ORCID Profile
0000-0001-7292-9714
Current Organisations
NOAA Marine Protected Areas Center
,
the Univeristy of Adelaide
,
Flinders University School of Medicine
,
Flinders University
,
University of Adelaide
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Publisher: Wiley
Date: 12-2012
Publisher: Oxford University Press (OUP)
Date: 29-11-2021
Abstract: Sleep spindles show morphological changes in obstructive sleep apnea (OSA). However, previous small studies have limited generalizability, leaving associations between OSA severity measures and spindle metrics uncertain. This study examined cross-sectional associations between OSA severity measures and spindle metrics among a large population-based s le of men. Community-dwelling men with no previous OSA diagnosis underwent home-based polysomnography. All-night EEG (F4-M1) recordings were processed for artifacts and spindle events identified using previously validated algorithms. Spindle metrics of interest included frequency (Hz), litude (µV2), overall density (11–16 Hz), slow density (11–13 Hz), and fast density (13–16 Hz) (number/minute). Multivariable linear regression models controlling for demographic, biomedical, and behavioral confounders were used to examine cross-sectional associations between OSA severity measures and spindle metrics. In adjusted analyses, higher apnea-hypopnea index (AHI/h, as a continuous variable) and percentage total sleep time with oxygen saturation & % (TST90) were associated with decreased slow spindle density (AHI, B = −0.003, p = 0.032 TST90, B = −0.004, p = 0.047) but increased frequency (AHI, B = 0.002, p = 0.009 TST90, B = 0.002, p = 0.043). Higher TST90 was also associated with greater spindle litude (N2 sleep, B = 0.04, p = 0.011 N3 sleep, B = 0.11, p & 0.001). Furthermore, higher arousal index was associated with greater spindle litude during N2 sleep (B = 0.31, p & 0.001) but decreased overall density (B = −1.27, p = 0.030) and fast density (B = −4.36, p = 0.028) during N3 sleep. Among this large population-based s le of men, OSA severity measures were independently associated with spindle abnormalities. Further population studies are needed to determine associations between spindle metrics and functional outcomes.
Publisher: Oxford University Press (OUP)
Date: 04-03-2022
Abstract: To determine if a novel EEG-derived continuous index of sleep depth/alertness, the odds ratio product (ORP), predicts self-reported daytime sleepiness and poor sleep quality in two large population-based cohorts. ORP values which range from 0 (deep sleep) to 2.5 (fully alert) were calculated in 3s intervals during awake periods (ORPwake) and NREM sleep (ORPNREM) determined from home sleep studies in the HypnoLaus (N = 2162: 1106 females, 1056 males) and men androgen inflammation lifestyle environment and stress (MAILES) cohorts (N = 754 males). Logistic regression was used to examine associations between ORPwake, ORPNREM, and traditional polysomnography measures (as comparators) with excessive sleepiness (Epworth sleepiness scale & ) and poor sleep quality (Pittsburgh sleep quality index & ) and insomnia symptoms. High ORPwake was associated with a ~30% increase in poor sleep quality in both HypnoLaus (odds ratio, OR, and 95% CI) 1.28 (1.09, 1.51), and MAILES 1.36 (1.10, 1.68). High ORPwake was also associated with a ~28% decrease in excessive daytime sleepiness in the MAILES dataset. ORPNREM was associated with a ~30% increase in poor sleep quality in HypnoLaus but not in MAILES. No consistent associations across cohorts were detected using traditional polysomnography markers. ORP, a novel EEG-derived metric, measured during wake periods predicts poor sleep quality in two independent cohorts. Consistent with insomnia symptomatology of poor perceived sleep in the absence of excessive daytime sleepiness, ORPwake may provide valuable objective mechanistic insight into physiological hyperarousal.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-07-2022
Abstract: Poor sleep quality is associated with increased incident hypertension. However, few studies have investigated the impact of objective sleep structure parameters on hypertension. This study investigated the association between sleep macrostructural and microstructural parameters and incident hypertension in a middle‐ to older‐aged s le. Participants from the HypnoLaus population‐based cohort without hypertension at baseline were included. Participants had at‐home polysomnography at baseline, allowing assessment of sleep macrostructure (nonrapid eye movement sleep stages 1, 2, and 3 rapid eye movement sleep stages and total sleep time) and microstructure including power spectral density of electroencephalogram in nonrapid eye movement sleep and spindles characteristics (density, duration, frequency, litude) in nonrapid eye movement sleep stage 2. Associations between sleep macrostructure and microstructure parameters at baseline and incident clinical hypertension over a mean follow‐up of 5.2 years were assessed with multiple‐adjusted logistic regression. A total of 1172 participants (42% men age 55±10 years) were included. Of these, 198 (17%) developed hypertension. After adjustment for confounders, no sleep macrostructure features were associated with incident hypertension. However, low absolute delta and sigma power were significantly associated with incident hypertension where participants in the lowest quartile of delta and sigma had a 1.69‐fold (95% CI, 1.00–2.89) and 1.72‐fold (95% CI, 1.05–2.82) increased risk of incident hypertension, respectively, versus those in the highest quartile. Lower spindle density (odds ratio, 0.87 95% CI, 0.76–0.99) and litude (odds ratio, 0.98 95% CI, 0.95–1.00) were also associated with higher incident hypertension. Sleep microstructure is associated with incident hypertension. Slow‐wave activity and sleep spindles, 2 hallmarks of objective sleep continuity and quality, were inversely and consistently associated with incident hypertension. This supports the protective role of sleep continuity in the development of hypertension.
