Publications by authors named "Andrew D Williams"

64 Publications

Joint effects of ethnic enclave residence and ambient volatile organic compounds exposure on risk of gestational diabetes mellitus among Asian/Pacific Islander women in the United States.

Environ Health 2021 May 8;20(1):56. Epub 2021 May 8.

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC, Bethesda, MD, 7004, USA.

Background: Asian/Pacific Islander (API) communities in the United States often reside in metropolitan areas with distinct social and environmental attributes. Residence in an ethnic enclave, a socially distinct area, is associated with lower gestational diabetes mellitus (GDM) risk, yet exposure to high levels of air pollution, including volatile organic compounds (VOCS), is associated with increased GDM risk. We examined the joint effects of ethnic enclaves and VOCs to better understand GDM risk among API women, the group with the highest prevalence of GDM.

Methods: We examined 9069 API births in the Consortium on Safe Labor (19 hospitals, 2002-2008). API ethnic enclaves were defined as areas ≥66th percentile for percent API residents, dissimilarity (geographic dispersal of API and White residents), and isolation (degree that API individuals interact with another API individual). High levels of 14 volatile organic compounds (VOC) were defined as ≥75th percentile. Four joint categories were created for each VOC: Low VOC/Enclave (reference group), Low VOC/No Enclave, High VOC/Enclave, High VOC/No Enclave. GDM was reported in medical records. Hierarchical logistic regression estimated odds ratios (OR) and 95% confidence intervals (95%CI) between joint exposures and GDM, adjusted for maternal factors and area-level poverty. Risk was estimated for 3-months preconception and first trimester exposures.

Results: Enclave residence was associated with lower GDM risk regardless of VOC exposure. Preconception benzene exposure was associated with increased risk when women resided outside enclaves [High VOC/No Enclave (OR:3.45, 95%CI:1.77,6.72)], and the effect was somewhat mitigated within enclaves, [High VOC/Enclave (OR:2.07, 95%:1.09,3.94)]. Risks were similar for 12 of 14 VOCs during preconception and 10 of 14 during the first trimester.

Conclusions: API residence in non-enclave areas is associated with higher GDM risk, regardless of VOC level. Ethnic enclave residence may mitigate effects of VOC exposure, perhaps due to lower stress levels. The potential benefit of ethnic enclaves warrants further study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12940-021-00738-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106843PMC
May 2021

Air pollution exposure and risk of adverse obstetric and neonatal outcomes among women with type 1 diabetes.

Environ Res 2021 Jun 18;197:111152. Epub 2021 Apr 18.

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20892, USA; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 401 Kimball Tower, Buffalo, NY, 14214, USA.

Aims/hypothesis: Women with type 1 diabetes have increased risk for poor obstetric outcomes. Prenatal air pollution exposure is also associated with adverse outcomes for women and infants. We examined whether women with type 1 diabetes are more vulnerable than other women to pollution-associated risks during pregnancy.

Methods: In singleton deliveries from the Consortium on Safe Labor (2002-2008), obstetric and neonatal outcomes were compared for women with type 1 diabetes (n = 507) and women without autoimmune disease (n = 204,384). Preconception, trimester, and whole pregnancy average air pollutant exposure (ozone (O), carbon monoxide (CO), particulate matter >10 μm (PM), PM > 2.5 μm (PM), sulfur dioxide (SO), nitrogen oxides (NO)) were estimated using modified Community Multiscale Air Quality models. Poisson regression models with diabetes*pollutant interaction terms estimated relative risks and 95% confidence intervals for adverse outcomes, adjusted for maternal characteristics and geographic region.

Results: For whole pregnancy exposure to SO, women with type 1 diabetes had 15% increased risk (RR:1.15 95%CI:1.01,1.31) and women without autoimmune disease had 5% increased risk (RR:1.05 95%CI:1.05,1.06) for small for gestational age birth (p = 0.09). Additionally, whole pregnancy O exposure was associated with 10% increased risk (RR:1.10 95%CI:1.02,1.17) among women with type 1 diabetes and 2% increased risk (RR:1.02 95%CI:1.00,1.04) among women without autoimmune disease for perinatal mortality (p = 0.08). Similar patterns were observed between PM exposure and spontaneous preterm birth.

Conclusions: Pregnant women with type 1 diabetes may be at greater risk for adverse outcomes when exposed to air pollution than women without autoimmune disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envres.2021.111152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190832PMC
June 2021

Effects of Activity Tracker Use With Health Professional Support or Telephone Counseling on Maintenance of Physical Activity and Health Outcomes in Older Adults: Randomized Controlled Trial.

JMIR Mhealth Uhealth 2021 01 5;9(1):e18686. Epub 2021 Jan 5.

School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia.

Background: Despite a range of efforts to increase physical activity participation in Australia, inactivity levels in older adults have remained high over recent decades, contributing to increased rates of chronic health conditions. Lifestyle interventions, including telephone counseling (TC), improve physical activity participation and associated health outcomes over the short term; however, ongoing feedback and support is required to maintain these changes. Newer technologies such as wearable activity trackers (ATs) may offer an alternative method for providing ongoing support.

Objective: This study aims to investigate whether newer technologies such as wearable ATs assist in providing ongoing support to maintain physical activity levels and health outcomes.

Methods: Older adults aged >60 years who had just completed a 12-week face-to-face individualized community exercise program in Tasmania, Australia, participated in the study. They were randomized to receive AT, TC, or usual care (UC). All groups received a home exercise program and an optional referral to a community-based exercise program. The AT group also received an AT and text message feedback from an accredited exercise physiologist (AEP). The TC group received phone calls from an AEP throughout the 12-month intervention. The primary outcome was daily steps measured by an ActivPAL (TM) accelerometer at baseline and at 3, 6, and 12 months. Secondary outcome measures included body composition, blood pressure, 10-time sit-to-stand (TTSTS) test, timed up and go test, and cardiorespiratory fitness. This trial was approved by the Tasmanian Health and Medical Human Research Ethics Committee (H0014713).

Results: A total of 117 participants were randomized to the study (AT, n=37; TC, n=38; UC, n=42). At baseline, the participants (75/117, 64.1% female; mean age 72.4 years, SD 6.4) completed an average of 6136 steps (SD 2985) per day. Although there were no significant differences between groups, the TC and AT groups maintained daily step counts (mean difference [MD] -79 steps, 95% CI -823 to 663 steps; P=.81; and MD -588 steps, 95% CI -1359 to 182 steps; P=.09), and UC showed a reduction in daily steps (MD 981 steps, 95% CI -1668 to -294 steps; P=.003) during the 12-month period. Diastolic blood pressure was significantly higher after AT than after UC (MD 5.62 mm Hg, 95% CI 1.30 to 9.94 mm Hg; P=.01), and TTSTS was significantly slower on TC compared with UC (MD 2.36 seconds, 95% CI -0.14 to 4.87 seconds; P=.03).

