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1.
Front Endocrinol (Lausanne) ; 12: 692677, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34239500

RESUMO

Body composition (fat, skeletal muscle and bone mass) is an important determinant of overall health and risk of endocrine disorders such as type 2 diabetes and osteoporosis. Although diet and physical activity are strongly implicated, body composition is also heritable. We conducted a discovery genome-wide association study on 31 phenotypes from the three-compartment body composition model (fat, lean and bone mass) in a set of 4 386 individuals (n = 2 109 males, n = 2 294 females) from the UK Biobank pilot imaging enhancement program that underwent a dual energy X-ray absorptiometry (DXA) scan for assessment of body composition and genetic screening. From 6 137 607 imputed single nucleotide polymorphisms (SNPs) we identified 17 body composition loci (P<5.0 x 10-8). GWAS from the combined dataset identified four statistically significant SNPs (rs7592270, rs145972737, rs13212044, rs77772562). In sex-stratified GWAS, 10 male specific SNPs across all traits were identified and five female specific SNPs. Of the 17 SNPs, six were in or close to a gene where there was a plausible functional connection. Three SNPs (rs7592270, rs77772562 and rs7552312) were correlated with obesity phenotypes, one SNP (rs2236705) with lean phenotypes and two with bone mass phenotypes (rs112098641 and rs113380185). These results highlight candidate genes and biological pathways related to body composition, including glucose metabolism and estrogen regulation, that are of interest to replicate in future studies.

2.
J Orthop Sports Phys Ther ; 51(5): 201-203, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33930982

RESUMO

SYNOPSIS: In 2020, 6 meta-analyses comparing arthroscopic hip surgery to physical therapy were published. All included the same 3 randomized controlled trials, and none used methods suitable for the analysis of fewer than 5 studies. When there are fewer than 5 studies and heterogeneity, a random-effects model with the Hartung-Knapp-Sidik-Jonkman adjustment for a maximally conservative estimate should be employed; if reliable prior information is available, a Bayesian random-effects meta-analysis should be employed. Our re-analysis, which employed the appropriate model, found that there is currently insufficient evidence to conclude that surgery is superior to physical therapy for femoroacetabular impingement (FAI) syndrome. Further randomized controlled trials are required to resolve the clinical question of what the best treatment approach is for FAI syndrome. We provide readers with tools to conduct appropriate meta-analysis of fewer than 5 trials. J Orthop Sports Phys Ther 2021;51(5):201-203. doi:10.2519/jospt.2021.0107.


Assuntos
Artroscopia , Impacto Femoroacetabular/terapia , Metanálise como Assunto , Modalidades de Fisioterapia , Projetos de Pesquisa , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
BMJ Open ; 11(4): e045362, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33795309

RESUMO

OBJECTIVES: To examine associations of three diet quality indices and a polygenic risk score with incidence of all-cause mortality, cardiovascular disease (CVD) mortality, myocardial infarction (MI) and stroke. DESIGN: Prospective cohort study. SETTING: UK Biobank, UK. PARTICIPANTS: 77 004 men and women (40-70 years) recruited between 2006 and 2010. MAIN OUTCOME MEASURES: A polygenic risk score was created from 300 single nucleotide polymorphisms associated with CVD. Cox proportional HRs were used to estimate independent effects of diet quality and genetic risk on all-cause mortality, CVD mortality, MI and stroke risk. Dietary intake (Oxford WebQ) was used to calculate Recommended Food Score (RFS), Healthy Diet Indicator (HDI) and Mediterranean Diet Score (MDS). RESULTS: New all-cause (n=2409) and CVD (n=364) deaths and MI (n=1141) and stroke (n=748) events were identified during mean follow-ups of 7.9 and 7.8 years, respectively. The adjusted HR associated with one-point higher RFS for all-cause mortality was 0.96 (95% CI: 0.94 to 0.98), CVD mortality was 0.94 (95% CI: 0.90 to 0.98), MI was 0.97 (95% CI: 0.95 to 1.00) and stroke was 0.94 (95% CI: 0.91 to 0.98). The adjusted HR for all-cause mortality associated with one-point higher HDI and MDS was 0.97 (95% CI: 0.93 to 0.99) and 0.95 (95% CI: 0.91 to 0.98), respectively. The adjusted HR associated with one-point higher MDS for stroke was 0.93 (95% CI: 0.87 to 1.00). There was little evidence of associations between HDI and risk of CVD mortality, MI or stroke. There was evidence of an interaction between diet quality and genetic risk score for MI. CONCLUSION: Higher diet quality predicted lower risk of all-cause mortality, independent of genetic risk. Higher RFS was also associated with lower risk of CVD mortality and MI. These findings demonstrate the benefit of following a healthy diet, regardless of genetic risk.