Publisher: Elsevier BV
Date: 09-2010
Abstract: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline removed stage 0 (chronic cough and sputum without airflow obstruction, GOLD-0) because of poor prognostic value. Preventative intervention may be relevant for those with chronic symptoms therefore, we assessed the stability, morbidity, and FEV(1) decline associated with GOLD stage 0 in a representative adult population cohort. Baseline (n = 4,060) and follow-up (n = 3,206, mean 3.5 years) clinic assessment of the North West Adelaide Health Study included postbronchodilator spirometry, anthropometry, and measures of doctor-diagnosed asthma, respiratory symptoms, smoking status, quality of life, and depression. Baseline GOLD-0 prevalence was 17.0% (n = 584). At follow-up (n = 420), 39.8% remained stable, 1.4% progressed to GOLD stages 1 to 2, and 58.8% resolved to no symptoms. Persistent GOLD-0 at follow-up was associated with persistent smoking (men: odds ratio [OR] = 11.9, 95% CI, 6.4-22.1 women: OR = 4.0, 95% CI, 2.1-7.4), and depressive symptoms (men: OR = 3.8, 95% CI, 1.9-7.6 women: OR = 3.2, 95% CI, 1.7-5.9), with highest quartile of FEV(1) decline (mL) per year (OR = 2.1, 95% CI, 1.2-3.7) and the metabolic syndrome (OR = 1.7, 95% CI, 1.01-3.0) in men, and with older age in women. These associations generally held in smokers and never-smokers. Resolving GOLD-0 was associated with smoking cessation (OR = 13.7 95% CI, 4.6-40.1), FEV(1) decline (mL) per year below the median (OR = 2.0 95% CI, 1.1-3.5), normal BMI, and younger age groups. Sensitivity analyses based on the presence of sputum did not change the observed associations. Persistent GOLD-0 identified people with physical and psychologic morbidity in both smokers and nonsmokers. Identification of those with persistent respiratory symptoms is therefore important. Excess FEV(1) decline in men suggests GOLD-0 may identify a group at risk to progress to COPD over time.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.JAMDA.2014.06.018
Abstract: Sarcopenia is the presence of low muscle mass and poor physical function. We have developed an anthropometric prediction equation (PE). We compared the accuracy of our previously developed anthropometric prediction equation (PE) to dual absorptiometry x-ray (DXA) in predicting low muscle mass and sarcopenia. Cross-sectional study design. Community dwelling. Men and women aged 65 years and older. Gender-specific low muscle mass cutoffs were identified using the lowest 20% of the skeletal muscle index (SMI) where muscle mass was determined using PE in 611 men and 375 women aged 65 years and older. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PE derived low muscle mass were compared with DXA-derived low muscle mass. The cohort was randomized into a development and validation group to identify various cutoffs for low muscle mass via the PE method and test its performance against the DXA method. The PE cutoff for low muscle mass was less than 8.05 kg/m(2) in men and less than 5.35 kg/m(2) in women. On validation of various cutoffs with improving sensitivity values from 70% to 97%, specificity increased from 45.5% to 85.7%, PPV increased from 31.3% to 56.9%, and NPV increased from 93.0% to 98.6% in men. In women, specificity improved from 42% to 72%, PPV reduced from 56.9% to 31.3%, and NPV improved from 93.0% to 98.6%. When the PE method was combined with a measure of muscle performance, a similar pattern of performance was observed. The PE when combined with a measure of muscle function to create a screening tool performs as a "rule-out" test with high sensitivity values and NPVs.
Publisher: Wiley
Date: 15-02-2022
DOI: 10.1111/JSR.13563
Abstract: Insomnia and obstructive sleep apnea commonly co‐occur (co‐morbid insomnia and sleep apnea), and their co‐occurrence has been associated with worse cardiometabolic and mental health. However, it remains unknown if people with co‐morbid insomnia and sleep apnea are at a heightened risk of incident cardiovascular events. This study used longitudinal data from the Sleep Heart Health Study ( N = 5803) to investigate potential associations between co‐morbid insomnia and sleep apnea and cardiovascular disease prevalence at baseline and cardiovascular event incidence over ~11 years follow‐up. Insomnia was defined as self‐reported difficulties initiating and/or maintaining sleep AND daytime impairment. Obstructive sleep apnea was defined as an apnea–hypopnea index ≥ 15 events per hr sleep. Co‐morbid insomnia and sleep apnea was defined if both conditions were present. Data from 4160 participants were used for this analysis. The prevalence of no insomnia/obstructive sleep apnea, insomnia only, obstructive sleep apnea only and co‐morbid insomnia and sleep apnea was 53.2%, 3.1%, 39.9% and 1.9%, respectively. Co‐morbid insomnia and sleep apnea was associated with a 75% (odd ratios [95% confidence interval] 1.75 [1.14, 2.67]) increase in likelihood of having cardiovascular disease at baseline after adjusting for pre‐specified confounders. In the unadjusted model, co‐morbid insomnia and sleep apnea was associated with a twofold increase (hazard ratio, 95% confidence interval: 2.00 [1.33, 2.99]) in risk of cardiovascular event incidence. However, after adjusting for pre‐specified covariates, co‐morbid insomnia and sleep apnea was not significantly associated with incident cardiovascular events (hazard ratio 1.38 [0.92, 2.07]). Comparable findings were obtained when an alternative definition of insomnia (difficulties initiating and/or maintaining sleep without daytime impairment) was used.
Publisher: Springer Science and Business Media LLC
Date: 13-12-2012
DOI: 10.1038/JHH.2012.62
Abstract: Identifying barriers to hypertension management may facilitate cardiovascular risk reduction. Therefore, our objective, was to determine the prevalence of hypertension not managed with medication ('untreated') in a representative adult s le and identify patient factors/beliefs, and aspects of the patient-general practitioner (GP) relationship associated with untreated hypertension. The North West Adelaide Health Study, a biomedical cohort study over three stages from 2000-2009, assesses hypertension (systolic > or =140 mm Hg and/or > or =90 mm Hg or current treatment with anti-hypertensive medication), chronic disease and associated risk factors and health-care experiences, including risk perception, decision-making preferences, GP rimary care provider affiliation and satisfaction with care (n=2425). The prevalence of hypertension was 32.1% (n=781) comprised of treated (19.0%, n=462) and untreated (13.1%, n=319) hypertension. Thus, 40.8% of hypertension was untreated. Among hypertensive subjects, non-treatment was significantly associated with male sex, age <45 years, workforce participation, infrequent GP visits, dissatisfaction with recent medical care, high total cholesterol, moderate-level physical activity and lower body weights. Compared with participants without hypertension (and no treatment), untreated subjects demonstrated significant (15%) 10-year Framingham general cardiovascular risk (odds ratio=6.44, 95% confidence interval=4.52-9.17). Novel screening strategies and public health messages to address beliefs and perceptions of both patients and the health system are required to identify untreated, at-risk hypertensive in iduals.
Publisher: John Wiley & Sons, Ltd
Date: 23-10-2001
Publisher: Elsevier BV
Date: 10-0002
Abstract: Respiratory public health interventions depend on accurate identification of the target group, yet this may vary depending on the diagnostic criteria used. We therefore compared the relative performance of various international criteria in identifying COPD cases. The burden of COPD due to smoking can only be determined from population-attributable risk (PAR) studies. These studies, lacking in the COPD literature, are necessary research in support of public health initiatives for COPD. In this representative population study, we also assessed the PAR for current and ex-smokers. A representative biomedical population s le of 2,501 South Australians aged > or = 18 years (The Northwest Adelaide Health [Cohort] Study). COPD diagnosis and severity were determined according to various FEV1/FVC and FEV1 percentage of predicted criteria recommended by international respiratory authorities. Demographic, health behavior, and quality-of-life data were obtained by telephone interview and self-completed questionnaire. Northwest Adelaide. The PAR of smoking (smokers and ex-smokers) for COPD ranged from 51 to 70% depending on the diagnostic respiratory criteria used. COPD prevalence varied depending on the criteria used: American Thoracic Society, 5.4% British Thoracic Society, 3.5% European Respiratory Society (ERS), 5.0% Global Initiative for Chronic Obstructive Lung Disease, 5.4%. There was also substantial disagreement in the cases identified. An alternative approach using ERS reference values one residual SD from the mean produced a COPD prevalence estimate of 6.9%, with improved level of agreement with the established respiratory criteria suggesting their potential as screening criteria. The COPD risks associated with smoking and ex-smoking history were quantifiable using PAR, but PAR also suggests other, yet unquantified, risks. Targeting COPD cases for public health interventions is difficult given the range of spirometry criteria and the associated high level of underdiagnosis.
