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Initial radiologic appearance rather than management strategy predicts the outcomes of sleeve gastrectomy leaks.Multiple modalities have been advocated for the treatment of sleeve gastrectomy leak, and there remains no consensus on the best treatment paradigm. For more than 10 years, we have variably attempted luminal occlusive therapies and repeated endoscopic debridement as treatment options. By evaluating the outcomes from these approaches, we aimed to determine whether the first management strategy is superior to the second in terms of outcomes.Patients were analyzed by group (luminal occlusive therapy versus repeated endoscopic debridement). Leaks were then stratified by radiologic appearance on computed tomography, defined as phlegmon, collection, contrast medium leak, or fistula. The primary outcome was length of stay (LOS). Secondary outcomes were comprehensive complication index and the need for resection.There were 54 patients, with 22 in the luminal occlusion group and 32 in the repeated debridement group. There was no difference in LOS (59.8 ± 41.6 versus 46.5 ± 51.2 days, P = .179) and no difference in the requirement for resection (4 versus 3 resections, p = .425). Subset analysis suggested that patients who underwent operative versus conservative management (P = .006) had a longer LOS. Excluding management strategy, radiologic appearance on admission significantly predicted LOS (P = .0053). Patients presenting with fistula (84 ± 25.4 days) and contrast medium leak (64.1 ± 40 days) had a significantly longer LOS than those diagnosed with phlegmon (13.5 ± 5.5 days). Radiologic appearance was predictive of complication severity (P.0001) and salvage resection (P = .008).There was no significant difference in outcomes between patients treated with intraluminal occlusion or repeated debridement. Initial radiologic appearance was predictive of LOS and complication severity. This highlights the need for routine use of a validated classification system in studies reporting outcomes and treatment of sleeve leaks.

Objectives A stepped-down program is one where clients transition from the care of a health professional to self-managed care. This study reviewed the effectiveness of stepped-down interventions to promote self-managed physical activity for health in military service veterans. Design Systematic review. Methods Literature searches of 11 electronic databases were performed (up to 28th April 2020) to identify randomised controlled trials that assessed self-managed physical activity interventions in military service veterans. Data were extracted on study characteristics, intervention programs (with strategies mapped against a taxonomy of behaviour change techniques), and physical activity outcomes; secondary outcomes were physical fitness/function, psychosocial health, and cost effectiveness. Study quality was assessed using a 15-item checklist adapted from the TESTEX scale. Results Searches identified 26 studies (all from the United States; N = 45 to 531 participants) representing 17 intervention programs. Studies were of good quality (M = 10.7; SD = 2.3). More than half (54%) reported positive between-group intervention effects for physical activity outcomes (mean increase of 80 min/week in self-reported physical activity at 10–12 months). Physical fitness/function outcomes improved in 38% of studies, but no studies found significant intervention effects for psychosocial health or cost effectiveness outcomes. Behaviour change techniques most frequently used to elicit physical activity changes were education, goal setting, goal review and self-monitoring. Conclusions Stepped-down programs that include specific behaviour change techniques have the potential to promote self-management of physical activity in military service veterans. Multi-national randomised controlled trials that use objective physical activity measures are needed to further build the evidence base.

Introduction Low muscle attenuation, as governed by increased intramuscular fat infiltration (myosteatosis), may associate with adverse surgical outcomes. We aimed to determine whether myosteatosis is associated with an increased risk of postoperative complications and reduced long-term survival after oesophago-gastric (OG) cancer surgery. Methods Patients who underwent radical OG cancer surgery with preoperative abdominal computed tomography (CT) imaging were included. Myosteatosis was evaluated using previously defined cut-points for low skeletal muscle attenuation measured by CT. Oncological, surgical, complications, and outcome data were obtained from a prospective database. Results Of 108 patients, 56% (n = 61) had myosteatosis. Patients with myosteatosis were older (69.1 ± 9.1 vs. 62.8 ± 9.8 years, p = 0.001) and had a similar body mass index (BMI) (23.4 ± 5.3 vs. 25.9 ± 6.7 kg/m2, p = 0.766) compared to patients with normal muscle attenuation. Patients with myosteatosis had a higher rate of anastomotic leaks (15% vs. 2%, p = 0.041). On multivariate analysis, myosteatosis was an independent predictor of overall (OR 3.03, 95% CI 1.31–6.99, p = 0.009) and severe complications (OR 4.33, 95% CI 1.26–14.9, p = 0.020). Patients with myosteatosis had reduced 5 year overall (54.1% vs. 83%, p = 0.004) and disease-free (55.2% vs. 87.2%, p = 0.007) survival. Conclusion Myosteatosis is associated with a significantly increased risk of overall and severe complications as well as substantially reduced long-term survival. Assessment of muscle attenuation provides analysis beyond standard anthropometrics and may form part of preoperative physiological staging tools used to improve surgical outcomes.