Assuntos
Doenças Cardiovasculares , Dieta Mediterrânea , Bancos de Espécimes Biológicos , Doenças Cardiovasculares/genética , Dieta , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Reino Unido/epidemiologia
4.
BMC Infect Dis ; 21(1): 312, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794783

RESUMO

BACKGROUND: Staphylococcus aureus (S. aureus) bacteraemia is increasingly acquired from community settings and is associated with a mortality rate of up to 40% following complications. Identifying risk factors for complicated S. aureus bacteraemia would aid clinicians in targeting patients that benefit from expedited investigations and escalated care. METHODS: In this prospective observational cohort study, we aimed to identify risk factors associated with a complicated infection in community-onset S. aureus bacteraemia. Potential risk factors were collected from electronic medical records and included: - patient demographics, symptomology, portal of entry, and laboratory results. RESULTS: We identified several potential risk factors using univariate analysis. In a multiple logistic regression model, age, haemodialysis, and entry point from a diabetic foot ulcer were all significantly protective against complications. Conversely, an unknown entry point of infection, an entry point from an indwelling medical device, and a C-reactive protein concentration of over 161 mg/L on the day of admission were all significantly associated with complications. CONCLUSIONS: We conclude that several factors are associated with complications including already conducted laboratory investigations and portal of entry of infection. These factors could aid the triage of at-risk patients for complications of S. aureus bacteraemia.


Assuntos
Bacteriemia/diagnóstico , Proteína C-Reativa/análise , Staphylococcus aureus/isolamento & purificação , Adulto , Idoso , Bacteriemia/complicações , Bacteriemia/microbiologia , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pneumonia/complicações , Pneumonia/diagnóstico , Estudos Prospectivos , Fatores de Risco , Dermatopatias/complicações , Dermatopatias/diagnóstico
6.
PLoS One ; 15(11): e0242906, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33253270

RESUMO

Migrant workers may experience higher burdens of occupational injury and illness compared to native-born workers, which may be due to the differential exposure to occupational hazards, differential vulnerability to exposure-associated health impacts, or both. This study aims to assess if the relationships between psychosocial job characteristics and mental health vary by migrant status in Australia (differential vulnerability). A total of 8969 persons from wave 14 (2014-2015) of the Household Income and Labour Dynamics in Australia Survey were included in the analysis. Psychosocial job characteristics included skill discretion, decision authority and job insecurity. Mental health was assessed via a Mental Health Inventory-5 score (MHI-5), with a higher score indicating better mental health. Migrant status was defined by (i) country of birth (COB), (ii) the combination of COB and English/Non-English dominant language of COB and (iii) the combination of COB and years since arrival in Australia. Data were analysed using linear regression, adjusting for gender, age and educational attainment. Migrant status was analysed as an effect modifier of the relationships between psychosocial job characteristics and mental health. Skill discretion and decision authority were positively associated with the MHI-5 score while job insecurity was negatively associated with the MHI-5 score. We found no statistical evidence of migrant status acting as an effect modifier of the psychosocial job characteristic-MHI-5 relationships. With respect to psychosocial job characteristic-mental health relationships, these results suggest that differential exposure to job stressors is a more important mechanism than differential vulnerability for generating occupational health inequities between migrants and native-born workers in Australia.


