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1.
Nutr Diet ; 2019 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-31680432

RESUMO

AIM: This study aimed to explore clustering among individual eating behaviours in a sample of Australian university students, and explore associations between clustered eating behaviours and demographic characteristics. METHODS: A cross-sectional analysis of data from the University of Newcastle (UON) Student Healthy Lifestyle Survey 2017 was conducted. Measures included eating behaviours (eg, vegetables, energy-dense nutrient poor [EDNP] food intakes) assessed using short diet questions, and demographic characteristics (eg, age, undergraduate/postgraduate student). Factor analysis was used to explore clustering of individual eating behaviours (ie, identify factors). Linear regression models were used to explore associations between eating behaviour factors identified and demographic characteristics. RESULTS: A total of 3062 students (70% female; 56% aged 17-24 years) were included in the analysis. The six eating behaviour factors identified (characterised by higher consumption of the named foods/drinks) were; EDNP snack foods, meat and takeaway foods, fruit and vegetables, sugary drinks, breakfast, and breads and cereals. A higher fruit and vegetable factor score was associated with being female (P < .001), and a higher meat and takeaway foods factor score was associated with being male (P < .001) and of younger age (P < .001). CONCLUSIONS: Nutrient-rich foods clustered together and EDNP foods clustered together, that is, the identified factors represent either nutrient-rich or EDNP foods. Interventions in the university setting should target students with the poorest eating behaviours, including males and younger students.

2.
Public Health Nutr ; : 1-12, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31607277

RESUMO

OBJECTIVE: To explore if better diet quality scores as a measure of adherence to the Australian Dietary Guidelines (ADG) and the Mediterranean diet (MedDiet) are associated with a lower incidence of hypertension and non-fatal CVD. DESIGN: Prospective analysis of the 1946-1951 cohort of the Australian Longitudinal Study on Women's Health (ALSWH). The Australian Recommended Foods Score (ARFS) was calculated as an indicator of adherence to the ADG; the Mediterranean Diet Score (MDS) measured adherence to the MedDiet. Outcomes included hypertension and non-fatal CVD. Generalised estimating equations estimated OR and 95 % CI across quartiles of diet quality scores. SETTING: Australia, 2001-2016. PARTICIPANTS: 1946-1951 cohort of the ALSWH (n 5324), without CVD, hypertension and diabetes at baseline (2001), with complete FFQ data. RESULTS: There were 1342 new cases of hypertension and 629 new cases of non-fatal CVD over 15 years of follow-up. Multivariate analysis indicated that women reporting better adherence to the ARFS (≥38/74) had 15 % (95 % CI 1, 28 %; P = 0·05) lower odds of hypertension and 46 % (95 % CI 6, 66 %; P = 0·1) lower odds of non-fatal CVD. Women reporting better adherence to the MDS (≥8/17) had 27 % (95 % CI 15, 47 %; P = 0·0006) lower odds of hypertension and 30 % (95 % CI 2, 50 %; P = 0·03) lower odds of non-fatal CVD. CONCLUSIONS: Better adherence to diet quality scores is associated with lower risk of hypertension and non-fatal CVD. These results support the need for updated evidenced based on the ADG as well as public health nutrition policies in Australia.

