Evaluation of acceptance and efficiency of exercise for Indigenous Australians to benefit physiological, anthropometric and metabolic syndrome outcomes

The proposed study will provide an increased understanding in a much-understudied area of how the Australian Indigenous community perceives physical activity and the beneficial effects for improving health outcomes. The PhD will be made up of three studies: 1) To design an exercise prescription that is culturally appropriate and specifically addresses the major Indigenous health issues around metabolic syndrome. The first will be a cross sectional study that surveys the motivators and barriers to physical activity within the Perth Noongar community. The results of this study will be used to enhance the intervention section of the PhD. It will provide a more accurate and the best means of ensuring not only a greater uptake, but also ways of developing positive lifelong physical activity habits. 2) Determining the amount of physical activity taking place within the Noongar community. Utilising the Global Physical Activity Questionnaire to measure the amount of physical activity and sedentary rates within the Indigenous community. 3) Evaluate the compliance and effectiveness of the developed intervention to inform future exercise therapy programmes for this population. The second study will be a randomised control trial looking at the physiological responses to a combination of aerobic and anabolic (resistance) exercise. The significance of this aspect of the PhD will be to capture and record physiological and quality of life measures some not previous recorded in the Indigenous community. This will inform policy relation to the most appropriate targets for eliciting successful behaviour change to improve health in Indigenous and non-Indigenous population

"It's not a quick fix" : consequences of weight loss during life and experiences of weight regain after bariatric surgery

Maintenance of weight loss is challenging for most people who intentionally lose weight. Complex factors interact with each other and obstruct weight management. This thesis focuses on the consequences of weight loss and experiences of regaining weight. These results could be helpful in treatment recommendations for individuals who live with obesity. Studies I, II, and III were qualitative studies that analyzed data from semistructured interviews with participants living with obesity who had regained an average of 36% from the lowest weight point after bariatric surgery. All participants had undergone gastric bypass surgery. Study I focused on how participants experienced support from healthcare professionals, families, and friends during weight regain following bariatric surgery. The thematic analysis showed that participants felt lonely and abandoned during post-surgical weight management. In addition, shame and self-blame could further obstruct the search for medical support. However, participants described social support from healthcare and family members as desired and helpful for a healthier lifestyle and weight management. Our findings indicate the importance of an empathetic and non-judgmental approach towards patients and access to a multi-professional healthcare team for long-term support. In Study II, we investigated the experiences of patients who had undergone bariatric surgery and struggled with weight regain. Further, we aimed to understand the factors that might be of interest in improving post-bariatric care. Thematic analysis showed that weight regain was a complex and unexpected experience that induced a negative emotional response. In addition, post-surgery weight management became challenging due to multiple daily obstacles, alterations in appetite, and physical and mental health issues. Nevertheless, most participants experienced lasting benefits from gastric bypass surgery, despite regaining weight. To reduce the burden of weight management, participants wished to focus more on self-care and receive positive support from healthcare providers. In Study III, we explored patients’ experiences with food- and eating-related behaviors during weight regain after gastric bypass surgery. In the thematic analysis, we found that participants experienced overwhelming dietary challenges. They had not expected to need to struggle with dietary issues such as mealtimes, sizes of portions, and cravings. They also described emotional and disordered eating and drinking patterns. Participants experienced a lack of nutritional knowledge and support. They turned to restrictive eating and dieting behaviors to manage their weight. In a prospective cohort study, Study IV, we investigated the association between weight loss earlier in life and mortality outcomes, specifically for all-causes, cardiovascular disease (CVD), and cancer mortality. We followed 34,346 individuals from the Swedish National March Cohort for over two decades to assess mortality. To calculate Hazard Ratios (HR) and 95% confidence intervals (CI), we employed Cox Proportional Hazard Models, with age serving as the timescale. We adjusted for multiple confounders and found that individuals who had lost >10 kg or >5 kg on three or more occasions had higher mortality rates for all causes and cardiovascular diseases than those who had not lost weight. Furthermore, men who had lost more than 10 kg had higher mortality rates for all causes and cardiovascular disease than men who had not lost weight. We did not observe any associations between weight loss and cancer mortality. Study V was a cross-sectional study in which we examined whether weight loss earlier in life in adolescents and young adults with obesity before starting a medical obesity treatment program might be associated with self-esteem and eating behaviors. We used self-reported data from 224 participants to determine associations using linear regression models. Our findings showed that those who had lost 5-10 kg and >5 kg two times or more often had higher cognitive restraint eating scores than adolescents and young adults with obesity who had not lost weight. However, we did not find any association between weight loss, selfesteem, and other eating behaviors such as uncontrolled eating and emotional eating. In conclusion, existing post-surgical support was experienced as insufficient by participants who had regained weight after bariatric surgery. They may have had unrealistic expectations concerning postoperative weight management and eating behaviors. Various internal and external challenges may obstruct weight management and eating behaviors, contributing to emotional distress and feelings of personal failure. Our results show the need for an extended follow-up. Special focus should be directed toward those with difficulties in weight loss maintenance. Weight loss earlier in life may increase all-cause and cardiovascular mortality, particularly in men. Furthermore, previous weight loss attempts may affect adolescents and young adults with obesity, leading them to struggle to control their eating behavior to a high degree without sustained weight loss. Healthcare professionals should assess patients’ weight loss history and eating behaviors, and encourage healthy eating for sustained weight management, regardless of sex, throughout life