Assuntos
Acidentes de Trabalho , Traumatismos Ocupacionais/epidemiologia , Estresse Ocupacional/epidemiologia , Migrantes/psicologia , Adolescente , Adulto , Austrália/epidemiologia , Grupos de Populações Continentais , Escolaridade , Emprego/psicologia , Feminino , Humanos , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Saúde do Trabalhador , Estresse Ocupacional/psicologia , Inquéritos e Questionários , Local de Trabalho/psicologia , Adulto Jovem
7.
Sports Med ; 50(11): 2001-2049, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32970291

RESUMO

BACKGROUND: Actual and perceived motor competence are important correlates of various health-related behaviors. As such, numerous studies have examined the association between both constructs in children and adolescents. OBJECTIVES: The first aim of this review and meta-analysis was to systematically examine, analyze and summarize the scientific evidence on the relationship between actual and perceived motor competence (and by extension more general physical self-perception) in children, adolescents and young adults with typical and atypical development. The second aim was to examine several a priori determined potential moderators (i.e., age, sex, and developmental status of study participants, as well as level of alignment between measurement instruments) of the relationship between actual motor competence and perceived motor competence/physical self-perception. DESIGN: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and was registered with PROSPERO on August 21st 2017. DATA SOURCES: A systematic literature search of five electronic databases (i.e., MEDLINE, SPORTDiscus, Web of Science, PsycINFO and EMBASE) with no date restrictions was conducted. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Eligibility criteria included (1) a study sample of youth aged 3-24 years, (2) an assessment of actual motor competence and perceived motor competence/physical self-perception, and (3) a report of the association between both, using a cross-sectional, longitudinal, or experimental design. Only original articles published in peer-reviewed journals with at least the title and abstract in English were considered. ANALYSES: Meta-analyses were conducted by type of actual motor competence (i.e., overall motor competence, locomotor, object control, stability/balance and sport-specific competence) through univariate and multivariable random-effects meta-regression and clustered random-effects meta-regression models. RESULTS: Of the 1643 articles screened, 87 were included for the qualitative review, while 69 remained for the final meta-analyses. All included studies had some risk of bias with only 15% meeting five of the six examined criteria. Significant (p < 0.001) pooled effects were found for overall motor competence (N = 54; r = 0.25; 95% CI [0.20, 0.29]), locomotor (N = 45; r = 0.19; 95% CI [0.13, 0.25]), object control (N = 50; r = 0.22; 95% CI [0.17, 0.27]), stability/balance (N = 8; r = 0.21; 95% CI [0.12, 0.30]), and sport-specific competence (N = 8; r = 0.46; 95% CI [0.28, 0.61]). None of the hypothesized moderators significantly influenced the relationship between actual motor competence and perceived motor competence/physical self-perception. CONCLUSIONS: The strength of the association between actual motor competence and perceived motor competence/physical self-perception in youth is low to moderate, with current data demonstrating that the strength of association does not differ by age, sex, developmental status, or alignment between measurement instruments. However, this review highlights the lack of clarity on the relationship between actual motor competence and perceived motor competence/physical self-perception. Future research should address issues surrounding the design of studies and measurement of actual motor competence and perceived motor competence/physical self-perception as well as explore other potential confounding variables (i.e., product- versus process-oriented assessments, race, culture) that might affect the relationship between these two constructs.


Assuntos
Destreza Motora , Autoimagem , Adolescente , Criança , Pré-Escolar , Humanos , Esportes , Adulto Jovem
8.
Brain Stimul ; 13(5): 1476-1488, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32758665

RESUMO

BACKGROUND: Many studies have attempted to identify the sources of interindividual variability in response to theta-burst stimulation (TBS). However, these studies have been limited by small sample sizes, leading to conflicting results. OBJECTIVE/HYPOTHESIS: This study brought together over 60 TMS researchers to form the 'Big TMS Data Collaboration', and create the largest known sample of individual participant TBS data to date. The goal was to enable a more comprehensive evaluation of factors driving TBS response variability. METHODS: 118 corresponding authors of TMS studies were emailed and asked to provide deidentified individual TMS data. Mixed-effects regression investigated a range of individual and study level variables for their contribution to iTBS and cTBS response variability. RESULTS: 430 healthy participants' TBS data was pooled across 22 studies (mean age = 41.9; range = 17-82; females = 217). Baseline MEP amplitude, age, target muscle, and time of day significantly predicted iTBS-induced plasticity. Baseline MEP amplitude and timepoint after TBS significantly predicted cTBS-induced plasticity. CONCLUSIONS: This is the largest known study of interindividual variability in TBS. Our findings indicate that a significant portion of variability can be attributed to the methods used to measure the modulatory effects of TBS. We provide specific methodological recommendations in order to control and mitigate these sources of variability.