3.
Lancet Respir Med ; 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31578168

RESUMO

BACKGROUND: Transbronchial lung cryobiopsy (TBLC) is a novel technique for sampling lung tissue for interstitial lung disease diagnosis. The aim of this study was to establish the diagnostic accuracy of TBLC compared with surgical lung biopsy (SLB), in the context of increasing use of TBLC in clinical practice as a less invasive biopsy technique. METHODS: COLDICE was a prospective, multicentre, diagnostic accuracy study investigating diagnostic agreement between TBLC and SLB, across nine Australian tertiary hospitals. Patients with interstitial lung disease aged between 18 and 80 years were eligible for inclusion if they required histopathological evaluation to aid diagnosis, after detailed baseline evaluation. After screening at a centralised multidisciplinary discussion (MDD), patients with interstitial lung disease referred for lung biopsy underwent sequential TBLC and SLB under one anaesthetic. Each tissue sample was assigned a number between 1 and 130, allocated in a computer-generated random sequence. Encoded biopsy samples were then analysed by masked pathologists. At subsequent MDD, de-identified cases were discussed twice with either TBLC or SLB along with clinical and radiological data, in random non-consecutive order. Co-primary endpoints were agreement of histopathological features in TBLC and SLB for patterns of definite or probable usual interstitial pneumonia, indeterminate for usual interstitial pneumonia, and alternative diagnosis; and for agreement of consensus clinical diagnosis using TBLC and SLB at MDD. Concordance and κ values were calculated for each primary endpoint. This study is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12615000718549. FINDINGS: Between March 15, 2016, and April 15, 2019, we enrolled 65 patients (31 [48%] men, 34 [52%] women; mean age 66·1 years [SD 9·3]; forced vital capacity 83·7% [SD 14·2]; diffusing capacity for carbon monoxide 63·4% [SD 12·8]). TBLC (7·1 mm, SD 1·9) and SLB (46·5 mm, 14·9) samples were each taken from two separate ipsilateral lobes. Histopathological agreement between TBLC and SLB was 70·8% (weighted κ 0·70, 95% CI 0·55-0·86); diagnostic agreement at MDD was 76·9% (κ 0·62, 0·47-0·78). For TBLC with high or definite diagnostic confidence at MDD (39 [60%] of 65 cases), 37 (95%) were concordant with SLB diagnoses. In the 26 (40%) of 65 cases with low-confidence or unclassifiable TBLC diagnoses, SLB reclassified six (23%) to alternative high-confidence or definite MDD diagnoses. Mild-moderate airway bleeding occurred in 14 (22%) patients due to TBLC. The 90-day mortality was 2% (one of 65 patients), following acute exacerbation of idiopathic pulmonary fibrosis. INTERPRETATION: High levels of agreement between TBLC and SLB for both histopathological interpretation and MDD diagnoses were shown. The TBLC MDD diagnoses made with high confidence were particularly reliable, showing excellent concordance with SLB MDD diagnoses. These data support the clinical utility of TBLC in interstitial lung disease diagnostic algorithms. Further studies investigating the safety profile of TBLC are needed. FUNDING: University of Sydney, Hunter Medical Research Institute, Erbe Elektromedizin, Medtronic, Cook Medical, Rymed, Karl-Storz, Zeiss, and Olympus.

4.
Physiol Rep ; 7(17): e14227, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31515958

RESUMO

Maternal obesity during pregnancy has a detrimental impact on offspring renal development and function. This is pertinent to Indigenous Australians as they are twice as likely as non-Indigenous Australians to develop chronic kidney disease (CKD). The aim of this study was to examine whether there was an association between maternal adiposity and fetal kidney growth in late gestation (>28 weeks) and kidney function in infants, <2.5 years of age, from the Gomeroi gaaynggal cohort. Pre-pregnancy body mass index (BMI) was recorded at the first prenatal visit and maternal adiposity indicators (percent body fat and visceral fat area) measured at >28 weeks gestation by bioelectrical impedance analysis. Fetal kidney structure was assessed by ultrasound. Renal function indicators (urinary albumin:creatinine and protein:creatinine) were measured in infants from a spot urine collection from nappies. Multiple linear regression and multi-level mixed effects linear regression models with clustering were used to account for repeated measures of urine. 147 mother-child pairs were examined. Estimated fetal weight (EFW), but not fetal kidney size, was positively associated with maternal adiposity and pre-pregnancy BMI. When adjusted for smoking, combined kidney volume relative to EFW was negatively associated with maternal percentage body fat. Infant kidney function was not influenced by maternal adiposity and pre-pregnancy BMI (n = 84 observations). Current findings show that Indigenous babies born to obese mothers have reduced kidney size relative to EFW. We suggest that these babies are experiencing a degree of glomerular hyperfiltration in utero, and therefore are at risk of developing CKD in later life, especially if their propensity for obesity is maintained. Although no impact on renal function was observed at <2.5 years of age, long-term follow-up of offspring is required to evaluate potential later life impacts.

