The association between graded physical activity in postmenopausal British women, and the prevalence and incidence of hip and wrist fractures.

BACKGROUND: physical activity is promoted for older women as a means of maintaining health and avoiding falls and fractures. Findings relating physical activity of older women to risk of falls and fracture are contradictory. The association between level of physical activity and prevalent and incident hip and wrist fractures was examined in a large representative sample of postmenopausal British women. METHODS: data from the British Women's Heart and Health Study, a cohort study of 4286 postmenopausal women aged 60-79, from 23 UK towns were used. Information on physical activity, anthropometry, falls and hip and wrist fractures from baseline examination and questionnaire (1999-2001) and follow-up questionnaire (2007) were available. Cross-sectional baseline prevalence data were analysed using logistic regression and cohort incidence data using a Cox proportional hazards model examining the association of physical activity with fracture outcomes. RESULTS: 3003 (70%) women, with complete baseline data, were studied. 13.6% had previously fractured a wrist and 1.3% a hip. Analyses unadjusted for confounders showed moderate protective associations between activity and fracture risk. After adjustment for confounders there was a weak trend towards fewer hip fractures (adjusted OR 0.13 [0.01, 1.18]) and more wrist fractures (adjusted OR 1.35 [0.76, 2.48]), amongst most active compared with inactive women. The crude incidence rate of wrist and/or hip fracture was 7.0 [5.9, 8.2] per 1000 person-years. No evidence was found for an association between physical activity and combined incident hip and/or wrist fracture (adjusted rate ratio inactive versus most active 1.69 [0.67, 4.24]). CONCLUSION: no clear associations between graded physical activity and hip/wrist fractures were seen but estimates were imprecise. Physical activities are heterogeneous and individual fracture types and mechanisms differ. Very large prospective observational studies are required to disentangle the precise effects of different activity patterns on different fracture types

Understanding the determinants and consequences of HIV status disclosure in Manicaland, Zimbabwe: cross-sectional and prospective analyses

Few longitudinal studies have measured trends and effects of disclosure over ART scale-up in general-population samples. We investigated levels, determinants and outcomes of disclosure to relatives and partners in a large general-population cohort in Zimbabwe. Trends in disclosure levels from 2003-2013 were analysed, and multivariable logistic regression was used to identify determinants. Longitudinal analyses were conducted testing associations between disclosure and prevention/treatment-related outcomes. Disclosure to anyone increased from 79% to 100% in men and from 63% to 98% in women from 2003-2008; but declined to 89% in both sexes in 2012-2013. More women than men disclosed to relatives (67.8% versus 44.4%; p<0.001) but fewer women disclosed to partners (85.3% versus 95.0%; p<0.001). In 2012-13, younger age, secondary/higher education, being single, and experience of stigma were associated with disclosure to relatives in both sexes. Partner characteristics and HIV-group attendance were associated with disclosure to partners for women. Reactions to disclosure were generally supportive but less so for females than males disclosing to partners (92.0% versus 97.4%). Partner disclosure was associated with greater social support and treatment adherence in females. To conclude, this study shows disclosure is vital to HIV prevention and treatment, and programmes to facilitate disclosure should be re-invigorated

HIV decline in Zimbabwe due to reductions in risky sex? Evidence from a comprehensive epidemiological review.

Published versio

Patterns of self-reported behaviour change associated with receiving voluntary counselling and testing in a longitudinal study from Manicaland, Zimbabwe.

Voluntary counselling and testing (VCT) is promoted as a potential HIV prevention measure. We describe trends in uptake of VCT for HIV, and patterns of subsequent behaviour change associated with receiving VCT in a population-based open cohort in Manicaland, Zimbabwe. The relationship between receipt of VCT and subsequent reported behaviour was analysed using generalized linear models with random effects. At the third survey, 8.6% of participants (1,079/12,533), had previously received VCT. Women who received VCT, both those positive and negative, reduced their reported number of new partners. Among those testing positive, this risk reduction was enhanced with time since testing. Among men, no behavioural risk reduction associated with VCT was observed. Significant increases in consistent condom use, with regular or non-regular partners, following VCT, were not observed. This study suggests that, among women, particularly those who are infected, behavioural risk reduction does occur following VCT

Age at puberty and accelerometer-measured physical activity:findings from two independent UK cohorts

Background It is unclear if puberty timing influences future physical activity (PA). Aim To investigate the association of puberty timing with PA across adolescence and adulthood. Subjects and methods Data were from two British cohorts. Participants from an adolescent birth cohort (females = 2349, males = 1720) prospectively reported age at menarche and voice break and had PA recorded by Actigraph accelerometers at ages 14 years and 16 years. A cohort of middle-aged and older adults (40–70 years; females = 48,282; males = 36,112) recalled their age at puberty and had PA (mean acceleration; mg) measured by AxivityAX3 accelerometers. Results After adjustment for age, education, smoking and BMI, per 1-year older age at menarche was associated with higher mean counts/minute at age 14 years (0.07 SD counts/minute; 95% CI = 0.04–0.11) with associations attenuated at age 16 years (0.02; −0.03–0.07). Differences in mean acceleration per older year at menarche were close to the null in women aged 40–49 years (0.02 mg; 0.01–0.03), 50–59 years (0.01; 0.00–0.02) and 60–70 years (0.01; 0.00–0.01). Age at voice break and PA associations were close to the null in both cohorts. Conclusion We found a positive association between puberty timing and PA in females which weakened at older ages and limited evidence of an association at any age in males

Performing Academic Practice: Using the Master Class to Build Postgraduate Discursive Competences

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Geography in Higher Education on 27/04/2010, available online: https://www.tandfonline.com/doi/full/10.1080/03098260903502695How can we find ways of training PhD students in academic practices, while reflexively analysing how academic practices are performed? The paper’s answer to this question is based on evaluations from a British–Nordic master class. The paper discusses how master classes can be used to train the discursive skills required for academic discussion, commenting and reporting. Methods used in the master class are: performing and creative arts pedagogical exercises, the use of written provocations to elicit short papers, discussion group exercises, and training in reporting and in panel discussion facilitated by a meta-panel discussion. The authors argue that master classes have the potential to further develop advanced-level PhD training, especially through their emphasis on reflexive engagement in the performance of key academic skills