Publisher: Springer Science and Business Media LLC
Date: 24-10-2016
Publisher: Springer Science and Business Media LLC
Date: 28-08-2021
DOI: 10.1186/S41927-021-00199-Y
Abstract: The aims of our study were two-fold. Firstly, to determine if there is an association between gout and OSA in a representative Australian adult population. Secondly, to explore associations between gout and patient reported sleep outcomes. A cross-sectional national online survey of a representative s le of Australian adults 18 years assessed self-reported doctor-diagnosed OSA, insomnia and patient reported sleep outcomes. Possible undiagnosed OSA was estimated using self-reported frequent loud snoring and witnessed apnoeas. Participants self-reported physician-diagnosed gout and other health conditions. Multivariable logistic regression analyses were performed for both objectives. Odds ratios with 95% confidence intervals were reported. There were 1948 participants of whom 126 (6.5%) had gout and 124 (6.4%) had diagnosed sleep apnoea. After adjusting for age, body mass index (BMI), sex, alcohol intake and the presence of arthritis, those with obstructive sleep apnoea diagnosed on polysomnography were twice as likely to report having gout compared to those without. (OR = 2.6, 95% CI 1.5–4.6). Additionally, participants with symptoms suggestive of sleep apnoea were also twice as likely to have gout compared to those without (OR = 2.8, 95%CI 1.6–5.1). There was also a higher likelihood of restless legs syndrome, insomnia and worry about sleep in patients with gout. Diagnosed and suspected OSA are associated with higher likelihood of gout. Participants with gout are also more likely to report suffering from restless legs syndrome, insomnia and worry about their sleep. Given the morbidity associated with sleep problems, we should be vigilant regarding sleep health in our patients with gout.
Publisher: Elsevier BV
Date: 09-2009
Publisher: Informa UK Limited
Date: 06-2023
DOI: 10.2147/NSS.S423397
Publisher: Hindawi Limited
Date: 2014
DOI: 10.1155/2014/361790
Abstract: Background. Sarcopenia is the presence of low muscle mass and low muscle function. The aim of this study was to establish cutoffs for low muscle mass using three published methods and to compare the prevalence of sarcopenia in older Australians. Methods. Gender specific cutoffs levels were identified for low muscle mass using three different methods. Low grip strength was determined using established cutoffs of kg for men and kg for women to estimate the prevalence of sarcopenia. Results. Gender specific cutoffs levels for low muscle mass identified were (a) .89 kg/m 2 for men and .32 kg/m 2 for women, standard deviation (SD) of a young reference population (b) .36 kg/m 2 for men and .81 kg/m 2 for women from the lowest 20% percentile of the older group and (c) −2.15 for men and −1.42 for women from the lowest 20% of the residuals of linear regressions of appendicular skeletal mass, adjusted for fat mass and height. Prevalence of sarcopenia in older (65 years and older) people by these three methods for men was 2.5%, 6.2%, and 6.4% and for women 0.3%, 9.3%, and 8.5%, respectively. Conclusions. Sarcopenia is common but consensus on the best method to confirm low muscle mass is required.
Publisher: Informa UK Limited
Date: 18-10-2016
DOI: 10.1080/15402002.2016.1228647
Abstract: To assess the suitability for use within economic evaluation of a widely used sleep-related instrument (the Epworth Sleepiness Scale [ESS]) by examining its convergent and discriminant validity with two widely used generic preference-based instruments (Short-Form 36 [SF-36] and the Assessment of Quality of Life 4 dimensions [AQoL-4D]). Data from a cross-section of 2,236 community-dwelling Australian men were analyzed. Convergent validity was investigated using Spearman's correlation, intraclass correlation, and modified Bland-Altman plots, while discriminant validity was examined using Kruskal Wallis tests. All instruments showed good discriminant validity. The ESS was weakly correlated to the Short Form 6 dimension, or SF-6D (derived from the SF-36) and AQoL-4D utilities (r = 0.20 and r = 0.19, respectively). Correlations between ESS and SF-36/AQoL-4D dimensions measuring the same construct were all in the hypothesized directions but also weak (range of absolute r = 0.00 to 0.18). The level of agreement between the ESS and AQoL-4D was the weakest, followed by that between the ESS and SF-6D. Moderate convergent validity was seen between the utilities. The lack of convergent validity between the ESS and the preference-based instruments shows that sleep-related constructs are not captured by the latter. The ESS has, however, demonstrated good discriminant validity comparable to that of the AQoL-4D and the SF-36/SF-6D and would therefore be equally useful for measuring subgroup differences within economic evaluation. We therefore recommend using the ESS within cost-effectiveness analysis as a complement to preference-based instruments in order to capture sleep-specific constructs not measured by the latter.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.CANEP.2017.11.007
Abstract: Comparative evidence on the burden, trend, and risk factors of cancer is limited. Using data from the Global Burden of Disease (GBD) study, we aimed to assess cancer burden - incidence, prevalence, mortality, disability-adjusted life years (DALYs) - and attributable risk factors for Australia between 1990 and 2015, and to compare them with those of 34 members of the Organisation for Economic Co-operation and Development (OECD). The general GBD cancer estimation methods were used with data input from vital registration systems and cancer registries. A comparative risk assessment approach was used to estimate the population-attributable fractions due to risk factors. In 2015 there were 198,880 (95% uncertainty interval [UI]: 183,908-217,365) estimated incident cancer cases and 47,562 (95% UI: 46,061-49,004) cancer deaths in Australia. Twenty-nine percent (95% UI: 28.2-29.8) of total deaths and 17.0% (95% UI: 15.0-19.1) of DALYs were caused by cancer in Australia in 2015. Cancers of the trachea, bronchus and lung, colon and rectum, and prostate were the most common causes of cancer deaths. Thirty-six percent (95% UI: 33.1-37.9) of all cancer deaths were attributable to behavioral risks. The age-standardized cancer incidence rate (ASIR) increased between 1990 and 2015, while the age-standardized cancer death rate (ASDR) decreased over the same period. In 2015, compared to 34 other OECD countries Australia ranked first (highest) and 24 The incidence of cancer has increased over 25 years, and behavioral risks are responsible for a large proportion of cancer deaths. Scaling up of prevention (using strategies targeting cancer risk factors), early detection, and treatment of cancer is required to effectively address this growing health challenge.
