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0000-0002-5611-6489
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Wellbeing SA
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Publisher: SAGE Publications
Date: 15-08-2014
Abstract: To determine the association between insomnia, obstructive sleep apnoea (OSA), and comorbid insomnia-OSA and depression, while controlling for relevant lifestyle and health factors, among a large population-based s le of US adults. We examined a s le of 11,329 adults (≥18 years) who participated in the National Health and Nutrition Examination Survey (NHANES) during the years 2005–2008. Insomnia was classified via a combination of self-reported positive physician diagnosis and high-frequency ‘trouble falling asleep’, ‘waking during the night’, ‘waking too early’, and ‘feeling unrested during the day’. OSA was classified as a combination of a positive response to a physician-diagnosed condition, in addition to a high frequency of self-reported nocturnal ‘snoring’, ‘snorting/stopping breathing’ and ‘feeling overly sleepy during the day’. Comorbid insomnia-OSA was further assessed by combining a positive response to either insomnia (all), or sleep apnoea (all), as classified above. Depressive symptomology was assessed by the Patient Health Questionnaire-9 (PHQ-9), with scores of used to indicate depression. Odds ratios (ORs) and 95% confidence intervals (CIs) for sleep disorders and depression were attained from logistic regression modelling adjusted for sex, age, poverty level, smoking status and body mass index (BMI). Those who reported insomnia, OSA or comorbid insomnia-OSA symptoms reported higher rates of depression (33.6%, 22.2%, 27.1%, respectively), and consistently reported poorer physical health outcomes than those who did not report sleep disorders. After adjusting for sex, age, poverty level, smoking status and BMI (kg/m 2 ), insomnia (OR 6.57, 95% CI 3.89-11.11), OSA (OR 5.14, 95% CI 3.14–8.41) and comorbid insomnia-OSA (OR 6.67, 95% CI 4.44–10.00) were associated with an increased likelihood of reporting depression. Insomnia, OSA and comorbid insomnia-OSA are associated with significant depressive symptomology among this large population-based s le of adults.
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.AMEPRE.2012.11.034
Abstract: Evidence is accumulating that sedentary behaviors have detrimental health effects. Comprehensive data on population changes in various sedentary behaviors over time are scarce. This study aimed to determine changes in non-occupational sedentary behaviors in the Dutch adult population between 1975 and 2005. The National Time Use Survey of the Netherlands was used, which has been collected in 5-year intervals since 1975 (seven time points, n range=1017-2845). Adult participants completed a 7-day time-use diary in which they recorded their primary activity in 15-minute intervals throughout or at the end of the day. A validated method was used to determine time spent in various non-occupational sedentary behaviors. Population-weighted analyses determining changes over time in various sedentary behaviors were carried out in 2011 and 2012. Between 1975 and 2005, the proportion of non-occupational time spent sedentary remained relatively constant at ~60%. However, absolute time decreased, because of a 4.7-hour/week increase in occupational time. Sedentary occupational time could not be studied but has likely increased over these 3 decades. Most non-occupational sedentary behavior was during leisure, and the proportion of sedentary leisure time that comes from screen time increased from 26% in 1975 to 43% in 2005. Between 1975 and 2005, sedentary transport increased by 2 hours/week. The nature and distribution of sedentary behaviors in the Dutch adult population changed substantially over 3 decades. Screen-based activities are playing an increasingly dominant role.
Publisher: Bentham Science Publishers Ltd.
Date: 15-05-2015
DOI: 10.2174/157488631002150515120209
Abstract: The efficacy of clozapine for the treatment of schizophrenia has been demonstrated. However, a range of adverse events have been associated with its use. To date, there remains a paucity of data regarding the prevalence of clozapine-induced cardiovascular (CV) and parameters associated with the development of metabolic syndrome, alongside associated risk factors for their development. An observational, clinical cohort study design of 355 clozapine patients who were enrolled in the Barwon Health Clozapine Program at Geelong Hospital, Victoria, Australia, between 2008-12. Medical records were accessed retrospectively. Multivariate logistic regression was used to determine associations with adverse event(s). Older age of commencement with clozapine was consistently associated with increased risk of CV abnormalities, with the exception of tachycardia where older age was protective (Odds Ratio [OR]: 0.97 95% Confidence Intervals [CI]: 0.95, 0.99). Males had significantly greater odds of most metabolic disturbances with the exception of being obese (BMI: ≥30 OR: 0.45 95% CIs: 0.24, 0.85). Older age of commencement was a significantly associated variable with High- Density Lipoprotein-cholesterol (OR: 1.03 95% CIs: 1.01, 1.07) and fasting glucose (OR:1.04 95% CIs: 1.02, 1.07). An increase in BMI was consistently and significantly associated with all metabolic events. Male patients who are obese at any point during treatment and older at treatment commencement may be the most vulnerable to adverse CV and metabolic events. While future studies using a matched case-control design may be required to verify these findings, we recommend that treating clinicians consider these risks when assessing patient suitability to clozapine therapy.
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.AMEPRE.2011.05.003
Abstract: Recent epidemiologic evidence points to the health risks of prolonged sitting, that are independent of physical activity, but few papers have reported the descriptive epidemiology of sitting in population studies with adults. This paper reports the prevalence of "high sitting time" and its correlates in an international study in 20 countries. Representative population s les from 20 countries were collected 2002-2004, and a question was asked on usual weekday hours spent sitting. This question was part of the International Prevalence Study, using the International Physical Activity Questionnaire (IPAQ). The sitting measure has acceptable reliability and validity. Daily sitting time was compared among countries, and by age group, gender, educational attainment, and physical activity. Data were available for 49,493 adults aged 18-65 years from 20 countries. The median reported sitting time was 300 minutes/day, with an interquartile range of 180-480 minutes. Countries reporting the lowest amount of sitting included Portugal, Brazil, and Colombia (medians ≤180 min/day), whereas adults in Taiwan, Norway, Hong Kong, Saudi Arabia, and Japan reported the highest sitting times (medians ≥360 min/day). In adjusted analyses, adults aged 40-65 years were significantly less likely to be in the highest quintile for sitting than adults aged 18-39 years (AOR=0.796), and those with postschool education had higher sitting times compared with those with high school or less education (OR=1.349). Physical activity showed an inverse relationship, with those reporting low activity on the IPAQ three times more likely to be in the highest-sitting quintile compared to those reporting high physical activity. Median sitting time varied widely across countries. Assessing sitting time is an important new area for preventive medicine, in addition to assessing physical activity and sedentary behaviors. Population surveys that monitor lifestyle behaviors should add measures of sitting time to physical activity surveillance. Moreover, the use of objective measures to capture the spectrum of sedentary (sitting) and physical activity behaviors is encouraged, particularly in low- and middle-income countries commencing new surveillance activities.
