Search

AimTo estimate the prevalence of micronutrient deficiencies and anaemia, and their association with body mass index (BMI) categories among Australian adults.MethodWe analysed data from the 2011–2013 Australian Health Survey from 3539 participants aged 18 years and over (without known pregnancy) with measured weight and height, and nutrient biomarkers. To address complex sampling, survey weights were used when estimating the prevalence of micronutrient deficiencies (vitamin B12deficiency; serum vitamin B122), reference; overweight (BMI 25.0 to 2), obesity class I (BMI 30.0 to 2), obesity class II/III (BMI 35.0 kg/m2or more).ResultThe prevalence of vitamin B12deficiency (range 0.9%─2.8%) and anaemia (range 3.9%─6.7%) were variable across BMI groups. The prevalence of iron deficiency in the obesity class I group was 12.0 percentage points lower than healthy weight group with an AOR of 0.50 (95% CI 0.30 to 0.83). The prevalence of vitamin D deficiency in the obesity class II/III group was 7.9 percentage points higher than the healthy weight group with an AOR of 1.62 (95% CI 1.01 to 2.60). Vitamin B12deficiency and anaemia were not consistently associated with BMI groups.ConclusionWe found a consistent association between severe obesity and vitamin D deficiency in Australian adults. We also found obesity class I was negatively associated with iron deficiency, whereas there was no consistent association between BMI groups and vitamin B12deficiency and anaemia. Public health strategies are needed to prevent vitamin D deficiency in this high-risk population.

We aimed to assess weight loss and metabolic outcomes by severity of weight-related complications following an intensive non-surgical weight management program (WMP) in an Australian public hospital. A retrospective cohort study of all patients aged ≥18 years with body mass index (BMI) ≥ 40 enrolled in the WMP during March 2018–March 2019 with 12-month follow-up information were stratified using the Edmonton Obesity Staging System (EOSS). Of 178 patients enrolled in the WMP, 112 (62.9%) completed at least 12 months’ treatment. Most patients (96.6%) met EOSS-2 (56.7%) or EOSS-3 (39.9%) criteria for analysis. Both groups lost significant weight from baseline to 12 months; EOSS-2: 139.4 ± 31.8 kg vs. 131.8 ± 31.8 kg (p < 0.001) and EOSS-3: 141.4 ± 24.2 kg vs. 129.8 ± 24.3 kg (p < 0.001). After adjusting for baseline age, sex and employment status, mean weight loss was similar but a greater proportion of EOSS-3 achieved >10% weight loss compared to EOSS-2, (40% vs. 15.9%, p = 0.024). Changes in metabolic parameters including HbA1c, BP and lipids did not differ between EOSS-2 and 3. Despite increased clinical severity, adult patients with class 3 obesity achieved clinically meaningful weight loss and similar improvements in metabolic parameters compared to patients with less severe complications after 12 months in an intensive non-surgical WMP.

Objective:This study aimed to synthesise the existing evidence on the performance of mid-upper arm circumference (MUAC) to identify children and adolescents with overweight and obesity.Design:Systematic review and meta-analysis.Setting:We searched PubMed, EMBASE, SCOPUS, Cochrane Library, Web of Science, CINAHL and Google scholar databases from their inception to December 10, 2021, for relevant studies. There were no restrictions regarding the language of publication. Studies reporting measures for the diagnostic performance of MUAC compared with a reference standard for diagnosing overweight and obesity in children and adolescents aged 2–19 years were included.Participants:A total of 54 381 children and adolescents from twenty-one studies were reviewed; ten studies contributed to meta-analyses.Results:In boys, MUAC showed a pooled AUC of 0·92 (95 % CI 0·89, 0·94), sensitivity of 84·4 (95 % CI 84·6, 90·8) and a specificity of 86·0 (95 % CI 79·2, 90·8), when compared against BMI z-score, defined overweight and obesity. As for girls, MUAC showed a pooled AUC of 0·93 (95 % CI 0·90, 0·95), sensitivity of 86·4 (95 % CI 79·8, 91·0), specificity of 86·6 (95 % CI 82·2, 90·1) when compared against overweight and obesity defined using BMI z-scores.Conclusion:In comparison with BMI, MUAC has an excellent performance to identify overweight and obesity in children and adolescents. However, no sufficient evidence on the performance of MUAC compared with gold standard measures of adiposity. Future research should compare performance of MUAC to the ‘golden standard’ measure of excess adiposity.

We hypothesized that unhealthy dietary pattern would be associated with weight related complications among overweight. We analysed data from the Australian Health Survey conducted from 2011 to 2013. A total of 5055 adults with at least overweight (body mass index ≥25 kg/m2) were analysed. We used logistic regression to assess the association between unhealthy dietary pattern, defined by low adherence to Mediterranean Diet Score (MDS), and weight related complications, defined by the Edmonton Obesity Staging System (EOSS). We repeated the logistic regression models by age and socio-economic disadvantage strata in sensitivity analyses. We also repeated the main analysis on a propensity score matched dataset (n = 3364). Complications by EOSS ≥2 was present in 3036 (60.1%) participants. There was no statistically significant association between unhealthy dietary pattern and weight related complication (odds ratio 0.98 (95%confidence interval: 0.85, 1.12)). The null association remained the same after repeating the analysis on three age and five socio-economic indexes for areas strata. The finding persisted after the analysis was repeated on a propensity score matched dataset. We found no evidence to support the hypothesis that unhealthy dietary pattern was associated with weight related complications in this cross-sectional study of the Australian population with overweight or obesity.

