Effectiveness of peers in delivering programs or motivating older people to increase their participation in physical activity: Systematic review and meta-analysis

The objective of this systematic review and meta-analysis was to evaluate the effectiveness of peers to deliver programs or encourage older people to be physically active and improve physical outcomes. Peer reviewed articles published in English between January 1976 and June 2016, retrieved from six databases according to the predefined inclusion criteria were included. Where possible results were pooled and meta-analyses conducted. Eighteen articles were included in the review, a total of 3,492 intervention participants, average age 66.5 years and 67.1% were female. Overall, study quality was medium to high. Interventions mainly included resistance, flexibility and cardiovascular training, however there was one aquatic exercise group. Eight studies were delivered by peers and five utilised peer support, which included advice and being positive but was not directly linked to an exercise intervention. While 16 of the 18 studies reported improvement in levels of physical activity and/or noted physical benefits by peer involvement, the meta-analyses findings supported the control groups for the six minute walk test (favoured intervention) and the timed-up-and-go (favoured controls) tests. Meta-analyses data were limited due to studies using a variety of measurement tools and included predominantly small sample size studies. Findings from this review suggest exercise programs involving peers can promote and maintain adherence to exercise programs. However, results are inconclusive as to whether peers have a positive effect on improving physical function for older people

The importance of left atrial volume assessment in identifying the cause of ischemic stroke

Separating cardioembolic from large artery stroke has important treatment implications. We investigated whether echocardiography could improve Cardioembolic Stroke (CES) prediction compared with traditional measures and cholesterol biomarkers. Data from 40 consecutive patients presenting with acute ischemic stroke which included brain and carotid imaging, ECG, echo, serum cholesterol and apolipoproteins were independently reviewed. Patients were classified into two groups: a) CES, defined by sustained or paroxysmal atrial fibrillation and \u3c50% stenosis of a perfusing cerebral artery; b) Large artery stroke (LAS) defined as \u3e 50% stenosis of an ipsilateral perfusing cerebral artery, with no evidence of AF on monitoring or evidence of small artery disease on neuroimaging and confirmed by an independent neurologist. Other than the CES group being older, the baseline characteristics of the two groups were similar. Left Atrial Volume (indexed for body surface area, LAVi) was significantly larger in CES (57.9 +/- 19.4 vs 31.1 +/- 8.3ml/m2, p\u3c0.01), with a simple equation that utilised age, LAVi and E wave accurately predicting 90% of CES. The difference in LAVi for CES was beyond that anticipated from the presence of AF alone. No differences in any of the lipid biomarkers were observed. These finding indicate that LAVi is the most important predictor of CES due to atrial fibrillation and is highly predictive of patients with CES due to atrial fibrillation. Cholesterol biomarkers offered no additional discriminatory value

Efficacy of infant simulator programmes to prevent teenage pregnancy: a school-based cluster randomised trial in Western Australia

Background: Infant simulator-based programmes seek to prevent teenage pregnancy. They are utilised in western and developing countries but, despite growing popularity, there is no published evidence of their long-term impact. The aim of this trial was to investigate the effect of such a programme, the Virtual Infant Parenting (VIP) Programme, on the pregnancy outcomes of birth and induced abortion. Methods: Fifty-seven of 66 eligible schools (86%) in Perth, Western Australia enrolled in the pragmatic clustered (by school) randomised trial (ISRCTN24952438) with even randomisation to the intervention and control groups. Between 2003 and 2006, the VIP programme was administered to 1,267 girls in the intervention schools, while 1,567 girls in the control schools received the standard health education curriculum. Participants were aged 13-15 years and were followed until age 20 via data linkage to hospital medical and abortion clinic records. Log binomial and Cox proportional hazards regression was used to test for differences in pregnancy rates between study groups. Findings: Compared to girls Findings: Compared to girls in the control group, a higher proportion of girls in the intervention group recorded at least one birth (7.6%, n=97; 4·3%, n=67) or at least one abortion as the first pregnancy event (8.9%, n=113; 6.4%, n=101). After adjustment for potential confounding, the intervention group had a higher overall pregnancy risk (RR = 1·36, 95% CI 1.10–1·67, p=0.003) compared to the control group. Similar results were obtained using proportional hazard models (HR = 1.35, 95% CI 1.10–1·67, p=0·016). Interpretation: The infant-simulator based VIP Programme did not achieve its aim of reducing teenage pregnancy. Girls in the intervention group were more likely to experience a birth or an induced abortion than those in the control group before turning 20 years of age. Funding: The Health Promotion Research Foundation of Western Australia (Healthway), Lotteries WA, the Western Australian Department of Education and Training and the Western Australian Department of Health