5.
Artigo em Inglês | MEDLINE | ID: mdl-31515714

RESUMO

This study examined the prevalence of and sociodemographic characteristics associated with elevated symptoms of depression among clients seeking alcohol or other drug (AOD) treatment. Consenting clients attending two AOD outpatient clinics answered demographics, treatment questions and the Patient Health Questionnaire to assess depressive symptoms. Counts and percentages were calculated to determine the prevalence of elevated depressive symptoms. Logistic regression was used to model the odds of having elevated depressive symptoms for client demographics. Of the 203 clients who completed the survey (87% consent rate), 55% (n = 111) demonstrated elevated depressive symptoms. Females were twice as likely to experience elevated symptoms of depression compared to males (OR 2.07; 95% CI 1.05, 4.08; P = 0.037). The high rates of elevated depressive symptoms among individuals seeking AOD treatment highlight the importance of ongoing research to provide effective treatments for this comorbidity. Routine screening and clear treatment pathways may assist with providing high quality care.

6.
Pediatr Res ; 2019 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-31493773

RESUMO

BACKGROUND: Young adults born preterm have remodeled hearts, i.e., altered cardiac shape and size with impaired cardiac function. At present, the natural history and pattern of prematurity related cardiac remodeling are not clearly established. The aim of this study was to compare the left ventricle (LV) geometry and function of preterm infants at 36 weeks postmenstrual age (PMA) with gestation matched newborn infants. METHODS: LV end diastolic volume index (LV EDVI), LV mass index (LVMI), relative wall thickness (RWT), and sphericity index (SI) were prospectively obtained with echocardiography. LV geometry was classified according to the Gaasch method. LV function was assessed by determining ejection fraction (EF), longitudinal strain (LS), mitral annulus systolic motion (s'), and estimated LV filling pressure (E/e'). RESULTS: Eighty-three preterm infants between 23 and 29 weeks gestation, and 40 infants of 36 weeks gestation at birth were analysed. LV EDVI, LVMI, SI, LS, s', and E/e' were higher in preterm group while RWT and EF were comparable between groups. LV showed normal geometry in 55.4%, physiological enlargement in 23% and dilated hypertrophy in 21.6% preterm infants. CONCLUSION: At 36 week, preterm infants have significantly dilated, hypertrophied, and more spherical LV with impaired diastolic function compared with PMA matched newborn infants.

7.
Am J Prev Med ; 57(4): 503-514, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31542128

RESUMO

INTRODUCTION: Interventions that improve both physical activity and sleep quality may be more effective in improving overall health. The purpose of the Synergy Study is to test the efficacy of a mobile health combined behavior intervention targeting physical activity and sleep quality. STUDY DESIGN: Randomized, waitlist-controlled trial. SETTING/PARTICIPANTS: This study had an app-based delivery mode, Australia-wide. The participants were 160 adults who reported insufficient physical activity and poor sleep quality in an eligibility survey. INTERVENTION: The intervention was a mobile app providing educational resources, goal setting, self-monitoring, and feedback strategies. It included 12 weeks of personalized support including weekly reports, tool sheets, and prompts. MAIN OUTCOME MEASURES: Outcomes were assessed at baseline, 3 months (primary), and 6 months (secondary endpoint). Self-reported minutes of moderate-to-vigorous intensity physical activity and sleep quality were co-primary outcomes. Resistance training; sitting time; sleep hygiene; sleep timing variability; insomnia severity; daytime sleepiness; quality of life; and depression, anxiety, and stress symptoms were secondary outcomes. Data were collected between June 2017 and February 2018 and analyzed in August 2018. RESULTS: At 3 months, between-group differences in moderate-to-vigorous intensity physical activity were not statistically significant (p=0.139). Significantly more participants in the intervention group engaged in ≥2 days/week (p=0.004) of resistance training. The intervention group reported better overall sleep quality (p=0.009), subjective sleep quality (p=0.017), sleep onset latency (p=0.013), waketime variability (p=0.018), sleep hygiene (p=0.027), insomnia severity (p=0.002), and lower stress symptoms (p=0.032) relative to waitlist controls. At 6 months, group differences were maintained for sleep hygiene (p=0.048), insomnia severity (p=0.002), and stress symptoms (p=0.006). Differences were observed for bedtime variability (p=0.023), sleepiness (p<0.001), daytime dysfunction (p=0.039), and anxiety symptoms (p=0.003) at 6 months, but not 3 months. CONCLUSIONS: This remotely delivered intervention did not produce statistically significant between-group differences in minutes of moderate-to-vigorous intensity physical activity. Significant short-term differences in resistance training and short- and medium-term differences in sleep health in favor of the intervention were observed. TRIAL REGISTRATION: This study is registered at anzctr.org.au ACTRN12617000376347.