Publisher: Informa UK Limited
Date: 04-2023
DOI: 10.2147/NSS.S397900
Publisher: Oxford University Press (OUP)
Date: 03-2014
DOI: 10.5665/SLEEP.3500
Publisher: Elsevier BV
Date: 06-2003
Abstract: To determine long-term survival rates of patients who underwent lung volume reduction surgery (LVRS) for emphysema and the factors associated with longer survival, and to evaluate levels of perceived dyspnea and health-related quality of life (HRQL) after a follow-up period of 3 to 5.5 years. Retrospective observational study. Academic medical center Telephone and postal surveys were used to obtain patient dyspnea scores and HRQL scores. Hospital databases and state registries were searched to determine patient survival and pulmonary function. Of 54 patients undergoing LVRS, 29 patients (18 men and 11 women) were available for follow-up, which ranged from 36 to 66 months (mean +/- SE, 51 +/- 1.5 months). There was significant sustained improvement in modified Medical Research Council scores compared to pre-LVRS: 2.19 +/- 0.19 vs 2.88 +/- 0.14 (p = 0.0000). Eleven of 22 patients demonstrated an increase in all three Mahler baseline dyspnea index grades of at least one level. Baseline body mass index (BMI) and post-LVRS length of stay (LOS) were significantly associated with survival: survivor vs deceased baseline BMI, 24.2 +/- 0.6 vs 21.4 +/- 0.5 (p = 0.002), and post-LVRS LOS, 15.4 +/- 1.7 days vs 28.7 +/- 5.3 days (p = 0.015). Compared to pre-LVRS, 20 patients with mean follow-up time of 45 months demonstrated significant sustained improvements in FEV(1) percentage of predicted (31.4 +/- 2.1% vs 39.8 +/- 3.5%, p = 0.038), total lung capacity percentage of predicted (136 +/- 4% vs 122 +/- 3%, p = 0.0004), and residual volume percentage of predicted (237 +/- 14% vs 172 +/- 11%, p = 0.0001). Patient HRQL measured using the Dartmouth Primary Care Co-operative Quality of Life questionnaire was more favorable than that reported in aged-care settings. Caregiver burden scale scores indicate caring for a recipient of LVRS carries similar burden to that for caring for in iduals with other chronic illnesses. In this population, a majority of the LVRS patients survived for >/= 3 years. Among survivors, dyspnea and lung function benefits were seen. Baseline BMI and postoperative LOS were significantly associated with survival.
Publisher: Springer Science and Business Media LLC
Date: 03-04-2010
DOI: 10.1007/S00420-010-0528-0
Abstract: To assess health status of South Australian (SA) metropolitan fire-fighters in terms of lung function and health-related quality of life, compare these with general population controls, and explore associations between fire-fighters' self-reported occupational exposure and health status. The study was a cross-sectional comparison of (respiratory) health indices between 501 fire-fighters and 1,324 general population controls taken from the North West Adelaide Health Study (NWAHS). All were men aged 21 to 61. Measurements included spirometry (i.e., forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), mid-expiratory flow (FEF(25-75)) and the Short Form 36 (SF-36) health-related quality of life questionnaire. Health status in the fire-fighters was generally better than in NWAHS controls. Mean % predicted FEV(1) and FVC were 103.4% [SD 12.1] versus 89.5% [13.7] and 110.0% [11.6] versus 88.5% [12.5] (both p < 0.001 in linear regression analysis, adjusted for age, smoking, BMI, and FEV(1) % predicted). FEV(1)/FVC and FEF(25-75) were significantly lower in the fire-fighters (p < 0.003). A total of 93 (18.6%) fire-fighters and 82 (6.2%) controls had an FEV(1)/FVC < 70% (p 6 h/week to dust, smoke, and fire showed lower FEV(1), FEV(1) % predicted, and FVC values compared to those who were less exposed (p < 0.05). Male metropolitan fire-fighters showed better general health, better lung health, and similar mental health compared to general population controls. The high rate of fire-fighters with FEV(1)/FVC values below the recommended cut-point for airflow obstruction illustrates the inappropriateness of this clinical cut-point for use in populations preselected on their physical fitness. The observed dose-effect relationship between self-reported occupational exposure and fire-fighters' lung function warrants further investigation.
Publisher: SAGE Publications
Date: 16-03-2015
DOI: 10.1111/IJS.12425
Publisher: Wiley
Date: 19-07-2006
Publisher: Wiley
Date: 07-10-2021
DOI: 10.1111/JSR.13477
Abstract: The few studies assessing the relationship between mental health and a multidimensional measure of sleep have been conducted in s les of almost exclusively women. In the present study, we therefore assessed associations of multidimensional sleep health with mental well‐being in Australian adults. A cross‐sectional, national online survey of sleep health was conducted in 2019 in 2,044 community dwelling adults aged 18–90 years. Composite scores of self‐reported healthy sleep were based on Ru‐SATED (R‐SATED ) dimensions of satisfaction, alertness, timing, efficiency and duration scored 0 (never/rarely), 1 (sometimes) or 2 (usually/always), and regularity (social jet lag) was scored 0 (≥1 hr) or 1 ( hr). Mental well‐being was identified by a report of no problem on the EuroQol (European quality of life) five dimension five level scale (EQ‐5D‐5L) anxiety/depression scale, as well as absence of six chronic depressive symptoms. Ordinal logistic regression analyses determined associations of mental well‐being with sleep dimensions, and total R‐SATED (range 0–11) and SATED scores (0–10), adjusted for sociodemographic and health factors. In males and females, healthy categories of SATED dimensions (but not regularity ) were associated with mental well‐being. A 1 unit increase in the total SATED score (mean [ SD ] 6.6 [2.1]) was associated with less problems on the EQ‐5D‐5L (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.08–1.14) and fewer chronic depressive symptoms (OR 1.20, 95% CI 1.17–1.23). These estimates did not differ when the total R‐SATED score was considered. Sleep health promotion focussing solely on traditional messaging around healthy sleep duration may limit mental health gains. Rather, a more holistic approach to public health messaging to improve sleep health literacy may be beneficial for mental well‐being.
