ORCID Profile
0000-0003-1073-3614
Current Organisation
Australian Catholic University
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Publisher: MDPI AG
Date: 06-04-2020
Abstract: Mothers of preschoolers (3 to 5 years old) risk being physically inactive. This study aimed to examine associations between socioeconomic status (education, employment, income) and moderate to vigorous physical activity (MVPA) among mothers of preschoolers in Hong Kong. Family functioning (e.g., having a domestic helper, ision of household chores and child-related activities) was explored as a potential mediator of associations between socioeconomic indicators and the mother’s self-reported MVPA. Using zero-inflated negative binomial modelling confounder-adjusted associations between socioeconomic indicators and MVPA (total effects) were estimated. Mediation analyses (joint-significance test) were also performed. Using generalized linear mixed models, intermediate pathways were identified. No significant total effects of any socioeconomic indicator on the mother’s MVPA were found. However, mediation analyses identified a complex network of inconsistent mediators partly explaining their associations via eight pathways. Also, whilst non-residents/extended family playing with the child(ren) was not associated with any socioeconomic indicator, this was negatively associated with the mother’s MVPA. A further pathway was mediated by the mother playing with her child(ren). Extended family playing with the child(ren) was inversely associated with the mother doing so. Associations between socioeconomic indicators and MVPA among preschoolers’ mothers are complex and inconsistent, requiring further investigation in erse contexts. Encouraging active play with their preschoolers may increase mothers’ physical activity levels.
Publisher: Springer Science and Business Media LLC
Date: 14-02-2008
Publisher: SAGE Publications
Date: 09-03-2017
Abstract: It is known that some people can, and do, sustain injury over a playing season. However, there is currently little high-quality epidemiological evidence about the risk of, and relationships between, multiple and subsequent injuries. To describe the subsequent injuries sustained by Australian Football League (AFL) players over 1 season, including their most common injury diagnoses. Cohort study Level of evidence, 3. Within-player linked injury data on all date-ordered match-loss injuries sustained by AFL players during 1 full season were obtained. The total number of injuries per player was determined, and in those with injury, the Subsequent Injury Classification (SIC) model was used to code all subsequent injuries based on their Orchard Sports Injury Classification System (OSICS) codes and the dates of injury. There were 860 newly recorded injuries in 543 players 247 players (45.5%) sustained ≥1 subsequent injuries after an earlier injury, with 317 subsequent injuries (36.9% of all injuries) recorded overall. A subsequent injury generally occurred to a different body region and was therefore superficially unrelated to an index injury. However, 32.2% of all subsequent injuries were related to a previous injury in the same season. Hamstring injuries were the most common subsequent injury. The mean time between injuries decreased with an increasing number of subsequent injuries. When relationships between injuries are taken into account, there is a high level of subsequent (and multiple) injuries leading to missed games in an elite athlete group.
Publisher: BMJ
Date: 14-09-2019
DOI: 10.1136/BJSPORTS-2018-099488
Abstract: Exercise-training programmes have reduced lower limb injuries in trials, but their population-level effectiveness has not been reported in implementation trials. This study aimed to demonstrate that routinely collected hospital data can be used to evaluate population-level programme effectiveness. A controlled ecological design was used to evaluate the effect of FootyFirst, an exercise-training programme, on the number of hospital-treated lower limb injuries sustained by males aged 16–50 years while participating in community-level Australian Football. FootyFirst was implemented with ‘support’ (FootyFirst+S) or ‘without support’ (FootyFirst+NS) in different geographic regions of Victoria, Australia: 22 clubs in region 1: FootyFirst+S in 2012/2013 25 clubs in region 2: FootyFirst+NS in 2012/2013 31 clubs region 3: control in 2012, FootyFirst+S in 2013. Interrupted time-series analysis compared injury counts across regions and against trends in the rest of Victoria. After 1 year of FootyFirst+S, there was a non-statistically significant decline in the number of lower limb injuries in region 1 (2012) and region 3 (2013) this was not maintained after 2 years in region 1. Compared with before FootyFirst in 2006–2011, injury count changes at the end of 2013 were: region 1: 20.0% reduction (after 2 years support) region 2: 21.5% increase (after 2 years without support) region 3: 21.8% increase (after first year no programme, second year programme with support) rest of Victoria: 12.6% increase. Ecological analyses using routinely collected hospital data show promise as the basis of population-level programme evaluation. The implementation and sustainability of sports injury prevention programmes at the population-level remains challenging.