Publisher: MDPI AG
Date: 26-07-2022
Abstract: (1) Background: Limited research has suggested that cardiopulmonary health outcomes should be considered in relation to pollen exposure. This study sets out to test the relationship between pollen types (grasses, trees, weeds) and cardiovascular, lower respiratory and COPD health outcomes using 15 years (2003–2017) of data gathered in Adelaide, South Australia (2) Methods: A time-series analysis by months was conducted using cardiopulmonary data from hospital admissions, emergency presentations and ambulance callouts in relation to daily pollen concentrations in children (0–17) for lower respiratory outcomes and for adults (18+). Incidence rate ratios (IRR) were calculated over lags from 0 to 7 days (3) Results: IRR increases in cardiovascular outcomes in March, May, and October were related to grass pollen, while increases in July, November, and December were related to tree pollen. IRRs ranged from IRR 1.05 (95% confidence interval (CI) 1.00–1.10) to 1.25 (95% CI 1.12–1.40). COPD increases related to grass pollen occurred only in May. Pollen-related increases were observed for lower respiratory outcomes in adults and in children (4) Conclusion: Notable increases in pollen-related associations with cardiopulmonary outcomes were not restricted to any one season. Prevention measures for pollen-related health effects should be widened to consider cardiopulmonary outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2011
Publisher: Portico
Date: 02-2019
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.AAP.2013.04.011
Abstract: Home injuries are a substantial health burden worldwide, with the home setting being at least as important as the road for injury. Focusing on common injury hazards presented by the home environment, we sought to examine the justification for significant expenditure on safety-related repairs to the housing stock. Trained inspectors assessed 961 New Zealand houses for injury hazards. Using administrative data from the Accident Compensation Corporation (the national injury insurance agency), 1328 home injuries were identified amongst the 1612 occupants of these houses over the 2006-2009 period. Telephone interviews gathered data on the location and nature of these injuries, and the attitudes of those injured to potential injury hazards in their homes. Commonly occurring injury hazards that could be repaired at modest cost were identified based on their prevalence estimated by the housing inspection, and their location with respect to the areas of the home where the injuries occurred (identified during the telephone interviews). About 38% of the home injuries studied were potentially related to a structural aspect of the home environment. Common safety hazards included the lack of working smoke detectors (65% of the s le), inadequately fenced driveways (55%), hot water temperatures measured at over 60° (49%) and poorly lit access to the house (34%). A protocol for identifying and repairing important common hazards was designed. The actual safety effects of this protocol are in the process of being examined in a randomised controlled trial.
Publisher: Wiley
Date: 09-02-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-04-2020
Publisher: S. Karger AG
Date: 2019
DOI: 10.1159/000499965
Abstract: b i Background and Objectives: /i /b Kidney disorders in pregnancy may be under-recognized and have variable impact on outcomes depending on diagnosis. Population-level data are limited, particularly for Australia, and comparison of impact of different kidney disorders on pregnancy has rarely been assessed. This study examined the prevalence and outcomes of varied kidney disorders using population-level perinatal data from a large cohort. b i Methods: /i /b Women with singleton pregnancies & #x3e 20 weeks’ gestation from the South Australian Pregnancy Outcomes Unit (1990–2012). Women with a kidney disorders diagnostic code were grouped into categories (immunological, cystic/genetic, urological, vesicoureteral reflux (VUR), pyelonephritis and “other”). Key pregnancy outcomes were assessed, with adjustment for demographic variables. b i Results: /i /b Kidney disorders were reported in 1,392 (0.3%) of 407,580 births. These pregnancies had increased risk of pregnancy-induced hypertension (OR 2.16, 95% CI 1.82–2.56), induction of labor (RRR vs. spontaneous birth 2.10, 95% CI 1.87–2.36), all Caesarean section (OR 1.31, 95% CI 1.17–1.47) as well as Caesarean section without labor (RRR 1.82, 95% CI 1.57–2.10), preterm birth (& #x3c 37 weeks 2.76, 95% CI 2.40–3.18), low birth weight (& #x3c 2,500 g) infants (OR 2.43, 95% CI 2.07–2.84), and neonatal intensive care admission (OR 2.64, 95% CI 2.12–3.29). Diagnostic subgroups demonstrated differing patterns of adverse outcomes, enabling the development of a matrix of risk. Women with immunological renal conditions and VUR had greatest risk overall, and only women with immunological diseases had increased risk of small-for-gestational age & #x3c 10th centile (OR 2.36, 95% CI 1.26–4.42). Women with nonchronic urological conditions and pyelonephritis had increased risk of preterm birth, but not other adverse events. VUR conferred particularly increased risk of Caesarean section and induced labor. b i Conclusions: /i /b In a cohort of & #x3e 1,300 women with varied kidney disorders, increased adverse obstetric and perinatal events were observed, and the nature and magnitude of risk differed according to diagnosis. In particular, vesicoureteric reflux is not a benign condition in pregnancy. Women with nonchronic conditions still had increased risk of preterm birth. We confirm that women with kidney disorders warrant vigilant and tailored prepregnancy care and clinical care in pregnancy.