Publisher: MDPI AG
Date: 19-03-2021
Abstract: Effective cardiovascular disease (CVD) prevention relies on timely identification and intervention for in iduals at risk. Conventional formula-based techniques have been demonstrated to over- or under-predict the risk of CVD in the Australian population. This study assessed the ability of machine learning models to predict CVD mortality risk in the Australian population and compare performance with the well-established Framingham model. Data is drawn from three Australian cohort studies: the North West Adelaide Health Study (NWAHS), the Australian Diabetes, Obesity, and Lifestyle study, and the Melbourne Collaborative Cohort Study (MCCS). Four machine learning models for predicting 15-year CVD mortality risk were developed and compared to the 2008 Framingham model. Machine learning models performed significantly better compared to the Framingham model when applied to the three Australian cohorts. Machine learning based models improved prediction by 2.7% to 5.2% across three Australian cohorts. In an aggregated cohort, machine learning models improved prediction by up to 5.1% (area-under-curve (AUC) 0.852, 95% CI 0.837–0.867). Net reclassification improvement (NRI) was up to 26% with machine learning models. Machine learning based models also showed improved performance when stratified by sex and diabetes status. Results suggest a potential for improving CVD risk prediction in the Australian population using machine learning models.
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.METABOL.2016.03.011
Abstract: To determine the longitudinal relationship of muscle mass and strength with incident type 2 diabetes, and previously unstudied mediating effects of testosterone and inflammation. Community-dwelling male participants (aged ≥35years) of the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study underwent biomedical assessment in 2002-2006 and 2007-2010, including hand grip strength (dynamometer), testosterone and inflammatory markers. Body composition (dual-energy X-ray absorptiometry) was assessed at baseline only. Incident type 2 diabetes was defined as a self-reported doctor diagnosis, diabetes medication use, fasting plasma glucose ≥7.0mmol/L, or glycated haemoglobin ≥6.5% (48mmol/mol) at follow-up, that was not present at baseline. Of n=1632 men, incident type 2 diabetes occurred in 146 (8.9%). Muscle mass was not associated with incident type 2 diabetes. Grip strength was inversely associated with incident type 2 diabetes [unadjusted odds ratio (OR) per 5kg: 0.87, 95% confidence interval (CI): 0.80-0.95 adjusted OR, 95% CI: 0.87, 0.78-0.97]. Arm muscle quality (grip strength ided by arm lean mass) was similarly associated with incident type 2 diabetes. Testosterone, IL-6 and TNF-α did not significantly mediate the associations. The population attributable fraction of type 2 diabetes from low grip strength was 27% (13-40%), assuming intervention could increase strength by 25%. Reduced muscle strength, but not reduced muscle mass, is a risk factor for incident type 2 diabetes in men. This is not mediated by testosterone or inflammation. Intervention could prevent a substantial proportion of disease.
Publisher: Informa UK Limited
Date: 08-2023
DOI: 10.2147/NSS.S412468
Publisher: Wiley
Date: 05-09-2022
DOI: 10.1111/JSR.13717
Abstract: Research with ‘good sleepers’ is ubiquitous, yet there are no standardised criteria to identify a ‘good sleeper’. The present study aimed to create and validate a questionnaire for identifying good sleepers for use in research studies known as the Good Sleeper Scale‐15 items (GSS‐15). Data were derived from a population‐based survey of Australian adults ( n = 2,044). A total of 23 items were chosen for possible inclusion. An exploratory factor analysis (EFA) was conducted on ~10% of the survey dataset ( n = 191) for factor identification and item reduction. A confirmatory factor analysis (CFA) was conducted on the remaining data ( n = 1,853) to test model fit. Receiver operating characteristic curves and correlations were conducted to derive cut‐off scores and test associations with sleep, daytime functioning, health, and quality‐of‐life. The EFA identified six factors: ‘Sleep Difficulties’, ‘Timing’, ‘Duration’, ‘Regularity’, ‘Adequacy’, and ‘Perceived Sleep Problem’. The CFA showed that model fit was high and comparable to other sleep instruments, χ 2 (63) = 378.22, p 0.001, root mean square error of approximation = 0.05, with acceptable internal consistency ( α = 0.76). Strong correlations were consistently found between GSS‐15 global scores and outcomes, including ‘a good night′s sleep’ ( r = 0.7), ‘feeling un‐refreshed’ ( r = −0.59), and ‘experienced sleepiness’ ( r = −0.51), p 0.001. Cut‐off scores were derived to categorise in iduals likely to be a good sleeper (GSS‐15 score ≥40) and those very likely to be a good sleeper (GSS‐15 score ≥45). The GSS‐15 is a freely available, robust questionnaire that will assist in identifying good sleepers for the purpose of sleep research. Future work will test relationships with other sleep measures in community and clinical s les.
Publisher: Wiley
Date: 26-07-2016
DOI: 10.1111/LUTS.12140
Abstract: To determine the suitability of using the International Prostate Symptom Score (IPSS), a condition-specific instrument, within economic evaluation of lower urinary tract symptom (LUTS) interventions. Data were obtained from a cohort of 2236 community-dwelling Australian men. Using correlations and a modified Bland-Altman plot, we investigated the convergent validity of the IPSS with two generic quality of life (GQol) instruments: the Assessment of Quality of Life 4 Dimensions (AQoL-4D) and the Short-Form 36 (SF-36). Discriminant validity was investigated using Wilcoxon-Mann-Whitney and Kruskal-Wallis tests, comparing instrument scores and utilities between subgroups varying in age, marital status, history of illness, smoking status and self-assessed general health. Discriminant validity was confirmed for all instruments by finding statistically significant differences in summary scores and utilities between nearly all subgroups. Convergent validity between the summary scores/utilities of the IPSS and the GQoL instruments was weak (absolute correlation value range, 0.11-0.23) but differed considerably between dimensions of the instruments (absolute correlation value range, 0.01-0.24). Weak to moderate correlation between the GQoL instruments was seen (absolute correlation value range, 0.01-0.49). Our findings suggest that the IPSS has comparable discriminant validity to the GQoL instruments and therefore useful for assessing subgroup differences related to urinary symptoms. The weak convergence between the IPSS and the GQoL instruments however suggests that, within economic evaluation, the IPSS should be viewed as a complement rather than a substitute to the GQoL instruments because it captures different quality of life constructs.