Publisher: SAGE Publications
Date: 04-12-2015
Abstract: Cluster randomised crossover trials have been utilised in recent years in the health and social sciences. Methods for analysis have been proposed however, for binary outcomes, these have received little assessment of their appropriateness. In addition, methods for determination of s le size are currently limited to balanced cluster sizes both between clusters and between periods within clusters. This article aims to extend this work to unbalanced situations and to evaluate the properties of a variety of methods for analysis of binary data, with a particular focus on the setting of potential trials of near-universal interventions in intensive care to reduce in-hospital mortality. We derive a formula for s le size estimation for unbalanced cluster sizes, and apply it to the intensive care setting to demonstrate the utility of the cluster crossover design. We conduct a numerical simulation of the design in the intensive care setting and for more general configurations, and we assess the performance of three cluster summary estimators and an in idual-data estimator based on binomial-identity-link regression. For settings similar to the intensive care scenario involving large cluster sizes and small intra-cluster correlations, the s le size formulae developed and analysis methods investigated are found to be appropriate, with the unweighted cluster summary method performing well relative to the more optimal but more complex inverse-variance weighted method. More generally, we find that the unweighted and cluster-size-weighted summary methods perform well, with the relative efficiency of each largely determined systematically from the study design parameters. Performance of in idual-data regression is adequate with small cluster sizes but becomes inefficient for large, unbalanced cluster sizes. When outcome prevalences are 6% or less and the within-cluster-within-period correlation is 0.05 or larger, all methods display sub-nominal confidence interval coverage, with the less prevalent the outcome the worse the coverage. As with all simulation studies, conclusions are limited to the configurations studied. We confined attention to detecting intervention effects on an absolute risk scale using marginal models and did not explore properties of binary random effects models. Cluster crossover designs with binary outcomes can be analysed using simple cluster summary methods, and s le size in unbalanced cluster size settings can be determined using relatively straightforward formulae. However, caution needs to be applied in situations with low prevalence outcomes and moderate to high intra-cluster correlations.
Publisher: Wiley
Date: 04-01-2018
DOI: 10.1111/DAR.12653
Publisher: Elsevier BV
Date: 07-2020
Publisher: Springer Science and Business Media LLC
Date: 21-04-2022
Publisher: BMJ
Date: 23-09-2015
Publisher: MDPI AG
Date: 02-09-2022
Abstract: The environment we live in, and our lifestyle within this environment, can shape our cognitive health. We investigated whether sociodemographic, neighbourhood environment, and lifestyle variables can be used to predict cognitive health status in adults. Cross-sectional data from the AusDiab3 study, an Australian cohort study of adults (34–97 years) (n = 4141) was used. Cognitive function was measured using processing speed and memory tests, which were categorized into distinct classes using latent profile analysis. Sociodemographic variables, measures of the built and natural environment estimated using geographic information system data, and physical activity and sedentary behaviours were used as predictors. Machine learning was performed using gradient boosting machine, support vector machine, artificial neural network, and linear models. Sociodemographic variables predicted processing speed (r2 = 0.43) and memory (r2 = 0.20) with good accuracy. Lifestyle factors also accurately predicted processing speed (r2 = 0.29) but weakly predicted memory (r2 = 0.10). Neighbourhood and built environment factors were weak predictors of cognitive function. Sociodemographic (AUC = 0.84) and lifestyle (AUC = 0.78) factors also accurately classified cognitive classes. Sociodemographic and lifestyle variables can predict cognitive function in adults. Machine learning tools are useful for population-level assessment of cognitive health status via readily available and easy-to-collect data.