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.NEULET.2013.03.059
Abstract: To determine if oxidative stress and inflammation are linked with major depressive disorder, nicotine dependence and both disorders combined. This study comprised 150 smokers and 191 never smokers. The instruments were: a socio-demographic questionnaire, diagnoses of mood disorder and nicotine dependence according to DSM-IV, (SCID-IV), and the Alcohol, Smoking and Substance Involvement Screening Test. Laboratory assessments included: nitric oxide metabolites (NOx), lipid hydroperoxides, malondialdehyde (MDA), total reactive antioxidant potential (TRAP), advanced oxidation protein products (AOPP), fibrinogen concentrations, homocysteine, erythrocytes sedimentation rate (ESR) and high-sensitivity C-reactive protein (hs-CRP) were assayed from blood specimens. Statistically significant differences were found among depressed smokers who had more severe depressive symptoms, a higher risk of alcohol consumption, more suicide attempts, and more disability for work than non-depressed never smokers. Depressed smokers had significantly higher levels of NOx, fibrinogen, hs-CRP, AOPP, ESR and lower levels of TRAP compared to non-depressed never smokers. Depressed smokers had significant levels of oxidative stress and inflammatory biomarkers after adjusting for gender, age, years of education, disability for work, and laboratory measures. The levels of NOx, lipid hydroperoxides, AOPP, and fibrinogen were substantially higher, whereas levels of TRAP were lower in depressed smokers compared to non-depressed never smokers. (1) Depressed smokers exhibited altered concentrations of NOx, lipid hydroperoxides, AOPP, TRAP, and fibrinogen. (2) Depressed smokers were more unable to work, showed more severe depressive symptoms and attempted suicide more frequently.
Publisher: Elsevier BV
Date: 04-2010
DOI: 10.1111/J.1753-6405.2010.00495.X
Abstract: To investigate the temporal relationship between the monthly count of salmonellosis notifications and the monthly average temperature in New Zealand during the period 1965-2006. A negative binomial regression model was used to analyse monthly average ambient temperature and salmonellosis notifications in New Zealand between 1965 and 2006. A 1°C increase in monthly average ambient temperature was associated with a 15% increase in salmonellosis notifications within the same month (IRR 1.15 95% CI 1.07 - 1.24). The positive association found in this study between temperature and salmonellosis notifications in New Zealand is consistent with the results of studies conducted in other countries. New Zealand is projected to experience an increase in temperature due to climate change. Therefore, all other things being equal, climate change could increase salmonellosis notifications in New Zealand. This association between temperature and salmonellosis should be considered when developing public health plans and climate change adaptation policies. Strategically, existing food safety programs to prevent salmonellosis could be intensified during warmer periods. As the association was strongest within the same month, focusing on improving food handling and storage during this time period may assist in climate change adaptation in New Zealand.
Publisher: Wiley
Date: 05-2017
DOI: 10.1111/BDI.12486
Abstract: Many people experience irritability when manic, hypomanic, or depressed, yet its impact on illness severity and quality of life in bipolar and schizoaffective disorders is poorly understood. This study aimed to examine the relationship between irritability and symptom burden, functioning, quality of life, social support, suicidality, and overall illness severity in a naturalistic cohort of people with bipolar I or schizoaffective disorder. We used data from 239 adult outpatients with bipolar I or schizoaffective disorder in the Bipolar Comprehensive Outcomes Study (BCOS) - a non-interventional observational study with a 2-year follow-up period. Baseline demographic and clinical characteristics of participants with and without irritability were compared. A mixed-model repeated measures analysis was conducted to examine the longitudinal effect of irritability on clinical and quality-of-life variables over follow-up using significant baseline variables. At baseline, 54% of participants were irritable. Baseline irritability was associated with illness severity, mania, depression, psychotic symptoms, suicidality, poor functioning, and quality of life, but not diagnosis (schizoaffective/bipolar disorder). Participants with irritability were less likely to have a partner and perceived less adequate social support. On average, over follow-up, those with irritability reported more symptoms, functional impairment, and suicidality. Furthermore, the effects of irritability could not be fully explained by illness severity. Irritability was associated with more negative symptomatic, functional, and quality-of-life outcomes and suicidality. The identification, monitoring, and targeted treatment of irritability may be worth considering, to enhance health and wellbeing outcomes for adults with bipolar and schizoaffective disorders.
Publisher: BMJ
Date: 11-2022
DOI: 10.1136/BMJOPEN-2022-066851
Abstract: We aim to establish daily risk estimates of the relationships between grass, tree and weed pollen and asthma health outcomes. Time series regression analysis of exposure and health outcomes using interaction by month to determine risk estimates all year round. Metropolitan Adelaide, South Australia. Health outcomes for asthma are based on 15 years of hospital admissions, 13 years emergency presentations and ambulance callouts. In adults (≥18 years), there were 10 381 hospitalisations, 26 098 emergency department (ED) presentations and 11 799 ambulance callouts and in children (0–17 years), 22 114, 39 813 and 3774, respectively. The cumulative effect of 7 day lags was calculated as the sum of the coefficients and reported as incidence rate ratio (IRR) related to an increase in 10 grains of pollen/m 3 . In relation to grass pollen, children and adults were disparate in their timing of health effects. Asthma outcomes in children were positively related to grass pollen in May, and for adults in October. Positive associations with weed pollen in children was seen from February to May across all health outcomes. For adults, weed pollen-related health outcomes were restricted to February. Adults were not affected by tree pollen, while children’s asthma morbidity was associated with tree pollen in August and September. In children, IRRs ranged from 1.14 (95% CI 1.06 to 1.21) for ED presentations for tree pollen in August to 1.98 (95% CI 1.06 to 3.72) for weed pollen in February. In adults, IRRs ranged from 1.28 (95% CI 1.01 to 1.62) for weed pollen in February to 1.31 (95% CI 1.08 to 1.57) for grass pollen in October. Monthly risk assessment indicated that most pollen-related asthma health outcomes in children occur in the colder part of the year, while adults are affected in the warm season. The findings indicate a need for year-round pollen monitoring and related health c aigns to provide effective public health prevention.
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.YPMED.2013.12.021
Abstract: Most studies on multiple health behaviors include physical inactivity, alcohol, diet, and smoking (PADS), with few including emerging lifestyle risks such as sleep or sitting. We examined whether adding sitting and sleep to a conventional lifestyle risk index improves the prediction of cross-sectional health outcomes (self-rated health, quality of life, psychological distress, and physical function). We also explored the demographic characteristics of adults with these multiple risk behaviors. We used baseline data of an Australian cohort study (n=191,853) conducted in 2006-2008 in New South Wales. Lifestyle risk index was operationalized as 1) PADS, 2) PADS+sitting, 3) PADS+sleep, and 4) PADS+sitting+sleep. We estimated receiver operating characteristic curve for self-reported binary health outcomes and calculated the area under the curve to illustrate how well each index classified the outcome. We used multiple logistic regression to determine the demographic characteristics of adults with multiple lifestyle risks. Adding sleep duration but not sitting time to the PADS index significantly improved the classification of all health outcomes. Men, those aged 45-54years, those with 10 years of education or less, and those living in regional/remote areas had higher odds of multiple risk behaviors. Future research on multiple health behaviors might benefit from including sleep as an additional behavior. In Australia, unhealthy lifestyles tend to cluster in adults with certain demographic characteristics.
