Readability and content analysis of lifestyle education resources for weight management in Australian general practice

© 2016 El-Haddad et al. Background: Weight management education is one of the key strategies to assist patients to manage their weight. Educational resources provide an important adjunct in the chain of communication between practitioners and patients. However, one in five Australian adults has low health literacy. The purpose of this study was to assess the readability and analyse the content of weight management resources. Methods: This study is based on the analysis of 23 resources found in the waiting rooms of ten Sydney-based general practices and downloaded from two clinical software packages used at these practices. The reading grade level of these resources was calculated using the Flesch Reading Ease, Flesch-Kincaid Grade Level, Fry Readability Graph, and the Simplified Measure of Gobbledygook. Resources' content was analysed for the presence of dietary, physical activity, and behaviour change elements, as recommended by the Clinical practice guidelines for the management of overweight and obesity in adults, adolescents, and children in Australia. Results: The resources' average reading grade level was for a 10th grader (9.5 ± 1.8). These findings highlight that the average reading grade level was two grades higher than the recommended reading grade level for health education resources of 8th grade level or below. Seventy percent of resources contained dietary and behaviour change elements. Physical activity was included in half of the resources. Two messages were identified to be inconsistent with the guidelines and three messages had no scientific basis. Conclusion: A body of evidence now exists that supports the need to develop evidence-based education resources for weight management that place low demand on literacy, without compromising content accuracy. The findings from this study suggest that there is significant room for improvement in the educational resources provided in general practices

Neighborhood and Social Environmental Influences on Child Chronic Disease Prevalence

We investigate how distinct residential environments uniquely influence chronic child disease. Aggregating over 200,000 pediatric geocoded medical records to the census tract of residence and linking them to neighborhood-level measures, we use multiple data analysis techniques to assess how heterogeneous exposures of social and environmental neighborhood conditions influence an index of child chronic disease (CCD) prevalence for the neighborhood. We find there is a graded relationship between degree of overall neighborhood disadvantage and children’s chronic disease such that the highest neighborhood CCD scores reside in communities with the highest concentrated disadvantage. Finally, results show that higher levels of neighborhood concentrated disadvantage and air pollution exposure associate with higher risks of having at least one chronic condition for children after also considering their individual- and family-level characteristics. Overall, our analysis serves as a comprehensive start for future researchers interested in assessing which neighborhood factors matter most for child chronic health conditions

Child Obesity and the Interaction of Family and Neighborhood Socioeconomic Context

The literature on neighborhoods and child obesity links contextual conditions to risk, assuming that if place matters, it matters in a similar way for everyone in those places. We explore the extent to which distinctive neighborhood types give rise to social patterning that produces variation in the odds of child obesity. We leverage geocoded electronic medical records for a diverse sample of over 135,000 children aged 2 to 12 and latent profile modeling to characterize places into distinctive neighborhood contexts. Multilevel models with cross-level interactions between neighborhood type and family socioeconomic standing (SES) reveal that children with different SES, but living in the same neighborhoods, have different odds of obesity. Specifically, we find lower-SES children benefit, but to a lesser degree, from neighborhood advantages and higher-SES children are negatively influenced, to a larger degree, by neighborhood disadvantages. The resulting narrowing of the gap in obesity by neighborhood disadvantage helps clarify how place matters for children’s odds of obesity and suggests that efforts to improve access to community advantages as well as efforts to address community disadvantages are important to curbing obesity and improving the health of all children

The Sloan Digital Sky Survey Reverberation Mapping Project: Velocity Shifts of Quasar Emission Lines

Quasar emission lines are often shifted from the systemic velocity due to various dynamical and radiative processes in the line-emitting region. The level of these velocity shifts depends both on the line species and on quasar properties. We study velocity shifts for the line peaks of various narrow and broad quasar emission lines relative to systemic using a sample of 849 quasars from the Sloan Digital Sky Survey Reverberation Mapping (SDSS-RM) project. The coadded (from 32 epochs) spectra of individual quasars have sufficient signal-to-noise ratio (SNR) to measure stellar absorption lines to provide reliable systemic velocity estimates, as well as weak narrow emission lines. The sample also covers a large dynamic range in quasar luminosity (~2 dex), allowing us to explore potential luminosity dependence of the velocity shifts. We derive average line peak velocity shifts as a function of quasar luminosity for different lines, and quantify their intrinsic scatter. We further quantify how well the peak velocity can be measured for various lines as a function of continuum SNR, and demonstrate there is no systematic bias in the line peak measurements when the spectral quality is degraded to as low as SNR~3 per SDSS pixel. Based on the observed line shifts, we provide empirical guidelines on redshift estimation from [OII]3728, [OIII]5008, [NeV]3426, MgII, CIII], HeII1640, broad Hbeta, CIV, and SiIV, which are calibrated to provide unbiased systemic redshifts in the mean, but with increasing intrinsic uncertainties of 46, 56, 119, 205, 233, 242, 400, 415, and 477 km/s, in addition to the measurement uncertainties. These more realistic redshift uncertainties are generally much larger than the formal uncertainties reported by the redshift pipelines for spectroscopic quasar surveys, and demonstrate the infeasibility of measuring quasar redshifts to better than ~200 km/s with only broad lines.Comment: matched to the published version; minor changes and conclusions unchange