Publisher: Informa UK Limited
Date: 10-2022
DOI: 10.2147/NSS.S379252
Publisher: Informa UK Limited
Date: 07-03-2022
DOI: 10.1080/07420528.2022.2032125
Abstract: Shift work disorder (SWD) is a circadian rhythm sleep-wake disorder, defined by symptoms of insomnia and excessive levels of sleepiness resulting from work that occurs during non-standard hours. Sleep problems are common in shift workers, yet our understanding of help seeking behaviours for sleep in shift workers is limited. The primary aim of this study was to examine the help seeking behaviours of Australian workers who meet criteria for SWD. Of the 448 (46% of s le,
Publisher: Wiley
Date: 09-2017
DOI: 10.1002/AQC.2809
Publisher: Informa UK Limited
Date: 05-2023
DOI: 10.2147/NSS.S401655
Publisher: Wiley
Date: 12-09-2012
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.SLEH.2017.10.006
Abstract: To determine the prevalence of sleep conditions (obstructive sleep apnea [OSA], insomnia symptoms, simple snoring, and restless legs) and their associated burden of chronic conditions in a community s le. Cross-sectional national adult online survey. Community-based s le. Australian adults ≥18 years, N = 1011. A cross-sectional national online survey assessed diagnosed OSA, OSA symptoms, insomnia symptoms, sleep problems, excessive daytime sleepiness (Epworth Sleepiness Scale ≥11), and physician-diagnosed health conditions (heart disease, diabetes, hypertension, reflux disease, lung disease, depression, anxiety anic disorder, arthritis). Possible undiagnosed OSA was estimated using self-reported frequent loud snoring and witness apneas. International Criteria for Sleep Disorders-3 criteria identified insomnia symptoms. Logistic regression models adjusted for age, sex, obesity, and smoking determined correlates of sleep disorders. Comorbid sleep conditions were common, with 56% of participants demonstrating ≥1 condition. Reporting ≥1 mental health condition (depression and/or anxiety) was independently associated with diagnosed OSA (odds ratio [95% confidence interval {CI}]: 6.6 [3.2-13.6]), undiagnosed OSA (3.2 [1.8-5.8]), simple snoring (2.4 [1.2-4.5]), insomnia symptoms (4.3 [2.5-7.3]), and restless legs (1.9 [1.2-3.1]). Diagnosed OSA was significantly associated with ≥1 cardiometabolic condition (2.9 [1.4-6.0]) and arthritis (3.6 [1.8-7.2]). ESS ≥11 was associated with diagnosed (3.1 [1.4-6.8]) and undiagnosed OSA (6.2 [3.4-11.4]), insomnia symptoms (2.6 [1.4-4.9]), and restless legs (2.3 [1.4-4.0]), and these sleep conditions were also significantly associated with ≥2 diagnosed medical problems. Strategies to facilitate the diagnosis and management of often comorbid sleep disorders in primary care are required to reduce the significant sleep-related disparities in cardiometabolic and mental health.
Publisher: Informa UK Limited
Date: 2005
DOI: 10.1080/02770900500265041
Abstract: Use of controller asthma medication and possession of asthma action plans remains suboptimal. Our aim was to investigate the association of the propensity of physicians to involve patients in their care (participatory decision-making style) and their asthma management in a representative population s le of 3015 adults. Current doctor-diagnosed asthma was reported by 393 (13.0%). People who rated their doctors as more participatory were significantly more likely to report more regular use of controller medications and possession of a written asthma action plan, but not less asthma morbidity. Possession of a written action plan was associated with more participatory interactions (OR 2.3 95% CI 1.1-4.7, for upper tertile scores compared to lowest tertile) more severe symptoms (OR 4.8 95% CI 1.7-13.0), being female (OR 2.2 95% CI 1.2-4.3), those with higher education, and residence outside the metropolitan area (OR 2.1 95% CI 1.1-4.0). Increasing patient participation in their own care is associated with better asthma management, independent of asthma symptoms. Longitudinal studies are needed to examine if increasing participation in decisions can also improve asthma outcomes.
Publisher: Oxford University Press (OUP)
Date: 04-2018
Publisher: Hindawi Limited
Date: 2018
DOI: 10.1017/GHEG.2018.9
Abstract: Multimorbidity is common but little is known about its relationship with obstructive sleep apnea (OSA). Men Androgen Inflammation Lifestyle Environment and Stress Study participants underwent polysomnography. Chronic diseases (CDs) were determined by biomedical measurement (diabetes, dyslipidaemia, hypertension, obesity), or self-report (depression, asthma, cardiovascular disease, arthritis). Associations between CD count, multimorbidity, apnea-hyponea index (AHI) and OSA severity and quality-of-life (QoL mental & physical component scores), were determined using multinomial regression analyses, after adjustment for age. Of the 743 men participating in the study, overall 58% had multimorbidity (2+ CDs), and 52% had OSA (11% severe). About 70% of those with multimorbidity had undiagnosed OSA. Multimorbidity was associated with AHI and undiagnosed OSA. Elevated CD count was associated with higher AHI value and increased OSA severity. We demonstrate an independent association between the presence of OSA and multimorbidity in this representative s le of community-based men. This effect was strongest in men with moderate to severe OSA and three or more CDs, and appeared to produce a greater reduction in QoL when both conditions were present together.
Publisher: Wiley
Date: 19-10-2023
DOI: 10.1111/JSR.14078
Publisher: Oxford University Press (OUP)
Date: 05-02-2020
Abstract: The use of smartphones/electronic devices and their relationship with outcomes are understudied in adult populations. We determined daytime functional correlates of using technology during the night in a population s le of Australian adults. A cross-sectional, national online survey of sleep health was conducted in 2019 (n = 1984, 18–90 years). Nocturnal technology use was assessed with: “In the past seven days, how often did you wake or were woken to send or receive text messages, emails or other electronic communications?” Waking to use technology during all/most nights was reported by 4.9%, with 13.8% reporting two to three nights per week, and 12.7% reporting just one night per week. Technology users were more likely to be younger, employed, experience financial stress, and speak English as a second language. In adjusted analyses, compared to no use, technology use at least two to three nights per week was significantly associated with daytime problems (sleepiness, fatigue and impaired mood, motivation, and attention) and was more evident in participants not reporting erceiving a sleep problem. Technology use was independently associated with at least one drowsy driving-related motor vehicle accidents/near miss per month (odds ratio [OR] = 6.4, 95% CI = 3.8 to 10.7) and with missing work (OR = 4.8, 95% CI: 3.2 to 7.2) and making errors at work (OR = 2.2, 95% CI = 1.5 to 3.3) at least 1 day in the past 3 months due to sleepiness/sleep problem. These associations were not significantly modified by age. Public health implications of waking to engage with electronic devices at night may be significant in terms of safety, productivity, and well-being. Limiting sleep-disrupting technology use will require innovative language- erse strategies targeted broadly across age groups.