Publisher: Cambridge University Press (CUP)
Date: 27-04-2009
DOI: 10.1017/S0950268809002465
Abstract: New Zealand has a higher reported incidence of cryptosporidiosis and giardiasis than most other developed countries. This study aimed to describe and compare the epidemiology of these infections in New Zealand, to better understand their impact on public health and to gain insight into their probable modes of transmission. We analysed cryptosporidiosis and giardiasis notification data for a 10-year period (1997–2006). Highest rates for both diseases were in Europeans, children aged 0–5 years, and those living in low-deprivation areas. Cryptosporidiosis distribution was consistent with mainly farm animal (zoonotic) reservoirs. There was a dose–response relationship with increasing grades of rurality, marked spring seasonality, and positive correlation with farm animal density. Giardiasis distribution was consistent with predominantly human (anthroponotic) reservoirs, with an important contribution from overseas travel. Further research should focus on methods to reduce transmission of Cryptosporidium in rural areas and on reducing anthroponotic transmission of Giardia .
Publisher: Elsevier BV
Date: 07-2023
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.GENHOSPPSYCH.2014.01.009
Abstract: To examine the relationship of poor dental health and depression, controlling for markers of inflammation (C-reactive protein CRP) and adiposity (body mass index BMI). Data from two National Health and Nutrition Examination Surveys (2005-2008) were utilized (n=10214). Dental health was assessed using the Oral Health Questionnaire (OHQ). Depression was measured using the Patient Health Questionnaire-9 (PHQ-9), where cases were identified using a cut off score of 10 or above. Logistic regression was applied to measure magnitude of associations, controlling for a range of covariates including CRP and BMI. After adjustment for covariates, a significant dose-response relationship between number of oral health conditions and likelihood of PHQ-9 defined depression was observed. Compared with in iduals without an oral health condition, adjusted odds ratio (95% confidence interval) for depression in those with two, four and six conditions were 1.60 (1.08-2.38), 2.13 (1.46-3.11) and 3.94 (2.72-5.72), respectively. Level of CRP and being underweight or obese were associated with being depressed. A positive association exists between poor dental health and depression that is independent of CRP and BMI.
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.JAD.2013.05.016
Abstract: There is evidence that depression is accompanied by inflammation, oxidative and nitrosative stress (O&NS) and metabolic disorders. However links between oxidative stress and suicide attempts in depressed patients are poorly understood. This study examines whether a history of suicide attempts is associated with inflammation, O&NS and metabolic disorders. Blood specimens were collected from study participants aged 18-60 (N=342) recruited at the State University of Londrina, Brazil, and measured for oxidative stress biomarkers: nitric oxide metabolites (NOx), lipid hydroperoxides, malondialdehyde, advanced oxidation protein products and plasma total antioxidant potential (TRAP) inflammatory biomarkers: fibrinogen, high-sensitivity C-reactive protein, erythrocyte sedimentation rate, interleukin-6 and tumor necrosis factor-α and metabolic variables. Subjects were ided into those with (n=141) and without (n=201) a history of suicidal attempts. In iduals with a history of suicide attempts had significantly higher levels of NOx and lipid hydroperoxides and lowered TRAP as compared to in iduals without suicide attempts. There were no significant associations between a history of suicide attempts and inflammatory and metabolic biomarkers and metabolic syndrome. Logistic regression showed that both unipolar and bipolar disorder, female gender, smoking behavior and lipid hydroperoxides were significantly associated with a history of suicide attempts. The combined effects of oxidative stress, smoking, depression, female gender were independent from classical risk factors, including marital status, years of education and anxiety. O&NS as well as lowered antioxidant levels may play a role in the pathophysiology of suicidal behavior independently from the effects of depression and smoking, both of which are associated with increased O&NS, and classical suicide predictors, such as years of education and marital status.
Publisher: Springer Science and Business Media LLC
Date: 24-09-2012
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.YPMED.2012.07.022
Abstract: With increasing rates of non-communicable disease, there is a need for implementing population-wide, evidence-based interventions for improving behavioural risk factors. Telephone-based interventions provide one option. This study reports on the evaluation of the Australia's Get Healthy Information and Coaching Service®, to improve lifestyle behaviours, amongst a population-wide s le who completed the 6-month coaching programme. Using a pre-post design, New South Wales participants who completed telephone-based coaching between February 2009 and December 2011 were included. Outcomes comprised self-reported weight, waist circumference, height, physical activity and dietary behaviours. Matched pair analyses and multivariate modelling were performed to assess behavioural changes. Participants (n=1440) reported statistically significant improvements in weight (-3.9 kg (5.1)) waist circumference (-5.0 cm (6.0)) and Body Mass Index (-1.4 BMI units (1.8)) number of walking and moderate-vigorous physical activity sessions of ≥30 min per week number of vigorous physical activity sessions of ≥20 min per week and servings of vegetables fruit take-away meals and sweetened drinks (all p<0.001). Improvements in weight, waist, moderate physical activity, fruit and vegetable and take-away meals consumption remained significant after adjusting for socio-demographic characteristics. These results support the effectiveness of replicating an evidence-based intervention in improving population risk factors for chronic disease.