The role of unhealthy dietary pattern in the association between socio-economic factors and obesity is unclear. The aim was to examine the association between socio-economic disadvantage and obesity and to assess mediation effect of unhealthy dietary pattern defined using the Mediterranean diet criteria. The data source was the Australian National Nutrition and Physical Activity Survey. The study sample included 7744 participants aged 18 years and over, 28% of whom had obesity. We used the Australian Socio-Economic Indexes for Areas (SEIFA) classification system for categorizing socio-economic disadvantage, calculated the Mediterranean Diet Score (MDS) using standard criteria, and used measured body mass index to define obesity. We conducted a mediation analysis using log–binomial models to generate the prevalence ratio for obesity and the proportion mediated by the MDS. The most disadvantaged group was associated with higher level of obesity after controlling for covariates (1.40, 95% CI 1.25, 1.56) compared to the least disadvantaged group, and in a dose–response way for each decreasing SEIFA quintile. The relationship between socio-economic disadvantage and obesity was mediated by the MDS (4.0%, 95% CI 1.9, 8.0). Public health interventions should promote healthy dietary patterns, such as the Mediterranean diet, to reduce obesity, especially in communities with high socio-economic disadvantage.

This rapid review aimed to examine the usefulness of the Edmonton Obesity Staging System (EOSS) for stratifying the presence and severity of weight-related health problems in clinical and community settings. We searched PubMed, CINAHL and ProQuest for records from 2009 to May 2020. We considered observational studies in participants with overweight or obesity that investigated the risk of any clinical outcome associated with increasing EOSS. We reviewed and appraised 20 observational studies (cohort = 4, case series = 7, cross-sectional = 9) published between 2011 and 2020. Of 12 studies in clinical populations, the EOSS was most consistently associated with an increased risk of postoperative complications following bariatric surgery, especially for EOSS 3-4, and inversely associated with weight loss, treatment time and resolution of hypertension following bariatric surgery and clinical weight management. Of eight studies in community populations, the EOSS most consistently predicted mortality outcomes, especially for EOSS 3, and was associated with polypharmacy, service use and poorer work outcomes. Studies reported diverse EOSS definitions and outcomes, which slightly weakens the overall evidence base. The EOSS should be routinely used for predicting risks and benefits of surgical and nonsurgical weight management, but it should be applied with caution for population health planning.

We aimed to describe the current state of specialist obesity services for adults with clinically severe obesity in public hospitals in Australia, and to analyse the gap in resources based on expert consensus. We conducted two surveys to collect information about current and required specialist obesity services and resources using open-ended questionnaires. Organizational level data were sought from clinician expert representatives of specialist obesity services across Australia in 2017. Fifteen of 16 representatives of current services in New South Wales (n = 8), Queensland (n = 1), Victoria (n = 2), South Australia (n = 3), and the Australian Capital Territory (n = 1) provided data. The composition of services varied substantially between hospitals, and patient access to services and effective treatments were limited by strict entry criteria (e.g. body mass index 40 kg/m2 or higher with specific complication/s), prolonged wait times, geographical location (major cities only) and out-of-pocket costs. Of these services, 47% had a multidisciplinary team (MDT), 53% had an exercise physiologist/physiotherapist, 53% had a bariatric surgeon and 33% had pharmacotherapy resources. Key gaps included staffing components of the MDT (psychologist, exercise physiologist/physiotherapist) and access to publicly funded weight loss pharmacotherapy and bariatric surgery. There was consensus on the need for significant improvements in staff, physical infrastructure, access to services, education/training in obesity medicine and targeted research funding. Based on the small number of existing, often under-resourced specialist obesity services that are located only in a few major cities, the vast majority of Australians with clinically severe obesity cannot access the specialist evidence based treatments needed.

Objective The Edmonton Obesity Staging System (EOSS) is based on weight related health complications among individuals with overweight and obesity requiring clinical intervention. We aimed to assess the clinical usefulness of a new screening tool based on the EOSS for activating weight management discussions in general practice. Methods We enrolled five General Practitioners (GPs) and 25 of their patients located nationwide in metropolitan areas of Australia to test the feasibility, acceptability, and accuracy of the new ‘EOSS-2 Risk Tool’, using cross-sectional and qualitative study designs. Diagnostic accuracy of the tool for the presence of EOSS ≥2 criteria was based on clinical information collected prospectively. To assess feasibility and applicability, we explored the views of GP and patient participants by thematic analysis of transcribed verbatim and de-identified data collected by semi-structured telephone interviews. Results Nineteen (76%) patients were aged ≥45 years, five (20%) were male, and 20 (80%) were classified with obesity. All 25 patients screened positive for EOSS ≥2 criteria by the tool. Interviews with patients continued until data saturation was reached resulting in a total of 23 interviews. Our thematic analysis revealed five themes: GP recognition of obesity as a health priority (GPs expressed strong interest in and understanding of its importance as a health priority); obesity stigma (GPs reported the tool helped them initiate health based and non-judgmental conversations with their patients); patient health literacy (GPs and patients reported increased awareness and understanding of weight related health risks), patient motivation for self-management (GPs and patients reported the tool helped focus on self-management of weight related complications), and applicability and scalability (GPs stated it was easy to use, relevant to a range of their patient groups, and scalable if integrated into existing patient management systems). Conclusion The EOSS-2 Risk Tool is potentially clinically useful for activating weight management discussions in general practice. Further research is required to assess feasibility and applicability.