Objectives Supporting healthy ageing is a key priority worldwide. Physical activity, diet quality and sleep are all associated with health outcomes, but few studies have explored their independent associations with all-cause mortality in an older population in the same model. The study aim was to examine associations between step-count, self-reported diet quality, restless sleep, and all-cause mortality in adults aged 55–85 years. Design A prospective cohort study of adults in Newcastle, New South Wales, Australia. Method Data were from 1697 participants (49.3% women; baseline mean age 65.4 ± 7.1 years). Daily steps (measured by pedometer), diet quality (from a modified Australian Recommended Food Score), and frequency of restless sleep (by self-report) were assessed in relation to all-cause mortality using Cox proportional hazard regression with adjustment for sex, age, household income and smoking. Baseline data were collected between January 2005 and April 2008, and last follow-up was in March 2017 (median follow-up 9.6 years). Results Higher step count (HR: 0.93, 95%CI: 0.88–0.98 per 1000-step increment) and higher diet quality (HR: 0.86, 95%CI: 0.74–0.99 per 8-point increment in diet quality score) were associated with reduced mortality risk. Restless sleep for ≥3 nights/week was not associated with mortality risk (HR: 1.03, 95%CI: 0.78–1.39). Sensitivity analyses, adjusting for chronic disease and excluding deaths Conclusions Increased daily steps and consumption of a greater variety of nutrient-dense foods every week would result in substantial health benefits for older people. Future research should include a greater variety of sleep measures.

Lack of physical activity (PA) and prolonged sitting time (ST) are associated with increased risk of mortality and chronic illnesses, including depression. While there have been claims that the two risks are 'independent', their joint and stratified effects are unclear. The aim of this study was to explore the combined effects of physical activity and sitting time on the 12year risk of depressive symptoms (DS) in young women.Cohort-9061 young participants in the Australian Longitudinal Study on Women's Health completed triennial surveys from 2000 (age 22-27), to 2012.Generalised Estimating Equation models were used to calculate the joint effects of PA and ST on DS, with4h/day of ST and the highest PA quartile as the reference categories. Relationships between PA and DS, and between ST and DS, were also examined after stratification by ST and PA respectively.In the adjusted joint effects model, compared with the reference category (low sitting, high PA), odds for DS were significantly higher in women who sat for4, 6 and 8h/day and reported doing no PA. In every physical activity category, women who sat for ≥10h/day were at highest risk of DS (OR for lowest physical activity quartile, 1.72 [95% CI=1.38-2.14]; OR for highest physical activity quartile, 1.49 [95% CI=1.16-1.91]). After stratification by ST, odds of DS were reduced in women who reported any physical activity (compared with none), except when ST was10h/day. After stratification by physical activity, the increased risk of sitting 8-10h/day was attenuated by any physical activity, but there was no reduction in risk of depressive symptoms with increasing PA levels in women who sat for ≥10h per day.These data suggest that there are both joint and stratified effects of too little activity and too much sitting on the risk of depressive symptoms in young women. High levels of PA are protective against the hazards of high ST at this life stage, except in women with very high levels of sitting.

Objectives The purpose of this study was to determine the number of monitoring days needed to reliably measure weekly activity behaviours with the ActivPAL (AP) monitor in adults. Design Cross-sectional study. Methods Participants (90 adults (51.1% men); age = 39.1 ± 12.43 years) wore an AP for 7 consecutive days. Mean time spent sitting/lying, standing and stepping per day, and mean number of transitions from sitting to standing per day were calculated for each participant using 7 days of monitoring (reference). Estimates for these activities were also derived from a combination of randomly selected days (from 1 to 6 days), and randomly selected weekdays and weekend days, and compared with the reference using ANOVA, correlation coefficients and Bland-Altman methods Spearman–Brown Prophecy Formula, based on Intraclass correlation of 0.8, was used to predict the minimum number of days needed to represent activity behaviours as measured with the AP. Results At least five days of monitoring were necessary to achieve a reliability of 0.8 for all postures and transitions. Correlation coefficients between estimates derived from any combination of 5 days and the reference were high (rho = 0.96–0.98). When using a combination of weekdays and weekend days, mean biases were comparable with those shown by any combination of days, but 95% limits of agreement were narrower. Conclusions When using the AP for a week, data from a combination of any 5 days provided reliable estimates of all activities and transitions per day, but more precise estimates were achieved if at least 1 weekend day was included.

Entropy measures of land use mix are a commonly used component of walkability. However, they present methodological challenges, and studies on their associations with walking have produced mixed findings. This study examined associations of the proportion of discrete land uses with walking, using isometric substitution models that take the complementary nature of land use proportions into account. Analysis of data collected from middle-aged adults living in Brisbane, Australia (n = 10,794) found that replacing residential or other land with commercial land was associated with higher levels of walking. The isometric substitution approach may explain the potential impact of land use changes on residents’ walking.

The aim of this study was to compare the feasibility and impact of sit-stand workstations plus advice, with or without exercise, on back pain and sitting time in office workers at risk of low back pain (LBP). Eligible participants (n = 29/169; 17% overall) were randomized to receive a sit-stand workstation and advice with (n = 16) or without (n = 13) progressive resistance exercise training for 4-weeks. Feasibility (recruitment, acceptability, adherence) and impact (LBP severity during a standardized standing task, workplace-sitting time) were assessed. Intervention acceptability (87.5% very satisfied) was good and adherence (60% completed all 12 exercise sessions) was satisfactory. Maximum LBP severity (mean difference of −1.3 (−2.0, −0.6) and workplace sitting time (82.7–99.3 min/8-hr workday reduction) were similarly reduced in both groups. The introduction of a sit-stand workstation with advice was feasible and achieved similar outcomes for LBP and workplace sitting time when administered with or without exercise.