Comprehensive Neighborhood Portraits and Child Asthma Disparities Introduction

Objectives Previous research has established links between child, family, and neighborhood disadvantages and child asthma. We add to this literature by first characterizing neighborhoods in Houston, TX by demographic, economic, and air quality characteristics to establish differences in pediatric asthma diagnoses across neighborhoods. Second, we identify the relative risk of social, economic, and environmental risk factors for child asthma diagnoses. Methods We geocoded and linked electronic pediatric medical records to neighborhood-level social and economic indicators. Using latent profile modeling techniques, we identified Advantaged, Middle-class, and Disadvantaged neighborhoods. We then used a modified version of the Blinder-Oaxaca regression decomposition method to examine differences in asthma diagnoses across children in these different neighborhoods. Results Both compositional (the characteristics of the children and the ambient air quality in the neighborhood) and associational (the relationship between child and air quality characteristics and asthma) differences within the distinctive neighborhood contexts influence asthma outcomes. For example, unequal exposure to PM2.5 and O3 among children in Disadvantaged and Middle-class neighborhoods contribute to asthma diagnosis disparities within these contexts. For children in Disadvantaged and Advantaged neighborhoods, associational differences between racial/ethnic and socioeconomic characteristics and asthma diagnoses explain a significant proportion of the gap. Conclusions for Practice Our results provide evidence that differential exposure to pollution and protective factors associated with non-Hispanic White children and children from affluent families contribute to asthma disparities between neighborhoods. Future researchers should consider social and racial inequalities as more proximate drivers, not merely as associated, with asthma disparities in children

The Sloan Digital Sky Survey Reverberation Mapping Project: Ensemble Spectroscopic Variability of Quasar Broad Emission Lines

We explore the variability of quasars in the MgII and Hbeta broad emission lines and UV/optical continuum emission using the Sloan Digital Sky Survey Reverberation Mapping project (SDSS-RM). This is the largest spectroscopic study of quasar variability to date: our study includes 29 spectroscopic epochs from SDSS-RM over $6$ months, containing 357 quasars with MgII and 41 quasars with Hbeta . On longer timescales, the study is also supplemented with two-epoch data from SDSS-I/II. The SDSS-I/II data include an additional $2854$ quasars with MgII and 572 quasars with Hbeta. The MgII emission line is significantly variable ($\Delta f/f$ 10% on 100-day timescales), a necessary prerequisite for its use for reverberation mapping studies. The data also confirm that continuum variability increases with timescale and decreases with luminosity, and the continuum light curves are consistent with a damped random-walk model on rest-frame timescales of $\gtrsim 5$ days. We compare the emission-line and continuum variability to investigate the structure of the broad-line region. Broad-line variability shows a shallower increase with timescale compared to the continuum emission, demonstrating that the broad-line transfer function is not a $\delta$-function. Hbeta is more variable than MgII (roughly by a factor of $1.5$), suggesting different excitation mechanisms, optical depths and/or geometrical configuration for each emission line. The ensemble spectroscopic variability measurements enabled by the SDSS-RM project have important consequences for future studies of reverberation mapping and black hole mass estimation of $1<z<2$ quasars.Comment: 20 pages, 25 figures. ApJ accepted: minor revisions following referee repor

The Sloan Digital Sky Survey Reverberation Mapping Project: No Evidence for Evolution in the M-sigma Relation to z~1