BackgroundUnintended pregnancy rates are substantially higher in developing regions, have significant health consequences, and disproportionately affect subgroups with socio-economic disadvantage. We aimed to examine whether there is an association between husbands' education status and their wives unintended pregnancy in southern Ethiopia.MethodsThe data source for this study was from a cross-sectional study on iron-folate supplementation and compliance in Wolaita, South Ethiopia. Data were collected from October to November 2015 in 627 married pregnant women regarding their husbands' education status, socio-demographic characteristics, and if they wanted to become pregnant at the time of survey using an interviewer administered questionnaire. Logistic regression was used to estimate Odds Ratios (ORs) with associated z-tests and 95% Confidence Intervals (95% CI) for variables associated with unintended pregnancy.ResultsThe proportion of unintended pregnancy in this sample was 20.6%. Husbands' education status, age, residence, and using family planning methods were associated with unintended pregnancy (all P-values < 0.05). Multivariable models consistently showed that being married to a husband with at least some college or university education was associated with a decreased OR for unintended pregnancy after controlling for age and use of family planning at conception period (OR 0.36 [95%CI: 0.17, 0.82]) and age and rural residence (OR 0.40 [95%CI: 0.18, 0.90]).ConclusionUnintended pregnancy among Ethiopian woman was consistently associated with being married to least educated husbands in southern Ethiopia. Increasing age and living in a rural vs urban area were also independently associated with unintended pregnancy. Strategies for addressing family planning needs of women with poorly educated husbands should be the subject of future research.

Background: Patients presenting with multiple chronic conditions have complex healthcare needs that are challenging to manage in primary care. This paper aims to evaluate the effectiveness of a patient-centred medical home (PCMH) model for improving clinical outcomes in high risk patients in Sydney, Australia. Methods: A cohort study design with a comparison group and a case-series study design were used to evaluate ‘between-group’ and ‘within-group’ effectiveness of a 12-month PCMH treatment called ‘WellNet’ delivered across several general practices in Sydney, Australia. The intervention group consists of 636 eligible participants who had been diagnosed with one or more chronic diseases and/or one or more elevated clinical risk factors; and had a Hospital Admission Risk Profile (HARP) score of greater than 10 at study enrolment between October 2016 and October 2017. The comparison group consists of 7750 randomly selected and well-matched patients receiving usual general practice (GP) care at four geographically comparable general practices in Sydney. Data collected from the general practices include socio-demographics; clinical measures; and self-completed health surveys. Outcomes include 12-month changes in clinical outcomes and patient reported general and disease-specific health assessments. Paired sample t-test and independent samples t-test will be used to determine significant ‘within-group’ and ‘between-group’ differences respectively. In addition, analysis of covariance (ANCOVA) and repeated measures ANCOVA will be used to determine any differences in the clinical measures and assessments after adjusting for covariates such as age, gender and baseline values. Discussion: To our knowledge, the WellNet study is the first study in Australia to generate evidence on the feasibility of recruitment, retention, and adherence into, as well as effectiveness of a comprehensive PCMH model using GP-based data. Baseline findings show that mean age of the study participants was 70.05 years with nearly even gender distribution of males and females. The most prevalent chronic diseases in descending order were: circulatory system disorders (69.8%), diabetes (47.4%), musculoskeletal disorders (43.5%), respiratory diseases (28.7%), mental illness (18.8%), and cancer (13.6%). Findings of this study may be beneficial to both patients and providers in terms of improved health outcomes, shared-decision making, and increased satisfaction in delivery of care respectively.

Background: Unintended pregnancy rates are substantially higher in developing regions, have significant health consequences, and disproportionately affect subgroups with socio-economic disadvantage. We aimed to examine if husband’s education is associated with their wife’s unintended pregnancy in southern Ethiopia. Methods: The data source for this study was from a cross-sectional study on iron-folate supplementation and compliance in Wolaita, South Ethiopia. Data were collected from 627 married pregnant women regarding their husband’s educational status, socio-demographic characteristics and if they wanted to become pregnant at the time of survey using an interviewer administered questionnaire. Odds Ratios (ORs) with associated z-tests and 95% confidence intervals and logistic regression analyses were used to identify variables associated with unintended pregnancy. Results: The proportion of unintended pregnancy was 20.6% in this study with husband’s educational status, age, residence, and using family planning methods predictive of unintended pregnancy (all P-values

Impaired physical capacity is common in people with severe levels of obesity. We aimed to investigate changes in physical capacity outcomes in patients with severe obesity following 12 months of physician-led multidisciplinary care from a "real world" Australian public hospital setting using a case series study design. We extracted data from medical records for all of the eligible patients referred to our clinical obesity service from 2010 to 2015 (69 of 239). We found significant (P < .05) pre-test/post-test (mean ± SD) improvements in the 6-minute walk test (6MWT) (339 ± 120 to 417 ± 112 m); 30-second sit-to-stand test (11 ± 4 to 15 ± 6 counts) and sit-and-reach test (-12 ± 13 to -8 ± 15 cm). Using linear mixed-effects models adjusting for repeated measurements over time (baseline vs 12 months) and testing for potential predictors, we found: mean 6MWT was associated with 12-month time period (56 m), body mass index (BMI, -3 m), no walking aid over 12 months (106 m) and no opioid analgesics (75 m); mean sit-to-stand was associated with 12-month time period (3 counts), age at referral (-0.2 counts), BMI (-0.2 counts), and diabetes (3 counts); and mean sit-and-reach was associated with 12-month time period (5 cm), female gender (5 cm) and total medications (-0.9 cm). Using causal mediation analysis, our results show that total exercise classes partially mediates change in walking capacity among those with cardiovascular disease. Our study shows that significant and clinically important improvements in physical capacity outcomes in patients with severe obesity can be achieved following 12 months of intensive specialist obesity services, such as ours.