The Relationship of Personal Characteristics, Behavorial Capability, Environmental Factors, and Hypertension Medication Adherence in African American Adults with Metabolic Syndrome

Disparities in medication adherence (MA) associated with African American (AA) adults may be related to a dynamic interplay between personal factors, behavioral capability, and environmental factors. The purpose of the study was to examine this relationship in AA adults with metabolic syndrome (MetS). A cross-sectional, correlational analysis was conducted from baseline data from a larger intervention study. Constructs from the Social Cognitive Theory were used to predict MA. The sample of 91 AA adults with MetS was primarily middle-aged (age range 45-70 years old; M 53, SD 6.3), female (79%), relatively well-educated, and married. Despite being on antihypertensive medications, 53% of the participants presented with uncontrolled high blood pressure (≥130/90 mmHg). Although the vast majority (95%) of the sample displayed adequate health literacy (HL), 30% of the sample was non-adherent to their medication regimen. A positive significant relationship was found between age and MA [χ2 (1, n = 90) = 6.71, p = .01)]. Stress [χ2 (1, n = 90) = 6.28, p = .012)] and social support (SS) [χ2 (1, n = 90) = 4.10, p = .04)] were the only significant relationships among environmental factors, barriers and hypertension MA. Highly stressed AA adults were significantly more likely to be non-adherent or had a 15% reduction in the odds of hypertension MA. Similarly, adults with a low income were 5.8 times more likely to be non-adherent (OR 5.828, 95% CI, 1.014-33.493, p= .0482), while those with low SS had a 9% reduction in the odds of MA; SS trended toward significance (OR.914. 95% CI .823-1.016, p =.09). With increasing age, AA adults were more likely to be non-adherent (OR 1.12, 95% CI 1.028-1.220, p =.0096). Most of the participants reported a high degree of autonomy, satisfaction with their health care climate, and the availability of SS. Although increasing age, adequate SS, high stress, and adequate HL appeared to influence MA in AA adults with MetS, the research questions were only partially answered. Further investigation of the relationships and potential mediating pathways between personal characteristics, environmental factors, behavioral capability and hypertension MA in AA adults with MetS is needed

Nutritional status of schoolchildren in Kuantan, Pahang

This study aimed to determine the nutritional status among primary schoolchildren in Kuantan, Pahang and to map the distribution using Geographical Information System (GIS). This community based cross sectional study was conducted in Kuantan, Pahang. Stratified random sampling method was used to select schoolchildren from seven subdivision of Kuantan district. A total of 391 schoolchildren age 7 years old were recruited. Data was collected using a questionnaire consisted of questions on socio demographic and anthropometry measurement. Schools’ coordinate were recorded and Geographical Information System (GIS) software was used to map and visualize the distribution of schoolchildren according to nutritional status. Findings showed that 13.8% (n=54) of the children were having overweight and obesity, 10.5% (n=41) stunting and 9.5% cases of underweight (n=37). The mean for BMI-for-age z score (BMIAZ), height-for-age score (HAZ) and weight-for-age z score (WAZ) were 0.07(1.68), -0.64(1.105), and -0.32(1.68) respectively. There were significant difference of BMIAZ and WAZ between urban and rural area (p=0.016) and (p=0.033). There were no significant difference between the three anthropometric measurements with gender, (p=0.947), (p=0.551) and (p=0.613) respectively. There was a significant association between WAZ with income per capita (p=0.014) but there is no association between BMIAZ, HAZ and WAZ with other socio demographic factors including education, occupation and household size. This study shows that the nutritional status among schoolchildren in this area is a major concern. The results warrant the need for further investigation to identify the root causes of childhood obesity in order to develop informed policy, intervention programs and guidelines

Towards an everyday life information literacy mind-set: a review of literature.

