LIFESTYLE INTERVENTIONS TO SUPPORT PEOPLE WITH CHRONIC NON-SPECIFIC LOW BACK PAIN

The broad aim of this thesis was to investigate the health and lifestyle factors influencing health care utilisation for low back pain, and to examine the role of psychological interventions (including lifestyle interventions) for improving health outcomes and/or reducing health service utilisation in people with chronic non-specific low back pain. To address the broad aim, the studies included in this thesis were conducted and organised according to three aims: (i) to identify health and lifestyle factors associated with patients seeking care for low back pain, (ii) to investigate the comparative effectiveness and safety of psychological interventions for improving health outcomes in patients with chronic low back pain, and (iii) to evaluate the effectiveness of introducing a lifestyle intervention, involving health coaching, into the discharge care pathway for patients with low back pain to reduce the use of health services for low back pain and improve health outcomes. Chapter One provided an overview of current literature related to the epidemiology and global patterns of health care utilisation for low back pain, as well as an introduction to the relevance of lifestyle interventions for improving health outcomes in people with chronic non-specific low back pain. Chapters Two and Three addressed the first aim. Chapter Two investigated the relationship between various anthropometric, sociodemographic, health, and lifestyle factors, and the use of medical care for chronic non-specific low back pain. A co-twin case-control design was used to adjust for the potential confounding influence of aggregated familial factors (e.g., genetics and the early shared environment) on the relationship between these factors and the use of medical care for chronic non-specific low back pain. Poor sleep quality was identified as the only factor associated with seeking medical care for low back pain in the long term, with the relationship being independent of aggregated familial factors. Chapter Three examined the relationship between different intensities, volumes, and/or domains of physical activity and sedentary behaviour, on various care-seeking behaviours for low back pain. The study in Chapter Three discovered that different intensities, volumes, and/or domains of physical activity and sedentary behaviour, at baseline, have different effects on varying patterns of health care utilisation for low back pain. Specifically, engagement in medium-to-high volumes of household domain physical activity at baseline significantly increases the risk of the overall utilisation of care, and the utilisation of self-management strategies, for low back pain over one year. Further, people who engage in medium-to-high volumes of physically demanding tasks at work at baseline utilise more overall care for low back pain, whilst people who engage in medium-to-high volumes of sedentary behaviour at baseline utilise more self-management strategies for low back pain, over a one-year period. In contrast, engagement in medium-to-high volumes of moderate-to-vigorous intensity physical activity appears to halve the risk of overall care utilisation for low back pain. No physical activity or sedentary behaviour variables demonstrated any significant associations with the utilisation of health services for low back pain. Chapters Four and Five addressed the second aim. Chapter Four described the protocol of a systematic review including a network meta-analysis of psychological interventions for chronic non-specific low back pain. The primary outcomes were patients’ physical function and pain intensity, and the secondary outcomes were fear avoidance, health-related quality of life and intervention compliance, and safety. The results of the systematic review and meta-analysis are presented in Chapter Five. In total, 97 randomised controlled trials involving 13,136 participants and 17 treatment nodes were included. Results of the network meta-analysis demonstrated that compared with physiotherapy care alone (mainly structured exercise), pain education programs delivered with physiotherapy care (mainly structured exercise) offer the most sustainable effects of treatment for physical function and fear avoidance. Differently, behavioural therapy delivered with physiotherapy care (mainly structured exercise) results in the most sustainable effects of treatment for pain intensity. There is uncertainty surrounding their long-term effectiveness (12 months post-intervention) because of a lack of studies with long-term follow-up periods. However, limited but consistent evidence suggests psychological interventions are safe for people with chronic non-specific low back pain, given that the occurrence of adverse events related to the intervention is rare (i.e., only reported in three of 20 studies). Even when reported, the adverse events are not considered serious in nature. The review also confirmed a prevailing lack of high-quality randomised clinical trials investigating the effectiveness of mindfulness-based interventions (i.e., mindfulness-based stress reduction), and counselling-based interventions (i.e., lifestyle interventions) for this population. Building on the evidence gaps identified in Chapters Four and Five, Chapters Six, Seven, and Eight addressed the final aim of this thesis. Chapter Six described the protocol of a randomised controlled trial designed to evaluate the effectiveness of introducing a support system, involving a lifestyle intervention (i.e., a health coaching program), into the discharge care pathway for patients with chronic non-specific low back pain (Get Back to Healthy trial). The comparison intervention is usual care provided at discharge from treatment, and the primary outcome is the use of health services for low back pain, over one year. The trial will recruit 374 adults in Australia. However, the unprecedented COVID-19 pandemic has caused significant delays in the progress of the trial. Disruptions to recruitment and data collection have precluded the completion of an additional study, which was intended for inclusion in this thesis. The proposed study was designed to investigate the joint association between physical activity and sleep on various care-seeking behaviours for low back pain. In the absence of sufficient data to complete the proposed study, Chapter Seven reports on the progress made during the early implementation phase of the trial, summarises preliminary findings to date, and describes the intended interim statistical analysis plan. To conclude, Chapter Eight provides a narrative summary of the specific challenges and key lessons learned during the implementation of the Get Back to Healthy trial, described in Chapter Six. Chapter Eight aimed to bring greater awareness to the complexity of conducting a large, pragmatic, multi-site randomised clinical trial of a lifestyle intervention, delivered by an established public health service, during a global pandemic. Practical recommendations to improve the conduct and implementation of clinical trials, in any context in the future, are presented in this chapter. Finally, Chapter Nine summarised the key findings, clinical implications, and strengths and limitations of this thesis, and also provided recommendations for future research