Summary Background/aim Last century, our laboratory produced Cultured Epithelial Autograft (CEA) for clinical use by the affiliated adult burn service and other burn units across the country. Production of CEA for clinical use was discontinued after several years because of a low success rate and subsequent low demand. Recently, at our burns unit, a cell culture program was reintroduced as a direct response to the need for improvement in ongoing deficiencies and clinical requirements in burn wound closure. The aim of this study was to validate the laboratory processes and clinical algorithms established and share our recent clinical experiences involving CEA. Methods This observational cohort study recruited patients with burns exceeding 35% TBSA admitted to the Victorian Adult Burns Service at The Alfred (December 2013–December 2016). Autologous keratinocytes were expanded and delivered through sheets of fibrin carrier. Results Twelve patients were recruited to participate in the study. Thirty-two sites were treated with CEA. CEA applied in combination with widely meshed SSG led to the highest take rate (90.1%) at 7–10 days. Further, debridement and grafting were necessary in sixteen of thirty-two sites treated, all involving wound beds prepared with Cuono method or sites treated with CEA only. Conclusion It is important to address the problem of wound bed contamination, either through increased resistance on the part of the construct or wound bed sterilization. Improved understanding of the relative importance of vascularization, control of cell behavior, the extracellular matrix, immune function, and intrinsic antimicrobial capacity for graft take would then inform a more targeted approach to skin tissue engineering for wound closure in severe burns.

Background: Although evidence on the health effects of sedentary behavior (SB) has grown systematically in recent years, few developing countries have reported population levels of SB, especially in South America. Our objective was to describe time spent sitting in a representative sample from Chile categorized by age, gender, educational level, and body mass index (BMI). Methods: A national health survey was conducted in Chile in a nationally representative sample (n = 5411) in 2009–2010. Sitting time (ST) was measured with the Global Physical Activity Questionnaire Version 2. Results: Data were from 5031 participants (43.26 ± 0.41 years, mean ± SE; 40.3% male). Overall, there were no gender differences in mean ST (men: 158.10 ± 5.80 min/day, women 143.45 ± 4.77 min/day; p = 0.05). ST was lower in those who lived in rural areas compared with urban areas (99.4 min/day vs. 160.0 min/day; p = 0.001). ST increased significantly with increasing BMI, but only in men (p = 0.009), and was positively related to years of education in both men and women (p

Microtia and anotia are congenital auricular anomalies that negatively impact the psychosocial development of those affected. Because the auricular cartilage is a type of elastic cartilage that lacks regenerative capacity, any notable defect in its structure requires a surgical approach to reconstruct the auricle. While there are several reconstructive options available between alloplastic and prosthetic implants, autologous rib cartilage grafts remain the most commonly used treatment modality. Still, this widely used technique is accompanied by significant patient discomfort in a young child, and it carries additional risks secondary to the traumatic process of rib cartilage extraction, such as pneumothorax, chest wall deformities, and the final aesthetic results may not be ideal. To circumvent these limitations, tissue-engineering approaches have been employed to create a realistic-looking ear that mirrors the complex anatomy of the normal ear. This article provides an overall description of the ear’s anatomy and reviews the traditional management options for auricular reconstruction. The biochemical and biomechanical properties of human auricular cartilage are detailed as they relate to design criteria. In addition, a variety of cell sources, biocompatible scaffolds, scaffold-free techniques, mechanical and biological stimuli have been discussed. This review aims to identify knowledge gaps in the literature related to auricular cartilage characteristics and make recommendations to drive the field of auricular tissue engineering.

Women and men tend to take different paths to leadership, with men being more intentional. When women do undertake leadership activities, they tend to be surprised by how much they enjoy it. Women's leadership styles tend to be more collaborative and inclusive. Women are used to multitasking and tend to persist under difficult circumstances. The nephrology manpower crisis affects both men and women, although some of the drivers are different. There is a persistent and well-known pay disparity between men and women physicians that many have tried to address without consistent success. Strategies also need to be developed to support and encourage both men and women in nephrology.