Objectives To determine the longitudinal relationship of muscle mass and strength with incident type 2 diabetes, and previously unstudied mediating effects of testosterone and inflammation. Methods Community-dwelling male participants (aged ≥ 35 years) of the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study underwent biomedical assessment in 2002–2006 and 2007–2010, including hand grip strength (dynamometer), testosterone and inflammatory markers. Body composition (dual-energy X-ray absorptiometry) was assessed at baseline only. Incident type 2 diabetes was defined as a self-reported doctor diagnosis, diabetes medication use, fasting plasma glucose ≥ 7.0 mmol/L, or glycated haemoglobin ≥ 6.5% (48 mmol/mol) at follow-up, that was not present at baseline. Results Of n = 1632 men, incident type 2 diabetes occurred in 146 (8.9%). Muscle mass was not associated with incident type 2 diabetes. Grip strength was inversely associated with incident type 2 diabetes [unadjusted odds ratio (OR) per 5 kg: 0.87, 95% confidence interval (CI): 0.80–0.95; adjusted OR, 95% CI: 0.87, 0.78–0.97]. Arm muscle quality (grip strength divided by arm lean mass) was similarly associated with incident type 2 diabetes. Testosterone, IL-6 and TNF-α did not significantly mediate the associations. The population attributable fraction of type 2 diabetes from low grip strength was 27% (13–40%), assuming intervention could increase strength by 25%. Conclusions Reduced muscle strength, but not reduced muscle mass, is a risk factor for incident type 2 diabetes in men. This is not mediated by testosterone or inflammation. Intervention could prevent a substantial proportion of disease.

OBJECTIVE This prospective cohort study sought to examine key biological measures linking depressive symptoms with Type 2 diabetes, specifically inflammation, microvascular dysfunction, and androgens. METHODS A cohort of 688 men without diabetes who were 35 years or older were followed up for 5 years. Venous interleukin-6, high-sensitivity C-reactive protein, sE-selectin, endogenous total testosterone, fasting glucose, and glycated hemoglobin (HbA1c) were quantified at baseline and 5 years later. Depressive symptoms were assessed using the Beck Depression Inventory-I, and men were categorized into persistent, remitted, incident, and nondepressed groups (reference). Logistic regression was used to determine odds ratios (ORs) for diabetes adjusted for propensity score calculated from 18 established risk factors. RESULTS Diabetes developed in 112 men (16.3% of sample). Persistent depressive symptoms were associated with diabetes (adjusted OR = 2.45, 95% confidence interval [CI] = 1.16-5.20, p = .019). Baseline testosterone (OR = 0.43, 95% CI = 0.22-0.81, p = .01) and follow-up testosterone (OR = 0.51, 95% CI = 0.31-0.84, p = .008) were inversely associated with Type 2 diabetes. Annualized HbA1c was positively associated with annualized change in cognitive Beck Depression Inventory symptoms (β = 0.14, p = .001) and inversely associated with annualized change in testosterone (β = -0.10, p = .014). Annualized change in fasting glucose was associated with sE-selectin (β = 0.12, p < .001) and somatic depressive symptoms (β = -0.12, p = .002). CONCLUSIONS The findings suggest that lower endogenous total testosterone levels and persistent depressive symptoms were associated with Type 2 diabetes risk and HbA1c in men over a 5-year period.

We aimed to develop an expert consensus on standardizing data collections in specialist obesity management clinics in Australia. A panel of 16 experts participated in a structured consensus-driven Delphi process to reach agreement on a minimum set of baseline patient data collections for consideration in specialist obesity services. The panel included surgeons, clinicians, allied health professionals (dietician, exercise physiologist, psychologist), a bariatric nurse and obesity researchers. We produced a recommended list of core and useful data items that should comprise the baseline patient data set. Consensus was achieved for recommended measures of demographic, anthropometric, biochemical, weight-loss history, medication, medical history and comorbidity data items using a 70% agreement threshold. In this iterative process, there was also consideration of specific data items for patients referred for bariatric surgery. We present the first expert panel consensus on recommendations for a minimum and standard set of baseline patient data collections in obesity management services in Australia. These may be relevant to other countries with similar obesity management service models. Implementation of these recommendations should facilitate data pooling for clinical audits and research collaborations across clinics seeking to improve the quality of specialist obesity care.

© 2019 The Author(s). Background: There has been a recent growth in research addressing mental health nurses' routine physical healthcare knowledge and attitudes. We aimed to systematically review the empirical evidence about i) mental health nurses' knowledge, attitudes, and experiences of physical healthcare for mental health patients, and ii) the effectiveness of any interventions to improve these aspects of their work. Methods: Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple electronic databases were searched using comprehensive terms. Inclusion criteria: English language papers recounting empirical studies about: I) mental health nurses' routine physical healthcare-related knowledge, skills, experience, attitudes, or training needs; and ii) the effectiveness of interventions to improve any outcome related to mental health nurses' delivery of routine physical health care for mental health patients. Effect sizes from intervention studies were extracted or calculated where there was sufficient information. An integrative, narrative synthesis of study findings was conducted. Results: Fifty-one papers covering studies from 41 unique samples including 7549 mental health nurses in 14 countries met inclusion criteria. Forty-two (82.4%) papers were published since 2010. Eleven were intervention studies; 40 were cross-sectional. Observational and qualitative studies were generally of good quality and establish a baseline picture of the issue. Intervention studies were prone to bias due to lack of randomisation and control groups but produced some large effect sizes for targeted education innovations. Comparisons of international data from studies using the Physical Health Attitudes Scale for Mental Health Nursing revealed differences across the world which may have implications for different models of student nurse preparation. Conclusions: Mental health nurses' ability and increasing enthusiasm for routine physical healthcare has been highlighted in recent years. Contemporary literature provides a base for future research which must now concentrate on determining the effectiveness of nurse preparation for providing physical health care for people with mental disorder, determining the appropriate content for such preparation, and evaluating the effectiveness both in terms of nurse and patient-related outcomes. At the same time, developments are needed which are congruent with the needs and wants of patients.