Water usage in Australian indigenous communities

Water usage in Australian indigenous communitie

Perspectives on issues and the application of the innovative procurement approaches for the Industrialised Building System (IBS)

Malaysia is making an aggressive effort of transformation to become a fully developed country. As one of the pillars for transformation, the construction industry has been undergoing a major reform with regard to the traditional method of construction. In recent years, the Industrialised Building System (IBS) has been promoted extensively with the government taking a lead with the practice. Studies showed that IBS has been able to expedite construction process, improve the time taken to accomplish a project, improve building quality, able to control cost and human resources, which in overall, raise occupational health and safety standard of construction. Despite, as most IBS projects were carried out under the traditional procurement method, the full benefits of IBS are somehow obscured. Several issues such as work delay, lack of communication and integration, lack of knowledge and increase in cost, which are synonymous to the traditional procurement method appear to outweigh the benefit of IBS. Hence, this research aims to suggest an alternative to the traditional procurement method with regard to IBS project implementation. The focus of this research has been on the challenges and innovative procurement methods most suited for IBS project. Two objectives were outlined: (1) to identify issues faced by client on current procurement method in IBS project; and (2) to identify the client’s perspective on innovative procurement method most suited for IBS project. Data for this research was collected through semi-structured interviews with five respondents from five major developers having experience in IBS project implementation. The results from the thematic analysis revealed that apart from the common issues which ascend from the sequential nature of the traditional procurement method, design integration issue was opined to aggravate the situation. Unanimously, respondents agreed that partnering is the way forward for IBS project implementation in Malaysian construction industry. This research contributes by providing important pointers for the local construction industry to move forward with IBS project implementation

The predominance of seafood allergy in Vietnamese adults: results from the first population-based questionnaire survey

Background: Food allergy (FA) is a serious, costly and growing health problem worldwide. FA occurs in both children and adults; however, there is a paucity of information on FA prevalence and its clinical features in the adult population, especially in Asia. We sought to assess the prevalence of FAs in Vietnamese adults and the distribution of offending food items among different regions throughout Vietnam. Methods: A nationwide, cross-sectional, population-based survey was conducted among University students aged 16-50 years. We used a structured, anonymous questionnaire, which was modified from recently published FA epidemiologic studies and based on European Academy of Allergy and Clinical Immunology (EAACI) guidelines, to collect data on FA prevalence, clinical presentations, and implicated food groups. Statistical analysis was performed to generate the prevalence of self-reported and doctor-diagnosed FA and to examine the association of key environmental factors and FA incidence in this population. Results: Of the 14,500 surveys distributed, a total of 9,039 responses were returned, resulting in a response rate of 62.4%. Among participants who reported food-induced adverse reactions, 48.0% have repeated reactions. 18.0% of the participants perceived FA symptoms, but less than half of them sought medical services for confirmation (37.9%). Stratifying for true FA symptoms, the prevalence of self-reported FA was 11.8% and of doctor-diagnosed FA, 4.6%. The most common doctordiagnosed FA was to crustacean (3.0%; 95% CI, 2.6-3.3), followed by fish (1.6%; 95% CI, 1.3-1.8), mollusk (1.3%; 95% CI, 1.0-1.5) and beef (1.0%; 95% CI, 0.8-1.2). The prevalence of doctordiagnosed FA differed among participants living in urban (6.5%) and rural regions (4.9%) (P< 0.001). Atopic family history was the strongest predictor for FA(odds ratio 8.0; 95% CI, 6.2-10.4). Conclusions: Seafood allergy among adults is predominant in Vietnam, followed by beef, milk, and egg, while peanut, soy, and tree nut allergy are much less common. Populations in rural regions have considerably less FA; however, the protective environmental factors have yet to be identified

Coevolution of Snake Venom Toxic Activities and Diet: Evidence that Ecological Generalism Favours Toxicological Diversity