Introduction Poor sleep health is common and has a substantial negative health impact. Physical activity has been shown to improve sleep health. Many sleep interventions do not explicitly target physical activity, potentially limiting changes in activity and also sleep. Few intervention target those with poor sleep health but without a diagnosed disorder. This study aims to examine the efficacy of a combined physical activity and sleep intervention to improve sleep quality in middle-aged adults and its effect on physical activity, depression and quality of life. Methods A three-arm randomised trial with a three-month primary time-point, will be conducted. Adults (N = 275) aged 40–65 years, who report physical inactivity and poor sleep quality, will be randomly allocated to either a combined Physical Activity and Sleep Health, a Sleep Health-Only or a Wait List Control group. The multi-component m-health intervention will be delivered using a smartphone/tablet “app”, supplemented with email and SMS. Participants will use the app to access educational material, set goals, self-monitor and receive feedback about behaviours. Assessments will be conducted at baseline, three-month primary time-point and six-month follow-up. Generalized linear models using an ANCOVA (baseline-adjusted) approach, will be used to identify between-group differences in sleep quality, following an intention-to-treat principle. Discussion This study will determine whether the addition of a physical activity intervention enhances the effectiveness of a sleep intervention to improve sleep quality, relative to a sleep-only intervention, in physically inactive middle-aged adults who report poor sleep health, but without a sleep disorder.

Background Cohort studies have examined whether change in transport mode is associated with change in bodyweight among commuters. We complement this research by examining trends in body mass index (BMI) for men and women who used the same transport mode between 2007 and 2013, and where transport was used for any activity of daily life. Methods Data are from the HABITAT study, a longitudinal investigation of health among 11,035 persons aged 40–65 residing in 200 neighbourhoods in Brisbane, Australia. Transport mode was measured as private motor vehicle (PMV), public transport, walking, and cycling. Analyses were conducted using random effects models before and after adjustment for time-varying and time-invariant confounders. Interactions between transport mode and time were modelled to assess whether the rate of change in BMI differed by mode. Results Averaged over the four time-points, the BMI of men who consistently walked or cycled was −3.20 kg/m2 (95%CI −4.28, −2.12) and −2.15 kg/m2 (95%CI −3.22, −1.08) lower respectively than PMV users: the corresponding difference for women who walked or cycled was −2.42 kg/m2 (95%CI −3.66, −1.18) and −2.44 kg/m2 (95%CI −5.98, 1.11). For men, there were no BMI differences between PMV and public transport users; among women, those who mainly used public transport had higher BMI (1.06 kg/m2 95%CI 0.51, 1.62) than PMV users. For men, no significant interactions were found between transport mode and time; for women, those who mainly walked for transport experienced a significant decline in BMI compared with PMV users. Conclusion Those who consistently walked or cycled sustained a lower BMI over time relative to those who consistently used a PMV. Transport and land use policies and behavioural interventions that successfully shift mode-share from PMV to active travel might help stem the global increase in obesity related chronic disease.

Introduction Adults with mental illness have increased risk of cardiovascular disease. High-intensity interval training (HIIT) is more efficacious than moderate-intensity continuous training (MICT) for improving cardiorespiratory fitness (CRF); however, the utility of HIIT for this group is unclear. The aim of this study was to compare the feasibility and acceptability of HIIT and MICT in adults with mental illness. A secondary aim was to compare the efficacy of HIIT and MICT on mental health and fitness. Method Inactive adults with self-reported mental illness participated in aerobic exercise three times/week over 12 weeks. Participants were randomised to HIIT (3x4-min bouts at 85–95% peak heart rate [HRpeak] interspersed with 3-min recovery bouts) or MICT (1 × 30-min at 65–75% HRpeak). Feasibility was assessed using attendance and withdrawal rates. Acceptability and mental health was assessed using self-administered questionnaires. Fitness was measured using indirect calorimetry during a graded fitness test to exhaustion. Results 24 participants consented and 16 participants began the intervention (HIIT, n = 8; MICT, n = 8). Completion rates (HIIT, n = 4; MICT, n = 5) and median attendances were similar (HIIT = 81%, MICT = 86%). Most participants were satisfied with their allocation (88% MICT; 100% HIIT), and found the exercise enjoyable (63% MICT; 100% HIIT). Equal numbers reported that they would like to continue the exercise (63%), and that they would feel confident doing so without supervision (75%). No significant differences were found between groups on mental health and fitness. Conclusion This preliminary evidence suggests that HIIT was as acceptable and feasible as MICT for adults with mental illness.

Objectives This study aimed to identify how different patterns of physical activity, sleep duration and sleep quality cluster together, and to examine how the identified clusters differ in terms of socio-demographic and health characteristics. Study design and outcome measures Participants were adults from Brisbane, Australia, aged 42–72 years who reported their physical activity, sleep duration, sleep quality, socio-demographic and health characteristics in 2011 (n = 5854). Two-step Cluster Analyses were used to identify clusters. Cluster differences in socio-demographic and health characteristics were examined using chi square tests (p Results Four clusters were identified: ‘Poor Sleepers’ (31.2%), ‘Moderate Sleepers’ (30.7%), ‘Mixed Sleepers/Highly Active’ (20.5%), and ‘Excellent Sleepers/Mixed Activity’ (17.6%). The ‘Poor Sleepers’ cluster had the highest proportion of participants with less-than-recommended sleep duration and poor sleep quality, had the poorest health characteristics and a high proportion of participants with low physical activity. Conclusion Physical activity, sleep duration and sleep quality cluster together in distinct patterns and clusters of poor behaviours are associated with poor health status. Multiple health behaviour change interventions which target both physical activity and sleep should be prioritised to improve health outcomes in mid-aged adults.