Study protocol for the evaluation of an Infant Simulator based program delivered in schools: a pragmatic cluster randomised controlled trial

Background: This paper presents the study protocol for a pragmatic randomised controlled trial to evaluate the impact of a school based program developed to prevent teenage pregnancy. The program includes students taking care of an Infant Simulator; despite growing popularity and an increasing global presence of such programs, there is no published evidence of their long-term impact. The aim of this trial is to evaluate the Virtual Infant Parenting (VIP) program by investigating pre-conceptual health and risk behaviours, teen pregnancy and the resultant birth outcomes, early child health and maternal health. Methods and Design: Fifty-seven schools (86% of 66 eligible secondary schools) in Perth, Australia were recruited to the clustered (by school) randomised trial, with even randomisation to the intervention and control arms. Between 2003 and 2006, the VIP program was administered to 1,267 participants in the intervention schools, while 1,567 participants in the non-intervention schools received standard curriculum. Participants were all female and aged between 13-15 years upon recruitment. Pre and post-intervention questionnaires measured short-term impact and participants are now being followed through their teenage years via data linkage to hospital medical records, abortion clinics and education records. Participants who have a live birth are interviewed by face-to-face interview. Kaplan-Meier survival analysis and proportional hazards regression will test for differences in pregnancy, birth and abortion rates during the teenage years between the study arms.Discussion: This protocol paper provides a detailed overview of the trial design as well as initial results in the form of participant flow. The authors describe the intervention and its delivery within the natural school setting and discuss the practical issues in the conduct of the trial, including recruitment. The trial is pragmatic and will directly inform those who provide Infant Simulator based programs in school settings

Psychiatric comorbidity in a cohort of heroin and amphetamine users in Perth Western Australia

Aims: To determine if amphetamine and opioid users attending a drug treatment service were more likely to be admitted to psychiatric services than users not receiving treatment.Method: Client records form Next Step Specialist Drug and Alcohol Services (Next Step) and the Community Based Methadone Program (CBMP) were linked to mental health and hospital morbidity data files using probabilistic matching.Participants: The sample comprised 4280 drug users (2887 opioid users, 1393 amphetamine users). Of these, 928 received methadone at either Next Step or the CBMP, 541 attended counselling or a support group at Next Step, and 2811 did not receive treatment from Next Step or the CBMP during the study.Findings: Irrespective of treatment received, clients who had recently withdrawn from treatment were at the highest risk of psychiatric admission, experiencing seven times the hazard of admission compared with those who did not access drug treatment. Amphetamine users had at least three times the hazard of psychiactric admission compared with opioid users. Clients with a history of psychiatric admissions had twice the hazard of subsequent admission compared with those with no psychiatric history.Conclusions: Clients presenting at a drug treatment service should be screened for mental health diasgnosis at their initial assessment so that appropriate treatment strategies can be offered to these dually diagnosed clients

Characteristics of quality activities in a tertiary teaching hospital in Western Australia