Conclusions: The use of an AT with AEP support or TC is effective at maintaining daily step count in older adults over a 12-month period, suggesting that wearable ATs are as effective as TC. Further research to investigate which option is more cost-effective would be beneficial.

Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12615001104549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369118.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/18686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815450PMC
January 2021

Ambient temperature and stillbirth: Risks associated with chronic extreme temperature and acute temperature change.

Environ Res 2020 10 19;189:109958. Epub 2020 Jul 19.

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, USA. Electronic address:

Background: Ambient temperature events are increasing in frequency and intensity. Our prior work in a U.S. nationwide study suggests a strong association between both chronic and acute temperature extremes and stillbirth risk.

Objective: We attempted to replicate our prior study by assessing stillbirth risk associated with average whole-pregnancy temperatures and acute ambient temperature changes in a low-risk U.S.

Population:

Methods: Singleton deliveries in the NICHD Consecutive Pregnancies Study (Utah, 2002-2010; n = 112,005) were identified using electronic medical records. Ambient temperature was derived from the Weather Research and Forecasting model. Binary logistic regression determined the adjusted odds ratio (aOR) and 95% confidence interval (95% CI) for stillbirth associated with whole-pregnancy exposure to extreme cold (<10th percentile) and hot (>90th percentile) versus moderate (10th-90th percentiles) average temperature, adjusting for maternal demographics, season of conception, hypertensive disorders of pregnancy, and gestational diabetes. In a case-crossover analysis, we estimated the stillbirth aOR and 95% CI for each 1° Celsius increase during the week prior to delivery using conditional logistic regression. In both models, we adjusted for relative humidity, ozone, and fine particulates.

Results: We observed 500 stillbirth cases among 498 mothers. Compared to moderate temperatures, whole-pregnancy exposure to extreme cold (aOR: 4.42, 95% CI:3.43, 5.69) and hot (aOR: 5.06, 95% CI: 3.34, 7.68) temperatures were associated with stillbirth risk. Case-crossover models observed a 7% increased odds (95% CI: 1.04, 1.10) associated with each 1° Celsius increase during the week prior to delivery.

Discussion: Both chronic and acute ambient temperature were associated with odds of stillbirth in this low-risk population, similar to our prior nationwide findings. Future increases in temperature extremes are likely and the observed risk in a low-risk population suggests this association merits attention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envres.2020.109958DOI Listing
October 2020

Clinical Application of Forced Oscillation Technique (FOT) in Early Detection of Airway Changes in Smokers.

J Clin Med 2020 Aug 27;9(9). Epub 2020 Aug 27.

Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania 7248, Australia.

The forced oscillation technique (FOT) is a non-invasive method to assess airway function by emitting oscillatory signals into the respiratory tract during tidal ventilation. This opinion piece discusses the current use, trialled modification and future directions in utilizing FOT as a novel diagnostic tool for early detection of small airway changes in smokers. The published evidence to date has shown that FOT parameters could be a sensitive diagnostic tool to detect early respiratory changes in smokers. Multiple frequencies and the frequency dependence of resistance and reactance can provide the most valuable and early information regarding smoking induced changes in airways. Considering its non-invasiveness, lower level of discomfort to patients than spirometry, feasibility, and cost effectiveness, it could be the first-choice diagnostic technique for detection of early respiratory changes in smokers. The finding of FOT could further be supported and correlated with inflammatory markers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9092778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565456PMC
August 2020

Concomitant exposure to area-level poverty, ambient air volatile organic compounds, and cardiometabolic dysfunction: a cross-sectional study of U.S. adolescents.

Ann Epidemiol 2020 08 5;48:15-22. Epub 2020 Jun 5.

Public Health Program, School of Medicine & Health Sciences, University of North Dakota, Grand Forks.

Purpose: A key to better understanding the influence of the place of residence on cardiometabolic function is the effect of concomitant exposure to both air pollution and residence in economically marginalized areas. We hypothesized that, among adolescents, the association between air pollution and cardiometabolic function is exacerbated among residents of economically marginalized areas.

Methods: In this cross-sectional study, individual-level data on cardiometabolic function collected from a representative sample of U.S. adolescents in the National Health and Nutrition Examination Survey (n = 10,415) were merged with data on area-level poverty (U.S. decennial survey and American Community Survey) and air pollution levels (National-Scale Air Toxics Assessment ) using contemporary census-tract identifiers. We excluded respondents who were pregnant, had hypertension or diabetes or using medication for hypertension or diabetes, or with missing data on outcome variables.

Results: We observed a significant interaction between area-level poverty and air pollution. Among residents of high-poverty areas, exposure to high levels of air pollution predicted a 30% elevated odds of cardiometabolic dysfunction (OR = 1.30; 95% CI: 1.04, 1.61), whereas in low-poverty areas, exposure to high levels of air pollution was not associated with elevated odds of cardiometabolic dysfunction (OR = 1.04; 95% CI: 0.85, 1.28).

Conclusions: Our findings suggest that the cardiometabolic consequences of air pollution are more readily realized among residents of economically marginalized areas. Structural remedies are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annepidem.2020.05.014DOI Listing
August 2020

Older adults' experiences of using a wearable activity tracker with health professional feedback over a 12-month randomised controlled trial.

Digit Health 2020 Jan-Dec;6:2055207620921678. Epub 2020 Apr 26.

School of Health Science, University of Tasmania, Australia.

Objective: Wearable activity trackers can help older adults remain physically active. However, knowledge of the user experience during long-term use is scarce. Therefore, this study examined older adults' experiences with, and perceptions of, wearable activity trackers combined with health professional feedback after a year's use as part of a randomised controlled trial.

Methods: Twenty older adults (73.6 ± 5.5 years) who had used a Jawbone UP24 activity tracker for 12 months during a randomised controlled trial were recruited for this study. All participants had at least one chronic condition. Acceptability data relating to activity tracker wear time was combined with focus group data to explore participants experiences of long-term activity tracker use. Data was analysed using thematic analysis.

Results: The activity tracker was well-accepted with the device worn on an average of 86% of possible days and participants reported an overall positive experience. Four themes were identified: (a) increased sense of awareness of activity levels is related to motivation; (b) the level of engagement with the activity tracker influences the user experience; (c) the role of feedback from a health professional in providing ongoing support; d) the role of habits in supporting long-term behaviour change.

