Obesity and chronic low back pain : an investigation of the relationship and possible mediating factors

Background: Obesity and chronic low back pain (cLBP) are prevalent social and economic burdens with significant contribution to poor overall health. Previous research has viewed the two health conditions as separate research and clinical problems, but there is evidence of a relationship between them. However, combined obesity and cLBP research is limited and not well understood. Aim: The aim of this thesis was to investigate the relationship between obesity and cLBP, and to explore the possible factors mediating that relationship. Methods: A series of three explorative studies were employed to examine the relationship between obesity and cLBP. Study 1 investigated associations between BMI and exercise-related cLBP changes. Study 2 was an exploration of associations between adipose tissue distribution and cLBP. Study 3 investigated the effect of body mass distribution on a known postural task, and the possible mediation by movement of the lumbar spine or lumbar muscle endurance. Results: BMI and BMI changes were not associated with cLBP, or successful predictors of cLBP changes. Regional adiposity, particularly the ratio of abdominal to lumbar adiposity, was associated with and a significant predictor of cLBP. Body mass distribution was shown to result in poorer postural task performance, but mediation by spinal movement or muscle endurance was not confirmed. Discussion: No significant relationships between BMI and cLBP were identified, indicating the reliance on BMI as an obesity measure may not be justified. The established associations between regional adiposity distribution and cLBP may suggest that adipose tissue is a key contributor within the obesity-cLBP relationship. Although mediation of spinal movement or muscle endurance was not supported in the experimental context used, the link between body composition and mass distribution with cLBP was further confirmed. Conclusion: The work of this thesis supports evidence of a link between obesity and cLBP. Adiposity and body mass distribution have been implicated in this relationship. Future studies should continue to explore possible mediating factors between obesity and cLBP in a variety of research contexts

Exploring the relationships between heritage tourism, sustainable community development and host communities' health and wellbeing : a systematic review

Previous studies examining the impact of heritage tourism have focused on specific ecological, economic, political, or cultural impacts. Research focused on the extent to which heritage tourism fosters host communities' participation and enhances their capacity to flourish and support long-term health and wellbeing is lacking. This systematic review assessed the impact of heritage tourism on sustainable community development, as well as the health and wellbeing of local communities. Studies were included if they: (i) were conducted in English; (ii) were published between January 2000 and March 2021; (iii) used qualitative and/or quantitative methods; (iv) analysed the impact of heritage tourism on sustainable community development and/or the health and wellbeing of local host communities; and (v) had a full-text copy available. The search identified 5292 articles, of which 102 articles met the inclusion criteria. The included studies covering six WHO regions (Western Pacific, African, Americas, South-East Asia, European, Eastern Mediterranean, and multiple regions). These studies show that heritage tourism had positive and negative impacts on social determinants of health. Positive impacts included economic gains, rejuvenation of culture, infrastructure development, and improved social services. However, heritage tourism also had deleterious effects on health, such as restrictions placed on local community participation and access to land, loss of livelihood, relocation and/or fragmentation of communities, increased outmigration, increases in crime, and erosion of culture. Thus, while heritage tourism may be a poverty-reducing strategy, its success depends on the inclusion of host communities in heritage tourism governance, decision-making processes, and access to resources and programs. Future policymakers are encouraged to adopt a holistic view of benefits along with detriments to sustainable heritage tourism development. Additional research should consider the health and wellbeing of local community groups engaged in heritage tourism. Protocol PROSPERO registration number: CRD42018114681

Protocol for a randomised controlled trial of a family strengthening program to prevent unhealthy weight gain among 5 to 11-year-old children from at-risk families : the Strong Families Trial