The laparoscopic adjustable gastric band (AGB) has been effective in reducing excess weight by approximately 50% for at least 16 years. However, as with all weight loss approaches, reduction in weight resulting from bariatric surgery is associated with a compensatory reduction in energy expenditure, which may confound and limit weight loss. Adjuvant therapies that reduce food intake and increase energy expenditure may be used to improve weight loss outcomes by ameliorating, or even reversing, this reduction in energy expenditure.Rats were either fitted with an AGB or were sham operated and received one of 2 adjunctive pharmacologic treatments, (1) thyroxine or (2) bupropion/naltrexone (Contrave), at a range of doses and matched with vehicle controls (n = 6-8/group) over a 4-week period of combined treatments. Metabolic parameters including food intake, weight, fat mass, and energy expenditure in brown adipose tissue (BAT), whole body calorimetry, and physical activity were assessed.Inflation of the AGB caused a reduction in weight gain that was further enhanced by cotreatment with either thyroxine or Contrave (P.05). Thyroxine completely ameliorated the reduction in AGB-induced BAT thermogenesis and significantly improved weight loss, particularly in fat mass. Contrave also augmented the loss of weight and fat mass associated with the AGB and increased BAT thermogenesis in banded rats even at doses below that required to change food intake.Adjuvant therapies can improve the efficacy of the AGB, at least in part by negating the compensatory reduction in energy expenditure, but also via a combined effect on food intake.

Background The development of a postdissection aortic arch aneurysm after open ascending aortic replacement for type A dissection places the patient at increased risk for an open operation due to the need for redo sternotomy and total arch replacement. We conducted a computed tomography–based feasibility study to assess what proportion of these patients would be anatomically suitable for branched endograft repair of an arch aneurysm. We also aimed to identify ways to tailor the index operation to increase suitability for future endovascular repair. Methods Our study was conducted at the Aortic Centre, Lille University Hospital, Lille, France. Postoperative images were assessed for patients after open replacement of the ascending aorta for acute type A dissection in this center between 2009 and 2015 to determine suitability for use of an aortic arch inner-branched device. Results The assessment found 52 of 73 patients (71.2%) were anatomically suitable for treatment with the aortic arch inner-branched device. The only cause for absolute exclusion from suitability was the absence of a proximal landing zone in the ascending aorta. Reasons for this were the ascending aortic graft being too short (71.4%), the presence of a major kink in the graft (23.8%), and the graft diameter being too large (4.8%). Conclusions Approximately 70% of patients with arch aneurysm formation after open ascending aortic replacement for type A dissection are anatomically suitable for treatment with the aortic arch inner-branched device. In the future, surgeons will be able to fashion the prosthetic graft at the time of the index operation to ensure it fulfills criteria for an adequate proximal landing zone.

Introduction The aims of this prospective cohort study were to examine 16-year trajectories of weight and BMI in young adult women who had a healthy BMI in 1996 and determinants of remaining in the healthy BMI category. Methods A total of 4,881 women with healthy BMI at baseline and either healthy, overweight, or obese BMI at 16-year follow-up reported their weight, height, health, and health behaviors in six surveys of the Australian Longitudinal Study on Women's Health between 1996 (aged 18–23 years) and 2012 (aged 34–39 years). Determinants of BMI maintenance were estimated using binary logistic regression and generalized estimating equations in 2015. Results Almost 60% remained in the healthy BMI category from 1996 to 2012, (mean weight gain, 0.19 kg/year), 29% transitioned to overweight BMI (0.83 kg/year), and 11.6% transitioned to obese (1.73 kg/year). The mean rates of annual weight gain in each group were consistent over time. Only three factors (low alcohol, moderate/high physical activity, having a university degree) were positively associated with maintaining a healthy BMI. Additional behavioral factors (smoking, high sitting time, energy intake, dieting, takeaway food, and use of oral contraceptives), as well as blue collar occupation, separation/divorce/widowhood, and major illness were negatively associated with BMI maintenance. Conclusions To prevent the transition from healthy to overweight/obese BMI, weight gain must be limited to

Background Dementia is the second leading cause of death in the United Kingdom, affecting 7.1% of older adults. One in five dementia cases in Europe can be attributable to physical inactivity. We examined the association between physical activity at age 50 or older and risk of dementia over 15 years. Methods The English Longitudinal Study of Ageing (ELSA) comprises a national population-based cohort that began in 2002–03 (baseline) with 9275 individuals aged ≥50 years. Dementia diagnosis was followed over 15 years. Physical activity in daily life and at work was measured at baseline and at two yearly intervals and participants were categorized as inactive, low, or moderate-to-high active. Cumulative incidence of dementia during follow-up was calculated; hazard ratios and 95% confidence intervals (CI) were estimated using survival analysis. Results At baseline, 69% of the sample were categorized as moderate-to-high active. The inactive, low, and moderate-to-high active groups had a cumulative incidence of dementia of 4.8% (95%CI: 4.4 to 5.4), 0.9% (95%CI:0.8 to 1.1), and 0.2% (95%CI: 0.1 to 0.5), respectively. In adjusted analyses, participants in the low and moderate-to-high active groups had, respectively, 60% and 78% lower risk of developing dementia than the inactive group. Survival analyses showed large between-group differences in the cumulative incidence of dementia over 15 years based on the physical activity categories. Conclusion In people aged 50 or more, there is an inverse dose-response association between physical activity and incidence of dementia over 15 years. Even low levels of physical activity have beneficial effects.