Background: Low circulating testosterone is associated with an increased risk of developing type 2 diabetes (T2DM) in overweight men with impaired glucose tolerance (IGT). Aims: To determine in a multi-centre, double-blinded placebo-controlled randomized trial whether testosterone treatment combined with lifestyle intervention (Weight Watchers) relative to lifestyle intervention alone reduces T2DM incidence and improves glucose tolerance at 2 years. Study population: Overweight or obese men aged 50-74 years with a serum testosterone of ≤14 nmol/L and IGT or newly diagnosed T2DM established by an oral glucose tolerance test (OGTT). Setting, drug and protocol: Six Australian capital city-based tertiary care centres. Participants were randomized 1:1 and injected with testosterone undecanoate (1000 mg/4 mL) or vehicle (4 mL castor oil), at baseline, 6 weeks and 3-monthly thereafter. Primary endpoints: (a) Proportion of participants with 2-hour OGTT ≥11.1 mmol/L at 2 years, and (b) a difference at 2 years ≥0.6 mmol/L in the mean 2-hour OGTT glucose between treatments. Secondary endpoints: Fasting insulin, HbA1c, body composition, maximal handgrip strength; sexual function and lower urinary tract symptoms; serum sex steroids and sex hormone binding globulin; mood and psychosocial function; adherence to lifestyle intervention; and healthcare utilization and costs. Safety: Overseen by an Independent Data Safety Monitoring Committee. Haematocrit, lipids and prostate-specific antigen (PSA) are assessed 6-monthly and information relating to haematological, urological and cardiovascular adverse events from each clinic visit. Sub-studies: (a) Changes in bone density and micro-architecture, (b) motivation and behaviour, (c) telomere length, (d) extended treatment up to 4 years, and (e) hypothalamo-pituitary testicular axis recovery at treatment end.

(1) Background: In clinical trials, dietary magnesium use can improve insomnia symptoms. However, little is known about the association between dietary magnesium consumption and sleep disorder symptoms including daytime falling asleep, sleepiness and snoring at the population level. (2) Methods: We used data from 1487 adults aged 20 and above attending the Jiangsu Nutrition Study. At baseline in 2002, dietary magnesium was assessed by 3-day weighed food records. At follow-up in 2007, sleep disorder symptoms, including daytime falling asleep, sleepiness and snoring at night, were gathered using a sleep questionnaire. (3) Results: The mean intake of magnesium was 332.5 mg/day. In total, 5.3%, 13.2% and 35.7% of the subjects reported daytime falling asleep, daytime sleepiness, and snoring during sleep, respectively. Compared with the lowest quartile of magnesium intake, the highest quartile was associated with decreased likelihood of falling asleep (odds ratio (OR) 0.12 (0.02, 0.57)) in women but not in men after adjusting for demographic, anthropometric, lifestyle factors, hypertension, and overall dietary patterns. No associations were found between dietary magnesium intake and daytime sleepiness nor night snoring in either gender. (4) Conclusions: Dietary magnesium intake may have long-term benefits in reducing the likelihood of daytime falling asleep in women.

Background Despite the growing evidence base supporting intensive lifestyle and medical treatments for severe obesity, patient engagement in specialist obesity services is difficult to achieve and poorly understood. To address this knowledge gap, we aimed to develop a model for predicting non-completion of a specialist multidisciplinary service for clinically severe obesity, termed the Metabolic Rehabilitation Programme (MRP). Method Using a case-control study design in a public hospital setting, we extracted data from medical records for all eligible patients with a body mass index (BMI) of ≥35 kg/m2 with either type 2 diabetes or fatty liver disease referred to the MRP from 2010 through 2015. Non-completion status (case definition) was coded for patients whom started but dropped-out of the MRP within 12 months. Using multivariable logistic regression, we tested the following baseline predictors hypothesised in previous research: age, gender, BMI, waist circumference, residential distance from the clinic, blood pressure, obstructive sleep apnoea (OSA), current continuous positive airway pressure (CPAP) therapy, current depression/anxiety, diabetes status, and medications. We used receiver operating characteristics and area under the curve to test the performance of models. Results Out of the 219 eligible patient records, 78 (35.6%) non-completion cases were identified. Significant differences between non-completers versus completers were: age (47.1 versus 54.5 years, p p = 0.018); obstructive sleep apnoea (OSA) (42.9% versus 56.7%, p = 0.050) and CPAP therapy (11.7% versus 28.4%, p = 0.005). The probability of non-completion could be independently associated with age, residential distance, and either OSA or CPAP. There was no statistically significant difference in performance between the alternate models (69.5% versus 66.4%, p = 0.57). Conclusions Non-completion of intensive specialist obesity management services is most common among younger patients, with fewer complex care needs, and those living further away from the clinic. Clinicians should be aware of these potential risk factors for dropping out early when managing outpatients with severe obesity, whereas policy makers might consider strategies for increasing access to specialist obesity management services.

Objectives We sought to determine whether screening for anxiety and depression, an emerging risk factor for type 2 diabetes (T2D), adds clinically meaningful information beyond current T2D risk assessment tools. Design Prospective cohort. Participants and setting The 45 and Up Study is a large-scale prospective cohort of men and women aged 45 years and over, randomly sampled from the general population of New South Wales, Australia. 51 588 participants without self-reported diabetes at baseline (2006–2009) were followed up for approximately 3 years (2010). Methods T2D status was determined by self-reported doctor who diagnosed diabetes after the age of 30 years, and/or current use of metformin. Current symptoms of anxiety and/or depression were measured by the 10-item Kessler Psychological Distress Scale (K10). We determined the optimal cut-off point for K10 for predicting T2D using Tjur’s R2 and tested risk models with and without the K10 using logistic regression. We assessed performance measures for the incremental value of the K10 using the area under the receiver operating characteristic (AROC), net reclassification improvement (NRI) and net benefit (NB) decision analytics with sensitivity analyses. Results T2D developed in 1076 individuals (52.4% men). A K10 score of ≥19 (prevalence 8.97%), adjusted for age and gender, was optimal for predicting incident T2D (sensitivity 77%, specificity 53% and positive predictive value 3%; OR 1.70 (95% CI 1.41 to 2.03, P