Purpose: Information literacy (IL) within the everyday life context is regarded as an important condition for civic participation and engagement, informed citizenship, health and well-being. However, compared to the significant amount of IL research within educational and workplace settings, there has been relatively little research in relation to the value of IL within everyday life situations. The purpose of this paper is to explore existing empirical research that addresses aspects of IL within the context of everyday life, identifying current gaps in the literature, highlighting key theoretical positions, and mapping trends. Design/methodology/approach: The review has been conducted in the form of a scoping study that aims to map the key concepts underpinning this research area and the main sources and types of evidence available. It is based on journal literature reporting primary research, published from 2000 to 2016 and sourced from a range of different databases covering IL research. Findings: IL practices take place within diverse everyday life contexts. The key research directions have been categorised into four broad contextual areas, encompassing leisure and community activities, citizenship and the fulfilment of social roles, public health and critical life situations. These point to the need for developing an IL mind-set which is discussed as an adaptive, transferable and ongoing activity that transgresses the boundaries of prescribed skills within the specific contexts of work and education. Originality/value: This research area is still in its infancy and more varied contexts need to be explored to nurture a robust understanding of the use and impact of IL in people’s everyday lives. The paper also highlights the implications of the lack of IL and identifies the key players in the advocacy of IL within different everyday life settings

Social Determinants of Health in Non-communicable Diseases

This book is open access under a CC BY-NC-ND 4.0 license. This open access book is the first compilation that reviews a wide range of social determinants of health (SDHs) for non-communicable diseases (NCDs) and healthy ageing in Japan. With the highest life expectancy and the largest elderly population in the world, Japan has witnessed health inequality by region and social class becoming more prevalent since the 2000s. The first half of this volume describes in detail major NCDs, such as cancers, heart and kidney diseases, diabetes, stroke, and metabolic syndrome. The second half, on the other hand, explores various SDHs relating to healthy ageing. All chapters review and focus on SDHs, particularly health inequality associated with socio-economic status and social capital, which are widely addressed in the field of social epidemiology. The book makes the argument that “Health for All” advocated by the WHO should be implemented based on social justice and benefits for the greater society. Public health researchers and policymakers, both in Japan and other nations, will gain scientific evidence from this book to prepare for the coming era as ageing becomes a global issue

Glucose as a Mediator of the Relationship Between Sleep and Cognitive Performance

ABSTRACT The Centers for Disease Control and Prevention (Y. Liu et al., 2016) reports that 34.8% of adults living in the United States of America are getting less than their recommended amount of sleep per night. Additionally, the National Sleep Foundation (2014) reports that 35% of adults have poor sleep quality. Sleep problems appear most prevalent in young adults (Hershner, 2015). Rates of type 2 diabetes mellitus are also on the rise in this specific population (Kaufman, 2002). Interestingly, research has consistently found that both sleep quantity and quality are associated with glucose levels (Ip & Mokhlesi, 2007; Padilha et al., 2011; Taub & Redeker, 2008). Further, both sleep quantity and quality, as well as glucose, can have a significant effect on cognitive performance (Alhola & Polo-Kantola, 2007; Zilliox et al., 2016). The purpose of the present study was to investigate the mediating effect of glucose on the relationship between sleep and cognitive performance. Sleep included sleep quantity and quality. Cognitive performance included both sustained attention and visuospatial working memory. It was predicted that sleep would be positively related to cognitive performance, and negatively related to glucose levels. It was also predicted that glucose levels, even in a prediabetic range, would be negatively related to cognitive performance, and that this would mediate the relationship between sleep and cognitive performance. To test these hypotheses, data were collected from 82 young adults. Participants answered demographic questionnaires, and surveys assessing their sleep quantity and quality. They then had their glucose levels assessed via finger-stick glucose monitoring. Following this, they completed computerized tasks measuring sustained attention and visuospatial working memory. A hierarchical multiple regression analysis was conducted to test the proposed hypotheses. After cleaning, 81 cases were found to be viable for analysis. Results obtained were in partial support of hypotheses. Poor sleep quality, as measured by the Adult Sleep-Wake Scale (ADSWS; Fortunato et al., 2008), was found to be associated with decreased visuospatial working memory (β = -.02, p = .039). No other hypotheses were supported, though some trending results were found. It is believed had a larger and/or more diverse sample been used, more significant results would have been found. Implications exist not only for students, but for all young adults. They are likely to be of interest to young adults, as well as those working with young adults. This includes mental health professionals, various medical personnel, teachers, and school administrators