Objectives This efficacy study assessed the added impact real time computer prompts had on a participatory approach to reduce occupational sedentary exposure and increase physical activity. Design Quasi-experimental. Methods 57 Australian office workers (mean [SD]; age = 47 [11] years; BMI = 28 [5] kg/m2; 46 men) generated a menu of 20 occupational ‘sit less and move more’ strategies through participatory workshops, and were then tasked with implementing strategies for five months (July–November 2014). During implementation, a sub-sample of workers (n = 24) used a chair sensor/software package (Sitting Pad) that gave real time prompts to interrupt desk sitting. Baseline and intervention sedentary behaviour and physical activity (GENEActiv accelerometer; mean work time percentages), and minutes spent sitting at desks (Sitting Pad; mean total time and longest bout) were compared between non-prompt and prompt workers using a two-way ANOVA. Results Workers spent close to three quarters of their work time sedentary, mostly sitting at desks (mean [SD]; total desk sitting time = 371 [71] min/day; longest bout spent desk sitting = 104 [43] min/day). Intervention effects were four times greater in workers who used real time computer prompts (8% decrease in work time sedentary behaviour and increase in light intensity physical activity; p < 0.01). Respective mean differences between baseline and intervention total time spent sitting at desks, and the longest bout spent desk sitting, were 23 and 32 min/day lower in prompt than in non-prompt workers (p < 0.01). Conclusions In this sample of office workers, real time computer prompts facilitated the impact of a participatory approach on reductions in occupational sedentary exposure, and increases in physical activity.

Objectives The aim of this study was to assess levels and patterns of physical activity and sedentary behaviour among inpatient adults with mental illness. Design Cross-sectional. Methods 101 participants completed questionnaires on time spent in walking, moderate- and vigorous-intensity activity in the past week and domain specific sitting time on a usual weekday and weekend day. 36 participants also provided valid accelerometry data. Regression analyses were used to explore associations between MVPA and sedentary behaviour and explanatory variables of gender, age, education, body mass index and psychological distress. Results Self-report data indicated median of 32 min/day (IQR: 14.46–85.71) in weighted MVPA and a median of 761 min/day (12.7 h) (IQR: 552.43–917.14) in sedentary behaviour. Accelerometry data indicated an average of 115 min/day in light activity, 37 min/day in MVPA and 664 min/day (11.1 h) in sedentary behaviour. Bivariate analyses indicated no significant associations between explanatory variables and MVPA and sedentary behaviour. Conclusions Inpatient adults with mental illness can be physically active, with walking comprising the major component of MVPA time. Inpatient adults with mental illness spend a significant amount of time sitting; intervention strategies could focus on reducing the time spent sitting in general relaxation and doing nothing.

Objectives To assess physical activity (PA) and sedentary behaviour (SB) in non-institutionalised adults with mental illness, using a combination of self-report and objective measures. Design Cross-sectional Methods Participants completed PA questionnaires (time spent walking for transport, walking for recreation, gardening, vigorous-, and moderate-intensity activities), and SB questionnaires (time spent sitting for TV, travel, work, computer use, and reclining). Participants also wore an accelerometer for 7 days. Accelerometry estimates of time spent in SB, light activity, and moderate-to-vigorous activity (MVPA), bout durations, and, breaks in sedentary time, were calculated. Results 142 participants completed the questionnaires. The median time spent in self-reported MVPA and SB was 4.5 h/week and 10.7 h/day, respectively. Walking for transport, and sitting to watch TV, contributed most to self-report estimates; time spent reclining was an important contributor to SB. Ninety-nine participants completed the accelerometry. The median time spent in accelerometer-derived MVPA and SB was 26 min/day and 9.2 h/day respectively; 7% of MVPA time was in bouts of 10 min or more, and 34% of SB time was in bouts of over 20 min. Conclusions A high proportion of participants reported activity levels consistent with physical activity guidelines; however, a small proportion of activity was accumulated in bouts of 10 min or more. Participants also had high levels of SB, about one-third of which was accumulated in bouts over 20 min. PA and SB interventions for this group could target increasing recreational walking, and reducing television time.

Highlights • More than 70% of all deaths in the BRICS countries are attributable to noncommunicable diseases. • There have been marked changes in physical activity levels, time use, and energy expenditure in these nations over the last 20 years. • There are marked gender differences in physical activity in 4 of the 5 BRICS nations, which largely reflect the overall gender inequalities in these countries.