ObjectivesWe examine the extent to which the adult Australian population on lipid-lowering medications receives the level of high-density lipoprotein cholesterol (HDL-C) testing recommended by national guidelines.DataWe analysed records from 7 years (2008–2014) of the 10% publicly available sample of deidentified, individual level, linked Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) electronic databases of Australia.MethodsThe PBS data were used to identify individuals on stable prescriptions of lipid-lowering treatment. The MBS data were used to estimate the annual frequency of HDL-C testing. We developed a methodology to address the issue of ‘episode coning’ in the MBS data, which causes an undercounting of pathology tests. We used a published figure on the proportion of unreported HDL-C tests to correct for the undercounting and estimate the probability that an HDL-C test was performed. We judged appropriateness of testing frequency by comparing the HDL-C testing rate to guidelines’ recommendations of annual testing for people at high risk for cardiovascular disease.ResultsWe estimated that approximately 49% of the population on stable lipid-lowering treatment did not receive any HDL-C test in a given year. We also found that approximately 19% of the same population received two or more HDL-C tests within the year. These levels of underutilisation and overutilisation have been changing at an average rate of 2% and −4% a year, respectively, since 2009. The yearly expenditure associated with test overutilisation was approximately $A4.3 million during the study period, while the cost averted because of test underutilisation was approximately $A11.3 million a year.ConclusionsWe found that approximately half of Australians on stable lipid-lowering treatment may be having fewer HDL-C testing than recommended by national guidelines, while nearly one-fifth are having more tests than recommended.

Background: Studies have consistently shown that risk of type 2 diabetes (T2D) is positively associated with dietary haem iron intake and inversely associated with dietary magnesium intake in a dose-response way. However, interaction effects of these two clinically important nutrients on T2DM risk in a prospective setting is unknown. Objective: To determine the five-year risk of developing impaired fasting glucose (IFG) associated with dietary magnesium-to-iron intake ratios (Mg/Fe), including Mg/total Fe, Mg/haem-Fe and Mg/non-haem Fe. Design: A cohort study of 1056 participants recruited into the Jiangsu Nutrition Study (JIN) from 2002 to 2007, aged at least 20 years and without known diabetes and IFG at baseline were followed up for five years. Dietary magnesium and iron intake at baseline was assessed by 3-day weighed food records. Fasting plasma glucose was measured both at baseline and follow up. Logistic regression models were performed to determine the associations between quartiles (using bottom quartiles as referent categories) of magnesium to iron (including total Fe, haem-Fe and non-haem Fe) ratio and the risk of IFG (>5.6 mmol/L) adjusted for covariates: age, gender, body mass index (BMI), hypertension, serum ferritin, haemoglobin and family history of diabetes. Results: The mean (SD) intake of total Fe and magnesium was 25.0 (9.2) mg/d and 323 (125) mg/d. The incidence of IFG during 5-year follow up was 11.8%. Inverse associations were found between quartiles (Q) of Mg/haem-Fe and the risk of IFG in the fully adjusted model: odds ratios (OR) were 1.00, 0.59 (95%CI 0.35, 0.98), 0.49 (95%CI 0.28, 0.84), and 0.28 (95% CI 0.14, 0.55) (Q4), respectively. Weaker associations were found for quartiles of Mg/total Fe and no association was found between Mg/non-haem Fe and IFG risk. Conclusions: Low Mg/haem-Fe ratio is an independent risk factor for developing IFG in Chinese adults. Future research to determine the added predictive value of assessment of low dietary Mg/haem-Fe ratio beyond current T2D risk models in specific populations is justified. Keywords: Dietary magnesium, Iron intake, Haem-Fe, Type 2 diabetes mellitus, Impaired fasting glucose, Chinese adults

Audience response system (ARS) technology is a recent innovation that is increasingly being used by health educators to improve learning outcomes. Equivocal results from previous systematic review research provide weak support for the use of ARS for improving learning outcomes at both short and long terms. This review sought to update and critically review the body of controlled experimental evidence on the use of ARS technology on learning outcomes in health students and professionals.This review searched using all identified keywords both electronic databases (CINAHL, Embase, ERIC, Medline, Science Direct, Scopus, and Web of Science) and reference lists of retrieved articles to find relevant published studies for review, from 2010 to April 2014. A descriptive synthesis of important study characteristics and effect estimates for learning outcomes was done.Three controlled trials in 321 participants from the United States were included for review. ARS knowledge retention scores were lower than the control group in one study, higher than control group provided that immediate feedback was given about each question in one study, and equivalent between intervention and control groups in another study.There is an absence of good quality evidence on effectiveness of ARS technologies for improving learning outcomes in health students and professionals.

Introduction. Obesity and diabetes are difficult to treat in public clinics. We sought to determine the effectiveness of the Metabolic Rehabilitation Program (MRP) in achieving long-term weight loss and improving glycaemic control versus “best practice” diabetes clinic (DC) in obese patients using a retrospective cohort study.Methods. Patients with diabetes and BMI > 30 kg/m2who attended the MRP, which consisted of supervised exercise and intense allied health integration, or the DC were selected. Primary outcomes were improvements in weight and glycaemia with secondary outcomes of improvements in blood pressure and lipid profile at 12 and 30 months.Results. Baseline characteristics of both cohorts (40 MRP and 40 DC patients) were similar at baseline other than age (63 in MRP versus 68 years in DC,P=0.002). At 12 months, MRP patients lost 7.65 ± 1.74 kg versus 1.76 ± 2.60 kg in the DC group (P<0.0001) and 9.70 ± 2.13 kg versus 0.98 ± 2.65 kg at 30 months (P<0.0001). Similarly, MRP patients had significant absolute reductions in %HbA1c at 30 months versus the DC group (−0.86 ± 0.31% versus 0.12% ± 0.33%,P<0.038), with nonsignificant improvements in lipids and blood pressure in MRP patients.Conclusion. Further research is needed to establish the MRP as an effective strategy for achieving sustained weight loss and improving glycaemic control in obese patients with type 2 diabetes.