Assuntos
Análise de Dados , Potencial Evocado Motor/fisiologia , Individualidade , Córtex Motor/fisiologia , Ritmo Teta/fisiologia , Estimulação Magnética Transcraniana/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Voluntários Saudáveis , Humanos , Colaboração Intersetorial , Masculino , Pessoa de Meia-Idade , Plasticidade Neuronal/fisiologia , Adulto Jovem
10.
Eur J Clin Nutr ; 74(10): 1483-1487, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32249817

RESUMO

Skinfold thickness is an indicator of body fat, allowing a more detailed description of obesity. In Vietnam, there are no published percentile values for triceps and subscapular skinfold measurements from population-based studies of adolescents. This study aims to establish percentile tables for triceps, subscapular, and triceps + subscapular skinfolds (TSF + SSSF) sum. We used data from a cross-sectional survey conducted in Ho Chi Minh City. BMI, triceps and subscapular skinfold measurements of 2660 students were obtained. The L (Box-Cox transformation), M (median), and S (coefficient of variation) parameters were used to generate exact percentiles. The proportion of overweight was higher in boys (18.4% vs. 8.2%, p < 0.0001). Triceps, subscapular skinfolds, and TSF + SSSF were significantly higher in girls than in boys (p < 0.001). Our results provide sex- and age-specific reference values for skinfold thickness that can be applied as a new complimentary assessment tool for Vietnamese adolescents.


Assuntos
Sobrepeso , Instituições Acadêmicas , Adolescente , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Pregas Cutâneas , Vietnã/epidemiologia
11.
Disabil Rehabil ; : 1-14, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32135069

RESUMO

Purpose: To investigate the effect of a knowledge translation intervention on knowledge and frequency of routine evidence-based assessment behaviours of healthcare professionals working with children with cerebral palsy.Methods: A before-and-after longitudinal study was conducted in five disability organisations. Four organisations (Commencing Knowledge Translation group) implemented a multifaceted intervention: knowledge brokers, targeted education, electronic-evidence library, and clinical outcomes database. These strategies were already in place at the fifth organisation (Comparison group). Outcomes evaluated at 0, 6, 12, and 24 months were health-professional knowledge and routine assessment behaviours (self-report and "completeness" of clinical assessment). Generalised estimating equations determined longitudinal changes.Results: Four hundred and forty-seven professionals involved 861 children in the study. The Comparison group had higher knowledge and routine assessment behaviours at baseline. Professional knowledge in both groups remained stable (differences in change from baseline to 24 months: 0.3 units, 95%CI: -0.76 to 1.36). Assessment completeness of the Comparison group was stable (baseline mean 68 units, 95%CI: 65-71); the Commencing Knowledge Translation group improved from baseline mean 35 units (95%CI: 33-36), peaking at 12 months (mean 68 (95%CI: 65-71).Conclusions: Multifaceted organisational support improved health-professional routine evidence-based assessment behaviours with children with cerebral palsy, despite no change in knowledge. Trial registration: This trial was not a controlled health care intervention and was registered retrospectively: ACTRN12616001616460. The protocol of the trial was published in 2015 as follows: Imms et al. [6].Implications for rehabilitationA multifaceted knowledge translation intervention increased allied health professionals' assessment behaviours.Knowledge translation strategies can be chosen to target change in knowledge and/or change in behaviour.Knowledge translation interventions should be designed to address organisational barriers and enhance organisational supports.Interventions that target healthcare professionals' behaviour directly can be effective even if their knowledge does not change.