Publisher: Elsevier BV
Date: 10-2013
Publisher: Oxford University Press (OUP)
Date: 26-08-2015
Abstract: Depression is common after a cardiac event however it often remains untreated. Previously, we reported the efficacy and feasibility of a 6-month tele-health programme (MoodCare), which integrates depression management into a cardiovascular disease (CVD) risk reduction programme for Acute Coronary Syndrome (ACS) patients with low mood. Here, we evaluate the long-term efficacy of the programme at 12-month follow-up. A two-arm, parallel, randomized design to compare the long-term effects of 'MoodCare' (n = 61) to usual care (UC) (n = 60) at 12 months. 121 ACS patients recruited from six hospitals in Victoria and Brisbane, Australia were randomized to a telephone-delivered cognitive behavioural therapy and risk-reduction programme or usual medical care. Mixed-model repeated measurements (MMRM) analysis was applied with results expressed as estimated marginal mean changes in depression and health-related quality of life (HRQOL) outcomes by group. After 12 months, treatment effects were observed for those with major depressive disorder (MDD) for PHQ-9 depression (MoodCare: mean score: 6.5 95% CI: 4.9-8.0 versus UC: 9.3 95% CI: 7.7-10.9, p = 0.012)) and SF-12 mental health scores (MoodCare: 42.5 95% CI: 39.8-45.2 versus UC: 36.8 95% CI: 34.1-39.6, p = 0.005). No beneficial treatment effects were observed in those with no MDD at baseline. After 12 months, MoodCare was superior to UC for improving mental health outcomes for those with a clinical diagnosis of major depression. Our findings support the implementation of depression-based interventions for cardiac patients with a clinical diagnosis of depression and provide evidence of longer term efficacy to one year.
Publisher: PUBLISHED BY IMPERIAL COLLEGE PRESS AND DISTRIBUTED BY WORLD SCIENTIFIC PUBLISHING CO.
Date: 12-2002
Publisher: BMJ
Date: 08-2008
Abstract: Tuberculosis (TB) remains an important infectious disease in New Zealand (NZ) and globally, but risk factors for transmission are still poorly understood. This research aimed to identify whether household crowding contributes to TB transmission in NZ. This ecological study used TB surveillance and census data to calculate TB incidence rates by census area unit (CAU). Census data were used to determine CAU characteristics including proportion of household crowding (a bedroom deficit of one or more), proportion of population who are migrants born in high-TB-incidence countries, median household income, and deprivation level. A negative binomial regression model was used to estimate the association between TB incidence and household crowding. The analysis included 1898 notified TB cases for the 2000-4 period. Univariate analysis showed TB incidence at the CAU level was associated with household crowding, for the total population and for all ethnic and age groups. After adjusting for the covariates of household income, existing TB burden, and proportion of migrants from high-TB-incidence countries, multivariate analysis showed statistically significant associations between TB incidence and household crowding. The incidence rate ratio (IRR) was 1.05 (95% CI 1.02 to 1.08) in the total population and 1.08 (95% CI 1.04 to 1.12) for NZ-born people <40 years. At the CAU level, TB incidence in NZ is associated with household crowding. An in idual-based study (e.g. case-control) in recently infected cases (detected by molecular epidemiology techniques) is suggested to complement these findings. Reducing or eliminating household crowding could decrease TB incidence in NZ and globally.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
DOI: 10.1097/AOG.0000000000002419
Abstract: To describe long-term trends in the prevalence of preterm birth and rates of preterm birth in singleton pregnancies complicated by hypertensive disorders of pregnancy, small for gestational age (SGA), and preterm prelabor rupture of membranes (PROM) in South Australia. We conducted a retrospective population study including all singleton live births in the state of South Australia from 1986 to 2014. Long-term trends for preterm birth, hypertensive disorders of pregnancy, SGA, preterm PROM as well as stillbirth were assessed using joinpoint regression analyses. Trends in maternal age, body mass index (BMI), ethnic ersity, parity, and smoking over time were also assessed. From 1986 to 2014, with a total of 539,234 singleton births, the overall preterm birth rates increased from 5.1% to 7.1% ( P .001) and for iatrogenic preterm birth increased from 1.6% to 3.2% ( P .001). The incidence of hypertensive disorders of pregnancy decreased from 8.7% to 7.2%. Among pregnancies complicated by hypertensive disorders of pregnancy, the proportion of preterm birth increased (10.4–17.5%, P .001). The incidence of SGA decreased from 11.1% to 8.0%. Among pregnancies complicated by SGA, the proportion of preterm birth increased (2.9–5.4%, P .001). The incidence of preterm PROM increased from 1.4% to 2.2%. Among pregnancies complicated by preterm PROM, the proportion of preterm birth remained stable. Preterm stillbirth rates declined (4.23–2.32%, P .001). Maternal age, BMI, and ethnic ersity have all increased since 1986, whereas maternal smoking has decreased. In South Australia, the preterm birth rate among singletons increased from 1986 to 2014 by 40%, with iatrogenic preterm birth being responsible for 80% of this increase. Incidence of hypertensive disorders of pregnancy and SGA declined. Among pregnancies complicated by hypertensive disorders of pregnancy and SGA, the proportions of preterm birth increased, indicating earlier interventions in these women. The diagnosis of preterm PROM increased from 1% to 2%, and greater than 80% of preterm PROM was associated with preterm birth after 1990. Increasing iatrogenic delivery may be attributable, in part, to changing maternal phenotype and to altered clinicians' behavior. However, improvements in fetal surveillance, particularly ultrasonography, and advanced neonatal care may underpin perinatal clinical decision-making and the likelihood of iatrogenic birth.
Publisher: Wiley
Date: 10-2008
DOI: 10.1111/J.1440-1754.2008.01384.X
Abstract: Acute rheumatic fever (ARF) and its sequela chronic rheumatic heart disease remain significant causes of morbidity and mortality in New Zealand, particularly among Māori and Pacific peoples. Despite its importance, ARF epidemiology has not been reviewed recently. The aims of this study were to assess trends in ARF incidence rates between 1996 and 2005 and the extent to which ARF is concentrated in certain populations based on age, sex, ethnicity and geographical location. This descriptive epidemiological study examined ARF incidence rates using hospitalisation data (1996-2005) and population data from the 1996 and 2001 censuses. Rates were compared by using rate ratios and 95% confidence intervals. New Zealand's annual ARF rate was 3.4 per 100,000. ARF was concentrated in certain populations: 5- to 14-year-olds, Māori and Pacific peoples and upper North Island areas. From 1996 to 2005, the New Zealand European and Others ARF rate decreased significantly while Māori and Pacific peoples' rates increased. Compared with New Zealand European and Others, rate ratios were 10.0 for Māori and 20.7 for Pacific peoples. Of all cases, 59.5% were Māori or Pacific children aged 5-14 years, yet this group comprised only 4.7% of the New Zealand population. ARF rates in New Zealand have failed to decrease since the 1980s and remain some of the highest reported in a developed country. There are large, and now widening, ethnic disparities in ARF incidence. ARF is so concentrated by age group, ethnicity and geographical area that highly targeted interventions could be considered, based on these characteristics.