The purpose of this study was to assess the safety and efficacy of progressive resistance training (PRT) in breast cancer. Randomized controlled trials (RCTs) published to November 2013 that reported on the effects of PRT (>6 weeks) on breast cancer-related lymphedema (BCRL) (incidence/exacerbation, arm volume, and symptom severity), physical functioning (upper and lower body muscular strength), and health-related quality of life (HRQoL) in breast cancer patients were included. Of 446 citations retrieved, 15 RCTs in 1,652 patients were included and yielded five studies on BCRL incidence/exacerbation (N = 647), four studies on arm volume (N = 384) and BCRL symptom severity (N = 479), 11 studies on upper body muscular strength (N = 1,252), nine studies on lower body muscular strength (N = 1,079), and seven studies on HRQoL (N = 823). PRT reduced the risk of BCRL versus control conditions [OR = 0.53 (95 % CI 0.31–0.90); I 2 = 0 %] and did not worsen arm volume or symptom severity (both SMD = −0.07). PRT significantly improved upper [SMD = 0.57 (95 % CI 0.37–0.76); I 2 = 58.4 %] and lower body muscular strength [SMD = 0.48 (95 % CI 0.30–0.67); I 2 = 46.7 %] but not HRQoL [SMD = 0.17 (95 % CI −0.03 to 0.38); I 2 = 47.0 %]. The effect of PRT on HRQoL became significant in our sensitivity analysis when two studies conducted during adjuvant chemotherapy [SMD = 0.30 (95 % CI 0.04–0.55), I 2 = 37.0 %] were excluded. These data indicate that PRT improves physical functioning and reduces the risk of BCRL. Clinical practice guidelines should be updated to inform clinicians on the benefits of PRT in this cohort.

Introduction The progress and determinants of sexual dysfunction in middle‐aged and elderly men remain unclear. Aim To describe the incidence or remission and biopsychosocial predictors of erectile dysfunction (ED) and low sexual desire (SD). Main Outcome Measures Erectile function (International Index of Erectile Function) and sexual desire (Sexual Desire Inventory 2) were assessed at follow‐up. Sociodemographic, lifestyle, and health‐related factors were examined in multivariate models of ED and low SD. Methods Data were collected from 810 randomly selected men residing in northern and western Adelaide, Australia, and aged 35–80 years at baseline, who made clinic visits 5 years apart. Results At baseline, 23.2% (n = 123) of men had ED. ED incidence and remission were observed in 31.7% (n = 179) and 29.0% (n = 71) of eligible men, respectively. At baseline, 19.2% (n = 165) had low solitary sexual desire, and 6.0% (n = 50) had low dyadic sexual desire; incidence of low sexual desire occurred in 17.6% (n = 83) (solitary) and 8.3% (n = 51) (dyadic), while remission occurred in 15.4% (n = 68) (solitary) and 22.6% (n = 40) (dyadic) of men. In the final regression models, predictors of incident ED were higher age, lower income, higher abdominal fat mass, low alcohol intake, higher risk of obstructive sleep apnea (OSA) risk, voiding lower urinary tract symptoms (LUTS), depression, and diabetes. Predictors of ED remission were lower age, current employment, and absence of voiding LUTS, angina, diabetes, and dyslipidemia. Predictors of low dyadic SD incidence included higher age, never having been married, widowhood, being unemployed, being retired, insufficient physical activity, and low alcohol intake. Predictors of low dyadic SD remission were being married, not being widowed, higher income, lower abdominal fat mass, lower OSA risk, and higher plasma testosterone. Predictors of low solitary SD included never having been married, being unemployed, low alcohol intake, lower testosterone, storage LUTS, and hypertension. Predictors of low solitary SD remission were being married, being employed, higher income, higher physical activity, moderate alcohol intake, and depression. Conclusions Sexual dysfunction in aging men is a dynamic disorder whose incidence and remission are predicted by a range of modifiable risk factors. Martin SA, Atlantis E, Lange K, Taylor AW, O'Loughlin P, Wittert GA, and members of the Florey Adelaide Male Ageing Study (FAMAS). Predictors of sexual dysfunction incidence and remission in men. J Sex Med 2014;11:1136–1147.

Hysterectomy is one of the commonest operative procedures in the developed world, mostly occurring among premenopausal women, with contradictory results regarding post-operative psychological wellbeing. This review aims to inform practice by examining whether hysterectomy predicts depression or anxiety outcomes. We searched PubMed, EMBASE, and PsycINFO electronic databases for articles published before November 2012. Reference lists of relevant articles were hand searched, and expert opinions were sought. Refereed studies investigating an association between hysterectomy for benign (non-cancerous) conditions and post-operative symptoms of depression or anxiety were chosen for this review. Two authors independently abstracted data from original articles. Authors of relevant studies were contacted for data that could not be extracted from the published articles. Review Manager 5.1 was used throughout the meta-analysis to calculate the summary relative risks (RRs), and the weighted standardized mean difference (WstdMD), and their corresponding 95% confidence intervals (CI). A random effects model was used in data analysis and verified using a fixed effect model. Overall, hysterectomy was associated with a decreased risk of clinically relevant depression (RR=1.69, 95% CI 1.19-2.38). Additionally, hysterectomy was associated with a decrease in standardized depression outcomes (standardized mean difference (SMD) 0.38 (95% CI 0.27-0.49)). Conversely, there was no significant association between hysterectomy and risk of clinically relevant anxiety (RR=1.41, 95% CI 0.72-2.75). In conclusion, data from before and after studies suggest that hysterectomy for benign gynecological conditions is not adversely associated with anxiety and may be positively rather than adversely associated with depression.

