Dealing with data : optimising data consistency to demonstrate the value of nurse practitioner service

Introduction: Other authors in this volume have argued for the need to undertake audit and research related to nurse practitioner practice. Audit and research require skills in competently reviewing literature on a topic, developing an answerable question and devising an appropriate design and methodology. However, these are not the only aspects that need consideration before commencing the data collection phase. Too often clinicians successfully review the literature, identify the question, design and methods and then launch into the ‘doing’ of the project without also planning how data will be managed and analysed. The organising and processing of data are just as important as any other phase of the project, but these components of a successful project are often overlooked in the planning stages

Systematic review of mental health and well-being outcomes following community-based obesity prevention interventions among adolescents

This paper aimed to systematically evaluate the mental health and well-being outcomes observed in previous community-based obesity prevention interventions in adolescent populations

Sleep duration and risk of obesity among a sample of Victorian school children

Abstract Background Insufficient sleep is potentially an important modifiable risk factor for obesity and poor physical activity and sedentary behaviours among children. However, inconsistencies across studies highlight the need for more objective measures. This paper examines the relationship between sleep duration and objectively measured physical activity, sedentary time and weight status, among a sample of Victorian Primary School children. Methods A sub-sample of 298 grades four (n = 157) and six (n = 132) Victorian primary school children (aged 9.2-13.2 years) with complete accelerometry and anthropometry data, from 39 schools, were taken from a pilot study of a larger state based cluster randomized control trial in 2013. Data comprised: researcher measured height and weight; accelerometry derived physical activity and sedentary time; and self-reported sleep duration and hypothesised confounding factors (e.g. age, gender and environmental factors). Results Compared with sufficient sleepers (67 %), those with insufficient sleep (<10 hrs/day) were significantly more likely to be overweight (OR 1.97, 95 % CI:1.11-3.48) or obese (OR 2.43, 95 % CI:1.26-4.71). No association between sleep and objectively measured physical activity levels or sedentary time was found. Conclusion The strong positive relationship between weight status and sleep deprivation merits further research though PA and sedentary time do not seem to be involved in the relationship. Strategies to improve sleep duration may help obesity prevention initiatives in the future

Composition of objectively measured physical activity and sedentary behaviour participation across the school-day, influence of gender and weight status: cross-sectional analyses among disadvantaged Victorian school children

BACKGROUND: The after-school period has been described as the \u27critical window\u27 for physical activity (PA) participation. However, little is known about the importance of this window compared with the before and during-school period among socioeconomically disadvantaged children, and influence of gender and weight status. METHODS: 39 out of 156 (RR=25%) invited primary schools across 26 local government areas in Victoria, Australia, consented to participate with 856 children (RR=36%) participating in the wider study. The analysis sample included 298 Grade 4 and Grade 6 children (mean age: 11.2&plusmn;1.1; 44% male) whom met minimum accelerometry wear-time criteria and had complete height, weight and health-behaviours questionnaire data. Accelerometry measured duration in daily light-intensity PA (LPA), moderate-to-vigorous PA (MVPA) and sedentary time (ST) was calculated for before-school=8-8:59, during-school=9:00-15:29 and after-school=15:30-18:00. Bivariate and multivariable linear regression analyses were conducted. RESULTS: During-school represented the greatest accumulation of LPA and MVPA compared with the before and after-school periods. Boys engaged in 102 min/day of LPA (95% CI 98.5 to 104.9) and 62 min/day of MVPA (95% CI 58.9 to 64.7) during-school; girls engaged in 103 min/day of LPA (95% CI 99.7 to 106.5) and 45 min/day of MVPA (95% CI 42.9 to 47.4). Linear regression models indicated that girls with overweight or obesity engaged in significantly less LPA, MVPA and more time in ST during-school. CONCLUSIONS: This study highlights the importance of in-school PA compared with after-school PA among socioeconomically disadvantage children whom may have fewer resources to participate in after-school PA

The prevalence of urinary distress in male and female adults with diabetes mellitus attending a Northern Australian endocrine centre