Publisher: Oxford University Press (OUP)
Date: 02-02-2016
DOI: 10.1093/IJNP/PYW008
Publisher: Oxford University Press (OUP)
Date: 26-02-2014
DOI: 10.1007/S12160-014-9592-0
Abstract: Depression is common after a cardiac event, yet there remain few approaches to management that are both effective and scalable. We aimed to evaluate the 6-month efficacy and feasibility of a tele-health program (MoodCare) that integrates depression management into a cardiovascular disease risk reduction program for acute coronary syndrome patients with low mood. A two-arm, parallel, randomized design was used comprising 121 patients admitted to one of six hospitals for acute coronary syndrome. Significant treatment effects were observed for Patient Health Questionnaire 9 (PHQ9) depression (mean difference [change] = -1.8 p = 0.025 effect size: d = 0.36) for the overall s le, when compared with usual medical care. Results were more pronounced effects for those with a history of depression (mean difference [change] = -2.7 p = 0.043 effect size: d = 0.65). MoodCare was effective for improving depression in acute coronary syndrome patients, producing effect sizes exceeding those of some face-to-face psychotherapeutic interventions and pharmacotherapy. ( ACTRN1260900038623.).
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.LFS.2014.02.033
Abstract: This study examined whether Castelli risk indexes 1 (total/high-density lipoprotein (HDL) cholesterol) and 2 (low density lipoprotein (LDL)/HDL cholesterol) and other shared metabolic disorders might underpin the pathophysiology of the metabolic syndrome, major depression or bipolar disorder. This cross-sectional study examined 92 major depressed, 49 bipolar depressed and 201 normal controls in whom the Castelli risk indexes 1 and 2 and key characteristics of the metabolic syndrome, i.e. waist/hip circumference, body mass index (BMI), systolic/diastolic blood pressure, total cholesterol, low-density lipoprotein (LDL) and HDL cholesterol, triglycerides, insulin, glucose, hemoglobin A1c (HbA1c) and homocysteine were assessed. Castelli risk indexes 1 and 2 were significantly higher in major depressed patients than in bipolar disorder patients and controls. There were no significant differences in waist or hip circumference, total and LDL cholesterol, triglycerides, plasma glucose, insulin, homocysteine and HbA1c between depression and bipolar patients and controls. Bipolar patients had a significantly higher BMI than major depressed patients and normal controls. Major depression is accompanied by increased Castelli risk indexes 1 and 2, which may be risk factors for cardiovascular disease. Other key characteristics of the metabolic syndrome, either metabolic biomarkers or central obesity, are not necessarily specific to major depression or bipolar disorder.
Publisher: Springer Science and Business Media LLC
Date: 23-01-2020
DOI: 10.1038/S41598-020-57704-5
Abstract: Cancer stage at diagnosis is an important gap for Australian population based cancer registries. The study aims to understand the quality and completeness of three different collections of cancer staging data. The South Australian Cancer Registry data collection for breast and colorectal cancer (CRC) cases diagnosed in 2011, was linked to Registry Derived Stage (RDS) data, pathology plus hospital metastasis codes (pathology stage), and the South Australian Clinical Cancer Registry Stage (SACCR stage). The agreement between staging systems was examined using kappa statistics. Kaplan-Meier curves and Cox regression were used to examine the difference in survival by staging methods. Among 2,530 breast and CRC cases 98.8% were stageable (n = 2,500) according to histology. Among stageable cases, 84.6% had RDS, 51.2% had pathology stage and 29.5% had SACCR stage. The kappa statistic for RDS and pathology stage was 0.930 for breast cancer and 0.973 for CRC, and 0.574 for RDS and SACCR stage for breast cancer and 0.632 for CRC. The agreement between pathology stage and SACCR stage was 0.430 for breast cancer and 0.528 for CRC. The distribution of stage was similar across staging methods, although more stage four cancers by pathology stage, and survival patterns were similar but not the same. The agreement was high between different staging systems. Pathology stage had a higher than expected stage 4 proportion. This study highlights an opportunity to collect stage information in a cost-effective manner, while collecting data that usefully represent stage at diagnosis across the population, for population based epidemiological analyses.
Publisher: IWA Publishing
Date: 09-03-2010
DOI: 10.2166/WH.2010.049
Abstract: Aim: To investigate the spatial relationship between climate variability and cryptosporidiosis and giardiasis notifications in New Zealand between 1997 and 2006. Methods: Negative binomial regression was used to analyse spatial relationships between cryptosporidiosis and giardiasis notifications in New Zealand between 1997 and 2006, and climatological average rainfall and temperature at the Census Area Unit (CAU) level. The quality of domestic water supplies, urban-rural status and deprivation were included as covariates. Main results: Giardiasis: There was a positive association between rainfall and giardiasis and between temperature and giardiasis. Cryptosporidiosis: There was a positive association between rainfall and cryptosporidiosis and a negative association between temperature and cryptosporidiosis. The effect of rainfall was modified by the quality of the domestic water supply. Conclusions: These findings suggest that climate variability affects protozoan disease rates in New Zealand. However, predicting the effect of climate change from this study is difficult, as these results suggest that the projected increases in temperature and rainfall may have opposing effects on cryptosporidiosis rates. Nevertheless, water supply quality appeared to modify the impact of increased rainfall on cryptosporidiosis rates. This finding suggests that improving water supply quality in New Zealand could reduce vulnerability to the impact of climate change on protozoan diseases.