We present host stellar velocity dispersion measurements for a sample of 88 broad-line quasars at 0.10.6) from the Sloan Digital Sky Survey Reverberation Mapping (SDSS-RM) project. High signal-to-noise ratio coadded spectra (average S/N~30 per 69 km/s pixel) from SDSS-RM allowed decomposition of the host and quasar spectra, and measurement of the host stellar velocity dispersions and black hole (BH) masses using the single-epoch (SE) virial method. The large sample size and dynamic range in luminosity (L5100=10^(43.2-44.7) erg/s) lead to the first clear detection of a correlation between SE virial BH mass and host stellar velocity dispersion far beyond the local universe. However, the observed correlation is significantly flatter than the local relation, suggesting that there are selection biases in high-z luminosity-threshold quasar samples for such studies. Our uniform sample and analysis enable an investigation of the redshift evolution of the M-sigma relation free of caveats by comparing different samples/analyses at disjoint redshifts. We do not observe evolution of the M-sigma relation in our sample, up to z~1, but there is an indication that the relation flattens towards higher redshifts. Coupled with the increasing threshold luminosity with redshift in our sample, this again suggests certain selection biases are at work, and simple simulations demonstrate that a constant M-sigma relation is favored to z~1. Our results highlight the scientific potential of deep coadded spectroscopy from quasar monitoring programs, and offer a new path to probe the co-evolution of BHs and galaxies at earlier times.Comment: replaced with the accepted version (minor changes and updated references); ApJ in press; changed title to highlight the main resul

Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare: Protocol for a cluster randomised controlled trial

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. Introduction Adults with lower levels of health literacy are less likely to engage in health-promoting behaviours. Our trial evaluates the impacts and outcomes of a mobile health-enhanced preventive intervention in primary care for people who are overweight or obese. Methods and analysis A two-arm pragmatic practice-level cluster randomised trial will be conducted in 40 practices in low socioeconomic areas in Sydney and Adelaide, Australia. Forty patients aged 40-70 years with a body mass index ≥28 kg/m 2 will be enrolled per practice. The HeLP-general practitioner (GP) intervention includes a practice-level quality improvement intervention (medical record audit and feedback, staff training and practice facilitation visits) to support practices to implement the clinical intervention for patients. The clinical intervention involves a health check visit with a practice nurse based on the 5As framework (assess, advise, agree, assist and arrange), the use of a purpose-built patient-facing app, my snapp, and referral for telephone coaching. The primary outcomes are change in health literacy, lifestyle behaviours, weight, waist circumference and blood pressure. The study will also evaluate changes in quality of life and health service use to determine the cost-effectiveness of the intervention and examine the experiences of practices in implementing the programme. Ethics and dissemination The study has been approved by the University of New South Wales (UNSW) Human Research Ethics Committee (HC17474) and ratified by the University of Adelaide Human Research Ethics committee. There are no restrictions on publication, and findings of the study will be made available to the public via the Centre for Primary Health Care and Equity website and through conference presentations and research publications. Deidentified data and meta-data will be stored in a repository at UNSW and made available subject to ethics committee approval. Trial Registrationregistration number ACTRN12617001508369; Pre-results

The Sloan Digital Sky Survey Reverberation Mapping Project : biases in z > 1.46 redshifts due to quasar diversity

We use the coadded spectra of 32 epochs of Sloan Digital Sky Survey (SDSS) Reverberation Mapping Project observations of 482 quasars with z > 1.46 to highlight systematic biases in the SDSS- and Baryon Oscillation Spectroscopic Survey (BOSS)-pipeline redshifts due to the natural diversity of quasar properties. We investigate the characteristics of this bias by comparing the BOSS-pipeline redshifts to an estimate from the centroid of He ii λ1640. He ii has a low equivalent width but is often well-defined in high-S/N spectra, does not suffer from self-absorption, and has a narrow component which, when present (the case for about half of our sources), produces a redshift estimate that, on average, is consistent with that determined from [O ii] to within the He ii and [O ii] centroid measurement uncertainties. The large redshift differences of ∼1000 km s-1, on average, between the BOSS-pipeline and He ii-centroid redshifts, suggest there are significant biases in a portion of BOSS quasar redshift measurements. Adopting the He ii-based redshifts shows that C iv does not exhibit a ubiquitous blueshift for all quasars, given the precision probed by our measurements. Instead, we find a distribution of C iv-centroid blueshifts across our sample, with a dynamic range that (i) is wider than that previously reported for this line, and (ii) spans C iv centroids from those consistent with the systemic redshift to those with significant blueshifts of thousands of kilometers per second. These results have significant implications for measurement and use of high-redshift quasar properties and redshifts, and studies based thereon.Publisher PDFPeer reviewe