Conclusions: The use of an activity tracker combined with health professional support can assist older adults to maintain their activity levels over 12 months. Consideration should be given to the previous technology experience of users and the design and accuracy of an activity tracker when recommending their use in a research or clinical setting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2055207620921678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218318PMC
April 2020

Ethnic Enclaves and Pregnancy and Behavior Outcomes Among Asian/Pacific Islanders in the USA.

J Racial Ethn Health Disparities 2020 04 14;7(2):224-233. Epub 2019 Nov 14.

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC, Bethesda, MD, 7004, USA.

Objectives: Ethnic enclaves are ethnically, spatially, and socially distinct communities that may promote health through access to culturally appropriate resources and reduced exposure to discrimination. This study examined ethnic enclave residence and pregnancy outcomes among Asian/Pacific Islander (API) women in the USA.

Design: We examined 9206 API births in the Consortium on Safe Labor (2002-2008). Ethnic enclaves were defined as hospital regions with high percentage of API residents (> 4%), high dissimilarity index (> 0.41; distribution of API and white residents within a geographic area), and high isolation index (> 0.03; interaction between API and white residents in an area). Gestational diabetes mellitus (GDM), preterm birth (PTB), small for gestational age (SGA), and smoking and alcohol use during pregnancy were reported in medical records supplemented with ICD-9 codes. Hierarchical logistic regression models estimated associations between ethnic enclaves and pregnancy outcomes, adjusted for maternal factors, area-level poverty, and air pollution.

Results: Women in enclaves had lower odds of GDM (OR 0.61; 95%CI 0.45, 0.82), PTB (OR 0.74; 95%CI 0.56, 0.99), and SGA (OR 0.68; 95%CI 0.52, 0.89) compared with women in non-enclaves. Prenatal smoking and alcohol use appeared less likely in enclaves, but estimates were imprecise. Within enclaves, about 10.5% of homes speak an API language, compared with 6.0% in non-enclaves. The mean percent of foreign-born API populations was 67.4% in enclaves and 68.8% in non-enclaves.

Conclusions: API women residing in ethnic enclaves had better pregnancy outcomes than API women residing in non-enclave areas. Access to culturally appropriate social supports and resources may be important for health promotion among API populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40615-019-00650-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104626PMC
April 2020

Sex-Specific Associations Between Area-Level Poverty and Cardiometabolic Dysfunction Among US Adolescents.

Public Health Rep 2020 01 14;135(1):47-55. Epub 2019 Nov 14.

Department of Family Science, Maternal and Child Health Program, University of Maryland College Park, College Park, MD, USA.

Objective: Cardiometabolic disease is the leading cause of mortality in the United States. Cardiometabolic function during adolescence predicts future cardiometabolic disease, yet few studies have examined early determinants of cardiometabolic function. Informed by evidence of sex differences in the prevalence and severity of cardiometabolic disorders and evidence of sexual dimorphism in the stress response, we examined sex differences in the association between living in poverty and cardiometabolic function during adolescence, a precursor of later cardiometabolic disorders.

Methods: We linked data from 10 415 adolescents aged 12-19 in the National Health and Nutrition Examination Survey (1999-2012) with US Census-tract data on area-level poverty (percentage of the population living in poverty, grouped into quartiles). We parameterized cardiometabolic dysfunction by summing the scores of 6 cardiometabolic biomarkers, grouped into quintiles. Hierarchical ordinal models estimated associations.

Results: Compared with residents in low-poverty areas, residents in high-poverty areas had elevated odds of cardiometabolic dysfunction (highest quartile of poverty odds ratio [OR] = 1.27; 95% confidence interval [CI], 1.08-1.50). This association was more pronounced among boys than girls (highest quartile of poverty for boys: OR = 1.36; 95% CI, 1.10-1.70; highest quartile of poverty for girls: OR = 1.17; 95% CI, 0.94-1.47).

Conclusion: Our study supports the existence of sex-specific associations. These results highlight the potential for community-based programs, such as housing assistance, to improve population health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0033354919884303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7119245PMC
January 2020

Study protocol for a multicentre, controlled non-randomised trial: benefits of exercise physiology services for type 2 diabetes (BEST).

BMJ Open 2019 08 21;9(8):e027610. Epub 2019 Aug 21.

School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia

Introduction: Controlled trials support the efficacy of exercise as a treatment modality for chronic conditions, yet effectiveness of real-world Exercise Physiology services is yet to be determined. This study will investigate the efficacy and cost-effectiveness of services provided by Accredited Exercise Physiologists (AEPs) for clients with type 2 diabetes (T2D) in clinical practice.

Methods And Analysis: A non-randomised, opportunistic control, longitudinal design trial will be conducted at ten Exercise Physiology Clinics. Participants will be individuals with T2D attending one of the Exercise Physiology Clinics for routine AEP services (exercise prescription and counselling) (intervention) or individuals with T2D not receiving AEP services (usual care) (control). The experimental period will be 6 months with measurements performed at baseline and at 6 months. Primary outcome measures will be glycosylated haemoglobin (HbA1c), resting brachial blood pressure (BP), body mass index, waist circumference, 6 min walk test, grip strength, 30 s sit to stand, Medical Outcomes Short-Form 36-Item Health Survey and Active Australia Questionnaire. Secondary outcomes will be medication usage, out-of-pocket expenses, incidental, billable and non-billable health professional encounters and work missed through ill health. Healthcare utilisation will be measured for 12 months prior to, during and 12 months after trial participation using linked data from Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data.

Ethics And Dissemination: The study is a multicentre trial comprising: University of Tasmania, University of New South Wales Lifestyle Clinic, University of Canberra, Baker Heart and Diabetes Institute (covered under the ethics approval of University of Tasmania Health and Medical Ethics Committee H0015266), Deakin University (Approval number: 2016-187), Australian Catholic University (2016-304R), Queensland University of Technology (1600000049), University of South Australia (0000035306), University of Western Australia (RA/4/1/8282) and Canberra Hospital (ETH.8.17.170). The findings of this clinical trial will be communicated via peer-reviewed journal articles, conference presentations, social media and broadcast media.

Trial Registration Number: ACTRN12616000264482.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2018-027610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707671PMC
August 2019

Consumer-Based Wearable Activity Trackers Increase Physical Activity Participation: Systematic Review and Meta-Analysis.

JMIR Mhealth Uhealth 2019 04 12;7(4):e11819. Epub 2019 Apr 12.

School of Health Science, College of Health and Medicine, University of Tasmania, Newnham, Australia.

