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Vitamin D deficiency is associated with an increased risk of falls and fractures. Assuming this association is causal, we aimed to identify the number and proportion of hospitalisations for falls and hip fractures attributable to vitamin D deficiency (25 hydroxy D (25(OH)D) <50 nmol/l) in Australians aged ≥65 years. We used 25(OH)D data from the 2011/12 Australian Health Survey and relative risks from published meta-analyses to calculate population-attributable fractions for falls and hip fracture. We applied these to data published by the Australian Institute of Health and Welfare to calculate the number of events each year attributable to vitamin D deficiency. In men and women combined, 8·3 % of hospitalisations for falls (7991 events) and almost 8 % of hospitalisations for hip fractures (1315 events) were attributable to vitamin D deficiency. These findings suggest that, even in a sunny country such as Australia, vitamin D deficiency contributes to a considerable number of hospitalisations as a consequence of falls and for treatment of hip fracture in older Australians; in countries where the prevalence of vitamin D deficiency is higher, the impact will be even greater. It is important to mitigate vitamin D deficiency, but whether this should occur through supplementation or increased sun exposure needs consideration of the benefits, harms, practicalities and costs of both approaches.
Background: For the rising number of people living with dementia, cost-effective community-based interventions to support psychosocial care are needed. The FindMyApps program helps people with dementia and their caregivers learn to use tablet computers and find user-friendly apps that facilitate self-management and engagement in meaningful activities. This definitive trial builds on previous feasibility pilot trials of FindMyApps and further evaluates cost-effectiveness.
Method: This is a protocol for a non-blinded randomized controlled trial (RCT) with two arms (intervention and usual care). 150 dyads (person with dementia and their carer) will be recruited. Participants must be resident in the community, with a diagnosis of Mild Cognitive Impairment or mild dementia (Mini Mental-State Examination 17-26, or Global Deterioration Scale 3-4. Dyads will be randomly assigned in equal proportions to receive either the FindMyApps intervention (experimental arm) or usual care (control arm). Primary outcomes measured at 3 months will be: patient self-management and social participation; caregiver sense of competence. Data will be collected through questionnaires filled in by the researcher (patient outcomes) or participants themselves (carer outcomes). In addition to a main effect analysis, a cost-effectiveness analysis will take place. In line with Medical Research Council (MRC) guidance for the evaluation of complex interventions, a process analysis will be undertaken, to identify factors that may influence trial outcomes. Semi-structured interviews and remotely collected data regarding use of the FindMyApps app will support the process analysis.
Result: Results of this study are expected in 2022. The study will be adequately powered to detect at least a moderate effect size of the intervention with respect to the primary outcomes.
Conclusion: This study will investigate the effectiveness and cost-effectiveness of the FindMyApps intervention. The results of the study will provide strong evidence to support or oppose scaling up implementation of the intervention. This is also an example of how the MRC framework for the evaluation of complex interventions can be implemented in practice. In a field which is often criticized for a lack of high quality evidence, randomized controlled trials should be applied more frequently designed for the robust and transparent evaluation of digital tools and technologies.
To update the estimate of mean salt intake for the Australian population made by the Australian Health Survey (AHS).
A secondary analysis of the data collected in a cross-sectional survey was conducted. Estimates of salt intake were made in Lithgow using the 24 h diet recall methodology employed by the AHS as well as using 24 h urine collections. The data from the Lithgow sample were age- and sex-weighted, to provide estimates of daily salt intake for the Australian population based upon (i) the diet recall data and (ii) the 24 h urine samples.
Lithgow, New South Wales, Australia.
Individuals aged ≥20 years residing in Lithgow and listed on the 2009 federal electoral roll.
Mean (95 % CI) salt intake estimated from the 24 h diet recalls was 6·4 (6·2, 6·7) g/d for the Lithgow population compared with a corresponding figure of 6·2 g/d for the Australian population derived from the AHS. The corresponding estimate of salt intake for Lithgow adults based upon the 24 h urine collections was 9·0 (8·6, 9·4) g/d. When the age- and sex-specific estimates of salt intake obtained from the 24 h urine collections in the Lithgow sample were weighted using Australian census data, estimated salt intake for the Australian population was 9·0 (8·6, 9·5) g/d. Further adjustment for non-urinary Na excretion made the best estimate of daily salt intake for both Lithgow and Australia about 9·9 g/d.
The dietary recall method used by the AHS likely substantially underestimated mean population salt consumption in Australia.