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/HE12201
Abstract: Despite recognition that urban infrastructure influences physical activity, there have been no comparisons between Australian city-level patterns of physical activity. This study ranked Australian cities in terms of adults' participation in leisure-time physical activity and examined city-level variations in activity trends between 2001 and 2009. Data on participation in leisure-time physical activity in adults (≥15 years) between 2001 and 2009 were obtained from the Exercise Recreation and Sport Survey (ERASS), a computer-assisted telephone interview conducted to collect population-level sport participation information by the Australian Sports Commission. Data were analysed for respondents residing in the eight capital cities of Australia. The prevalence of meeting recommended 'health-enhancing physical activity' (HEPA) and levels of walking were calculated by age, gender and survey year. Multiple linear logistic regression analyses were used to compare cities. Pooled data from 174,323 adults across years showed that Melbourne, Brisbane, Perth and Canberra residents were significantly more active than Sydney, Adelaide and Hobart residents in terms of HEPA. Hobart, Perth and Melbourne residents were significantly more likely to walk ≥5 sessions a week compared with their counterparts in other cities. HEPA and walking increased across most cities between 2001 and 2009. There are significant differences between Australian cities in physical activity and walking levels, over and above differences attributable to age, gender or educational levels. While this may be due to infrastructure differences, comparative information on indicators of the built environment and transport infrastructure are not available.
Publisher: Physicians Postgraduate Press, Inc
Date: 27-05-2015
DOI: 10.4088/JCP.14L09378
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Publisher: SAGE Publications
Date: 28-11-2018
Abstract: To describe changes in the place of death of patients with cancer from 1990 to 2012, and to identify issues for their end-of-life care. Population-based descriptive study, with analyses of place of death patterns, using the South Australian Cancer Registry records of 86 257 patients with cancer who died from 1990 to 2012. From 1990 to 2012, the proportion of cancer deaths in hospital decreased from 63.4% to 50.9%, and in nursing homes increased from 8.2% to 22.5%. After the year 2000, the proportions in hospices and at home were both below 15%. Multivariate analyses showed that young patients with cancer were more likely to die in a hospice or at home, compared to elderly patients with cancer who were more likely to die in a nursing home the likelihood of dying in a hospice increased with socioeconomic status patients with a short survival time or a hematological malignancy were more likely to die in a metropolitan hospital. Compared to most other countries, the proportion of cancer deaths at home was low, and many patients would not have died at their preferred place. The trend for more cancer deaths to occur in nursing homes is likely to continue, but nursing homes generally lack the resources and skilled staff to provide quality palliative care. Models of palliative care delivery should take account of patient preferences, the growth of terminal cancer care in nursing homes, and apparent inequities.
Publisher: Informa UK Limited
Date: 06-2011
DOI: 10.3109/17477166.2010.517313
Abstract: This study evaluated the impact of the Australian Food and Grocery Council (AFGC) self-regulatory initiative on unhealthy food marketing to children, introduced in January 2009. The study compared patterns of food advertising by AFGC and non-AFGC signatory companies in 2009, 2007 and 2006 on three Sydney commercial free-to-air television channels. Data were collected across seven days in May 2006 and 2007, and four days in May 2009. Advertised foods were coded as core, non-core and miscellaneous. Regression for counts analyses was used to examine change in rates of advertisements across the s led periods and differential change between AFGC-signatory or non-signatory companies between 2007 and 2009. Of 36 food companies that advertised during the 2009 s le period, 14 were AFGC signatories. The average number of food advertisements decreased significantly from 7.0 per hour in 2007 to 5.9 in 2009. There was a significant reduction in non-core food advertising from 2007 to 2009 by AFGC signatories compared with non-signatory companies overall and during peak times, when the largest numbers of children were viewing. There was no reduction in the rate of non-core food advertisements by all companies, and these advertisements continue to comprise the majority during peak viewing times. While some companies have responded to pressures to reduce unhealthy food advertising on television, the impact of the self-regulatory code is limited by the extent of uptake by food companies. The continued advertising of unhealthy foods indicates that this self-regulatory code does not adequately protect children.
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.JSAMS.2011.10.009
Abstract: Public health recommendations for older adults highlight the need to engage in a combination of aerobic, muscle strength, flexibility and balance activities. This study characterised leisure time physical activity in older Australians (≥ 65 years), examining the ersity in reported activities Cross-sectional monitoring. The Exercise Recreation and Sport Surveys (2001-2009) were combined and analysed for 22,050 elderly. Walking was reported by 45.6%, of those 53% engaged exclusively in walking. Prevalent sports (i.e., >1%) were bowls (9.4%), aerobics/callisthenics exercise (9.1%), golf (7.7%), swimming (6.4%), gym work (5.2%), cycling (3.2%), tennis (2.9%), dancing (2.1%), fishing (2.0%), tai chi (1.4%), weight lifting (1.2%) and yoga (1.1%). Significant gender differences were apparent. Over time, significant increases were reported in walking, aerobic/callisthenics and gym workout in both genders. In the previous year, 32.0% of older adults participated in "nil" activity, 40.6% engaged in one activity, 19.5% and 8.0% participated in two or three or more activities, respectively. Common combinations were walking with another aerobic activity. Only 2.6% reported a combination of aerobic, balance and strength activities. Multiple-activity participation increased over the years, but declined with increasing age, education and for the most disadvantaged, compared to single-activity participation. Partially or exclusively organised participation, combined, was reported by 42.5% of older adults. Women were more likely to combine mode of participation. Geographic region was associated with multiple-activity participation and organised-only participation. Most elderly people engage in one activity, if at all. An increase in participation in balance enhancing activities and weight training is warranted to maximize health benefits.
Publisher: Elsevier BV
Date: 04-2023
Publisher: Oxford University Press (OUP)
Date: 10-10-2011
DOI: 10.1093/HER/CYR091
Abstract: To address increasing rates of overweight and obesity, a population-based telephone intervention was introduced in New South Wales, Australia. The Get Healthy Information and Coaching Service® (GHS) offered participants a 6-month coaching program or detailed self-help information. Determining the population reach of GHS is of public health importance to ensure that the program reaches disadvantaged groups. This paper describes the socio-demographic and risk profile of participants (n = 4828) in the first 18 months of operations, determines how representative they are of the population, assesses changes in participants' socio-demographic profile and compares 'information-only' and 'coaching' participants. The results show that GHS users are representative of the adult population in relation to education, employment status, Aboriginal status, fruit and vegetable consumption and alcohol use. However, more female, middle-aged, English-speaking, rural and socially disadvantaged adults participated in GHS. Coaching Participants were more likely to be overweight and to be ex-smokers than the general population. There was substantial variability in GHS recruitment, when mass-reach television advertising was used, participants enrolled from a major city and from more disadvantaged communities. The GHS has broader population reach than many local interventions, but further efforts are needed to increase reach by Aboriginal communities, other minorities and men.