Background: The range of benefits associated with regular physical activity participation is irrefutable. Despite the well-known benefits, physical inactivity remains one of the major contributing factors to ill-health throughout industrialized countries. Traditional lifestyle interventions such as group education or telephone counseling are effective at increasing physical activity participation; however, physical activity levels tend to decline over time. Consumer-based wearable activity trackers that allow users to objectively monitor activity levels are now widely available and may offer an alternative method for assisting individuals to remain physically active.

Objective: This review aimed to determine the effects of interventions utilizing consumer-based wearable activity trackers on physical activity participation and sedentary behavior when compared with interventions that do not utilize activity tracker feedback.

Methods: A systematic review was performed searching the following databases for studies that included the use of a consumer-based wearable activity tracker to improve physical activity participation: Cochrane Controlled Register of Trials, MEDLINE, PubMed, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature, SPORTDiscus, and Health Technology Assessments. Controlled trials of adults comparing the use of a consumer-based wearable activity tracker with other nonactivity tracker-based interventions were included. The main outcome measures were physical activity participation and sedentary behavior. All studies were assessed for risk of bias, and the Grades of Recommendation, Assessment, Development, and Evaluation system was used to rank the quality of evidence. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. A random-effects meta-analysis was completed on the included outcome measures to estimate the treatment effect of interventions that included an activity tracker compared with a control group.

Results: There was a significant increase in daily step count (standardized mean difference [SMD] 0.24; 95% CI 0.16 to 0.33; P<.001), moderate and vigorous physical activity (SMD 0.27; 95% CI 0.15 to 0.39; P<.001), and energy expenditure (SMD 0.28; 95% CI 0.03 to 0.54; P=.03) and a nonsignificant decrease in sedentary behavior (SMD -0.20; 95% CI -0.43 to 0.03; P=.08) following the intervention versus control comparator across all studies in the meta-analyses. In general, included studies were at low risk of bias, except for performance bias. Heterogeneity varied across the included meta-analyses ranging from low (I=3%) for daily step count through to high (I=67%) for sedentary behavior.

Conclusions: Utilizing a consumer-based wearable activity tracker as either the primary component of an intervention or as part of a broader physical activity intervention has the potential to increase physical activity participation. As the effects of physical activity interventions are often short term, the inclusion of a consumer-based wearable activity tracker may provide an effective tool to assist health professionals to provide ongoing monitoring and support.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/11819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484266PMC
April 2019

A method to estimate inertial properties and force plate inertial components for instrumented platforms.

Med Eng Phys 2019 04 11;66:96-101. Epub 2019 Mar 11.

Department of Mechanical Engineering, University of Alberta, 10-203 Donadeo Innovation Centre for Engineering, 9211 116 Street NW, Edmonton, Alberta T6G 1H9, Canada; Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta T6G 2V2, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta T5G 0B7, Canada. Electronic address:

Kinetic data acquired from force plates embedded in moving platforms naturally contain artifacts due to platform acceleration, called force plate inertial components. While they can be estimated and removed from the measured signals, the system's inertial properties need to be known. Our objective was to: (1) develop a method for estimating the inertial properties and force plate inertial components for any instrumented platform; (2) estimate the inertial properties specifically for the Computer-Assisted Rehabilitation Environment (CAREN); and (3) validate the estimates with new experimental data. Unloaded ramp-and-hold perturbations (for estimation) and unloaded random perturbations (for validation) were executed to obtain the force, moment, and motion of the CAREN platform. Inertial properties were estimated by minimizing the error between the measured and computed inertial forces and moments. Obtained estimates were validated by calculating the coefficient of determination (R) between the measured and computed forces or moments when keeping the inertial properties fixed. The estimates of the CAREN's inertial properties exhibited low variability across trials, and R for the validation trials was 0.90 ± 0.08 (mean ± standard deviation). The developed method can be used for removing inertial components from force plate signals, yielding reliable estimates of ground reactions in dynamic biomechanical research and clinical assessments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.medengphy.2019.02.012DOI Listing
April 2019

A Vibrotactile Feedback Device for Seated Balance Assessment and Training.

J Vis Exp 2019 01 20(143). Epub 2019 Jan 20.

Department of Biomedical Engineering, University of Alberta; Department of Mechanical Engineering, University of Alberta; Glenrose Rehabilitation Hospital, Alberta Health Services;

Postural perturbations, motion tracking, and sensory feedback are modern techniques used to challenge, assess, and train upright sitting, respectively. The goal of the developed protocol is to construct and operate a sitting platform that can be passively destabilized while an inertial measurement unit quantifies its motion and vibrating elements deliver tactile feedback to the user. Interchangeable seat attachments alter the stability level of the device to safely challenge sitting balance. A built-in microcontroller allows fine-tuning of the feedback parameters to augment sensory function. Posturographic measures, typical of balance assessment protocols, summarize the motion signals acquired during timed balance trials. No dynamic sitting protocol to date provides variable challenge, quantification, and sensory feedback free of laboratory constraints. Our results demonstrate that non-disabled users of the device exhibit significant changes in posturographic measures when balance difficulty is altered or vibrational feedback provided. The portable, versatile device has potential applications in rehabilitation (following skeletal, muscular, or neurological injury), training (for sports or spatial awareness), entertainment (via virtual or augmented reality), and research (of sitting-related disorders).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3791/58611DOI Listing
January 2019

Ambient Volatile Organic Compounds and Racial/Ethnic Disparities in Gestational Diabetes Mellitus: Are Asian/Pacific Islander Women at Greater Risk?

Am J Epidemiol 2019 02;188(2):389-397

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.

US Asian/Pacific Islander (API) communities experience high air pollution levels. APIs may be predisposed to pancreatic β-cell dysfunction and have the highest prevalence of gestational diabetes mellitus (GDM) compared with other racial/ethnic groups. Exposure to high levels of volatile organic compounds (VOCs) impairs pancreatic β-cell function, leading to insulin resistance, but racial/ethnic differences in this association are unexamined. We analyzed singleton deliveries (n = 220,065) from the Consortium on Safe Labor (2002-2008). Exposure to 14 VOCs in each hospital referral region was based on modified Community Multiscale Air Quality models. Logistic regression estimated odds ratios for GDM associated with high (≥75th percentile) versus low (<75th percentile) VOC exposure 3 months before conception and during the first trimester of pregnancy. Preconception and first-trimester exposure to high VOC levels was associated with increased odds of GDM among whites and APIs. GDM risk was significantly higher for APIs than whites for most VOCs. Preconception benzene exposure was associated with 29% (95% confidence interval: 12, 47) increased odds of GDM among whites compared with 45% (95% confidence interval: 16, 81) increased odds among APIs. These findings highlight environmental health disparities affecting pregnant women. Increased focus on GDM risk in US API communities is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/aje/kwy256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357797PMC
February 2019

Cardiometabolic Dysfunction Among U.S. Adolescents and Area-Level Poverty: Race/Ethnicity-Specific Associations.