8.
BMJ Open ; 9(8): e030731, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31434782

RESUMO

INTRODUCTION: Stereotactic body radiotherapy (SBRT) is a non-invasive alternative to surgery for the treatment of non-metastatic prostate cancer (PC). The objectives of the Novel Integration of New prostate radiation schedules with adJuvant Androgen deprivation (NINJA) clinical trial are to compare two emerging SBRT regimens for efficacy with technical substudies focussing on MRI only planning and the use of knowledge-based planning (KBP) to assess radiotherapy plan quality. METHODS AND ANALYSIS: Eligible patients must have biopsy-proven unfavourable intermediate or favourable high-risk PC, have an Eastern Collaborative Oncology Group (ECOG) performance status 0-1 and provide written informed consent. All patients will receive 6 months in total of androgen deprivation therapy. Patients will be randomised to one of two SBRT regimens. The first will be 40 Gy in five fractions given on alternating days (SBRT monotherapy). The second will be 20 Gy in two fractions given 1 week apart followed 2 weeks later by 36 Gy in 12 fractions given five times per week (virtual high-dose rate boost (HDRB)). The primary efficacy outcome will be biochemical clinical control at 5 years. Secondary endpoints for the initial portion of NINJA look at the transition of centres towards MRI only planning and the impact of KBP on real-time (RT) plan assessment. The first 150 men will demonstrate accrual feasibility as well as addressing the KBP and MRI planning aims, prior to proceeding with total accrual to 472 patients as a phase III randomised controlled trial. ETHICS AND DISSEMINATION: NINJA is a multicentre cooperative clinical trial comparing two SBRT regimens for men with PC. It builds on promising results from several single-armed studies, and explores radiation dose escalation in the Virtual HDRB arm. The initial component includes novel technical elements, and will form an important platform set for a definitive phase III study. TRIAL REGISTRATION NUMBER: ANZCTN 12615000223538.

9.
J Med Internet Res ; 21(8): e13423, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31464188

RESUMO

BACKGROUND: Variations in an individual's electronic health (eHealth) literacy may influence the degree to which health consumers can benefit from eHealth. The eHealth Literacy Scale (eHEALS) is a common measure of eHealth literacy. However, the lack of guidelines for the standardized interpretation of eHEALS scores limits its research and clinical utility. Cut points are often arbitrarily applied at the eHEALS item or global level, which assumes a dichotomy of high and low eHealth literacy. This approach disregards scale constructs and results in inaccurate and inconsistent conclusions. Cluster analysis is an exploratory technique, which can be used to overcome these issues, by identifying classes of patients reporting similar eHealth literacy without imposing data cut points. OBJECTIVE: The aim of this cross-sectional study was to identify classes of patients reporting similar eHealth literacy and assess characteristics associated with class membership. METHODS: Medical imaging outpatients were recruited consecutively in the waiting room of one major public hospital in New South Wales, Australia. Participants completed a self-report questionnaire assessing their sociodemographic characteristics and eHealth literacy, using the eHEALS. Latent class analysis was used to explore eHealth literacy clusters identified by a distance-based cluster analysis, and to identify characteristics associated with class membership. RESULTS: Of the 268 eligible and consenting participants, 256 (95.5%) completed the eHEALS. Consistent with distance-based findings, 4 latent classes were identified, which were labeled as low (21.1%, 54/256), moderate (26.2%, 67/256), high (32.8%, 84/256), and very high (19.9%, 51/256) eHealth literacy. Compared with the low class, participants who preferred to receive a lot of health information reported significantly higher odds of moderate eHealth literacy (odds ratio 16.67, 95% CI 1.67-100.00; P=.02), and those who used the internet at least daily reported significantly higher odds of high eHealth literacy (odds ratio 4.76, 95% CI 1.59-14.29; P=.007). CONCLUSIONS: The identification of multiple classes of eHealth literacy, using both distance-based and latent class analyses, highlights the limitations of using the eHEALS global score as a dichotomous measurement tool. The findings suggest that eHealth literacy support needs vary in this population. The identification of low and moderate eHealth literacy classes indicate that the design of eHealth resources should be tailored to patients' varying levels of eHealth literacy. eHealth literacy improvement interventions are needed, and these should be targeted based on individuals' internet use frequency and health information amount preferences.

