A Validation Study of the Family Environment Scale: Family Incongruence Score

This study investigated the validity of the family incongruence score, a statistic which quantifies the discrepancies between family members\u27 perceptions of their family system using answers given on the Family Environment Scale. Based on findings concerning incongruence in other environments, it was hypothesized that high family incongruence scores would be associated with more problems in the family system

The clinical utility of the AUSDRISK tool in assessing change in type 2 diabetes risk in overweight/obese volunteers undertaking a healthy lifestyle intervention

The objective of this study was to assess the clinical utility of the AUSDRISK tool for determining risk of Type 2 diabetes mellitus (T2DM). In this secondary analysis from the HealthTrack study, the AUSDRISK tool was applied to data from overweight/obese volunteers completing a lifestyle intervention trial. Participants were volunteer residents of the Illawarra region recruited in 2014-2015. From 377 trial participants (BMI 25-40 kg/m2, 25-54 yr), 161 provided data required for measurement of AUSDRISK, collected at 0 and 12 months. They had been randomised to one of two lifestyle interventions (±a healthy food sample, 30 g walnuts/day, I and IW) delivered by dietitians, or a control intervention (C) delivered by nurse practitioners. HbA1c measures were considered for comparison. At baseline the AUSDRISK score indicated n = 83 (51.5%) were at high risk of T2DM within 5 years (≥12 points). After 12 months the proportion scored as high risk significantly decreased in the IW group (51.5% vs 33.3%; p = 0.005), but not I (51.2% vs 39.0%; p = 0.063) or C group (51.9% vs 38.9%; p = 0.065). By comparison, HbA1c measures indicated high risk in n = 24 (17%) of 139 participants at baseline and borderline non-significant changes over time in the randomised groups. In conclusion, the AUSDRISK tool has reasonable clinical utility in identifying T2DM risk in clinical samples of overweight/obese individuals

Development of a matching file of Australian food composition databases (AUSNUT 2007 to 2011-13)

Changes to the food supply and analytical methods necessitate updating food composition databases over time. In Australia, survey-specific databases include AUSNUT 1999, 2007, and 2011-13. There is no standardized method to match AUSNUT 2007 foods to 2011-13 counterparts. This study aimed to develop an AUSNUT 2007 to 2011-13 matching file, and demonstrate its use in the clinical trial context. Food items aligned with AUSNUT 2007 were back-matched to 1999 and then forward to 2011-13 using food identification codes and existing matching files. Any unmatched AUSNUT 2007 foods were manually matched to appropriate 2011-13 foods based on conceptual and nutritional similarities. The file was then applied to clinical trial data originally collected using AUSNUT 2007. Of the n = 3874 products in AUSNUT 2007, n = 1270 were initially matched to 2011-13 equivalents using existing matching files. Of these foods, n = 1070 were deemed to have an acceptable one-to-one match. A total of n = 2804 AUSNUT 2007 foods required manual matching. Application to clinical trial data found small differences in nutrient intake between original and converted data. The AUSNUT 2007 to 2011-13 matching file will facilitate conversion of dietary data originally collected using AUSNUT 2007 into 2011-13 foods and groups, and to allow re-coding of intake data

Relationship between long-chain omega-3 polyunsaturated fatty acid intake and ankle brachial index, pulse wave velocity and resting heart rate in a sample of overweight adults: A secondary analysis of baseline data in the HealthTrack study

Aim: The present study aimed to explore the association between dietary long-chain omega-3 polyunsaturated fatty acid (LCn3PUFA) intake and cardiovascular risk indicators (ankle brachial index, resting heart rate and brachial-ankle pulse wave velocity) in a clinical sample of overweight and obese participants volunteering for a weight loss trial. Methods: This was a secondary analysis of baseline data from the HealthTrack study (n = 351). LCn3PUFA intake was calculated via a diet history and the association with ankle brachial index, resting heart rate and brachio-ankle pulse wave velocity was explored using linear regression after controlling for covariates. Results: LCn3PUFA intake was inversely associated with ankle brachial index (R2change = 0.021, F change (1, 339) = 8.864, P \u3c 0.05) and resting heart rate (R2change = 0.014, F change (1, 342) = 5.337, P \u3c 0.05) but not with brachio-ankle pulse wave velocity (R2change = 0.001, F change (1, 339) = 0.725, P \u3e 0.05). Conclusions: In this clinical sample of overweight adults, LCn3PUFA consumption was significantly associated with a lower resting heart rate, adding to the current evidence on the potential benefits of LCn3PUFA consumption. It also supports the value of targeting a diet rich in this nutrient when planning future dietetic approaches. Relationships with ankle brachial index and pulse wave velocity require further investigation. Future research should assess the effect of changes in dietary LCn3PUFA intake on novel cardiovascular risk indicators

Development of an at-risk assessment approach to dietary data quality in a food-based clinical trial