Publisher: Springer Science and Business Media LLC
Date: 16-08-2018
DOI: 10.1007/S00484-018-1593-4
Abstract: Heatwaves can be a common occurrence in Australia, and the public health impacts can be severe. Heat warnings and interventions are being adopted widely to reduce the preventable health impacts. This study examines the effects of heatwaves on morbidity and mortality in different climatic regions in the state of South Australia, to inform the targeting of heat warnings according to regional needs. Heatwaves were defined using the excess heat factor (EHF), an index based on mean daily temperature indices that quantifies heatwave severity relative to the local climate. In all regions, there were increases in morbidity (daily rates of ambulance call-outs and heat-related emergency presentations and hospital admissions) on heatwave days compared to non-heatwave days, which increased with heatwave severity. This study demonstrates that a consistent measure for heatwave severity, based on EHF, can be used to underpin public health warnings for climatically erse areas.
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1016/J.JINF.2011.07.019
Abstract: Because of concerns following necrotizing fasciitis (NF) reports in the media, we aimed to describe the incidence, mortality, case fatality and distribution of NF in New Zealand (NZ). By using International Classification of Disease codes to identify NF cases we analyzed the national hospital discharge and mortality data and reviewed 299 charts from 8 hospitals. The sensitivity and positive predictive value (PPV) of the hospital discharge data were calculated by comparing with the mortality dataset and chart review finding respectively. Between 1990 and 2006 there was a highly significant rise in annual incidence and mortality rates of NF from 0.18 to 1.69 and from 0 to 0.3 per 100,000 person-years respectively. The causes of this increase are unknown, and were not related to 2004 coding changes for NF. Hospital discharge data had a PPV of 82.6% and sensitivity of 76.8%. The case fatality was 20.8%. Disease risk was highest in the elderly, males, and Pacific and Maori populations. These findings suggest that incidence and mortality of NF are increasing in NZ. Further work is needed to investigate the causes of this increase and the marked ethnic inequalities in disease rates, particularly factors that may be preventable.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.PNPBP.2014.10.002
Abstract: Schizophrenia is a chronic and often debilitating disorder in which stage of illness appears to influence course, outcome, prognosis and treatment response. Current evidence suggests roles for oxidative, neuroinflammatory, neurotrophic, apoptotic, mitochondrial and glutamatergic systems in the disorder all targets of N-acetyl cysteine (NAC). A double blind, placebo controlled trial suggested NAC to be beneficial to those diagnosed with schizophrenia. The current manuscript aims to investigate duration of the illness as a key factor that may be modulating the response to NAC in the participants who took part in the study. A s le of 121 participants were randomised in a double fashion to 24 weeks (placebo=62 NAC=59). Clinical and functional variables were collected over the treatment period. Duration of the illness at baseline was grouped into <10 years, 10- 20 years. Mixed Model Repeated Measures Analysis was used to explore the effect of illness duration on response to treatment with NAC. A significant interaction between duration of the illness and response to treatment with NAC was consistently found for positive symptoms and functional variables, but not for negative or general symptoms or for side effect related outcomes. The pattern of changes suggests that this mediator effect of duration of illness in response to treatment is more evident in those participants with 20 years or more of illness duration. Our results suggest a potential advantage of adjunctive NAC over placebo on functioning and positive symptoms reduction in those patients with chronic schizophrenia. This has potential for suggesting stage specific treatments.
Publisher: Elsevier BV
Date: 08-2021
Publisher: BMJ
Date: 2012
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.COMPPSYCH.2014.05.009
Abstract: The aim of this study was to evaluate the health-related quality of life (HRQoL) in bipolar type I (BD I) and schizoaffective (SQA) patients during a 2-year period in a naturalistic study. This study was based on the data generated by the Bipolar Comprehensive Outcome Study, a prospective, non-interventional, observational study of participants with BD I and SQA disorder. Mixed-Model Repeated Measures Analysis was used to analyze changes in the SF-36 and EQ-5D. Participants exhibited low health status at baseline with SF-36 mean scores of 46.7±10.5 and 36.9±12.9 (best imaginable health=100, normal population≈50) for physical and mental components, respectively. No significant differences were found between the ratings of the BD I and SQA patients on HRQoL. The SF-36 SMC improved significantly over 24 months although SPC scores remained consistent across the study. On the whole, the lowest SMC score was observed among the depressed patients (38.20), followed by the patients with a mixed state (39.01) and the manic patients (39.83). The observational design may have limited the causal relationships and the generalizability within the current findings. HRQoL was significantly impaired in all stages of BD and SQA when compared to the general population. The impairment of HRQoL was most pronounced in the depressed state, followed by the mixed state and then the manic state. The euthymic patients showed the least impairment. In addition, patients showed a global improvement in their mental health satisfaction over the 2 years follow up period.
Publisher: Hindawi Limited
Date: 2013
DOI: 10.1155/2013/109841
Abstract: Outdoor recreational spaces have the potential to increase physical activity. This study used a quasi-experimental evaluation design to determine how a playground renovation impacts usage and physical activity of children and whether the visitations correlate with children’s physical activity levels and parental impressions of the playground. Observational data and intercept interviews were collected simultaneously on park use and park-based activity among playground visitors at pre- and postrenovation at an intervention and a comparison park during three 2-hour periods each day over two weeks. No detectable difference in use between parks was observed at followup. In the intervention park, attendance increased among boys, but decreased among girls although this (nonsignificant) decline was less marked than in the comparison park. Following renovation, there was no detectable difference between parks in the number of children engaged in MVPA (interaction between park and time: P = 0.73 ). At the intervention park, there was a significant decline in girls engaging in MVPA at followup ( P = 0.04 ). Usage was correlated with parental/carer perceptions of playground features but not with physical activity levels. Renovations have limited the potential to increase physical activity until factors influencing usage and physical activity behavior are better understood.
No related grants have been discovered for Kamalesh Venugopal.