10.
J Foot Ankle Res ; 12: 39, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31388357

RESUMO

Background: The ankle brachial index (ABI) is widely used in clinical practice as a non-invasive method to detect the presence and severity of peripheral arterial disease (PAD). Current guidelines suggest that it should be used to monitor potential progression of PAD in affected individuals. As such, it is important that the test is reliable when used for repeated measurements, by the same or different health practitioners. This systematic review aims to examine the literature to evaluate the inter- and intra-rater reliability of the ABI. Methods: A systematic search of MEDLINE, EMBASE and CINAHL Complete was conducted to 20 January 2019. Two authors independently reviewed and selected relevant studies and extracted the data. Methodological quality was determined using the Quality Appraisal of Reliability (QAREL) Checklist. Results: Fifteen studies of ABI reliability in a range of patient populations were identified as suitable for inclusion in the review: seven considered inter-rater reliability, four intra-rater reliability, and four studies evaluated both inter- and intra-rater reliability. Inter-rater reliability was found to be highly variable, with intraclass correlation coefficients (ICC's) ranging from poor to excellent (ICC 0.42-1.00), while intra-rater also demonstrated considerable variation, with ICCs from 0.42-0.98. Meta-analysis was not possible due to the lack of statistical information reported. Conclusions: Results of included studies suggest the inter- and intra-tester reliability of the ABI is acceptable. However, inconsistencies in obtaining systolic pressure measurements, calculating ABI values, and incomplete reporting of methodologies and statistical analysis make it difficult to determine the validity of the results of included studies. Further research, with more consistent reliability methodology, statistical analysis and reporting conducted in populations at risk of PAD is needed to conclusively determine the ABI reliability.

11.
BMJ Open ; 9(7): e028417, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31366650

RESUMO

INTRODUCTION: Treatment fidelity is an important and often neglected component of complex behaviour change research. It is central to understanding treatment effects, especially for evaluations conducted outside of highly controlled research settings. Ensuring that promising interventions can be delivered adequately (ie, with fidelity) by real-world clinicians within real-world settings is an essential step in developing interventions that are both effective and 'implementable'. Whether this is the case for behaviour change counselling, a complex intervention developed specifically for maximising the effectiveness of real-world consultations about health behaviour change, remains unclear. To improve our understanding of treatment effects, best practice guidelines recommend the use of strategies to enhance, monitor and evaluate what clinicians deliver during patient consultations. There has yet to be a systematic evaluation of whether and how these recommendations have been employed within evaluations of behaviour change counselling, nor the impact on patient health behaviour and/or outcome. We seek to address this gap. METHODS AND ANALYSIS: Methods are informed by published guidelines. Ten electronic databases (Medline, PubMed, EMBASE, PsycINFO, CINAHL Complete, ScienceDirect, Taylor and Francis; Wiley, ProQuest and Open Grey) will be searched for published and unpublished articles that evaluate behaviour change counselling within real-world clinical settings (randomised and non-randomised). Eligible papers will be rated against the National Institute of Health fidelity framework. A synthesis, evaluation and critical overview of fidelity practices will be reported and linear regression used to explore change across time. Random-effect meta-regression is planned to explore whether fidelity (outcomes reported and methods used) is associated with the impact of behaviour change counselling. Standardised effect sizes will be calculated using Hedges' g (continuous outcomes) and ORs (binary/dichotomous outcomes). ETHICS AND DISSEMINATION: No ethical issues are foreseen. Findings will be disseminated via journal publication and conference presentation(s). PROSPERO REGISTRATION NUMBER: CRD42019131169.