J Adolesc Health 2018 11;63(5):546-553

National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.

Purpose: To examine race/ethnicity-specific associations between area-level poverty and cardiometabolic dysfunction among U.S. adolescents.

Methods: Data were from 10,415 adolescents aged 12-19 in the National Health and Nutrition Examination Survey (1999-2012), linked with census tract data on area-level poverty (the percent population living in poverty, grouped into race/ethnicity-specific quartiles). Cardiometabolic dysfunction was parameterized by summing z-scores of six cardiometabolic biomarkers, grouped into quintiles. Hierarchical ordinal models estimated overall and race/ethnicity specific associations. Posthoc analysis explored associations between area-level poverty and family poverty-to-income ratio.

Results: Overall, compared to adolescents residing in areas with the lowest area-level poverty (i.e., first quartile), residents in third (OR 1.32, 95% CI 1.13, 1.53) and fourth (OR 1.27, 95% CI 1.08, 1.50) quartiles of area-level poverty experienced elevated odds of cardiometabolic dysfunction. Area-level poverty predicted cardiometabolic dysfunction between non-Hispanic white and Mexican American adolescents, but not between non-Hispanic black adolescents.

Conclusions: We found race/ethnicity-specific associations between area-level poverty and cardiometabolic dysfunction among U.S. adolescents, highlighting the moderating effect of race-ethnicity. Among non-Hispanic black adolescents, neither higher area-level nor family-level socioeconomic status is associated with cardiometabolic health, in contrast to non-Hispanic white adolescents. Similar associations among non-Hispanic white and Mexican American groups aligns with evidence of the Hispanic Paradox. Future studies of effect of area-level determinants of cardiometabolic dysfunction may consider race/ethnicity-specific associations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jadohealth.2018.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318802PMC
November 2018

Exercise for reducing falls in people living with and beyond cancer.

Cochrane Database Syst Rev 2018 Oct 15;10:CD011687. Epub 2018 Oct 15.

School of Health Sciences, University of Tasmania, Launceston, Australia.

Background: Current treatment modalities for cancer have been successful in achieving improved survivorship; however, they come with a number of long-term adverse effects. Accidental falls are a common and clinically significant adverse event in people living with and beyond cancer and rates are higher than in the rest of the population.

Objectives: To assess the effects of prescribed or provided exercise for reducing accidental falls, and falls risk factors of strength, flexibility and balance, in people living with and beyond cancer.

Search Methods: We searched the following electronic databases from inception to 10 July 2018, with no restrictions: CENTRAL, MEDLINE, Embase, and seven other databases. We searched clinicaltrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP) for ongoing trials, and reference lists of reviews and retrieved articles for additional studies.

Selection Criteria: We included all randomised controlled trials investigating exercise interventions versus no treatment, usual care or non-exercise interventions on falls incidence or falls risk factors in adults living with and beyond cancer (18 years of age or older at diagnosis). We excluded cross-over studies and studies in acute or inpatient hospice care.

Data Collection And Analysis: At least two review authors independently completed data extraction for included papers. We used Covidence software to manage screening, data collection and extraction. We assessed evidence using GRADE and presented results in a 'Summary of findings' table.

Main Results: Eleven studies (835 participants) compared exercise to usual care. No studies compared exercise with no treatment or non-exercise interventions. The quality of the evidence was very low for the primary outcome rates of falls, and very low to low for the secondary outcomes. We downgraded the evidence due to study limitations (risk of bias), and issues of imprecision due to small sample sizes, inconsistency and indirectness. All studies were at high risk of bias for blinding of participants and personnel due to inability to blind participants to an exercise intervention. Risk of bias was generally low or unclear for other categories.There was generally little information on the important outcomes comparing exercise to usual care.Rates of falls and number of fallers: one study (223 participants) measured accidental falls, but reported neither the rate of falls or the number of fallers; there was no difference in the number of falls between exercise and usual care (very low-quality evidence).Strength: 10 studies (813 participants) reported on strength outcomes. Two analyses favoured exercise over usual care: quadriceps strength (2 studies, 72 participants; mean difference (MD) 8.99 kg, 95% confidence interval (CI) 1.29 to 16.70; low-quality evidence), and leg press (4 studies, 388 participants; MD 21.1 kg, 95% CI 8.47 to 33.74; low-quality evidence). In one analysis of the Sit-to-Stand Test, there was no difference between exercise and usual care (4 studies, 214 participants; standardised mean difference (SMD) -0.45, 95% CI -1.05 to 0.14; very low-quality evidence).Flexibility: one study (21 participants) reported on flexibility for Sit-and-Reach Distance (MD 2.05 cm, 95% CI 0.59 to 3.51; very low-quality evidence).Balance: five studies (350 participants) measured three different balance outcomes. Two analyses favoured exercise over usual care: postural balance (4 studies, 127 participants; standardised mean difference (SMD) 0.44, 95% CI 0.08 to 0.79; very low-quality evidence), and Backward Walk Test (2 studies, 280 participants; SMD -0.24, 95% CI -0.48 to -0.01; low-quality evidence). There was no difference between exercise and usual care for the Timed Up-and-Go Test (1 study, 15 participants; MD -0.35 seconds, 95% CI -1.47 to 0.77; low-quality evidence).Number of people sustaining a fall-related fracture: the quality of the evidence for exercise reducing fall-related fractures was very low.Adverse events: a single study (223 participants) noted some temporary muscle soreness on initiation of exercise or when there was an increase in the weight lifted. As no occurrence data were reported, we could not assess this variable further. No studies reported musculoskeletal injury. Analysis indicated that there was very low-quality evidence that exercise did not increase fatigue.

Authors' Conclusions: There is a paucity of evidence for exercise training to reduce fall rates in people living with and beyond cancer. Exercise training may improve strength, flexibility and balance for people in this population, but the evidence is very low quality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/14651858.CD011687.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517115PMC
October 2018

Racial residential segregation and racial disparities in stillbirth in the United States.

Health Place 2018 05 30;51:208-216. Epub 2018 Apr 30.

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge, Bethesda, MD 20892, USA. Electronic address:

We examined whether current and/or persistent racial residential segregation is associated with black-white stillbirth disparities among 49,969 black and 71,785 white births from the Consortium on Safe Labor (2002-2008). Black-white segregation was measured using the dissimilarity index and the isolation index, categorized into population-based tertiles. Using hierarchical logistic models, we found low and decreasing levels of segregation were associated with decreased odds of stillbirth, with blacks benefitting more than whites. Decreasing segregation may prevent approximately 900 stillbirths annually among U.S. blacks. Reducing structural racism, segregation in particular, could help reduce black-white stillbirth disparities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthplace.2018.04.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287738PMC
May 2018

Exercise Professionals with Advanced Clinical Training Should be Afforded Greater Responsibility in Pre-Participation Exercise Screening: A New Collaborative Model between Exercise Professionals and Physicians.