Background: Obesity is an increasing health concern in Australia among adult and child populations alike and is often associated with other serious comorbidities. While the rise in the prevalence of childhood obesity has plateaued in high-income countries, it continues to increase among children from disadvantaged and culturally diverse backgrounds. The family environment of disadvantaged populations may increase the risk of childhood obesity through unhealthy eating and lifestyle practices. The Strong Families Trial aims to assess the effectiveness of a mixed behavioural and lifestyle intervention for parents and carers of at-risk populations, i.e. families from culturally diverse and disadvantaged backgrounds, in preventing unhealthy weight gain among children aged 5 to 11 years. Methods: Eight hundred families from low socio-economic areas in Greater Western Sydney, NSW, and Melbourne, VIC, will be recruited and randomised into a lifestyle intervention or control group. The intervention comprises 90-minute weekly sessions for 6 weeks (plus two-booster sessions) of an integrated, evidence-based, parenting and lifestyle program that accounts for the influences of family functioning. Primary (anthropometric data) and secondary (family functioning, feeding related parenting, physical activity, consumption of healthy foods, health literacy, family and household costs) outcome measures will be assessed at baseline, immediately following the intervention, and 12 months post-intervention. Discussion: This study will elucidate methods for engaging socially disadvantaged and culturally diverse groups in parenting programs concerned with child weight status. Trial Registration: This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001019190). Registered 16 July 2019

Forest-linked livelihoods in a globalized world.

Forests have re-taken centre stage in global conversations about sustainability, climate and biodiversity. Here, we use a horizon scanning approach to identify five large-scale trends that are likely to have substantial medium- and long-term effects on forests and forest livelihoods: forest megadisturbances; changing rural demographics; the rise of the middle-class in low- and middle-income countries; increased availability, access and use of digital technologies; and large-scale infrastructure development. These trends represent human and environmental processes that are exceptionally large in geographical extent and magnitude, and difficult to reverse. They are creating new agricultural and urban frontiers, changing existing rural landscapes and practices, opening spaces for novel conservation priorities and facilitating an unprecedented development of monitoring and evaluation platforms that can be used by local communities, civil society organizations, governments and international donors. Understanding these larger-scale dynamics is key to support not only the critical role of forests in meeting livelihood aspirations locally, but also a range of other sustainability challenges more globally. We argue that a better understanding of these trends and the identification of levers for change requires that the research community not only continue to build on case studies that have dominated research efforts so far, but place a greater emphasis on causality and causal mechanisms, and generate a deeper understanding of how local, national and international geographical scales interact.This work was funded by the UK’s Department for International Development (grant number 203516-102) and governed by the University of Michigan’s Institutional Review Board (HUM00092191). JAO acknowledges the 520 support of a European Union FP7 Marie Curie international outgoing fellowship (FORCONEPAL). LVR was funded by the European Research Council (ERC) under the European Union’s Horizon 2020 Research and Innovation Programme (Grant agreement No. 853222 FORESTDIET). AJB acknowledges the support of an Australian Research Council Australia Laureate Fellowship (grant number 525 FL160100072). LBF acknowledges support from the European Union Marie Curie global fellowship (CONRICONF). PM was supported by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (Grant agreement No 677140 MIDLAND)

The burden of chronic diseases and patients' preference for healthcare services among adult patients suffering from chronic diseases in Bangladesh

Background: Low‐and middle‐income countries (LMICs) have a disproportionately high burden of chronic diseases, with inequalities in health care access and quality services. This study aimed to assess patients' preferences for healthcare services for chronic disease management among adult patients in Bangladesh. Methods: The present analysis was conducted among 10,385 patients suffering from chronic diseases, drawn from the latest Household Income and Expenditure Survey 2016–2017. We used the multinomial logistic regression to investigate the association of chronic comorbid conditions and healthcare service‐related factors with patients' preferences for healthcare services. Results: The top four dimensions of patient preference for healthcare services in order of magnitude were quality of treatment (30.3%), short distance to health facility (27.6%), affordability of health care (21.7%) and availability of doctors (11.0%). Patients with heart disease had a 29% significantly lower preference for healthcare affordability than the quality of healthcare services (relative risk ratio [RRR] = 0.71; 0.56–0.90). Patients who received healthcare services from pharmacies or dispensaries were more likely to prefer a short distance to a health facility (RRR = 6.99; 4.80–9.86) or affordability of healthcare services (RRR = 3.13; 2.25–4.36). Patients with comorbid conditions were more likely to prefer healthcare affordability (RRR = 1.39; 1.15–1.68). In addition, patients who received health care from a public facility had 2.93 times higher preference for the availability of medical doctors (RRR = 2.93; 1.70–5.04) than the quality of treatment in the health facility, when compared with private service providers. Conclusions: Patient preferences for healthcare services in chronic disease management were significantly associated with the type of disease and its magnitude and characteristics of healthcare providers. Therefore, to enhance service provision and equitable distribution and uptake of health services, policymakers and public health practitioners should consider patient preferences in designing national strategic frameworks for chronic disease management. Patient or Public Contribution: Our research team includes four researchers (co‐authors) with chronic diseases who have experience of living or working with people suffering from chronic conditions or diseases