Internationally, diabetes is one of the major contributors to health care costs. As the population ages, it is expected that the personal and economic burden of diabetes on individuals, families, health systems and countries will continue to increase. It is important that the aetiology and comorbidities of diabetes are investigated. There is a known, strong association between diabetes and incontinence but exploration of specific subgroups at risk is needed. This study explored prevalence and associated characteristics of incontinence and storage lower urinary tract symptoms in people with diabetes mellitus. A convenience sample comprised 273 adults of both sexes who attended a regional diabetes service. A self-administered, paper-based survey method was used and included the Modified Urinary Distress Inventory Short Form (UDI-6). The level of urinary distress was high. Over two-thirds of both men and women reported symptoms of incontinence, irritation or both. Significantly, more respondents with type 2 diabetes than type 1 diabetes reported symptoms. The study identified a high prevalence of urinary incontinence in adults with diabetes, with a high level of distress in males identified that had not previously been reported in Australia. These findings have significant public health importance and all adults attending diabetes services, both male and female, should receive opportunistic screening for voiding dysfunction and continence issues

Healthy together Victoria and childhood obesity: a methodology for measuring changes in childhood obesity in response to a community-based, whole of system cluster randomized control trial

BACKGROUND: Healthy Together Victoria (HTV) - a complex \u27whole of system\u27 intervention, including an embedded cluster randomized control trial, to reduce chronic disease by addressing risk factors (physical inactivity, poor diet quality, smoking and harmful alcohol use) among children and adults in selected communities in Victoria, Australia (Healthy Together Communities). OBJECTIVES: To describe the methodology for: 1) assessing changes in the prevalence of measured childhood obesity and associated risks between primary and secondary school students in HTV communities, compared with comparison communities; and 2) assessing community-level system changes that influence childhood obesity in HTC and comparison communities. METHODS: Twenty-four geographically bounded areas were randomized to either prevention or comparison (2012). A repeat cross-sectional study utilising opt-out consent will collect objectively measured height, weight, waist and self-reported behavioral data among primary [Grade 4 (aged 9-10y) and Grade 6 (aged 11-12y)] and secondary [Grade 8 (aged 13-14y) and Grade 10 (aged 15-16y)] school students (2014 to 2018). Relationships between measured childhood obesity and system causes, as defined in the Foresight obesity systems map, will be assessed using a range of routine and customised data. CONCLUSION: This research methodology describes the beginnings of a state-wide childhood obesity monitoring system that can evolve to regularly inform progress on reducing obesity, and situate these changes in the context of broader community-level system change

Adolescent dietary patterns in Fiji and their relationships with standardized body mass index

BACKGROUND: Obesity has been increasing in adolescents in Fiji and obesogenic dietary patterns need to be assessed to inform health promotion. The objective of this study was to identify the dietary patterns of adolescents in peri-urban Fiji and determine their relationships with standardized body mass index (BMI-z). METHODS: This study analysed baseline measurements from the Pacific Obesity Prevention In Communities (OPIC) Project. The sample comprised 6,871 adolescents aged 13-18 years from 18 secondary schools on the main island of Viti Levu, Fiji. Adolescents completed a questionnaire that included diet-related variables; height and weight were measured. Descriptive statistics and regression analyses were conducted to examine the associations between dietary patterns and BMI-z, while controlling for confounders and cluster effect by school. RESULTS: Of the total sample, 24% of adolescents were overweight or obese, with a higher prevalence among Indigenous Fijians and females. Almost all adolescents reported frequent consumption of sugar sweetened beverages (SSB) (90%) and low intake of fruit and vegetables (74%). Over 25% of participants were frequent consumers of takeaways for dinner, and either high fat/salt snacks, or confectionery after school. Nearly one quarter reported irregular breakfast (24%) and lunch (24%) consumption on school days, while fewer adolescents (13%) ate fried foods after school. IndoFijians were more likely than Indigenous Fijians to regularly consume breakfast, but had a high unhealthy SSB and snack consumption.Regular breakfast (p&lt;0.05), morning snack (p&lt;0.05) and lunch (p&lt;0.05) consumption were significantly associated with lower BMI-z. Consumption of high fat/salt snacks, fried foods and confectionery was lower among participants with higher BMI-z. CONCLUSIONS: This study provides important information about Fijian adolescents' dietary patterns and associations with BMI-z. Health promotion should target reducing SSB, increasing fruit and vegetables consumption, and increasing regularity of meals among adolescents. Future research is needed to investigate moderator(s) of inverse associations found between BMI-z and consumption of snacks, fried foods and confectionery to assess for potential reverse causality