Objective: This study aims to describe the characteristics of quality activities in a tertiary quaternary hospital in Western Australia. Methods: Data from the study hospital’s electronic quality management system Governance, Evidence, Knowledge and Outcome between 1 January 2015 and 31 December 2019 was analysed by using descriptive and thematic methods. Results: Quality assurance (QA) accounted for 68.3% of all quality activities in the study hospital. Principal investigators of activities were mostly in clinical roles and relatively senior in their profession. Collaboration within the same profession and same team was common, but much less so across departments. The median quality cycle length measured by proposal submission to completion was 202 days, but 190 days when measured by proposal approval to completion. A majority (93.2%) of quality activities were undertaken as part of everyday business. Common issues outlined in activity reports were documentation and compliance 44.8% (n = 100), data and tool limitations 10.8% (n = 24), variation in care 9.9% (n = 22), process 9.4% (n = 21), and knowledge and awareness 9.0% (n = 20). Common recommendations to address the issues were communicating findings to relevant teams and governance committees 26.8% (n = 104), further data collection including reaudit 26.0% (n = 101), education and training 20.4% (n = 79), process review and/or development 13.9% (n = 54), and policy/guidelines review and/or development 4.4% (n = 17). Conclusion: Understanding the characteristics of quality activities from a whole hospital perspective provides insights and informs discussions relating to the efficiency and effectiveness of quality activities in hospitals. Embedding quality activities into everyday business is achievable for hospitals but considerations need to occur on how to sustain staff motivation and enthusiasm by helping individuals and teams reach the ultimate goals for improvement and keeping performance monitoring as close to the real time of care as possible. There is a need to transform QA into quality improvement, with the 90-day cycle being a feasible target for QA in hospitals

Bouncing back from COVID-19: A Western Australian community perspective

Introduction: This study explored the behavioral profiles of residing Western Australians during a COVID-19 lockdown period and transitions in behavior post-lockdown. Methods: A total of 313 participants (76% female, age: M = 50.1, SD = 15.7 years) completed behavioral and mental health questionnaire items ~2 months after a 3-month COVID-19 lockdown in October 2020, using a retrospective recall to assess their experience during the lockdown period. Latent transition analysis (LTA) was used to identify behavioral profiles and transitions. Indicators were identified by assessing during–post-lockdown group differences (Kruskal–Wallis, chi-square tests) and profiles described using qualitative open-ended questions. Results: Significant indicators included changes in physical activity, leisure screen time, alcohol intake, psychological distress, and loneliness, but not fast food consumption. The significant indicators were used to form LTA models. The five latent class model showed the best model fit (Log-likelihood = −1301.66, AIC = 426.12, BIC = 609.68). Approximately one in four participants reported a change in their behavior profiles after the lockdown ceased. Key differences between the profiles were age, household income, education, resilience, sense of control, existing mental health issues, and social relations. Washing hands and social distancing were the most recalled and effective health campaigns across the classes, with health campaigns encompassing physical activity/alcohol consumption, or domestic violence having the least attention. Discussion: Overall, while most participants recovered relatively well after the lockdown period, LTA did identify subgroups such as those who were inactive and lonely experienced more difficulties than other groups, and engagement with public health campaigns differed. The results provide important insights for future public health campaigns on how these campaigns might be diversified to effectively target more people and particular groups to maximize engagement for maintaining people\u27s mental health with additional focus on physical activity, alcohol consumption, and domestic violence

Burden of stroke in Indigenous Western Australians: A study using data linkage

Background And Purpose- Despite the disproportionate burden of cardiovascular disease among indigenous Australians, information on stroke is sparse. This article documents the incidence and burden of stroke (in disability-adjusted life years) in indigenous and non-indigenous people in Western Australia (1997-2002), a state resident to 15% of indigenous Australians comprising 3.4% of the population of Western Australia. Methods- Indigenous and non-indigenous stroke incidence and excess mortality rates were estimated from linked hospital and mortality data, with adjustment for nonadmitted events. Nonfatal burden was calculated from nonfatal incidence, duration (modeled from incidence, excess mortality, and remission), and disability weights. Stroke death counts formed the basis of fatal burden. Nonfatal and fatal burden were summed to obtain disability-adjusted life years, by indigenous status. Results- The total burden was 55 099 and 2134 disability-adjusted life years in non-indigenous and indigenous Western Australians, respectively. The indigenous to non-indigenous age-standardized stroke incidence rate ratio (15 years) was 2.6 in males (95% CI, 2.3-3.0) and 3.0 (95% CI, 2.6-3.5) in females, with similar rate ratios of disability-adjusted life years. The burden profile differed substantially between populations, with rate ratios being highest at younger ages. Conclusions- The differential between indigenous and non-indigenous stroke burden is considerable, highlighting the need for comprehensive intersectoral interventions to reduce indigenous stroke incidence and improve outcomes. Programs to reduce risk factors and increase access to culturally appropriate stroke services are required. The results here provide the quantitative basis for policy development and monitoring of stroke outcomes