Publisher: BMJ
Date: 25-03-2016
Publisher: Wiley
Date: 27-04-2016
DOI: 10.1002/ACR.22744
Abstract: To investigate whether a 12-week physical therapist-delivered combined pain coping skills training (PCST) and exercise (PCST/exercise) is more efficacious and cost effective than either treatment alone for knee osteoarthritis (OA). This was an assessor-blinded, 3-arm randomized controlled trial in 222 people (73 PCST/exercise, 75 exercise, and 74 PCST) ages ≥50 years with knee OA. All participants received 10 treatments over 12 weeks plus a home program. PCST covered pain education and training in cognitive and behavioral pain coping skills, exercise comprised strengthening exercises, and PCST/exercise integrated both. Primary outcomes were self-reported average knee pain (visual analog scale, range 0-100 mm) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, range 0-68) at week 12. Secondary outcomes included other pain measures, global change, physical performance, psychological health, physical activity, quality of life, and cost effectiveness. Analyses were by intent-to-treat methodology with multiple imputation for missing data. A total of 201 participants (91%), 181 participants (82%), and 186 participants (84%) completed week 12, 32, and 52 measurements, respectively. At week 12, there were no significant between-group differences for reductions in pain comparing PCST/exercise versus exercise (mean difference 5.8 mm [95% confidence interval (95% CI) -1.4, 13.0]) and PCST/exercise versus PCST (6.7 mm [95% CI -0.6, 14.1]). Significantly greater improvements in function were found for PCST/exercise versus exercise (3.7 units [95% CI 0.4, 7.0]) and PCST/exercise versus PCST (7.9 units [95% CI 4.7, 11.2]). These differences persisted at weeks 32 (both) and 52 (PCST). Benefits favoring PCST/exercise were seen on several secondary outcomes. Cost effectiveness of PCST/exercise was not demonstrated. This model of care could improve access to psychological treatment and augment patient outcomes from exercise in knee OA, although it did not appear to be cost effective.
Publisher: Wiley
Date: 12-2009
Publisher: Springer Science and Business Media LLC
Date: 05-05-2023
DOI: 10.1186/S12966-023-01460-Y
Abstract: Inference using standard linear regression models (LMs) relies on assumptions that are rarely satisfied in practice. Substantial departures, if not addressed, have serious impacts on any inference and conclusions potentially rendering them invalid and misleading. Count, bounded and skewed outcomes, common in physical activity research, can substantially violate LM assumptions. A common approach to handle these is to transform the outcome and apply a LM. However, a transformation may not suffice. In this paper, we introduce the generalized linear model (GLM), a generalization of the LM, as an approach for the appropriate modelling of count and non-normally distributed (i.e., bounded and skewed) outcomes. Using data from a study of physical activity among older adults, we demonstrate appropriate methods to analyse count, bounded and skewed outcomes. We show how fitting an LM when inappropriate, especially for the type of outcomes commonly encountered in physical activity research, substantially impacts the analysis, inference, and conclusions compared to a GLM. GLMs which more appropriately model non-normally distributed response variables should be considered as more suitable approaches for managing count, bounded and skewed outcomes rather than simply relying on transformations. We recommend that physical activity researchers add the GLM to their statistical toolboxes and become aware of situations when GLMs are a better method than traditional approaches for modeling count, bounded and skewed outcomes.