Sports Med 2018 06;48(6):1293-1302

School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, VIC, Australia.

Regular exercise improves health but can also induce adverse responses. Although such episodes are rare, many guidelines for pre-participation exercise screening have historically had a low threshold for recommending medical clearance prior to the commencement of exercise, placing the responsibility for decision making about exercise participation on physicians. The 'clearance to exercise' model still occurs widely in practice, but creates cost burdens and barriers to the uptake of exercise. Moreover, many physicians are not provided the training, nor time in a standard consultation, to be able to effectively perform this role. We present a model for pre-participation exercise screening and the initial assessment of clients wishing to commence an exercise programme. It is designed to guide professional practice for the referral, assessment and prescription of exercise for people across the health spectrum, from individuals who are apparently healthy, through to clients with pre-existing or occult chronic conditions. The model removes the request that physicians provide a 'clearance' for patients to engage in exercise programmes. Instead the role of physicians is identified as providing relevant clinical guidance to suitably qualified exercise professionals to allow them to use their knowledge, skills and expertise in exercise prescription to assess and manage any risks related to the prescription and delivery of appropriate exercise programmes. It is anticipated that removing unjustified barriers to exercise participation, such as mandated medical review, will improve the uptake of exercise by the unacceptably high proportion of the population who do not undertake sufficient physical activity for health benefit.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40279-018-0888-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5948234PMC
June 2018

Design and Evaluation of an Instrumented Wobble Board for Assessing and Training Dynamic Seated Balance.

J Biomech Eng 2018 04;140(4)

Mem. ASME Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, 9211-116 Street, Edmonton, AB T6G 1H9, Canada e-mail: .

Methods that effectively assess and train dynamic seated balance are critical for enhancing functional independence and reducing risk of secondary health complications in the elderly and individuals with neuromuscular impairments. The objective of this research was to devise and validate a portable tool for assessing and training dynamic seated balance. An instrumented wobble board was designed and constructed that (1) elicits multidirectional perturbations in seated individuals, (2) quantifies seated balance proficiency, and (3) provides real-time, kinematics-based vibrotactile feedback. After performing a technical validation study to compare kinematic wobble board measurements against a gold-standard motion capture system, 15 nondisabled participants performed a dynamic sitting task using the wobble board. Our results demonstrate that the tilt angle measurements were highly accurate throughout the range of wobble board dynamics. Furthermore, the posturographic analyses for the dynamic sitting task revealed that the wobble board can effectively discriminate between the different conditions of perturbed balance, demonstrating its potential to serve as a clinical tool for the assessment and training of seated balance. Vibrotactile feedback decreased the variance of wobble board tilt, demonstrating its potential for use as a balance training tool. Unlike similar instrumented tools, the wobble board is portable, requires no laboratory equipment, and can be adjusted to meet the user's balance abilities. While future work is warranted, obtained findings will aid in effective translation of assessment and training techniques to a clinical setting, which has the potential to enhance the diagnosis and prognosis for individuals with seated balance impairments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1115/1.4038747DOI Listing
April 2018

Guidelines for teaching yoga to women with breast cancer-related lymphoedema: an evidence-based approach.

Int J Yoga Therap 2017 Nov;27(1):95-112

4. Department of Surgery, Flinders University, Adelaide, Australia.

Breast cancer-related lymphoedema (BCRL) is a chronic condition that requires lifelong management to prevent the condition worsening and to reduce the threat of infection. Women are affected in all domains of their life. As a holistic practice, yoga may be of benefit by reducing both the physical and psychosocial effects of lymphoedema. Women with BCRL are attending yoga classes in increasing numbers, so it is essential that yoga be based on principles that ensure lymphoedema is controlled and not exacerbated. Two Randomised Controlled Trials with a yoga intervention have had positive results after an 8-week intervention (n=28) and 6-months after a 4-week intervention (n=18). The first study had several significant results and women reported increased biopsychosocial improvements. Both studies showed trends to improved lymphoedema status. The yoga interventions compromised breathing, physical postures, meditation and relaxation practices based on Satyananda Yoga®, with modifications to promote lymphatic drainage and following principles of best current care for those with BCRL. Individual needs were considered. The yoga protocol that was used in the 8-week trial is presented. Our aim is to provide principles for yoga teachers/therapists working with this clientele that can be adapted to other yoga styles. Further, these principles may provide a basis for the development of yoga programs for people with secondary lymphoedema in other areas of their body as the population requiring cancer treatment continues to increase. Whilst the style of yoga presented here has had positive outcomes, further application and research is needed to fully demonstrate its effectiveness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17761/1531-2054-27.1.95DOI Listing
November 2017

Cardiac Rehabilitation for Patients With Coronary Artery Disease: A Practical Guide to Enhance Patient Outcomes Through Continuity of Care.

Clin Med Insights Cardiol 2017 12;11:1179546817710028. Epub 2017 Jun 12.

Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia.

Coronary artery disease (CAD) is a leading cause of disease burden worldwide. Referral to cardiac rehabilitation (CR) is a class I recommendation for all patients with CAD based on findings that participation can reduce cardiovascular and all-cause mortality, as well as improve functional capacity and quality of life. However, programme uptake remains low, systematic progression through the traditional CR phases is often lacking, and communication between health care providers is frequently suboptimal, resulting in fragmented care. Only 30% to 50% of eligible patients are typically referred to outpatient CR and fewer still complete the programme. In contemporary models of CR, patients are no longer treated by a single practitioner, but rather by an array of health professionals, across multiples specialities and health care settings. The risk of fragmented care in CR may be great, and a concerted approach is required to achieve continuity and optimise patient outcomes. 'Continuity of care' has been described as the delivery of services in a coherent, logical, and timely fashion and which entails 3 specific domains: informational, management, and relational continuity. This is examined in the context of CR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1179546817710028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470863PMC
June 2017

Response to yoga protocol for treatment of breast cancer-related lymphedema.

Int J Yoga 2017 Jan-Apr;10(1):50-51

School of Health Sciences, University of Tasmania, Launceston, Tasmania 7250, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0973-6131.194567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225747PMC
February 2017

The effect of ongoing feedback on physical activity levels following an exercise intervention in older adults: a randomised controlled trial protocol.

BMC Sports Sci Med Rehabil 2017 10;9. Epub 2017 Jan 10.