12.
Radiat Oncol ; 14(1): 140, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387597

RESUMO

BACKGROUND: To investigate the prognostic significance of positron emission tomography (PET) parameters from F-18 fluorodeoxyglucose (FDG) PET scans performed pre- and post- chemo-radiotherapy (CRT) for squamous cell carcinoma of the anal canal (AC). METHODS: From January 2013 to January 2017, 19 patients with non-metastatic AC enrolled on a prospective trial underwent FDG-PET/CT imaging before and 12 weeks following CRT. A computer-generated volume of interest (VOI) was snapped around the primary tumour using six different standard uptake value (SUV) thresholds and the following parameters were extracted: SUV max, mean, median, standard deviation and peak as well as metabolic tumour volume (MTV) and total lesion glycolysis. Exact logistic regression and ROC AUC analyses were performed for each metric at each timepoint. RESULTS: With a median follow up of 15.8 months, 3/19 patients had a local recurrence and 5/19 had any recurrence. On post-CRT PET, the median SUV within a VOI bounded by an SUV of 3 correlated with local recurrence (p < 0.01) and demonstrated excellent discrimination (ROC AUC 1.00, perfect separation was achieved at a median SUV of 3.38). The mean SUV at this threshold did not quite reach significance for prediction of local recurrence (p = 0.06) but demonstrated excellent discrimination (ROC AUC 0.91). The MTV bounded by a threshold of 41% SUVmax on the pre-CRT PET predicted for any recurrence (p = 0.03) and showed excellent discrimination (ROC AUC 0.89). CONCLUSIONS: FDG-PET parameters are predictive of recurrence in AC. FDG-PET may represent a valuable tool for prognostication and response assessment in AC. TRIAL REGISTRATION: ANZCTR, ACTRN12614001219673 . Registered 19 November 2014 - Retrospectively registered.

13.
Trials ; 20(1): 491, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399140

RESUMO

BACKGROUND: Recurrent stroke is a major contributor to stroke-related disability and costs. Improving health-risk behaviours and mental health has the potential to significantly improve recovery, enhance health-related quality of life (HRQoL), independent living, and lower the risk of recurrent stroke. The primary aim will be to test the effectiveness of an online intervention to improve HRQoL among stroke survivors at 6 months' follow-up. Programme effectiveness on four health behaviours, anxiety and depression, cost-effectiveness, and impact on other hospital admissions will also be assessed. METHODS/DESIGN: An open-label randomised controlled trial is planned. A total of 530 adults will be recruited across one national and one regional stroke registry and block randomised to the intervention or minimal care control group. The intervention group will receive access to the online programme Prevent 2nd Stroke (P2S); the minimal care control group will receive an email with Internet addresses of generic health sites designed for the general population. The primary outcome, HRQoL, will be measured using the EuroQol-5D. A full analysis plan will compare between groups from baseline to follow-up. DISCUSSION: A low-cost per user option to supplement current care, such as P2S, has the potential to increase HRQoL for stroke survivors, and reduce the risk of second stroke. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry, ID: ACTRN12617001205325p . Registered on 17 August 2017.