12.
Ear Hear ; 41(3): 622-629, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31592904

RESUMO

OBJECTIVES: Previous research has investigated whether the apolipoprotein E (APOE) ε4 allele, which is associated with an increased risk of cognitive decline, is also associated with hearing loss in older people. Results of the very limited research to date are conflicting, and sample sizes for all but one study were small. The present study aimed to investigate whether there is an association between the APOE ε4 allele and hearing loss in a large, population-based sample of community-dwelling older adults. DESIGN: Cross-sectional audiometric data on hearing levels and APOE genotypes for 2006 participants (aged 55 to 85 years) of the Hunter Community Study were analyzed using multiple linear regression to examine the association between APOE ε4 carrier status and the 4-frequency pure-tone average (0.5 to 4 kHz) in the better hearing ear, and also across individual frequencies in the better ear. RESULTS: Observed and expected APOE allele frequency distributions did not differ significantly overall from established general population allele frequency distributions. Unadjusted modeling using better ear pure-tone average showed a statistically significant association between APOE ε4 allele status (0, 1, 2 copies) and reduced hearing loss, but when the model was adjusted for age, this was no longer statistically significant. Across individual hearing frequencies, unadjusted regression modeling showed APOE ε4 status was significantly associated with a reduction in mean hearing thresholds at 1 and 2 kHz, but again this effect was no longer statistically significant after adjusting for age. CONCLUSIONS: The results of this study did not provide any evidence of a statistically significant association between APOE ε4 allele status and hearing loss for older adults. Further investigation of the effect of homozygous carrier status on hearing thresholds is required.

13.
Br J Sports Med ; 54(8): 475-479, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31242988

RESUMO

OBJECTIVES: To determine whether specific injury measures were associated with team performance in the Australian Football League (AFL). METHODS: 15 289 injuries caused players from 18 teams to miss 51 331 matches between 1997 and 2016. Data were aggregated to the team level. We analysed the associations among injury measures and team performance (reaching finals/playoffs and specific ladder/table position). Injury measures per team included: injury incidence, injury severity, injury burden, player match availability and percentage of the full player roster injured. We also weighted injury measures by five measures of player value. RESULTS: AFL teams' injury burden and player match availability were associated with final table position (r2=0.03, p<0.05). Player value weighted injury burden was different between finalists and non-finalists (mean difference=-8, p<0.001) and explained 12% of the variation in the table position of teams (p<0.001). For a team, nine missed matches due to injury (burden weighted by a best and fairest player rating system) was associated with one lower table position. Player match availability weighted by player value was higher for finalists than non-finalists (mean difference=1.7, p<0.01) and explained 7% of the variation in the table position of teams (p<0.001). DISCUSSION AND POTENTIAL IMPLICATIONS: The impact of injury (burden weighted by best and fairest) explained up to 12% of the variation in final table position-this is particularly relevant to making/not making playoffs as well as home ground/travel advantages for those teams that make the one-game format of AFL playoffs (not home-away or best of seven format).


Assuntos
Traumatismos em Atletas/epidemiologia , Desempenho Atlético , Comportamento Competitivo , Futebol/lesões , Austrália/epidemiologia , Humanos , Incidência , Escala de Gravidade do Ferimento , Estudos Longitudinais , Masculino , Viagem
14.
Intern Med J ; 50(4): 434-440, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31180166