Publisher: SAGE Publications
Date: 04-2004
DOI: 10.1191/1479972304CD028OA
Abstract: Aims: Benefits of long acting beta 2 agonists are unclear for severe chronic obstructive pulmonary disease (COPD) patients with poor response to short acting bronchodilators. We aimed to evaluate 1) effects of eformoterol in such patients using a ‘n-of-1’ double crossover study design, and 2) aggregate data as a double-blind, double crossover randomized control trial. Methods: Subjects with forced expiratory volume in one second (FEV 1 ) 60% predicted, and poor response to short acting bronchodilators were studied six times over 18 weeks. During that time they were prescribed four weeks of either eformoterol or placebo, followed by the alternate, and then a second crossover. Four-weekly measures included six minute walk distance (6MWD), FEV 1 , previous two weeks of symptoms, and chronic respiratory questionnaire (CRQ) including treatment goal items. Results: Of 27 original subjects (21 male, mean age of 70 years, five smokers, mean prebronchodilator FEV 1 , 36% predicted), one subject had clinically significant concordant improvement in the CRQ dyspnoea domain and 6MWD (by 51 metres), but not for other outcomes. There were no concordant improvements in any other subjects. Aggregate double crossover data analysis demonstrated no improvement in any outcome measures. Conclusions: The ‘n-of-1’ study design and aggregate data analysis demonstrated lack of benefit from eformoterol in COPD patients with poor response to short acting bronchodilators.
Publisher: John Wiley & Sons, Ltd
Date: 23-07-2001
Publisher: BMJ
Date: 27-07-2022
Abstract: Sleep difficulties are common in people with multiple sclerosis (MS), but whether associations between poor sleep quality and quality of life are independent of MS symptoms, obesity and other MS-related factors remains unclear. Cross-sectional analyses of data from the Australian MS Longitudinal Study (n=1717). Sleep was assessed using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and International Restless Legs Syndrome Study Group Rating Scale health-related quality of life using the Assessment of Quality-of-Life 8-D. Poor sleep quality was common (67%), and more common than in community s les. Sleep measures clustered independently within MS symptoms. The clusters 'fatigue and cognitive', 'feelings of anxiety and depression', 'pain and sensory', were independently associated with poor sleep quality. Quality-of-Life utility scores were a clinically meaningful 0.19 units lower in those with poor sleep. Sleep quality, daytime sleepiness and restless leg syndrome were associated with reduced quality of life, independent of MS-related symptoms and body mass index. Poor sleep quality is common in MS and was strongly associated with worse health-related quality of life, independent of other MS symptoms and did not cluster with other common MS symptoms. Improving sleep quality may substantially improve quality of life in people with MS.
Publisher: Elsevier BV
Date: 12-2017
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/AH11098
Abstract: Objective. To obtain prevalence estimates of clinical features of obstructive sleep apnoea (OSA) and identify the dimensions of the public health problem requiring further investigation for an Australian population. Methods. The South Australian Health Omnibus Survey is an annual representative population survey of South Australians aged ≥15 years, conducted via interviewer-administered questionnaire. In 2009, 3007 participants were asked the STOP-BANG instrument measure of obstructive sleep apnoea risk, which includes symptoms of loud snoring, frequent tiredness during daytime, observed apnoea, and high blood pressure (STOP), and measured body mass index, age, neck circumference and gender (BANG). Three or more positive response categorises a person at high risk for OSA. Results. Snoring was reported by 49.7% of adults. Tiredness after sleep more than 3 – 4 times per week was reported by 24.8%, and during wake-time by 27.7% of adults, with 8.8% reporting having fallen asleep while driving. Over half of the surveyed men (57.1%, n = 566) and 19.3% (n = 269) of the women were classified at high-risk of OSA with the STOP-BANG measure. In multivariable models, high risk was associated with less education, lower income, and residence in a regional rather than metropolitan area. Conclusion. The high prevalence of adults at risk for OSA suggests that the capacity currently available within the healthcare system to investigate and diagnose OSA is likely to be inadequate, particularly outside urban areas. This highlights an important public health problem that requires further detailed study and trials of new models of care. What is known about the topic? Obstructive sleep apnoea (OSA) is associated with obesity, and although it is associated with significant morbidity and mortality there is no simple clinical test for this condition. While the prevalence of snoring or sleepiness is reported to be high and increasing with obesity, there is little recent information on how many adults report combinations of frequent sleep-related breathing abnormalities, unsatisfactory sleep, or unexplained daytime sleepiness, that justify further investigation with tests such as polysomnography that require considerable health service investment. What does this paper add? In a representative adult population s le of 3007 adults, 27.8% were classified at high risk of OSA with a validated screening tool that uses symptoms and body measurements (STOP-BANG). Risk was greater with lower income and education, and residence outside of metropolitan areas. What are the implications for practitioners? Clinicians need to be aware that over a quarter of adults may need investigation for OSA, and should adopt an active approach to identifying people at risk. Health services and policy makers need to plan for this problem, and innovative approaches to provision of investigation and management need to be trialled.
Publisher: Informa UK Limited
Date: 05-2021
DOI: 10.2147/NSS.S301493
Publisher: Informa UK Limited
Date: 11-2020
DOI: 10.2147/NSS.S276932
Publisher: FapUNIFESP (SciELO)
Date: 2021
DOI: 10.1590/0102-311X00255920
Abstract: Abstract: There is a conflict in the literature regarding the association between serum uric acid (SUA) levels and glycemic status. Therefore, we evaluated the association between SUA level and glycemic status - impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus - and insulin resistance, in a large Brazilian study. This is a cross-sectional, observational study with 13,207 participants aged 35-74 years, at baseline (2008-2010) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). A multinomial regression analysis was performed to test the association between SUA and glycemic status (IFG, IGT, and newly diagnosed type 2 diabetes at the cohort baseline) after adjustments by age, sex, skin color, body mass index, physical activity, smoking, alcohol consumption, comorbidities, and medicines use. Logistic regression model was used to evaluate the association between SUA and insulin resistance by HOMA-IR. Stratified analyses by sex were performed. The mean age (standard deviation) was 51.4 (8.9) years, 55.2% of participants were women. There were 1,439 newly diagnosed diabetes. After all adjustments, higher SUA was associated with IFG, IGT, and diabetes, with odds ratio (OR) = 1.15 (95%CI: 1.06 1.25), 1.23 (95%CI: 1.14 1.33), and 1.37 (95%CI: 1.24 1.51), respectively. There was association between SUA levels and insulin resistance with OR = 1.24 (95%CI: 1.13 1.36). In analysis stratified by sex, higher SUA persisted independently associated with impaired glycemic status. Our results suggest that a higher SUA levels were significantly associated with glycemic status in a large Latin American population, mainly among women.
Publisher: Bentham Science Publishers Ltd.