Older adults’ perspectives towards optimizing lifestyle behaviors and strategies to support healthy brain ageing during COVID-19 restrictions

Introduction: It is unknown how the impact of COVID-19 restrictions has affected brain healthy behaviors that contribute to dementia risk reduction in older adults. Our aim was to explore perspectives of older adults on lifestyle behaviors that support positive brain health and dementia risk reduction during and following COVID-19 restrictions. Methods: Community-dwelling older Australians (N = 159) during June to October 2021 (the second wave of COVID-19 restrictions) who had taken part in a pre-post dementia risk reduction intervention program were invited to discuss the impact of COVID-19 on their lifestyle behaviors. Semi-structured interviews explored individual’s adaptability to pandemic restrictions, intended behavior changes following restrictions easing, and feedback on the effectiveness of ongoing intervention programs for sustaining brain health. Thematic data analysis was performed using a deductive approach. Results: Participants had an average age of 73.1 years (SD = 5.6; range: 65–90), majority were female (74.7%), lived in a major city (82.2%) and mean 9.5 years (SD = 1.7) of education. Older adults’ views about lifestyle prevention strategies during the pandemic were both positive (e.g., more spare time and adaptive leisure activities) and negative (e.g., social isolation, lack of motivation, adverse emotions). Participants highlighted a continuous conscious effort to adapt certain brain healthy behaviors despite the persistence of adverse impacts of COVID-19 restrictions. Participants also expressed the intention and desire to revert to their previous lifestyle before the COVID-19 pandemic or a sense of the ‘new normal’. Conclusion: This formative research will inform future interventions targeting dementia risk reduction to consider the immediate and lasting effects of COVID-19 restrictions on older adult’s lifestyle behavior

Specific trunk and general exercise elicit similar changes in anticipatory postural adjustments in patients with chronic low back pain : a randomized controlled trial

Study Design. A randomized controlled trial. Objective. To compare changes in self-rated disability, pain, and anticipatory postural adjustments between specific trunk exercise and general exercise in patients with chronic low back pain. Summary of Background Data. Chronic low back pain is associated with altered motor control of the trunk muscles. The best exercise to address altered motor control is unclear. Methods. Sixty-four patients with chronic low back pain were randomly assigned to a specific trunk exercise group (SEG) that included skilled cognitive activation of the trunk muscles in addition to a number of other best practice exercises, whereas the general exercise group performed only seated cycling exercise. The training program lasted for 8 weeks. Self-rated disability and pain scores were collected before and after the training period. Electromyographic activity of various trunk muscles was recorded during performance of a rapid shoulder flexion task before and after training. Muscle onsets were calculated, and the latency time (in ms) between the onset of each trunk muscle and the anterior deltoid formed the basis of the motor control analysis. Results. After training, disability was significantly lower in the SEG (d = 0.62, P = 0.018). Pain was reduced in both groups after training (P < 0.05), but was lower for the SEG (P < 0.05). Despite the general exercise group performing no specific trunk exercise, similar changes in trunk muscle onsets were observed in both groups after training. Conclusion. SEG elicited significant reductions in self-rated disability and pain, whereas similar between-group changes in trunk muscle onsets were observed. The motor control adaptation seems to reflect a strategy of improved coordination between the trunk muscles with the unilateral shoulder movement. Trunk muscle onsets during rapid limb movement do not seem to be a valid mechanism of action for specific trunk exercise rehabilitation programs