Snake venom evolution is typically considered to be predominantly driven by diet-related selection pressures. Most evidence for this is based on lethality to prey and non-prey species and on the identification of prey specific toxins. Since the broad toxicological activities (e.g., neurotoxicity, coagulotoxicity, etc.) sit at the interface between molecular toxinology and lethality, these classes of activity may act as a key mediator in coevolutionary interactions between snakes and their prey. Indeed, some recent work has suggested that variation in these functional activities may be related to diet as well, but previous studies have been limited in geographic and/or taxonomic scope. In this paper, we take a phylogenetic comparative approach to investigate relationships between diet and toxicological activity classes on a global scale across caenophidian snakes, using the clinically oriented database at toxinology.com. We generally find little support for specific prey types selecting for particular toxicological effects except that reptile-feeders are more likely to be neurotoxic. We find some support for endothermic prey (with higher metabolic rates) influencing toxic activities, but differently from previous suggestions in the literature. More broadly, we find strong support for a general effect of increased diversity of prey on the diversity of toxicological effects of snake venom. Hence, we provide evidence that selection pressures on the toxicological activities of snake venom has largely been driven by prey diversity rather than specific types of prey. These results complement and extend previous work to suggest that specific matching of venom characteristics to prey may occur at the molecular level and translate into venom lethality, but the functional link between those two is not constrained to a particular toxicological route

Identification and assessment of water quality risks associated with sludge supernatant recycling in the presence of cyanobacteria.

This study focussed on the fate of cyanobacteria cells and associated metabolites during the sludge management processes that follow the conventional drinking water treatment train. The topic is of importance, as the release of metabolites during sludge treatment may pose a risk to water quality if supernatant is recycled to the head of the plant. The study of the kinetics of cell damage and metabolite release into the supernatant is complicated by simultaneous and rapid natural removal processes. In this study, the release of organic material from cyanobacterial sludge was monitored simultaneously with secondary metabolites (Microcystins (MCs), cylindrosperopsin (CYN), and geosmin (GSM)) as an additional parameter to aid in understanding the range of processes occurring in sludge. Only GSM produced by Dolichospermum circinale was found to represent a low risk, as the compound is readily degraded. In contrast, the metabolites CYN and MC were shown to increase in concentration during simulated sludge treatment, suggesting that this could occur within full scale sludge treatment facilities with a range of cyanobacteria species, metabolites and water quality. A generic risk matrix was developed, incorporating the type of cyanobacteria, metabolite production, and the treatment

Impact of UV-H₂O₂ advanced oxidation and aging processes on GAC capacity for the removal of cyanobacterial taste and odor compounds

ABSTRACT: Cyanobacteria and their taste and odor (T&O) compounds are a growing concern in water sources globally. Geosmin and 2-methylisoborneol (MIB) are the most commonly detected T&O compounds associated with cyanobacterial presence in drinking water sources. The use of ultraviolet and hydrogen peroxide (H₂O₂) as an advanced oxidation treatment for T&O control is an emerging technology. However, residual H₂O₂ (>80% of the initial dose) has to be removed from water prior final disinfection. Recently, granular activated carbon (GAC) is used to remove H₂O₂ residual. The objective of this study is to assess the impact of H₂O₂ quenching and aging processes on GAC capacity for the removal of geosmin and MIB. Pilot columns with different types of GAC and presence/absence of H₂O₂ have been used for this study. H₂O₂ removal for the operational period of 6 months has no significant impact on GAC capacity to remove the geosmin and MIB from water

Microbial and clinical factors are related to recurrence of symptoms after childhood lower respiratory tract infection

Childhood lower respiratory tract infections (LRTI) are associated with dysbiosis of the nasopharyngeal microbiota, and persistent dysbiosis following the LRTI may in turn be related to recurrent or chronic respiratory problems. Therefore, we aimed to investigate microbial and clinical predictors of early recurrence of respiratory symptoms as well as recovery of the microbial community following hospital admission for LRTI in children. To this end, we collected clinical data and characterised the nasopharyngeal microbiota of 154 children (4 weeks–5 years old) hospitalised for a LRTI (bronchiolitis, pneumonia, wheezing illness or mixed infection) at admission and 4–8 weeks later. Data were compared to 307 age-, sex- and time-matched healthy controls. During follow-up, 66% of cases experienced recurrence of (mild) respiratory symptoms. In cases with recurrence of symptoms during follow-up, we found distinct nasopharyngeal microbiota at hospital admission, with higher levels of Haemophilus influenzae/haemolyticus, Prevotella oris and other gram-negatives and lower levels of Corynebacterium pseudodiphtheriticum/propinquum and Dolosigranulum pigrum compared with healthy controls. Furthermore, in cases with recurrence of respiratory symptoms, recovery of the microbiota was also diminished. Especially in cases with wheezing illness, we observed a high rate of recurrence of respiratory symptoms, as well as diminished microbiota recovery at follow-up. Together, our results suggest a link between the nasopharyngeal microbiota composition during LRTI and early recurrence of respiratory symptoms, as well as diminished microbiota recovery after 4–8 weeks. Future studies should investigate whether (speed of) ecological recovery following childhood LRTI is associated with long-term respiratory problems