RESUMO

BACKGROUND: The high mortality rate of patients with enterococcal infections has been shown to be associated with the severity of underlying comorbidities. AIMS: To characterise the epidemiology, clinical characteristics, outcomes and predictors of mortality in patients with enterococcal bacteraemia. METHODS: This was a retrospective cohort study of all enterococcal bacteraemia episodes in the Barwon region between January 2010 and March 2017. We assessed the epidemiology, clinical characteristics, outcomes and predictors of mortality using descriptive statistics and simple and multiple logistic regression analyses. RESULTS: The incidence of enterococcal bacteraemia was 19.9/100 000 person-years. Males comprised 68.4%, and the median age was 71 years. Common comorbidities were gastrointestinal tract disease, urological disease, malignancies and cardiovascular disease. Infective endocarditis was observed in 15% of patients, and 1 of 27 also had colorectal cancer. Twelve patients referred for colonoscopy demonstrated previously undiagnosed colorectal neoplasia in 75% of these cases. The 30-day and 1-year mortality rates were 11.7 and 40.2% respectively. Sixty-nine cases with vancomycin-resistant Enterococcus were observed. Multiple logistic regression suggested that the presence of underlying urological malignancy (adjusted odds ratio = 3.57, 95% confidence intervals = 1.10-11.65, P = 0.035) and colorectal cancer (adjusted odds ratio = 4.47, 95% confidence intervals = 1.36-14.66, P = 0.014) were significant predictors of 1-year mortality. CONCLUSIONS: Microbiological cure was inversely associated with 30-day mortality. The presence of underlying urological and colorectal malignancy was a predictor of 1-year mortality. We identified the importance of evaluating patients with Enterococcus faecalis bacteraemia for underlying colorectal neoplasia. Routine colonoscopy is recommended in patients with E. faecalis bacteraemia or infective endocarditis with an unclear source of infection.


Assuntos
Bacteriemia , Infecções por Bactérias Gram-Positivas , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Incidência , Masculino , Estudos Retrospectivos
15.
J Clin Epidemiol ; 118: 55-59, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31706962

RESUMO

OBJECTIVES: Nonresponse can bias prevalence estimates in population surveys. Effects of selective participation in behavior change intervention trials have been little studied. We tested hypotheses that trial participants who are hard to recruit are (1) more likely to be lost-to-follow-up and (2) less responsive to intervention. STUDY DESIGN AND SETTING: We undertook a two-stage individual participant data meta-analysis of four alcohol intervention trials involving 9,251 university students in Australia, New Zealand, and Sweden, comparing participants who enrolled "late" (after the final invitation to participate) vs. "early" (before that). Outcomes were whether participants completed assessments at each trial's primary endpoint (late/early) and number of drinks consumed per week (intervention/control) among late enrolees vs. early enrolees. RESULTS: Late enrolees were more likely to be lost-to-follow-up than early enrolees (OR 2.3, 95% CI: 1.7, 2.9). Intervention effect estimates were smaller for late vs. early enrolees, but not significantly so (RR = 0.93; 95% CI: 0.79, 1.08). CONCLUSION: Greater effort to recruit trial participants was associated with higher attrition, but there was no clear evidence of bias in effect estimation. The possibility that intervention effect estimates do not generalize beyond a relatively compliant minority of trial participants may warrant further study.


Assuntos
Pacientes Desistentes do Tratamento/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Sujeitos da Pesquisa/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/psicologia , Consumo de Bebidas Alcoólicas/terapia , Humanos , Seleção de Pacientes , Sujeitos da Pesquisa/psicologia
16.
Br J Sports Med ; 54(21): 1279-1287, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31666220

RESUMO

OBJECTIVE: Examine the effectiveness of specific modes of exercise training in non-specific chronic low back pain (NSCLBP). DESIGN: Network meta-analysis (NMA). DATA SOURCES: MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL. ELIGIBILITY CRITERIA: Exercise training randomised controlled/clinical trials in adults with NSCLBP. RESULTS: Among 9543 records, 89 studies (patients=5578) were eligible for qualitative synthesis and 70 (pain), 63 (physical function), 16 (mental health) and 4 (trunk muscle strength) for NMA. The NMA consistency model revealed that the following exercise training modalities had the highest probability (surface under the cumulative ranking (SUCRA)) of being best when compared with true control: Pilates for pain (SUCRA=100%; pooled standardised mean difference (95% CI): -1.86 (-2.54 to -1.19)), resistance (SUCRA=80%; -1.14 (-1.71 to -0.56)) and stabilisation/motor control (SUCRA=80%; -1.13 (-1.53 to -0.74)) for physical function and resistance (SUCRA=80%; -1.26 (-2.10 to -0.41)) and aerobic (SUCRA=80%; -1.18 (-2.20 to -0.15)) for mental health. True control was most likely (SUCRA≤10%) to be the worst treatment for all outcomes, followed by therapist hands-off control for pain (SUCRA=10%; 0.09 (-0.71 to 0.89)) and physical function (SUCRA=20%; -0.31 (-0.94 to 0.32)) and therapist hands-on control for mental health (SUCRA=20%; -0.31 (-1.31 to 0.70)). Stretching and McKenzie exercise effect sizes did not differ to true control for pain or function (p>0.095; SUCRA<40%). NMA was not possible for trunk muscle endurance or analgesic medication. The quality of the synthesised evidence was low according to Grading of Recommendations Assessment, Development and Evaluation criteria. SUMMARY/CONCLUSION: There is low quality evidence that Pilates, stabilisation/motor control, resistance training and aerobic exercise training are the most effective treatments, pending outcome of interest, for adults with NSCLBP. Exercise training may also be more effective than therapist hands-on treatment. Heterogeneity among studies and the fact that there are few studies with low risk of bias are both limitations.