School of Health Sciences, University of Tasmania, Locked Bag 1322, TAS 7250 Launceston, Australia.

Background: Physical inactivity ranks as a major contributing factor in the development and progression of chronic disease. Lifestyle interventions reduce the progression of chronic disease, however, compliance decreases over time and health effects only persist as long as the new lifestyle is maintained. Telephone counselling (TC) is an effective way to provide individuals with ongoing support to maintain lifestyle changes. Remote physical activity monitoring and feedback (RAMF) via interactive technologies such as activity trackers and smartphones may be a cost-effective alternative to TC, however, this comparison has not been made. This study, therefore, aims to determine the effect of ongoing feedback (TC vs. RAMF) on the maintenance of physical activity following a 12-week individualised lifestyle program, and the effect of this on health risk factors and health services usage.

Methods And Design: A randomised controlled trial with a parallel groups design. A total of 150 adults (≥60 years) who participate in a 12-week face-to-face individualised lifestyle program will be randomised to twelve months of RAMF ( = 50), TC ( = 50), or usual care ( = 50). Participants randomised to RAMF will use a smartphone activity tracker app, synced to a wrist worn activity tracker, to provide them with automated feedback regarding compliance to prescribed activity targets. Telephone counselling involves a follow-up phone call every fortnight for the first three months and a monthly call for the remaining nine months of the follow-up period. The primary outcome measures are physical activity compliance (accelerometry and Active Australia survey). Secondary outcome measures include cardiorespiratory fitness, muscle strength, dynamic balance, quality of life, blood pressure, body composition, and health services usage. Measures will be made before and after the individualised lifestyle program, and at three, six and twelve months during the intervention.

Discussion: The results of this study will help to determine the efficacy of RAMF devices on compliance to prescribed physical activity compared to the current gold standard of TC. If the remote monitoring proves effective, it may provide a cost efficient alternative method of assisting maintenance of behaviour change from lifestyle interventions.

Trial Registration: ACTRN12615001104549. Retrospectively Registered 20/10/2015.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13102-016-0066-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223294PMC
January 2017

The effects of yoga on shoulder and spinal actions for women with breast cancer-related lymphoedema of the arm: A randomised controlled pilot study.

BMC Complement Altern Med 2016 Sep 2;16:343. Epub 2016 Sep 2.

School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, TAS, 7250, Australia.

Background: We aimed to evaluate the effect of an 8-week yoga intervention on the shoulder and spinal actions of women with breast cancer-related arm lymphoedema.

Method: A randomised controlled pilot trial. The intervention group (n = 12) completed eight weeks of daily yoga sessions while the control group (n = 11) continued with best current care including information on compression sleeves, skin care, risks of temperature variations and recommended safe use of affected arm. Lumbo-pelvic posture, range of motion (ROM) in the shoulder and spine, and strength in shoulder and pectoral major and minor, and serratus anterior were taken at baseline, week 8 and after a 4-week follow-up. Outcome assessors were blinded to allocation.

Results: At week eight the intervention group had an improvement in lumbo-pelvic posture, as indicated by a reduction in pelvic obliquity compared to the control group (mean difference = -8.39°, 95 % CI: -15.64 to -1.13°, p = 0.023). A secondary finding was that strength in shoulder abduction significantly increased following the yoga intervention in both the affected (9.5 kg; CI: 0.34 to 18.66, p = 0.042) and non-affected arm (11.58 kg; CI: 0.25 to 22.91; p = 0.045). There were no significant between group changes in any ROM measures as a result of the yoga intervention.

Conclusion: This pilot study demonstrates that participation in yoga may provide benefits for posture and strength in women with Breast Cancer Related Lymphoedema. The improvements may be attributed to the focus of yoga on overall postural and functional movement patterns. Further trials with longer intervention that follow this methodology are warranted.

Trial Registration: The Australian New Zealand Clinical Trials Registry ACTRN12611000202965 .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12906-016-1330-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010718PMC
September 2016

Exaggerated blood pressure response to early stages of exercise stress testing and presence of hypertension.

J Sci Med Sport 2016 Dec 20;19(12):1039-1042. Epub 2016 Apr 20.

Menzies Institute for Medical Research, University of Tasmania, Australia. Electronic address:

Objectives: Exaggerated exercise blood pressure (EEBP) recorded during exercise testing at moderate-intensity is independently associated with cardiovascular mortality. It is hypothesized that EEBP may be indicative of underlying hypertension unnoticed by standard clinic (resting) BP measures (thus explaining increased mortality risk), but this has never been confirmed by association with hypertension defined using ambulatory BP monitoring, which was the aim of this study.

Design: Cross-sectional study.

Methods: 100 consecutive patients free from coronary artery disease (aged 56±9 years, 72% male) underwent clinically indicated exercise stress testing. Exercise BP was recorded at each stage of the Bruce protocol. Presence of hypertension was defined as 24-hour systolic BP ≥130mmHg or daytime systolic BP ≥135mmHg.

Results: Exercise systolic BP at stage 1 and 2 of the test was significantly associated with the presence of hypertension (P<0.05), with the strongest association observed between stage 1 exercise systolic BP and 24-h systolic BP >130mmHg (AUC=0.752, 95% CI's 0.649-0.846, P<0.001). 79% of participants achieving systolic BP ≥150mmHg at stage 1 of the test were classified as having hypertension, with systolic BP >150mmHg predicting hypertension independently of age, sex and in-clinic hypertension status (OR=4.83, 95% CI's 1.62-14.39, P=0.005).

Conclusions: Irrespective of resting BP, systolic BP ≥150mmHg during early stages of the Bruce exercise stress test is associated with presence of hypertension. EEBP should be a warning signal to health/exercise professionals on the presence of hypertension and the need to provide follow up care to reduce cardiovascular risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsams.2016.04.004DOI Listing
December 2016

Accidental Fall Rates in Community-Dwelling Adults Compared to Cancer Survivors During and Post-Treatment: A Systematic Review With Meta-Analysis.

Oncol Nurs Forum 2016 Mar;43(2):E64-72

University of Tasmania.

Purpose/objectives: To identify whether rates of accidental falls are greater for cancer survivors living in the community during or post-treatment than people with no history of cancer.
.

Data Sources: In a systematic literature review that was conducted in December 2013, MEDLINE®, EMBASE, PubMed, and Web of Science were searched for cancer or oncology and accidental falls in prospective and retrospective cohort and case-controlled studies. Studies were included if they were conducted in a community-dwelling adult population and excluded if they were conducted in acute hospitals and hospice.
.