Introduction A valid day of accelerometry is commonly defined as an absolute duration of wear time. Data processing inconsistencies can arise when using absolute valid-day criteria for adults with varied waking hours. The aim was to compare the use of absolute and relative valid-day criteria in a sample of adults with mental illness. Methods Data were from 99 non-institutionalised adults with mental illness. Participants were asked to wear an ActiGraph GT3X+ accelerometer continuously for seven days, and to note sleep and non-wear times. Absolute valid-day criteria were defined as a set number of hours/day, and relative criteria as a proportion of waking hours. The mean waking duration, non-wear time, and time spent in physical activity (PA) and sedentary behaviour (SB), were derived from accelerometer data, and compared for a range of absolute and relative criteria. The potential inaccuracy of PA and SB estimates were also estimated. Results Use of absolute criteria systematically biased the sample toward those with longer waking hours, and resulted in a median of 86% (IQR = 47%–198%) more non-wear time than relative criteria. The potential inaccuracy of SB was from −2.5% to 0% with relative criteria, and from −2.2% to 10.6% for absolute criteria. Conclusions For participant samples with varied waking hours, such as adults with mental illness, a valid-day criterion should be based on the proportion of waking hours, rather than the absolute time. The specific valid-day criterion should be chosen for each study independently, and be accompanied with a measure of the non-wear time.

Objectives Although physical activity can potentially reduce symptoms of arthritis, 50% of people with arthritis are insufficiently active. The aim was to identify psychosocial factors associated with increased physical activity in mid-age adults with arthritis who did not meet recommended physical activity levels. Design Longitudinal cohort study. Methods Data were from 692 insufficiently active men and women (mean age 55 ± 6.6 years) with arthritis, who answered mailed surveys in 2007 and 2009 in the HABITAT study. Increased physical activity was defined as a change of ≥200 MET min/week in walking, moderate and vigorous activities from 2007 to 2009. Scale scores were used to measure psychosocial factors including intention, experiences, attitudes, efficacy, barriers, motivation, social support, and health professional advice. Associations between (1) 2007 psychosocial factors and (2) 2007–2009 improvement (≥+1 standard deviation) in psychosocial factors and increased physical activity were examined with logistic regression models. Results were adjusted for education, body mass index, and self-rated health. Results Between 2007 and 2009, 296 participants (42.8%) increased their physical activity. Engagement, mastery and physical activity intention in 2007 were associated with this increase in physical activity (engagement OR = 1.11, 99% confidence interval (CI) = 1.05–1.17; mastery OR = 1.12, 99%CI = 1.02–1.22; physical activity intention OR = 1.29, 99%CI = 1.06–1.56). Improved scores for encouragement (OR = 2.07, CI = 1.07–4.01) and self-efficacy (OR = 2.27, CI = 1.30–3.97) were also significantly associated with increased physical activity. Conclusions Positive physical activity experiences and intentions were predictors of increased physical activity among people with arthritis. Improved physical activity confidence and social support were associated with increased physical activity. It is important to consider these psychosocial factors when planning physical activity interventions for people with arthritis.

To examine patterns of the incidence of diabetes, hypertension, and mortality by single units of body mass index (BMI) and 5-year age groups using longitudinal data from middle-aged and older women.Middle-aged (born between 1946 and 1951; N = 13,715) and older (born between 1921 and 1926; N = 12,432) participants in the Australian Longitudinal Study on Women's Health completed surveys in 1996 and at approximately 3-year intervals thereafter until 2011. Proportions of women with diabetes, hypertension, and mortality over 3-year intervals were estimated for each unit of BMI and 5-year age group (45 to50, 50 to55, 55 to60, 70 to75, 75 to80, and 80 to85 years) using generalized additive modeling with adjustment for time-varying covariates.Three-year incidence of diabetes (1.2%-3.6%), hypertension (5.2%-17.8%), and death (0.4%-9.5%) increased with age. For both diabetes and hypertension, the associations with BMI were curvilinear in middle-aged women and became almost linear in older women. With increasing age, the slope became steeper, and the increase started at lower BMI values. For hypertension, there was a marked increase in intercept from 75 years onward. In contrast, mortality risks were highest for low BMI (≤ 20) in all age groups. A clear U-shaped curve was observed only in the oldest age group.The shapes of the relationships between BMI and incidence of diabetes, hypertension, and mortality change with age, suggesting that weight management interventions should be tailored for different age groups.

Objective Few postpartum ethnic minority women perform leisure-time moderate-to-vigorous physical activity (MVPA). The study tested the effectiveness of a 12-month tailored intervention to increase MVPA in women with infants 2–12 months old. Methods From 2008 to 2011, women ( n = 311) with infants (average age = 5.7 months) from Honolulu, Hawaii were randomly assigned to receive tailored telephone calls and access to a mom-centric website ( n = 154) or access to a standard PA website ( n = 157). MVPA was measured at baseline, 6, and 12 months using self-report and acclerometers. Results Controlling for covariates, the tailored condition significantly increased self-reported MVPA from an average of 44 to 246 min/week compared with 46 to 156 min/week for the standard condition ( p = 0.027). Mothers with ≥ 2 children had significantly greater increases in MVPA in response to the tailored intervention than those with one child ( p = 0.016). Accelerometer-measured MVPA significantly increased over time ( p = 0.0001), with no condition differences. There was evidence of reactivity to initially wearing accelerometers; the tailored intervention significantly increased MVPA among women with low baseline accelerometer MVPA minutes, but not among those with high minutes ( p interaction = 0.053). Conclusion A tailored intervention effectively increased MVPA over 12 months in multiethnic women with infants, particularly those with more than one child.