Publisher: Springer Science and Business Media LLC
Date: 19-01-2021
DOI: 10.1186/S12966-021-01085-Z
Abstract: Adolescents (11–18-year-olds) are at risk of physical inactivity. There is limited knowledge of physical activity (PA) levels among adolescents in the school setting in Hong Kong. We developed and tested a novel theoretical model of how household/family characteristics, school-level social and physical environmental factors and in idual adolescent’s characteristics impact on their school-based PA during and after school hours. Cross-sectional study participants were Hong Kong adolescents attending secondary school, paired with their parent/caregiver ( n = 1299 dyads). Parents survey-reported on household/family characteristics, parental PA and rules related to PA. Adolescents survey-reported on school PA-friendly policy, PA equipment at school (combined to create PA-friendly index), social support for PA from peers, athletic ability, attitude to and enjoyment of PA. Adolescents self-reported their school-based PA during school hours (physical education recess) and after school (sports teams/classes). Objectively-measured moderate-to-vigorous PA (MVPA) was measured using accelerometers for a sub-s le of adolescents ( n = 588). Generalized additive mixed models were used to estimate how household/family-level and school-level factors, and adolescents’ in idual characteristics were related to adolescents’ school-based PA in Hong Kong, and to identify potential mediators of these associations. A complex network of potential pathways of influence on adolescents’ school-based PA was identified. Overall, most of the significant effects were indirect ones. However, there were far fewer significant pathways between household/family characteristics and objectively-measured MVPA at school than there were for self-reported PA at school. In fact, there were no indirect pathways between these variables and MVPA at school. Gender disparities among pathways were identified. For ex le, school PA-friendly index was significantly associated with MVPA after school only among girls (e b = 1.06, 95%CI (1.02,1.12)). Key points of intervention identified by our study may be in the re-design of PE classes so that adolescents spend more time being physically active during these classes, and promotion of active play during recess. Further research measuring amount, intensity and location of adolescents’ PA using accelerometer and Global Positioning Systems is required in Hong Kong, as well as observational studies of PA during PE classes and in the schoolyard during recess, to guide the design of PA interventions.
Publisher: Springer Science and Business Media LLC
Date: 2016
Publisher: Springer Science and Business Media LLC
Date: 28-05-2019
Publisher: AMPCo
Date: 2017
DOI: 10.5694/MJA16.00341
Abstract: To evaluate the impact of comprehensive public awareness c aigns by the National Heart Foundation of Australia on emergency medical service (EMS) use by people with chest pain. A retrospective analysis of 253428 emergency ambulance attendances for non-traumatic chest pain in Melbourne, January 2008 - December 2013. Time series analyses, adjusted for underlying trend and seasonal effects, assessed the impact of mass media c aigns on EMS use. Monthly ambulance attendances. The median number of monthly ambulance attendances for chest pain was 3609 (IQR, 3011-3891), but was higher in c aign months than in non-c aign months (3880 v 3234, P<0.001). After adjustments, c aign activity was associated with a 10.7% increase (95% CI, 6.5-14.9% P<0.001) in monthly ambulance use for chest pain, and a 15.4% increase (95% CI, 10.1-20.9% P<0.001) when the two-month lag periods were included. Clinical presentations for suspected acute coronary syndromes, as determined by paramedics, increased by 11.3% (95% CI, 6.9-15.9% P<0.001) during c aigns. Although the number of patients transported to hospital by ambulance increased by 10.0% (95% CI, 6.1-14.2% P<0.001) during c aign months, the number of patients not transported to hospital also increased, by 13.9% (95% CI, 8.3-19.8% P<0.001). A public awareness c aign about responding to prodromal acute myocardial infarction symptoms was associated with an increase in EMS use by people with chest pain and suspected acute coronary syndromes. C aign activity may also lead to increased EMS use in low risk populations.
Publisher: Japan Epidemiological Association
Date: 2010
Publisher: Springer Science and Business Media LLC
Date: 03-01-2021
Publisher: Springer Science and Business Media LLC
Date: 23-06-2016
DOI: 10.1038/SC.2015.108
Abstract: This is a prospective open-cohort case series. The objective of this study was to assess changes over time in the duration of key acute hospital process barriers for patients with spinal cord damage (SCD) from admission until transfer into spinal rehabilitation unit (SRU) or other destinations. The study was conducted in Acute hospitals, Victoria, Australia (2006-2013). Duration of the following discrete sequential processes was measured: acute hospital admission until referral to SRU, referral until SRU assessment, SRU assessment until ready for SRU transfer and ready for transfer until SRU admission. Time-series analysis was performed using a generalised additive model (GAM). Seasonality of non-traumatic spinal cord dysfunction (SCDys) was examined. GAM analysis shows that the waiting time for admission into SRU was significantly (P<0.001) longer for patients who were female, who had tetraplegia, who were motor complete, had a pelvic pressure ulcer and who were referred from another health network. Age had a non-linear effect on the duration of waiting for transfer from acute hospital to SRU and both the acute hospital and SRU length of stay (LOS). The duration patients spent waiting for SRU admission increased over the study period. There was an increase in the number of referrals over the study period and an increase in the number of patients accepted but not admitted into the SRU. There was no notable seasonal influence on the referral of patients with SCDys. Time-series analysis provides additional insights into changes in the waiting times for SRU admission and the LOS in hospital for patients with SCD.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2010