Depressive symptomatology, weight status and obesogenic risk among Australian adolescents: a prospective cohort study

OBJECTIVES: Adolescence is a period of increased risk for mental health problems and development of associated lifestyle risk behaviours. This study examined cross-sectional and longitudinal associations between obesogenic risk factors, weight status, and depressive symptomatology in a cohort of Australian adolescents. DESIGN: Prospective cohort study. SETTING: The study used repeated measures data from the Australian Capital Territory (ACT) It\u27s Your Move project, an Australian community-based obesity prevention intervention. Intervention effect was non-significant therefore intervention and comparison groups were combined in this study. PARTICIPANTS: Total sample was 634 secondary school students (female n=338, male n=296) with mean age 13 years (SD=0.6) at baseline (2012) and 15 years (SD=0.6) at follow-up (2014) recruited from 6 government secondary schools in the ACT. PRIMARY AND SECONDARY OUTCOMES MEASURES: Primary outcome was depressive symptomatology measured by Short Mood and Feelings Questionnaire. Secondary outcomes were weight status, physical activity, screen time and diet related measures. RESULTS: Increased physical activity was associated to lower depressive symptomatology among males (OR=0.35, p&lt;0.05). Sweet drink (OR=1.15, p&lt;0.05) and takeaway consumption (OR=1.84, p&lt;0.05) were associated with higher levels of depressive symptomatology among females at follow-up. Males who were classified as overweight or obese at baseline, and remained so over the study period, were at increased risk of depressive symptomatology at follow-up (b=1.63, 95% CI 0.33 to 2.92). Inactivity among males over the 2-year study period was predictive of higher depressive symptomatology scores at follow-up (b=2.55, 95% CI 0.78 to 4.32). For females, those who increased their consumption of takeaway foods during the study period were at increased risk for developing depressive symptomatology (b=1.82, 95% CI -0.05 to 3.71). CONCLUSIONS: There are multiple, probably complex, relationships between diet, physical activity and outcomes of obesity and mental health as well as between the outcomes themselves. Healthier diets and increased physical activity should be foundations for healthier body weight and mental health.<br /

The Cross-Sectional Association between Diet Quality and Depressive Symptomology amongst Fijian Adolescents

OBJECTIVE: To examine the relationship between diet quality and depressive symptomology amongst a community-based sample of Fijian adolescents. METHODS: Participants included 7,237 adolescents (52.6% girls; mean age 15.6 years) at baseline (2005) and 2,948 (56% girls; mean age 17.4 years) at follow-up (2007/2008), from the Pacific Obesity Prevention in Communities Project. Intervention schools (n = 7) were selected from Nasinu, near Suva on the main Fijian island Viti Levu, and comparison schools (n = 11) were chosen from towns on the opposite, west side of the island. A dietary questionnaire was used to measure diet quality. Factor analysis clustered dietary variables into two unique and independent factors, referred to as healthy diet quality and unhealthy diet quality. Depressive symptomology was assessed via the emotional subscale of the Paediatric Quality of Life Inventory. Both measures were self-reported and self-administered. Multiple linear regression was used to test cross-sectional associations (at baseline and follow-up) between diet quality and depressive symptomology. Variables controlled for included gender, age, ethnicity, study condition, BMI-z scores, and physical activity. FINDINGS: Strong, positive dose-response associations between healthy diet and high emotional scores (lower depressive symptomology) were found in cross-sectional analyses at baseline and follow-up, among boys and girls. No association was found between emotional health and unhealthy diet. CONCLUSIONS: This study suggests that cross-sectional relationships exist between a high quality diet during adolescence and less depressive symptoms, however more evidence is required to determine if these two variables are linked causally. Trial population health strategies that use dietary interventions as a mechanism for mental health promotion provide an opportunity to further test these associations. If this is indeed a true relationship, these forms of interventions have the potential to be inexpensive and have substantial reach, especially in Low and Middle Income Countries. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12608000345381