Accurate and valid dietary data is the basis to investigate diet-disease relationships. Potential data discrepancies may be introduced when collecting and analysing data, despite rigorous quality assurance protocols. The aim of this study was to identify at-risk areas of dietary data in a food-based clinical trial. Source data verification was performed on a 10% random sample (n=38) of paper-based baseline diet history interview records in a registered clinical trial. All items listed in the source data underwent 100% manual verification based on the food input data from FoodWorks nutrient analysis software. Food item discrepancies were explored using food categories and summarised based on meals. The differences in identified discrepancies for energy and macronutrient output generated from FoodWorks software between previously entered data and re-entered data were compared. An overall discrepancy rate of 4.88% was identified. It was found that dinner intake data were more prone to discrepancy incidences than breakfast, lunch and snacks. Furthermore, assessing intake based on reported quantity and frequency may be more effective to correct discrepancies for quality improvement. Therefore, the dinner meal appeared to be an at risk area of dietary data. The method implemented in this study offers a systematic approach to evaluating dietary data in a research setting

“Be patient, dear mother … wait for me”: the neo-infirmity film, female illness and contemporary cinema

In social reality, illness and death occur in myriad ways, yet Hollywood films have historically preferred spectacular, violent death over realist depictions of the terminal stages of life. Yet an ever-growing number of popular films, which I term neo-infirmity films, incorporate episodes of women characters debilitated by illness or injury. Operating at the intersection of melodrama and realism, the scenes are instrumental in staging contemporary cinema's gender politics. I argue that women's deathbed and hospital-bed scenes in contemporary cinema validate anew the maternal role and the figure of the mother, transporting the woman-centered discursive space of melodrama into narrative terrain often hostile to women's presence. Through this relocation, the films emphasize her importance to sons in particular (and less often to daughters, husbands, and the larger family unit). Many such scenes simultaneously undermine women's agency, reducing mothers to principally symbolic, literally immobile roles. Ailing women can become catalysts for male psychological transformation occurring through grief, action, or both in combination. In all, such scenes speak to continued ambivalence surrounding women's representation in popular cinema, and to continued patrolling of the boundaries of female power. This essay compares selected texts from contemporary Hollywood cinema, alongside three parallel discourses that also deploy melodramatic modes of articulation: nonfiction amateur video as relayed via television news programs, international art cinema, and US independent cinema. Arguing for homologies across multiple fields of textual production, I seek through this comparison to generate insights into the cultural work done by filmic representation

Postdischarge quality of care: Do age disparities exist among Department of Veterans Affairs ischemic stroke patients?

This study examined whether age disparities existed across postdischarge quality indicators (QIs) for veterans with ischemic stroke who received care at Department of Veterans Affairs medical centers (VAMCs). This retrospective cohort included a national sample of 3,196 veterans who were diagnosed with ischemic stroke and received acute and postdischarge stroke care at 127 VAMCs in fiscal year 2007 (10/1/06 through 9/30/07). Data included an assessment of postdischarge stroke QIs in the outpatient setting during the 6 mo postdischarge. The QIs included measurement of and goal achievement for (1) blood pressure, (2) serum international normalized ratio (INR) for all patients discharged on warfarin, (3) cholesterol (low-density lipoprotein [LDL]) levels, (4) serum glycosylated hemoglobin, and (5) depression treatment. The mean age for the 3,196 veterans included in this study was 67.2 +/– 11.3 yr. Before risk adjustment, there were age differences in (1) depression screening/treatment, (2) blood pressure goals, and (3) LDL levels. After we adjusted for patient sociodemographic, clinical, and facility-level characteristics by using hierarchical linear mixed modeling, none of these differences remained significant but INR goals for patients discharged on warfarin differed significantly by age. After we adjusted for patient and facility characteristics, fewer age differences were found in the postdischarge stroke QIs. Clinical trial registration was not required

Rural-Urban Differences in Inpatient Quality of Care in US Veterans With Ischemic Stroke

Purpose Differences in stroke care quality for patients in rural and urban locations have been suggested, but whether differences exist across Veteran Administration Medical Centers (VAMCs) is unknown. This study examines whether rural-urban disparities exist in inpatient quality among veterans with acute ischemic stroke. Methods In this retrospective study, inpatient stroke care quality was assessed in a national sample of veterans with acute ischemic stroke using 14 quality indicators (QIs). Rural-Urban Commuting Areas codes defined each VAMC's rural-urban status. A hierarchical linear model assessed the rural-urban differences across the 14 QIs, adjusting for patient and facility characteristics, and clustering within VAMCs. Findings Among 128 VAMCs, 18 (14.1%) were classified as rural VAMCs and admitted 284 (7.3%) of the 3,889 ischemic stroke patients. Rural VAMCs had statistically significantly lower unadjusted rates on 6 QIs: Deep vein thrombosis (DVT) prophylaxis, antithrombotic at discharge, antithrombotic at day 2, lipid management, smoking cessation counseling, and National Institutes of Health Stroke Scale completion, but they had higher rates of stroke education, functional assessment, and fall risk assessment. After adjustment, differences in 2 QIs remained significant—patients treated in rural VAMCs were less likely to receive DVT prophylaxis, but more likely to have documented functional assessment. Conclusions After adjustment for key demographic, clinical, and facility-level characteristics, there does not appear to be a systematic difference in inpatient stroke quality between rural and urban VAMCs. Future research should seek to understand the few differences in care found that could serve as targets for future quality improvement interventions