Publisher: Wiley
Date: 20-04-2012
DOI: 10.1111/J.1365-2222.2012.03995.X
Abstract: Few studies have focused on the role of grass pollen on asthma emergency department (ED) presentations among children. None have examined whether a dose-response effect exists between grass pollen levels and these asthma exacerbations. To examine the association between increasing ambient levels of grass pollen and asthma ED presentations in children. To determine whether these associations are seen only after a thunderstorm, or whether grass pollen levels have a consistent influence on childhood asthma ED visits during the season. A short time series ecological study was conducted for asthma presentations to ED among children in Melbourne, Victoria, and grass pollen, meteorological and air quality measurements recorded during the selected 2003 period. A semi-parametric Poisson regression model was used to examine dose-response associations between daily grass pollen levels and mean daily ED attendance for asthma. A smoothed plot suggested a dose-response association. As ambient grass pollen increased to about 19 grains/m(3) , the same day risk of childhood ED presentations also increased linearly (P < 0.001). Grass pollen levels were also associated with an increased risk in asthma ED presentations on the following day (lag 1, P < 0.001). This is the first study to establish a clear relationship between increased risk of childhood asthma ED attendance and levels of ambient grass pollen below 20 grains/m(3) , independent of any impact of thunderstorm-associated asthma. These findings have important implications for patient care, such as asthma management programs that notify the general public regarding periods of high grass pollen exposure, as well as defining the timing of initiation of pollen immunotherapy.
Publisher: Elsevier BV
Date: 10-2015
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.HEALTHPLACE.2019.102196
Abstract: Within the growing body of research linking neighbourhood environmental attributes with physical activity, associations between recreational destinations and non-walking leisure-time physical activity (LTPA) are rarely studied, and to date, not across multiple cities. We examined six potential associations of objectively-measured access to private recreational facilities (e.g., fitness centres, swimming pools) and parks with adults' non-walking LTPA (e.g., swimming, cycling, tennis), using data gathered with consistent methods from adults living in international cities with a range of environment attributes. The potential effects of socio-demographic moderators and between-city variations were also examined. Data from 6725 adults from 10 cities (6 countries) were gathered. Adults were more likely to engage in non-walking LTPA if they had a greater number of private recreational facilities within 0.5 or 1 km of the home, particularly in women, and if they lived closer to a park. The amount of non-zero LTPA was only associated (positively) with the number of recreational facilities within 1 km. Relationships between amount of LTPA and park proximity appear complex, with likely contextual and cultural differences. Improving access to private recreational facilities could promote non-walking LTPA, especially in women.
Publisher: BMJ
Date: 09-2016
Publisher: Wiley
Date: 07-09-2015
DOI: 10.1111/RESP.12613
Abstract: The 2006-2007 wildfire period was one of the most extensive and long lasting fires in Australian history with high levels of fine particulate matter (PM2.5 ). Large populations were exposed to smoke for over 2 months. The study aimed to investigate the association between wildfire-related PM2.5 exposure and emergency department (ED) visits for asthma. A time-stratified case-crossover design was used to investigate associations between daily average PM2.5 and ED attendances for asthma from December 2006 to January 2007. ED data were obtained from the Victorian Emergency Minimum Dataset. Smoke dispersion during the wildfire event was modelled using a validated chemical transport model. Exposure data (daily average PM2.5 , temperature and relative humidity) were modelled for the study period. Various lag periods were investigated. There were 2047 ED attendances for asthma during the study period. After adjusting for temperature and relative humidity, an interquartile range increase in PM2.5 levels of 8.6 μg/m(3) was associated with an increase in ED attendances for asthma by 1.96% (95%CI: 0.02, 3.94) on the day of exposure. Lag periods up to 2 days prior did not show any association. A strong association was observed among women 20 years and older (5.08% 95%CI: 1.76, 8.51). Wildfire-related PM2.5 was associated with increased risk of ED attendance for asthma during the wildfire event. It is important to understand the role of wildfire PM2.5 as a trigger for asthma presentations.