Objective: This study examined chronic disease risks and the use of a smartphone activity tracking application during an intervention in Australian truck drivers (April‐October 2014). Methods: Forty‐four men (mean age=47.5 [SD 9.8] years) completed baseline health measures, and were subsequently offered access to a free wrist‐worn activity tracker and smartphone application (Jawbone UP) to monitor step counts and dietary choices during a 20‐week intervention. Chronic disease risks were evaluated against guidelines; weekly step count and dietary logs registered by drivers in the application were analysed to evaluate use of the Jawbone UP. Results: Chronic disease risks were high (e.g. 97% high waist circumference [≥94 cm]). Eighteen drivers (41%) did not start the intervention; smartphone technical barriers were the main reason for drop out. Across 20‐weeks, drivers who used the Jawbone UP logged step counts for an average of 6 [SD 1] days/week; mean step counts remained consistent across the intervention (weeks 1–4=8,743[SD 2,867] steps/day; weeks 17–20=8,994[SD 3,478] steps/day). The median number of dietary logs significantly decreased from start (17 [IQR 38] logs/weeks) to end of the intervention (0 [IQR 23] logs/week; p

Despite a body of evidence on the relationship between neighborhood socioeconomic disadvantage and body mass index (BMI), few studies have examined this relationship over time among ageing populations. This study examined associations between level of neighborhood socioeconomic disadvantage and the rate of change in BMI over time. The sample included 11,035 participants aged between 40 and 65 years at baseline from the HABITAT study, residing in 200 neighborhoods in Brisbane, Australia. Data were collected biennially over four waves from 2007 to 2013. Self-reported height and weight were used to calculate BMI, while neighborhood disadvantage was measured using a census-based composite index. All models were adjusted for age, education, occupation, and household income. Analyses were conducted using multilevel linear regression models. BMI increased over time at a rate of 0.08 kg/m2 (95% CI 0.02, 0.13) and 0.17 kg/m2 (95% CI 0.11, 0.29) per wave for men and women respectively. Both men and women residing in the most disadvantaged neighborhoods had a higher average BMI than their counterparts living in the least disadvantaged neighborhoods. There were no evident differences in the rate of BMI change over time by level of neighborhood disadvantage. The findings suggest that by mid-older age, the influence of neighborhood socioeconomic conditions over time on BMI may have already played out. Future research should endeavor to identify the genesis of neighborhood socioeconomic inequalities in BMI, the determinants of these inequalities, and then suitable approaches to intervening.

Dermacentor andersoni, known as the Rocky Mountain wood tick, is found in the western United States and transmits pathogens that cause diseases of veterinary and public health importance including Rocky Mountain spotted fever, tularemia, Colorado tick fever and bovine anaplasmosis. Tick saliva is known to modulate both innate and acquired immune responses, enabling ticks to feed for several days without detection. During feeding ticks subvert host defences such as hemostasis and inflammation, which would otherwise result in coagulation, wound repair and rejection of the tick. Molecular characterization of the proteins and pharmacological molecules secreted in tick saliva offers an opportunity to develop tick vaccines as an alternative to the use of acaricides, as well as new anti-inflammatory drugs. We performed proteomics informed by transcriptomics to identify D. andersoni saliva proteins that are secreted during feeding. The transcript data generated a database of 21,797 consensus sequences, which we used to identify 677 proteins secreted in the saliva of D. andersoni ticks fed for 2 and 5days, following proteomic investigations of whole saliva using mass spectrometry. Salivary gland transcript levels of unfed ticks were compared with 2 and 5day fed ticks to identify genes upregulated early during tick feeding. We cross-referenced the proteomic data with the transcriptomic data to identify 157 proteins of interest for immunomodulation and blood feeding. Proteins of unknown function as well as known immunomodulators were identified.

Objective: To examine changes in sitting time (ST) in women over nine years and to identify associations between life events and these changes. Methods: Young (born 1973-78, n. = 5215) and mid-aged (born 1946-51, n. = 6973) women reported life events and ST in four surveys of the Australian Longitudinal Study on Women's Health between 2000 and 2010. Associations between life events and changes in ST between surveys (decreasers ≥. 2. h/day less, increasers ≥. 2. h/day more) were estimated using generalized estimating equations. Results: Against a background of complex changes there was an overall decrease in ST in young women (median change - 0.48. h/day, interquartile range [IQR]. = - 2.54, 1.50) and an increase in ST in mid-aged women (median change 0.43. h/day; IQR. = - 1.29, 2.0) over nine years. In young women, returning to study and job loss were associated with increased ST, while having a baby, beginning work and decreased income were associated with decreased ST. In mid-aged women, changes at work were associated with increased ST, while retiring and decreased income were associated with decreased ST. Conclusions: ST changed over nine years in young and mid-aged Australian women. The life events they experienced, particularly events related to work and family, were associated with these changes.