Data Synthesis: Of 484 articles initially identified, 10 were included in the review. Of these, three included a control or comparator group and had comparable outcome measures to include in a meta-analysis. The risk ratio for falls for the group with cancer was 1.11.
.

Conclusions: Accidental fall rates in community-dwelling adults with a cancer diagnosis are greater than rates of falls in adults without cancer; this elevated rate remains after acute care is finished. Patients undergoing active treatment have greater rates of falls. Pain, fatigue, and deconditioning may affect fall rates in the longer term. 
.

Implications For Nursing: Nurses have the capacity to reduce risk of falls in community-dwelling cancer survivors during or post-treatment through provision of information, advocacy, and support around pain and fatigue management and promotion of physical activity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1188/16.ONF.E64-E72DOI Listing
March 2016

Defects in mitochondrial ATP synthesis in dystrophin-deficient mdx skeletal muscles may be caused by complex I insufficiency.

PLoS One 2014 26;9(12):e115763. Epub 2014 Dec 26.

Centre for Chronic Disease Prevention and Management, College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia; Institute of Sport, Exercise & Active Living (ISEAL), Victoria University, Melbourne, Victoria, Australia; Australian Institute of Musculoskeletal Science, Western Health, Victoria, Australia.

Duchenne Muscular Dystrophy is a chronic, progressive and ultimately fatal skeletal muscle wasting disease characterised by sarcolemmal fragility and intracellular Ca2+ dysregulation secondary to the absence of dystrophin. Mounting literature also suggests that the dysfunction of key energy systems within the muscle may contribute to pathological muscle wasting by reducing ATP availability to Ca2+ regulation and fibre regeneration. No study to date has biochemically quantified and contrasted mitochondrial ATP production capacity by dystrophic mitochondria isolated from their pathophysiological environment such to determine whether mitochondria are indeed capable of meeting this heightened cellular ATP demand, or examined the effects of an increasing extramitochondrial Ca2+ environment. Using isolated mitochondria from the diaphragm and tibialis anterior of 12 week-old dystrophin-deficient mdx and healthy control mice (C57BL10/ScSn) we have demonstrated severely depressed Complex I-mediated mitochondrial ATP production rate in mdx mitochondria that occurs irrespective of the macronutrient-derivative substrate combination fed into the Kreb's cycle, and, which is partially, but significantly, ameliorated by inhibition of Complex I with rotenone and stimulation of Complex II-mediated ATP-production with succinate. There was no difference in the MAPR response of mdx mitochondria to increasing extramitochondrial Ca2+ load in comparison to controls, and 400 nM extramitochondrial Ca2+ was generally shown to be inhibitory to MAPR in both groups. Our data suggests that DMD pathology is exacerbated by a Complex I deficiency, which may contribute in part to the severe reductions in ATP production previously observed in dystrophic skeletal muscle.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0115763PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277356PMC
September 2015

Exercise in CKD: why is it important and how should it be delivered?

Am J Kidney Dis 2014 Sep;64(3):329-31

The University of Queensland, St. Lucia, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.ajkd.2014.06.004DOI Listing
September 2014

Yoga management of breast cancer-related lymphoedema: a randomised controlled pilot-trial.

BMC Complement Altern Med 2014 Jul 1;14:214. Epub 2014 Jul 1.

School of Health Sciences, University of Tasmania, Launceston, Australia.

Background: Secondary arm lymphoedema continues to affect at least 20% of women after treatment for breast cancer requiring lifelong professional treatment and self-management. The holistic practice of yoga may offer benefits as an adjunct self-management option. The aim of this small pilot trial was to gain preliminary data to determine the effect of yoga on women with stage one breast cancer-related lymphoedema (BCRL). This paper reports the results for the primary and secondary outcomes.

Methods: Participants were randomised, after baseline testing, to receive either an 8-week yoga intervention (n = 15), consisting of a weekly 90-minute teacher-led class and a 40-minute daily session delivered by DVD, or to a usual care wait-listed control group (n = 13). Primary outcome measures were: arm volume of lymphoedema measured by circumference and extra-cellular fluid measured by bioimpedance spectroscopy. Secondary outcome measures were: tissue induration measured by tonometry; levels of sensations, pain, fatigue, and their limiting effects all measured by a visual analogue scale (VAS) and quality of life based on the Lymphoedema Quality of Life Tool (LYMQOL). Measurements were conducted at baseline, week 8 (post-intervention) and week 12 (four weeks after cessation of the intervention).

Results: At week 8, the intervention group had a greater decrease in tissue induration of the affected upper arm compared to the control group (p = 0.050), as well as a greater reduction in the symptom sub-scale for QOL (p = 0.038). There was no difference in arm volume of lymphoedema or extra-cellular fluid between groups at week 8; however, at week 12, arm volume increased more for the intervention group than the control group (p = 0.032).

Conclusions: An 8-week yoga intervention reduced tissue induration of the affected upper arm and decreased the QOL sub-scale of symptoms. Arm volume of lymphoedema and extra-cellular fluid did not increase. These benefits did not last on cessation of the intervention when arm volume of lymphoedema increased. Further research trials with a longer duration, higher levels of lymphoedema and larger numbers are warranted before definitive conclusions can be made.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1472-6882-14-214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4083036PMC
July 2014

The Association between Seasonal Variation in Vitamin D, Postural Sway, and Falls Risk: An Observational Cohort Study.

J Aging Res 2013 7;2013:751310. Epub 2013 Oct 7.

School of Human Life Sciences, University of Tasmania, Launceston, TAS 7250, Australia.

Introduction. Low serum vitamin D levels are associated with increased postural sway. Vitamin D varies seasonally. This study investigates whether postural sway varies seasonally and is associated with serum vitamin D and falls. Methods. In a longitudinal observational study, eighty-eight independently mobile community-dwelling older adults (69.7 ± 7.6 years) were evaluated on five occasions over one year, measuring postural sway (force platform), vitamin D levels, fall incidence, and causes and adverse outcomes. Mixed-methods Poisson regression was used to determine associations between measures. Results. Postural sway did not vary over the year. Vitamin D levels varied seasonally (P < 0.001), peaking in summer. Incidence of falls (P = 0.01) and injurious falls (P = 0.02) were lower in spring, with the highest fall rate at the end of autumn. Postural sway was not related to vitamin D (P = 0.87) or fall rates, but it was associated with fall injuries (IRR 1.59 (CI 1.14 to 2.24, P = 0.007). Conclusions. Postural sway remained stable across the year while vitamin D varied seasonally. Participants with high values for postural sway demonstrated higher rates of injurious falls. This study provides important evidence for clinicians and researchers providing interventions measuring balance outcomes across seasons.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2013/751310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816055PMC
November 2013