Understanding the Mechanisms of Collective Decision Making in Ecological Restoration: An Agent-Based Model of Actors and Organizations

Ecological restoration, particularly in urban contexts, is a complex collective decision-making process that involves a diversity of stakeholders and experts, each with their own perceptions and preferences about what landscapes should and can look like, how to get them to the desired state, and on what timeline. We investigate how structural and behavioral factors may influence collective decision making in the context of ecological restoration, with the purpose of establishing general relationships between management styles (defined by structural and behavioral factors of the organization) and decision outcomes. Informed by existing literature on collective decision making and by empirical data from the Chicago Wilderness region, we present a stylized agent-based model that maps out and simulates the processes by which individuals within restoration organizations communicate, discuss, and ultimately make a decision. Our study examines how structural and behavioral characteristics - including: (a) the number of actors and groups involved in decision making, (b) the frequency and type of interactions among actors, (c) the initial setup of positions and respect, (d) outside information, and (e) entrenchment and cost of dissent - lead to or prohibit group convergence in terms of collective position, variation in position across actors, and final decision strategies. We found that formal meetings and group leaders are important facilitators of convergence, especially when multiple groups are present, new information is introduced in the process, and participants are polarized around an issue. Also, intergroup interactions are particularly important for overall convergence. Position entrenchment slows the convergence process and increases the need for decision strategies involving outside intervention. Cost of dissent can reinforce these effects. Our study formalizes collective decision-making processes within the context of ecological restoration, establishes generalizable relationships between these processes and decision outcomes, and provides a foundation for further empirical and modeling research

Relative abdominal adiposity is associated with chronic low back pain : a preliminary explorative study

Background: Although previous research suggests a relationship between chronic low back pain (cLBP) and adiposity, this relationship is poorly understood. No research has explored the relationship between abdominal-specific subcutaneous and visceral adiposity with pain and disability in cLBP individuals. The aim of this study therefore was to examine the relationship of regional and total body adiposity to pain and disability in cLBP individuals. Methods: A preliminary explorative study design of seventy (n = 70) adult men and women with cLBP was employed. Anthropometric and adiposity measures were collected, including body mass index, waist-to-hip ratio, total body adiposity and specific ultrasound-based abdominal adiposity measurements. Self-reported pain and disability were measured using a Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) questionnaires respectively. Relationships between anthropometric and adiposity measures with pain and disability were assessed using correlation and regression analyses. Results: Significant correlations between abdominal to lumbar adiposity ratio (A-L) variables and the waist-to-hip ratio with self-reported pain were observed. A-L variables were found to predict pain, with 9.1–30.5 % of the variance in pain across the three analysis models explained by these variables. No relationships between anthropometric or adiposity variables to self-reported disability were identified. Conclusions: The findings of this study indicated that regional distribution of adiposity via the A-L is associated with cLBP, providing a rationale for future research on adiposity and cLBP

Pain reported during prolonged standing is associated with reduced anticipatory postural adjustments of the deep abdominals

Within the context of low back pain, the measurement of deep abdominal anticipatory postural adjustments (APAs) during rapid limb movement has received much interest. There is dispute about the association between APAs and back pain. Moreover, there is limited evidence examining compensatory postural adjustments (CPAs) in back pain. This study examined the relationship between APAs and CPAs with pain reported in the low back during 2 h of prolonged standing. Twenty-six participants with no history of severe back pain performed 2-h prolonged standing. APAs and CPAs of the deep abdominal muscles (transverse abdominis/internal obliques) were measured by surface electromyography during rapid shoulder flexion and extension. APAs and CPAs measured prestanding revealed symmetrical anticipatory activity, but an asymmetry between the different sides of the abdominal wall for CPAs. APAs and CPAs measured pre-standing were not associated with pain reported during standing. For the whole group, APA amplitudes were reduced post-standing during shoulder flexion (p = 0.005). Pain reported during standing was associated with the changes in APA amplitudes post-standing (rs = 0.43, p = 0.002). These findings support previous research using hypertonic saline injections to induce back pain that showed reduced APA amplitudes, and extends findings to suggest pain does not effect compensatory postural adjustments