14.
Clin Biomech (Bristol, Avon) ; 69: 52-57, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302489

RESUMO

BACKGROUND: Limited ankle dorsiflexion, or equinus, is associated with elevated plantar pressures, which have been implicated in the development and non-healing of foot ulcer. A stretching intervention may increase ankle dorsiflexion and reduce plantar pressures in people with diabetes. METHODS: Two arm parallel randomised controlled trial from September 2016 to October 2017. Adults with diabetes and ankle equinus (≤5° dorsiflexion) were randomly allocated to receive an 8 week static calf stretching intervention or continue with their normal activities. Primary outcome measures were change in weight bearing and non-weight bearing ankle dorsiflexion and forefoot peak plantar pressure. Secondary outcome measures were forefoot pressure time integrals and adherence to the stretching intervention. FINDINGS: 68 adults (mean (standard deviation) age and diabetes duration 67.4 (10.9) years and 14.0 (10.8) years, 64.7% male) were randomised to stretch (n = 34) or usual activity (n = 34). At follow up, no significant differences were seen between groups (adjusted mean difference) for non-weight (+1.3°, 95% CI:-0.3 to 2.9, p = 0.101) and weight bearing ankle dorsiflexion (+0.5°, 95% CI:-2.6 to 3.6, p = 0.743) or forefoot in-shoe (+1.5 kPa, 95% CI:-10.0 to 12.9, p = 0.803) or barefoot peak pressures (-19.1 kPa, 95% CI:-96.4 to 58.1, p = 0.628). Seven of the intervention group and two of the control group were lost to follow up. INTERPRETATION: Our data failed to show a statistically significant or clinically meaningful effect of static calf muscle stretching on ankle range of motion, or plantar pressures, in people with diabetes and ankle equinus.

15.
Aust N Z J Public Health ; 43(5): 464-469, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31268211

RESUMO

OBJECTIVE: Uptake of screening through the Australian National Bowel Cancer Screening Program remains low. General practice guidelines support the general practitioners' role to offer CRC screening. This study tests the effect that an intervention including point-of-care FOBT provision, printed screening advice and GP endorsement has on self-reported FOBT uptake. METHODS: A multisite, 1:1 parallel-arm, cluster-randomised controlled trial. Participants aged 50-74, at average risk of CRC and overdue for screening were recruited from four general practices in New South Wales, Australia, from September 2016 to May 2017. Self-report of FOBT up to eight weeks post baseline. RESULTS: A total of 336 participants consented to complete a baseline survey (64% consent rate), of which 123 were recruited into the trial (28 usual care days and 26 intervention days). Follow-up data was collected for 114 participants (65 usual care and 49 intervention). Those receiving the intervention had ten times greater odds of completing screening compared to usual care (39% vs. 6%; OR 10.24; 95%CI 2.9-36.6, p=0.0006). CONCLUSIONS: A multicomponent intervention delivered in general practice significantly increased self-reported FOBT uptake in those at average risk of CRC. Implications for public health: General practice interventions could serve as an important adjunct to the Australian National Bowel Cancer Screening Program to boost plateauing screening rates.


Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Programas de Rastreamento , Sangue Oculto , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso , Austrália/epidemiologia , Neoplasias Colorretais/epidemiologia , Assistência à Saúde , Feminino , Medicina Geral , Humanos , Masculino , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , New South Wales , Avaliação de Processos e Resultados (Cuidados de Saúde) , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
16.
Aust J Prim Health ; 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31288905

RESUMO

National and international guidelines recommend opportunistic screening for chronic kidney disease to allow for early detection and management. Despite these guidelines, screening for chronic kidney disease in general practice settings is often suboptimal. This paper reports the results of a study that evaluated: (a) the effect of an asynchronous web-based e-learning module on general practice nurses' knowledge about chronic kidney disease risk factors and screening practices; and (b) general practice nurses' perceived satisfaction with the e-learning module. Changes in chronic kidney disease knowledge were assessed using a pre-test and post-test evaluative design, and satisfaction scores were measured on completion of the module. Participants' baseline knowledge scores were poor, with mean pre-test scores of 3.77 (s.d. 1.66) out of 10. Post-test scores revealed a significant improvement (mean difference 1.81, (95% CI: 1.53 - 2.09), P < 0.01); however, overall final scores remained inadequate. Participants highly rated their satisfaction with the design of the module. Our results suggest that an asynchronous web-based e-learning module can improve general practice nurses' knowledge about chronic kidney disease risk factors and screening practice. Efforts are required to increase practice nurses' access to educational opportunities designed to improve knowledge in this area with the aim of increasing opportunistic screening for chronic kidney disease in the general practice setting.