Assuntos
Terapia por Exercício/métodos , Dor Lombar/terapia , Adulto , Exercício Físico , Técnicas de Exercício e de Movimento , Humanos , Dor Lombar/fisiopatologia , Força Muscular/fisiologia , Exercícios de Alongamento Muscular , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Treinamento de Força
17.
Ann Work Expo Health ; 63(9): 975-989, 2019 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-31621876

RESUMO

AIMS: Previous studies have suggested that migrants have higher exposures to psychosocial job stressors than native-born workers. We explored migrant status-related differences in skill discretion/job complexity and decision authority, and whether the differences varied by gender, age, and educational attainment. METHODS: Data were from Wave 14 of the Household Income and Labour Dynamics in Australia (HILDA) Survey. A total number of 9031 persons were included in the analysis. Outcomes included skill discretion/job complexity and decision authority. Exposure included migrant status defined by (i) country of birth (COB), (ii) the combination of COB and English/Non-English dominant language of COB, and (iii) the combination of COB and years since arrival in Australia. Data were analysed using linear regression, adjusting for gender, age, and educational attainment. These covariates were also analysed as effect modifiers of the relationship between migrant status and job stressor exposure. RESULTS: In the unadjusted analysis, only migrant workers from Non-English-speaking countries (Non-ESC-born) had significantly lower skill discretion and job complexity than Australia-born workers (-0.29, 95% CI: -0.56; -0.01); however, results from fully adjusted models showed that all migrant groups, except migrant workers from Main-English-speaking countries, had significantly lower skill discretion and job complexity than Australia-born workers (overseas-born workers, -0.59, 95% CI: -0.79; -0.38; Non-ESC-born, -1.01, 95% CI: -1.27; -0.75; migrant workers who had arrived ≤5 years ago, -1.33, 95% CI: -1.94; -0.72; arrived 6-10 years ago, -0.92, 95% CI: -1.46; -0.39; and arrived ≥11 years ago, -0.45, 95% CI: -0.67; -0.22). On the contrary, the unadjusted model showed that migrant workers had higher decision authority than Australia-born workers, whereas in the fully adjusted model, no difference in decision authority was found between migrant workers and Australia-born workers. Effect modification results showed that as educational attainment increased, differences in skill discretion and job complexity between Australia-born workers and Non-ESC-born migrants progressively increased; whereas Non-ESC-born migrants with postgraduate degree showed significantly lower decision authority than Australia-born workers. CONCLUSIONS: This study suggests that skill discretion and job complexity but not decision authority is associated with migrant status. Migrants with high educational attainment from Non-English-speaking countries appear to be most affected by lower skill discretion/job complexity and decision authority; however, differences in skill discretion and job complexity attenuate over time for Non-ESC-born migrants, consistent with an acculturation effect. Low skill discretion and job complexity, to the extent that it overlaps with underemployment, may adversely affect migrant workers' well-being. Targeted language skill support could facilitate migrant integration into the Australian labour market.