Observational studies have suggested that 25-hydroxyvitamin D (25(OH)D) levels are associated with inflammatory markers. Most trials reporting significant associations between vitamin D intake and inflammatory markers used specific patient groups. Thus, we aimed to determine the effect of supplementary vitamin D using secondary data from a population-based, randomised, placebo-controlled, double-blind trial (Pilot D-Health trial 2010/0423). Participants were 60- to 84-year-old residents of one of the four eastern states of Australia. They were randomly selected from the electoral roll and were randomised to one of three trial arms: placebo (n 214), 750 μg (n 215) or 1500 μg (n 215) vitamin D3, each taken once per month for 12 months. Post-intervention blood samples for the analysis of C-reactive protein (CRP), IL-6, IL-10, leptin and adiponectin levels were available for 613 participants. Associations between intervention group and biomarker levels were evaluated using quantile regression. There were no statistically significant differences in distributions of CRP, leptin, adiponectin, leptin:adiponectin ratio or IL-10 levels between the placebo group and either supplemented group. The 75th percentile IL-6 level was 2·8 pg/ml higher (95 % CI 0·4, 5·8 pg/ml) in the 1500 μg group than in the placebo group (75th percentiles:11·0 v. 8·2 pg/ml), with a somewhat smaller, non-significant difference in 75th percentiles between the 750 μg and placebo groups. Despite large differences in serum 25(OH)D levels between the three groups after 12 months of supplementation, we found little evidence of an effect of vitamin D supplementation on cytokine or adipokine levels, with the possible exception of IL-6.
For all IPS drinks, the mean package size was larger than the mean serving size (mean (sd)=412 (157) ml and 359 (159) ml, respectively). The mean (sd) package size of IPS drinks was significantly different for all countries (range: Australia=370 (149) ml to New Zealand=484 (191) ml; P<0·01). The mean (sd) package size of Dutch BPS drinks (1313 (323) ml) was significantly smaller compared with the other countries (New Zealand=1481 (595) ml, Australia=1542 (595) ml, Canada=1550 (434) ml; P<0·01). The mean (sd) serving size of BPS drinks was significantly different across all countries (range: Netherlands=216 (30) ml to Canada=248 (31) ml; P<0·00). New Zealand had the largest package and serving sizes of the countries assessed. In all countries, a large number of different serving sizes were used to provide information on the amount appropriate to consume in one sitting.
At this point there is substantial inconsistency in package sizes and manufacturer-recommended serving sizes of sweet beverages within and between four high-income countries, especially for IPS drinks. As consumers do factor serving size into their judgements of healthiness of a product, serving size regulations, preferably set by governments and global health organisations, would provide consistency and assist individuals in making healthier food choices.
To describe the training and participant experience of patients with both severe mental illness (SMI) and diabetes (DM) who were enrolled in a Peer Educator Training Program adapted to a primary health care setting.
The mortality of patients with both SMI and DM is high. Illness self-management includes medications, psychosocial treatments, and healthy behaviors, yet treatment engagement is often sub-optimal with adherence rates of 52% for diabetic medications and 62% for antipsychotic medications among the SMI. To address this problem, a new behavioral intervention study targeting SMI and DM self-management used trained peer educators (PEs) with the same chronic conditions to enhance program effectiveness. A manual facilitated training on intervention topics such as SMI and DM therapies, stress management, and stigma reduction as well as training in group intervention techniques, telephone skills, and crisis management.
We assessed PE attitudes and input using in-depth face-to-face interviews. Interviews were audio-taped, transcribed, coded, and analyzed using the classic method of content analysis emphasizing dominant themes. A member check-in was conducted where participants commented on analysis results.
Six relevant descriptive themes emerged: (1) positive group experience; (2) success with learning manual content; (3) increased knowledge about SMI and DM; (4) improved self-management skills; (5) increased self-confidence and self-efficacy in becoming a PE; and being (6) united in purpose to help others self-manage their SMI and DM. Qualitative evidence supports structured training for SMI-DM PEs. Key components include written educational materials and the power of the group process to increase knowledge, self-management skills, confidence, and self-efficacy. Recommendations are offered to support further endeavors to mobilize peers with SMI to help other patients with complex comorbidities better manage their own health.