Background The longitudinal associations between depression or anxiety and COPD, and their comorbid effect on prognosis, have not been adequately addressed by previous reviews. We aimed to systematically assess these associations to inform guidelines and practice. Methods We searched electronic databases for articles published before May 2012. Longitudinal studies in adult populations that reported an association between clinically relevant depression or anxiety and COPD, or that reported their comorbid effect on exacerbation and/or mortality, were eligible. Risk ratios (RRs) were pooled across studies using random-effects models and were verified using fixed-effects models. Heterogeneity was explored with subgroup and metaregression analyses. Results Twenty-two citations yielded 16 studies on depression or anxiety as predictors of COPD outcomes (incident COPD/chronic lung disease or exacerbation) and/or mortality, in 28,759 participants followed for 1 to 8 years, and six studies on COPD as a predictor of depression in 7,439,159 participants followed for 1 to 35 years. Depression or anxiety consistently increased the risk of COPD outcomes (RR, 1.43; 95% CI, 1.22-1.68), particularly in higher-quality studies and in people aged ≤ 66 years. Comorbid depression increased the risk of mortality (RR, 1.83; 95% CI, 1.00-3.36), particularly in men. Anxiety (or psychologic distress) increased the risk of COPD outcomes/mortality in most studies (RR, 1.27; 95% CI, 1.02-1.58). Finally, COPD consistently increased the risk of depression (RR, 1.69; 95% CI, 1.45-1.96). Conclusions Depression and anxiety adversely affect prognosis in COPD, conferring an increased risk of exacerbation and possibly death. Conversely, COPD increases the risk of developing depression. These bidirectional associations suggest potential usefulness of screening for these disease combinations to direct timely therapeutic intervention.

The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study was established in 2009 to investigate the associations of sex steroids, inflammation, environmental and psychosocial factors with cardio-metabolic disease risk in men. The study population consists of 2569 men from the harmonisation of two studies: all participants of the Florey Adelaide Male Ageing Study (FAMAS) and eligible male participants of the North West Adelaide Health Study (NWAHS). The cohort has so far participated in three stages of the MAILES Study: MAILES1 (FAMAS Wave 1, from 2002–2005, and NWAHS Wave 2, from 2004–2006); MAILES2 (FAMAS Wave 2, from 2007–2010, and NWAHS Wave 3, from 2008–2010); and MAILES3 (a computer-assisted telephone interview (CATI) survey of all participants in the study, conducted in 2010). Data have been collected on a comprehensive range of physical, psychosocial and demographic issues relating to a number of chronic conditions (including cardiovascular disease, diabetes, arthritis and mental health) and health-related risk factors (including obesity, blood pressure, smoking, diet, alcohol intake and inflammatory markers), as well as on current and past health status and medication. Initial approaches or enquiries regarding the study can be made to either the principal investigator (gary.wittert@adelaide.edu.au) or the project coordinator (sean.martin@adelaide.edu.au).

The population of Aotearoa, New Zealand, has changed significantly since the signing of the Treaty of Waitangi between the indigenous people, Māori, and the British Crown in 1840. Several waves of immigration by Polynesians from various Pacific Islands since the 1960s and from Asia since the 1980s, along with migration by Māori into cities, have exposed these populations to Westernisation with resultant increases in obesity and type 2 diabetes. Since the early studies in the 1960s, Māori and Pacific peoples have been shown to experience two- to fourfold rates of type 2 diabetes as European New Zealanders, an excess now shown in Asian New Zealanders. Overall, Māori and the Pacific people have poorer blood glucose, blood pressure and blood lipid control with their diabetes. Associated with these are substantially higher rates of end-stage renal disease (with, e.g. up to 25-fold need renal replacement therapy among Māori), diabetic eye disease (including blindness), amputation and cardiovascular disease. Significant investment is clearly required into well-organised approaches that will reduce the incidence of type 2 diabetes, improve metabolic control and reduce the very high rates of diabetes complications that are now being seen.

Background Effective prevention of type 2 diabetes (T2D) requires early identification of high-risk individuals who might benefit from intervention. We sought to determine whether low serum testosterone, a novel risk factor for T2D in men, adds clinically meaningful information beyond current T2D risk models. Methods The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study population consists of 2563 community-dwelling men aged 35–80 years in Adelaide, Australia. Of the MAILES participants, 2038 (80.0 %) provided information at baseline (2002–2006) and follow-up (2007–2010). After excluding participants with diabetes (n = 317), underweight (n = 5), and unknown BMI status (n = 11) at baseline; and unknown diabetes status (n = 50) at follow-up; 1655 participants were followed for 5 years. T2D at baseline and follow-up was defined by self-reported diabetes, or fasting plasma glucose (FPG) ≥7.0 mmol/L (126.1 mg/dL), or glycated haemoglobin (HbA1c) ≥6.5 %, or diabetes medications. Risk models were tested using logistic regression models. Sensitivity, specificity, positive predictive values (PPV) were used to identify the optimal cut-off point for low serum testosterone for incident T2D and the area under the receiver operating characteristic (AROC) curve was used to summarise the predictive power of the model. 15.5 % of men had at least one missing predictor variable; addressed through multiple imputation. Results The incidence rate of T2D was 8.9 % (147/1655) over a median follow-up of 4.95 years (interquartile range: 4.35-5.00). Serum testosterone level predicted incident T2D (relative risk 0.96 [95 % CI: 0.92,1.00], P = 0.032) independent of current risk models including the AUSDRISK, but did not improve corresponding AROC statistics. A cut-off point of