Date: 28-06-2012
Publisher: Informa UK Limited
Date: 10-2021
DOI: 10.2147/NSS.S327478
Publisher: Wiley
Date: 22-10-2023
DOI: 10.1111/JSR.14069
Publisher: BMJ
Date: 1992
DOI: 10.1136/JNNP.55.1.4
Abstract: To clarify the role of endothelial cells in the pathogenesis of vasculitis affecting peripheral nerve and skeletal muscle, the endothelial expression of adhesion molecules and major histocompatibility antigens (MHC) in different vasculitic syndromes were studied, and related to the presence of anti-endothelial cell antibodies (AECA). Increased expression of the intercellular adhesion molecule ICAM-1 in vasculitic lesions in nerve and muscle was shown, and this was associated with increased expression of MHC class I and II antigens. AECA were detected in low titre in only a minority of patients. The findings suggest that endothelial cells have a critical role in mediating the tissue injury in vasculitis affecting nerve and muscle and that the process is triggered by cellular and not antibody-mediated mechanism in the majority of patients.
Publisher: Wiley
Date: 09-1991
DOI: 10.1111/J.1365-3083.1991.TB01546.X
Abstract: Antibodies directed to a co-factor associated with negatively charged phospholipids, such as cardiolipin, occur in patients with systemic lupus erythematosus (SLE), and possibly more often in those with venous or arterial thrombosis, thrombocytopenia or recurrent fetal loss. They are also found in patients without any of these manifestations and their biological effect, if any, might thus be related to their IgG subclass. To investigate this possibility, we determined anticardiolipin antibodies (ACA) by enzyme immunoassay (EIA) using monoclonal antibodies (MoAb) against human IgG subclasses. A net absorbance of x +3 SD of the value of 30 blood donors was taken as the cut-off point. The specificity of the assay was verified through inhibition experiments using cardiolipin micelles. Thirty-three patients with SLE were studied, all of whom had been shown to have ACA by a point dilution screening assay. IgG1 ACA were found in 85% of the patients, and ACA of the IgG2, IgG3 and IgG4 subclasses in 42%, 39% and 15%. There was a significant correlation between the presence of IgG3 ACA and of anti-DNA antibodies but none between subclass distribution and major clinical manifestations of SLE.
Publisher: John Wiley & Sons, Ltd
Date: 22-04-2003
Publisher: Informa UK Limited
Date: 04-2022
DOI: 10.2147/NSS.S359437
Publisher: Wiley
Date: 10-1999
DOI: 10.1111/J.1445-5994.1999.TB01621.X
Abstract: Chronic obstructive pulmomary disease (COPD) is associated with substantial mortality, morbidity, and costs to the health care system. With the increasing interest in outreach care programmes it is important to evaluate their impact upon patients and health services, for conditions such as COPD. To determine the effectiveness of an outreach respiratory nurse in a shared care approach, with collaboration between general practitioners and hospital services, in the management of patients with severe COPD. Patients with severe COPD attending The Queen Elizabeth Hospital, Adelaide participated in a randomised controlled trial of a home based nursing intervention (HBNI) over 12 months with outcome measures including mortality rate, hospital service utilisation, FEV1 and health related quality of life (HRQL) using a modified Dartmouth Primary Care Co-operative Quality of Life questionnaire. There were 48 subjects in each study arm, with no differences in mortality rate (eight deaths in the HBNI group and seven in the control group), hospital admissions, length of stay, number of outpatient and Emergency Service visits. The study had inadequate follow-up of FEV1 and HRQL within the control group. Within the HBNI group, a small improvement in HRQL (in three of ten indices measured) was demonstrated, despite a deterioration in FEV1 (11% reduction, p=0.04) compared to baseline. Quality of life of HBNI subjects' carers did not change. An increased level of care given by an outreach respiratory nurse in a shared care approach for patients with severe COPD produced small improvements in HRQL but did not result in the prevention of deaths or reduced health care utilisation.
Publisher: Wiley
Date: 07-06-2017
DOI: 10.1111/RESP.13064
Abstract: Obstructive sleep apnoea (OSA) and insomnia coexist in clinical populations but prevalence in the community and risk factors remain largely unknown. We examined the prevalence and profile of previously undiagnosed co-morbid OSA and insomnia symptoms (COMISA) in community-dwelling men. Men (n = 700, aged 58.5 ± 11.0 (mean ± SD) years) without a prior diagnosis of OSA completed full at-home unattended polysomnography, the Pittsburgh Sleep Quality Index and 36-item short form (SF-36) survey (2007-2012). Insomnia symptoms included difficulty initiating/maintaining sleep in the presence of daytime fatigue (DIMS-F). Depressive symptoms were assessed using the Beck Depression Inventory-1A, Centre for Epidemiological Studies Depression Scale and Patient Health Questionnaire-9 (PHQ-9) (2007-2010). Univariate (χ COMISA prevalence was 6.7%. Depression prevalence (COMISA, 42.6% DIMS-F, 21.6% OSA, 8.4%, χ 14.0 ± 4.9, P < 0.01 and OSA: 11.4 ± 3.0, P = 0.01) were highest in men with COMISA. In COMISA, respiratory and arousal indices were similar to those observed in OSA whilst reductions in subjective sleep and day dysfunction scores were similar to DIMS-F. After adjustment, predicted mean depression scores were all higher in DIMS-F and COMISA using linear regression (e.g. PHQ-9 β (95% CI): DIMS-F: 2.3 (1.2, 3.5) COMISA: 4.1 (3.0, 5.1)). Men with COMISA have a greater prevalence, and severity, of depression than men with only one disorder.
Publisher: Wiley
Date: 19-07-2006
Publisher: Wiley
Date: 19-04-2006
Publisher: Hindawi Limited
Date: 18-08-2015
DOI: 10.1155/2015/607472
Abstract: Self-report of musculoskeletal conditions is often used to estimate population prevalence and to determine disease burden and influence policy. However, self-report of certain musculoskeletal conditions is frequently inaccurate, suggesting inadequate communication to the patient of their diagnosis. The aim of this study is to determine the association between functional health literacy (FHL) and self-reported musculoskeletal conditions in a representative population survey. FHL was measured using Newest Vital Sign in 2824 randomly selected adults. Participants also self-reported medically diagnosed arthritis, gout, and osteoporosis. Multiple logistic regression was adjusted for age and sex. The prevalence of self-reported arthritis, gout, and osteoporosis was 25.2%, 4.9%, and 5.6%, respectively. The prevalence of those at risk for inadequate FHL was 24.0% and high likelihood of inadequate FHL was 21.0%. However, over 50% of respondents with arthritis or gout had at risk/inadequate FHL, increasing to 70% of those self-reporting osteoporosis. After adjustment for age and sex, respondents in the arthritis subgroup of “don’t know” and self-reported osteoporosis were significantly more likely to have inadequate FHL than the general population. This study indicates a substantial burden of low health literacy amongst people with musculoskeletal disease. This has implications for provider-patient communication, in idual healthcare, population estimates of musculoskeletal disease, and impact of public health messages.
Publisher: Springer Science and Business Media LLC
Date: 24-02-2020
Location: United States of America
No related grants have been discovered for Sarah Appleton.