18.
BMJ Open ; 9(6): e025293, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167863

RESUMO

OBJECTIVES: This study aimed to examine the impact of the 'ICAN QUIT in Pregnancy' intervention on individual health providers (HPs) smoking cessation care (SCC) knowledge, attitudes and practices in general, and specifically regarding nicotine replacement therapy (NRT) prescription. DESIGN: Step-wedge clustered randomised controlled study. HPs answered a preintervention and 1-6 months postintervention survey. SETTING: Six Aboriginal Medical Services (AMSs) in three states of Australia. PARTICIPANTS: All HPs were invited to participate. Of 93 eligible, 50 consented (54%), 45 completed the presurvey (90%) and 20 the post (40%). INTERVENTION: Included three 1-hour webinar sessions, educational resource package and free oral NRT. OUTCOMES: HPs knowledge was measured using two composite scores-one from all 24 true/false statements, and one from 12 NRT-specific statements. Self-assessment of 22 attitudes to providing SCC were measured using a five-point Likert scale (Strongly disagree to Strongly agree). Two composite mean scores were calculated-one for 15 general SCC attitudes, and one for 7 NRT-specific attitudes. Self-reported provision of SCC components was measured on a five-point Likert scale (Never to Always). Feasibility outcomes, and data collected on the service and patient level are reported elsewhere. RESULTS: Mean knowledge composite scores improved from pre to post (78% vs 84% correct, difference 5.95, 95% CI 1.57 to 10.32). Mean NRT-specific knowledge composite score also improved (68% vs 79% correct, difference 9.9, 95% CI 3.66 to 16.14). Mean attitude composite score improved (3.65 (SD 0.4) to 3.87 (SD 0.4), difference 0.23, 95% CI 0.05 to 0.41). Mean NRT-specific attitudes composite score also improved (3.37 (SD 0.6) to 3.64 (SD 0.7), difference 0.36, 95% CI 0.13 to 0.6). Self-reported practices were unchanged, including prescribing NRT. CONCLUSIONS: A multicomponent culturally sensitive intervention in AMSs was feasible, and might improve HPs provision of SCC to pregnant Aboriginal women. Changes in NRT prescription rates may require additional intensive measures. TRIAL REGISTRATION NUMBER: ACTRN 12616001603404; Results.

19.
Breast ; 46: 25-31, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31059987

RESUMO

BACKGROUND: Neoadjuvant systemic therapy (NAST) is used for large operable or highly proliferative breast cancers. It is not known whether psychological outcomes differ according to the treatment sequence (chemotherapy or surgery first) or tumour response. METHODS: This was a planned analysis of a multi-institutional single arm longitudinal study of patients considering NAST for operable breast cancer. Participants completed patient reported outcome questionnaires before and after the decision about NAST, between chemotherapy and surgery, and 12 months after diagnosis. RESULTS: Fifty-nine women enrolled. Fourteen of 51 (28%) who received NAST experienced pathological complete response (pCR). Patients who had surgery first (n = 7) had higher baseline anxiety, and a greater decrease in anxiety at 12 months follow up, compared with patients who received NAST (n = 50) (a decrease from baseline of 34 pts vs 17 points; p = 0.033). Distress declined at a similar rate in surgery first and NAST groups. Mean satisfaction with decision score post-decision was significantly lower in the adjuvant group compared with NAST (22 vs 26, p = 0.02). No differences were seen between patients with pCR vs residual cancer in: distress, anxiety, satisfaction with decision, fear of progression, and decision regret. CONCLUSION: Most patients in this study proceeded with NAST when their surgeon offered it as an option. This exploratory analysis suggests that patients who chose surgery first tended to be more anxious, and had lower satisfaction with their decision, than those who had NAST. In patients who had NAST, lack of pCR does not appear to correlate with adverse psychological outcomes.

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