The idea of ‘human dignity’ is, notoriously, as ambiguous as it is compelling. Notwithstanding the absence of any clear or settled definition of human dignity, either in the abstract or in terms of what it means in practice, it is an idea which takes pride of place in international legal documents, in judicial reasoning, and in scholarship across a range of disciplines, where it seems, particularly in recent years, to have become the focus for an explosion of academic interest and an accompanying proliferation of literature. Much of the existing literature attempts to uncover the meaning, or multiple meanings, of ‘human dignity’, focusing on the uncertainty surrounding the substance or content of the idea and trying to compose a catalogue of use-types. In this paper, my primary aim will be to address another type of uncertainty, namely uncertainty about the role, function or status within legal frameworks of the ‘dignity norm’ – the norm requiring respect for human dignity. I want to explore several possibilities: first, that the dignity norm is simply a proxy for respect for autonomy; second, that it is a right in the sense that we can speak of a specific ‘right to have dignity respected’; and third, that it is a legal principle. Having problematised each of these in turn, I will contend that the function of the dignity norm is best captured by describing it as the ‘substantive basic norm’ of the legal systems wherein it appears.
Searching for transit timing variations in the known transiting exoplanet systems can reveal the presence of other bodies in the system. Here we report such searches for two transiting exoplanet systems, TrES-1 and WASP-2. Their new transits were observed with the 4.2m William Herschel Telescope located on La Palma, Spain. In a continuing programme, three consecutive transits were observed for TrES-1, and one for WASP-2 during September 2007. We used the Markov Chain Monte Carlo simulations to derive transit times and their uncertainties. The resulting transit times are consistent with the most recent ephemerides and no conclusive proof of additional bodies in either system was found.
This article describes a pharmacogenetic investigation of nicotine metabolism in twins. One hundred and thirty-nine twin pairs (110 monozygotic and 29 dizygotic) were recruited and assessed for smoking status, zygosity, and health conditions known or suspected to affect drug metabolism. Participants underwent a 30-minute infusion of stable isotope-labeled nicotine and its major metabolite, cotinine, followed by an 8-hour in-hospital stay. Blood and urine samples were taken at regular intervals for analysis of nicotine, cotinine, and metabolites by gas chromatography–mass spectrometry or liquid chromatography–mass spectrometry and subsequent characterization of pharmacokinetic phenotypes. DNA was genotyped to confirm zygosity and for variation in the primary gene involved in nicotine metabolism, CYP2A6. Univariate and multivariate biometric analyses planned for the future will determine genetic and environmental influences on each pharmacokinetic measure individually and in combination with each other, and in the presence and absence of covariates, including measured genotype. When the analyses are completed, this study will result in a more complete characterization of the impact of genetic and environmental influences on nicotine and cotinine metabolic pathways than has heretofore been reported. The approach taken, with its use of a quantitative model of nicotine metabolism, highly refined metabolic phenotypes, measured genotype, and advanced tools for biometric genetic analysis, provides a model for the use of twins in next-generation studies of complex drug-metabolism phenotypes.
Recent studies have detected basal ganglia atrophy
in clinically asymptomatic persons with the genetic mutation
that causes Huntington's disease (HD). Whether reductions
in caudate and putamen volume on MRI scans are associated
with changes in cognitive and neurologic functioning was
examined in 13 healthy adults with the IT-15 mutation.
Reduced striatal volume was found to correlate with greater
neurologic (largely motor) impairment, slower mental processing
speed, and poorer verbal learning, although none of the
participants met even liberal criteria for clinical diagnosis
of HD. These correlations are strikingly similar to those
observed in symptomatic HD patients, possibly reflecting
the earliest manifestations of disease. (JINS,
1998, 4, 467–473.)
It is generally agreed that attitudes are composed of elements from the affective, behavioral, and cognitive domains. The affective component has been referred to as a feeling or an emotional response of liking or disliking, a gut reaction, or sympathetic nervous activity. The behavioral component includes overt actions or intentions of action, and verbal statements regarding future behavior. The cognitive component includes knowledge and beliefs of the attitude object that describe its characteristics, and its relationship to other objects (Breckler 1984, Katz 1960, Morris and Stuckhardt 1977).
Recent attitude research suggests discriminating between the three psychological domains, either by measuring each or by specifying which one is the focus of concern. Discrimination may be appropriate since the three domains are distinguishable from one another and correlations among them are sometimes moderate (Breckler 1984). Discrimination among attitudinal domains also appears to be necessary since it has been found that directing change at one of the three domains may affect a shift in the other two (Cialdini et al. 1976, Katz 1960), and because differences between groups of subjects may fall within one or two of the domains rather than all three (Quattrone 1985).
The physical adsorption of chemical substances onto surfaces in soils or inside plants has been of considerable interest with respect to the fate of herbicides in soils, the selectivity of growth regulator herbicides, and even with respect to the toxic activities of growth regulators in plants. Comparative measurements of the adsorption of various herbicides are limited in number and scope. Experiments are presented here which attempt to measure the relative adsorptive qualities of various chlorinated phenoxyacetic acids, and to provide some evidence concerning the bearing of adsorption on herbicidal action.
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