Publisher: Public Library of Science (PLoS)
Date: 24-01-2017
Publisher: Wiley
Date: 17-12-2008
DOI: 10.1111/J.1440-1843.2008.01416.X
Abstract: Uncontrolled bushfires produce copious amounts of smoke that can result in adverse effects on human health and so are important considerations for emergency, public health and environmental protection agencies. During January to March 2003, the north-east and Alpine regions of the state of Victoria experienced major bushfires that created a blanket of smoke over the entire state for extended periods of time. This study aimed to explore the daily trends in air pollutants and temporal correlations with changes in respiratory outcomes and to determine whether variation in particulate matter < 10 microm (PM(10)), visibility-reducing particles and ozone produced by bushfires could explain variation in respiratory outcomes. A time-series ecological study was conducted using hospital admission and emergency attendances, air quality and meteorological data. A semi-parametric overdispersed Poisson regression model was used to evaluate the effect of air pollutants. In a semi-parametric analysis of respiratory outcomes adjusted for day-of-the-week and trend effects, only daily levels of PM(10) were strongly associated with emergency department attendances and weakly associated with hospital admissions. Elevated levels of PM(10) increase the risk for exposed people to attend emergency departments for respiratory conditions. The health effects of bushfire smoke need to be considered when planning health and emergency services and designing public health messages.
Publisher: Informa UK Limited
Date: 2004
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.GAITPOST.2017.06.019
Abstract: The conventional methods to assess human gait are either expensive or complex to be applied regularly in clinical practice. To reduce the cost and simplify the evaluation, inertial sensors and adaptive algorithms have been utilized, respectively. This paper aims to summarize studies that applied adaptive also called artificial intelligence (AI) algorithms to gait analysis based on inertial sensor data, verifying if they can support the clinical evaluation. Articles were identified through searches of the main databases, which were encompassed from 1968 to October 2016. We have identified 22 studies that met the inclusion criteria. The included papers were analyzed due to their data acquisition and processing methods with specific questionnaires. Concerning the data acquisition, the mean score is 6.1±1.62, what implies that 13 of 22 papers failed to report relevant outcomes. The quality assessment of AI algorithms presents an above-average rating (8.2±1.84). Therefore, AI algorithms seem to be able to support gait analysis based on inertial sensor data. Further research, however, is necessary to enhance and standardize the application in patients, since most of the studies used distinct methods to evaluate healthy subjects.
Publisher: Springer Science and Business Media LLC
Date: 24-03-2014
Publisher: Scandinavian Journal of Work, Environment and Health
Date: 09-11-2017
DOI: 10.5271/SJWEH.3602
Abstract: Objectives The aim of this study was to investigate the association between high ambient temperature and acute work-related injury, expanding on previous research in this area. Specifically we examined the relationship between both daytime and overnight temperatures and injury risk and disentangled physically demanding occupational exposures from exposure to outdoor working conditions. Methods A time-stratified case-crossover study design was used to examine the association between ambient temperatures and acute work-related injuries in Melbourne, Australia, 2002-2012, using workers' compensation claims to identify work-related injuries. The relationship was assessed for both daily maximum and daily minimum temperatures using conditional logistic regression. Results Significant positive associations between temperature and acute work-related injury were seen for younger workers (<25 years), with the odds of injury increasing by 1% for each 1 °C increase in daily minimum temperature, and by 0.8% for each 1 °C increase in daily maximum temperature. Statistically significant associations were also observed between daily maximum temperature and risk of injury for workers employed in the highest strength occupations and for male workers, and between daily minimum temperature and injury for all cases combined, female workers, workers aged 25-35 and ≥55 years, "light" and "limited" physical demand groups, and "in vehicle or cab" and "regulated indoor climate" workplace exposure groups. Conclusions Young workers, male workers and workers engaged in heavy physical work are at increased risk of injury on hot days, and a wider range of worker subgroups are vulnerable to injury following a warm night. In light of climate change projections, this information is important for informing injury prevention strategies.
No related grants have been discovered for Muhammad Akram.