exposure estimates post-event.


Assuntos
Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Poeira/análise , Exposição por Inalação/estatística & dados numéricos , Poluentes Atmosféricos/análise , Austrália , Cidades , Carvão Mineral/análise , Monitoramento Ambiental , Humanos , Mineração , Hidrocarbonetos Policíclicos Aromáticos/análise , Estudos Retrospectivos , Fumaça/análise
19.
Pregnancy Hypertens ; 19: 218-225, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31810823

RESUMO

OBJECTIVE(S): To investigate the associations between adiposity in childhood, and adiposity change from childhood to adulthood, with pregnancy hypertension. STUDY DESIGN: The study followed-up 985 girls from the 1985 Australian Schools Health and Fitness Survey (aged 9-15 years) who were ever pregnant in 2004-2006 and/or 2009-2011. In childhood, overweight and obesity were defined by age-sex-specific international standard for body mass index (BMI) and in adulthood as BMI ≥ 25 kg/m2. Childhood and adult abdominal obesity were defined as waist-to-height ratio (WHtR) ≥ 0.5. A subsample of adults had abdominal obesity measures (n = 549). MAIN OUTCOME MEASURES: Pregnancy hypertension was self-reported as having had high blood pressure during or due to pregnancy. RESULTS: Childhood overweight/obesity (relative risk [RR] = 1.66, 95% confidence interval [CI]:1.07-2.52) and abdominal obesity (RR = 2.55, 95% CI:1.34-4.85) were associated with higher risks of pregnancy hypertension after adjustment for age, socioeconomic status and parity. Further adjustment for adult BMI attenuated the association for childhood overweight/obesity which was no longer statistically significant (RR = 1.28, 95% CI:0.79-2.07). The association with childhood abdominal obesity persisted after adjustment for adult WHtR (RR = 2.15, 95% CI:1.10-4.20). Compared to participants with persistently normal BMI or WHtR, those who were overweight/obese in adulthood only (RR = 1.49, 95% CI:1.10-2.02), persistently overweight/obese (RR = 2.06, 95% CI:1.29-3.29) or persistently abdominally obese (RR = 3.09, 95% CI:1.54-6.20) had increased risks of pregnancy hypertension. CONCLUSION(S): Childhood adiposity was associated with increased risk of pregnancy hypertension, with the association of childhood abdominal obesity independent of adult abdominal obesity. Women who were persistently overweight/obese or abdominally obese since childhood had the highest risk of pregnancy hypertension.

20.
J Sports Sci ; 38(1): 38-45, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31613185

RESUMO

To help inform strategies aimed at increasing muscular fitness levels, we examined factors associated with childhood muscular fitness (strength and power) that preceded the recently observed secular decline. Data were available from a nationally representative sample of Australian children aged 7-15 years in 1985 (n = 8469). Muscular fitness measures included strength (right and left grip, shoulder extension and flexion, and leg strength) and power (standing long jump distance). Anthropometric (adiposity, fat-free mass), cardiorespiratory fitness (CRF), flexibility, speed capability, physical activity (individual and parental), dietary quality and intake (fruit, vegetable, protein) and sociodemographic (area-level socioeconomic status (SES), school type) data were available. Statistical analyses included sex-stratified linear regression. Of all examined factors, measures of adiposity, fat-free mass, CRF, flexibility and speed capability were associated with muscular fitness at levels that met Cohen's threshold for important effects (r-squared = 0.02 to 0.28). These findings highlight the multifactorial relationship between muscular fitness and its determinants. Collectively, these factors were powerful in explaining muscular strength (females: r-squared = 0.32; males: r-squared = 0.41) and muscular power (females: r-squared = 0.36; males: r-squared = 0.42). These findings highlight modifiable and environmental factors that could be targeted to increase childhood muscular fitness.


Assuntos
Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Aptidão Física/fisiologia , Adiposidade/fisiologia , Adolescente , Austrália , Índice de Massa Corporal , Aptidão Cardiorrespiratória/fisiologia , Criança , Estudos Transversais , Dieta , Meio Ambiente , Exercício Físico/fisiologia , Feminino , Humanos , Masculino , Fenótipo , Classe Social
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