Factors Influencing the Body Composition of Adolescents and Young Adults with Down Syndrome

The aim of this thesis was to describe the body composition of adolescents and young adults with Down syndrome and relationships with physiological, behavioural and social factors including dietary intake and physical activity. A high proportion of adolescents and young adults with Down syndrome had an anthropometry and body composition indicative of overweight and obesity. Young people with Down syndrome need to be supported to be more physically active and consume a healthier diet

Establishing the association of type 2 diabetes and insulin resistance with Tuberculosis and Coronary Heart Diseases among euglycaemic and diabetic patients in Saudi Arabia

Background: Patients with Coronary Heart Disease (CHD) or Tuberculosis (TB) are more likely to have Type 2 Diabetes Mellitus (T2DM). Insulin Resistance (IR) in patients with normal glucose may also be a risk factor for these conditions. Methods: This thesis explored whether T2DM and IR are risk factors for TB enrolled patients receiving TB treatment in the previous year and controls. In addition, the thesis explores whether T2DM and IR are risk factors for CHD among patients with stable CHD and controls. The studies were based in Saudi Arabia and used cross sectional surveys and case controls design. Controls were asymptomatic adults attending the TB clinics for labour reasons. All participants were screened for fasting plasma glucose (FPG), insulin, glycated haemoglobin (HbA1c) and lipids. We assessed the severity of the clinical presentation of TB among patients with T2DM, IR and normal glucose. Finally, we described the quality of life of patients with CHD among patients with T2DM, IR and normal glucose. Results: One hundred seventy-five adults with pulmonary TB and 140 controls were recruited (36.6% and 40.7% female and 63.4% and 59.3% male, respectively). Twenty-nine per cent of TB cases had T2DM and 22% normoglycemic IR. 3.3% of patients were unaware of their T2DM diagnosis. TB was associated with prediabetes (AOR 5.112, p = 0.032), low level of risky HDL Cholesterol (AOR 0.316, p = 0.001) and non-Saudi nationalities (AOR 4.018, p ˂ 0.001). Former TB cases were more likely to eat fast foods (1 – 2 times/week, AOR 2.857 and 2 – 3 times/month, AOR 3.126, p = 0.026, respectively) and to have a fair or poor diet (AOR 13.518, and AOR 37.766, respectively) (p ˂ 0.001). Three hundred twenty-five patients with stable CHD and were recruited (29.2% and 39.9% female and 70.8% and 60.1% male, respectively). Of these 65% had T2DM and 31.3% normoglycemic IR. Almost 6% of patients were unaware of their T2DM status. CHD were more likely to have T2DM (AOR 4.974, p = 0.034), high FPG (AOR 5.034, p = 0.021), to be male (AOR 9.950, p ˂ 0.001), aged above 50 years old (p ˂ 0.015), Saudi (AOR 6.879, p = 0.002), to have primary education (AOR 20.315, p = 0.004), hypertension (AOR 5.920, p = 0.003) and to take lipid lowering medications (AOR 24.516, p ˂ 0.001) than controls. Cases were more likely to have high WHR (AOR 33.997, p ˂ 0.001) and diastolic BP (AOR 1.080, p = 0.004) than controls. CHD-IR cases had lower quality of life and satisfaction scores with bodily appearance (p = 0.003), overall perception of satisfaction with themselves (p = 0.041) and score in the psychological domains (p = 0.006) than controls. Patients with CHD and T2DM had lower overall scores for quality of life (p = 0.002), satisfaction with bodily appearance (p = 0.012), overall perception of satisfaction with themselves (p = 0.015), with access to health services (p = 0.049) and satisfaction score with transport (p = 0.027) than controls. Conclusion: TB was more prevalent among non-Saudi nationals and males. Patients with TB were more likely to have T2DM, and to be prediabetic, but not more likely to have IR than controls. More efforts are required to upscale the detection of T2DM among TB patients. Patients with CHD were more likely to be male and to have T2DM and IR than controls. Patients with CHD and IR had a lower quality of life than controls. More efforts are required to upscale the management of T2DM and IR among CHD patients