Assuntos
Emprego/psicologia , Exposição Ocupacional/análise , Estresse Ocupacional/psicologia , Migrantes/psicologia , Adolescente , Adulto , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autonomia Pessoal , Análise de Regressão , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-31661926

RESUMO

Job insecurity is a modifiable risk factor for poor health outcomes, and exposure to job insecurity varies by population groups. This study assessed if job insecurity exposure varied by migrant status and if the differences varied by gender, age, educational attainment, and occupational skill level. Data were from wave 14 of the Household Income and Labour Dynamics in Australia Survey. The outcome was job insecurity. Exposure was migrant status defined by (1) the country of birth (COB), (2) the dominant language of the COB, and (3) the number of years since arrival in Australia. Data were analysed using linear regression, adjusting for gender, age, educational attainment, and occupational skill level. These covariates were also analysed as effect modifiers for the migrant status-job insecurity relationships. Migrant workers, especially those from non-English speaking countries (non-ESC-born), experienced higher job insecurity than Australia-born workers; however, these disparities disappeared after 11+ years post-arrival. The migrant status-job insecurity relationships were modified by educational attainment. Unexpectedly, the disparities in job insecurity between non-ESC-born migrants and Australia-born workers increased with increasing educational attainment, and for those most highly educated, the disparities persisted beyond 11 years post-arrival. Our findings suggested that continuing language skill support and discrimination prevention could facilitate migrant integration into the Australian labour market.


Assuntos
Emprego/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Austrália , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Ocupações , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
19.
Calcif Tissue Int ; 105(6): 609-618, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31506707

RESUMO

Identification of sarcopenia in lower- and middle-income countries (LMICs) is limited by access to technologies that assess muscle mass. We investigated associations between two functional measures of sarcopenia, grip strength and gait speed (GS), with functional disability in adults from six LMICs. Data were extracted from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007-2010) for adults (≥ 65 years) from China, Mexico, Ghana, India, Russia and South Africa (n = 10,892, 52.8% women). We calculated country-specific prevalence of low grip strength, slow GS (≤ 0.8 m/s), and both measures combined. Using multivariable negative binomial regression, we separately assessed associations between low grip strength, slow GS, and both measures combined, with the WHO Disability Assessment Schedule 2.0, accounting for selected socioeconomic factors. In women, low grip strength ranged from 7 in South Africa to 51% in India; in men, it ranged from 17 in Russia to 51% in Mexico. Country-specific proportions of slow GS ranged from 77 in Russia, to 33% in China. The concomitant presence of both was the lowest in South Africa and the highest in India (12.3% vs. 33%). Independent of age, those with both low grip strength and slow GS had between 1.2- and 1.5-fold worse functional disability scores, independent of comorbidities, low education, and low wealth (all country-dependent). Low grip strength, slow GS, and the combination of both, were all associated with higher levels of functional disability, thus indicating these objective measures offer a reasonably robust estimate for potential poor health outcomes.


Assuntos
Envelhecimento , Sarcopenia/epidemiologia , Fatores Socioeconômicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Países em Desenvolvimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Velocidade de Caminhada , Organização Mundial da Saúde/organização & administração
20.
Int J Ment Health Nurs ; 28(5): 1186-1197, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31290238

RESUMO

Risk assessment is a pre-requisite for violence prevention in mental health settings. Extant research concerning risk assessment and nursing intervention is limited and has focused on the predictive validity of various risk assessment approaches and instruments, with few attempts to elucidate and test interventions that might prevent aggression, and reduce reliance on coercive interventions. The integration of risk assessment and violence prevention strategies has been neglected. The aim of this feasibility study was to test a novel Aggression Prevention Protocol designed to prioritize the instigation of less restrictive interventions on an acute forensic mental health unit for female patients. A prospective quasi-experimental study was designed to test an Aggression Prevention Protocol, linked to an electronic application of the Dynamic Appraisal of Situational Aggression (DASA). Following introduction of the DASA and Aggression Prevention Protocol, there were reductions in verbal aggression, administration of Pro Re Nata medication, the rate of seclusion, and physical and mechanical restraint. There was also an increase in documented nursing interventions. Overall, these results support further testing of the electronic application of the DASA and the Aggression Prevention Protocol.


Assuntos
Agressão/psicologia , Psiquiatria Legal/métodos , Violência/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Prisioneiros/psicologia , Escalas de Graduação Psiquiátrica , Medição de Risco , Adulto Jovem
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