Suicide prevention training in Aboriginal and Torres Strait Islander communities is a national health priority in Australia.
This paper describes a qualitative study to increase understanding of how ...a mobile application (app) could be used to support suicide prevention gatekeepers in Indigenous communities. We respectfully use the term Indigenous to refer to Australian peoples of Aboriginal and/or Torres Strait Islander descent.
Two participatory design workshops were held with 12 participants who were either Indigenous health workers or community members. The workshops first explored what knowledge, skills, and support suicide prevention gatekeepers in Indigenous communities may require, as well as how technology, specifically mobile apps, could be used to support these needs.
Qualitative analysis identified four themes related to perceptions of who gatekeepers are, their role requirements, technology and supporting resources, as well as broader community issues. Participants thought training programs should target key, accessible, and respected people from diverse, designated, and emergent groups in Indigenous communities to act as gatekeepers, but requested an alternative, more culturally appropriate term to ‘gatekeeper’ (e.g., responder). Training should prepare gatekeepers for multifaceted suicide prevention roles, including the identification and management of at-risk Indigenous persons, the provision of psychoeducation and ongoing support, as well as facilitate integrated care in collaboration with community services. A combination of multiple support resources was recommended, including multi-platform options in the technology (e.g., mobile applications, social media) and physical domains (e.g., wallet cards, regular meetings). Recommended app features included culturally appropriate refresher content on suicide intervention, training recall, integrated care, how to access gatekeeper peer support, and debriefing. Broader community concerns on gatekeeper support needs were also considered.
•Qualitative study explores new suicide prevention tools for Indigenous Australians.•Multi-platform technology and physical gatekeeper support resources recommended.•Key app functions include suicide intervention, refresher training, and referral.•Gatekeeper/responder selection criteria and training recommendations are provided.
Abstract
Background
Musculoskeletal conditions and physical frailty have overlapping constructs. We aimed to quantify individual contributions of musculoskeletal factors to frailty.
Methods
...Participants included 347 men and 360 women aged ≥60 yr (median ages; 70.8 (66.1–78.6) and 71.0 (65.2–77.5), respectively) from the Geelong Osteoporosis Study. Frailty was defined as ≥3, pre-frail 1–2, and robust 0, of the following; unintentional weight loss, weakness, low physical activity, exhaustion, and slowness. Measures were made of femoral neck BMD, appendicular lean mass index (ALMI, kg/m
2
) and whole-body fat mass index (FMI, kg/m
2
) by DXA (Lunar), SOS, BUA and SI at the calcaneus (Lunar Achilles Insight) and handgrip strength by dynamometers. Binary and ordinal logistic regression models and AUROC curves were used to quantify the contribution of musculoskeletal parameters to frailty. Potential confounders included anthropometry, smoking, alcohol, prior fracture, FMI, SES and comorbidities.
Results
Overall, 54(15.6%) men and 62(17.2%) women were frail. In adjusted-binary logistic models, SI, ALMI and HGS were associated with frailty in men (OR = 0.73, 95%CI 0.53–1.01; OR=0.48, 0.34–0.68; and OR = 0.11, 0.06–0.22; respectively). Muscle measures (ALMI and HGS) contributed more to this association than did bone (SI) (AUROCs 0.77, 0.85 vs 0.71, respectively). In women, only HGS was associated with frailty in adjusted models (OR = 0.30 95%CI 0.20–0.45, AUROC = 0.83). In adjusted ordinal models, similar results were observed in men; for women, HGS and ALMI were associated with frailty (ordered OR = 0.30 95%CI 0.20–0.45; OR = 0.56, 0.40–0.80, respectively).
Conclusion
Muscle deficits appeared to contribute more than bone deficits to frailty. This may have implications for identifying potential musculoskeletal targets for preventing or managing the progression of frailty.
While it is understood that body composition impacts on physical conditions, such as diabetes and cardiovascular disease, it is only now apparent that body composition might play a role in the ...genesis of common mental disorders, depression and anxiety. Sarcopenia occurs in ageing and comprises a progressive decline in muscle mass, strength and function, leading to frailty, decreased independence and poorer quality of life. This review presents an emerging body of evidence to support the hypothesis that shared pathophysiological pathways for sarcopenia and the common mental disorders constitute links between skeletal muscle and brain function. Contracting skeletal muscle secretes neurotrophic factors that are known to play a role in mood and anxiety, and have the dual role of nourishing neuronal growth and differentiation, while protecting the size and number of motor units in skeletal muscle. Furthermore, skeletal muscle activity has important immune and redox effects that impact behaviour and reduce muscle catabolism.
We aimed to identify combinations of health service use specific to each major osteoporotic fracture (MOF) site – hip, distal forearm, vertebrae and humerus – associated with recovery of ...health-related quality of life (HRQoL) 12-months post-MOF.
Patients were 4126 adults aged ≥50 years with a MOF (1657 hip, 1354 distal forearm, 681 vertebral, 434 humerus) from the International Costs and Utilities Related to Osteoporotic fractures Study (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain and the UK). HRQoL (pre-fracture and 12-months post-fracture) was measured using the EQ-5D-3L. Health service use data were collected via interviews and medical record reviews and included in-hospital care, outpatient care, supported living, community health services, and medication use. Latent class analyses were undertaken to identify different combinations of health service use (“classes”); and logistic regression to assess associations between classes and HRQoL recovery. Fracture site-specific analyses were performed using pooled data from all 10 countries.
The proportion of patients who recovered to their pre-fracture HRQoL at 12-month follow-up varied across fracture sites: 37.3%, 65.8%, 48.9% and 49.5% for hip, distal forearm, vertebrae, and humerus, respectively. We observed several site-specific classes associated with improved odds of HRQoL recovery. Generally, the combination of hospital presentations without admission; primary care center visits; use of osteoporosis-related medications; vitamin D/calcium supplementation; and non-opioid analgesic use was associated with greater likelihood of HRQoL recovery.
The identified fracture site-specific health service use pathways associated with recovery of HRQoL could potentially improve the management and health outcomes of patients treated for a MOF.
•Recovery to pre-fracture HRQoL at 12-months varies across individual fracture sites.•Distinct health service use pathways are associated with HRQoL recovery.•A one-size-fits-all approach for all fracture patients is not appropriate.
Obesity is a risk factor for cancer. However, it is not known if general adiposity, as measured by body mass index (BMI) or central adiposity e.g., waist circumference (WC) have stronger associations ...with cancer, or which anthropometric measure best predicts cancer risk. We included 79,458 men and women from the Australian and New Zealand Diabetes and Cancer Collaboration with complete data on anthropometry BMI, WC, Hip Circumference (HC), WHR, waist to height ratio (WtHR), A Body Shape Index (ABSI), linked to the Australian Cancer Database. Cox proportional hazards models assessed the association between each anthropometric marker, per standard deviation and the risk of overall, colorectal, post‐menopausal (PM) breast, prostate and obesity‐related cancers. We assessed the discriminative ability of models using Harrell's c‐statistic. All anthropometric markers were associated with overall, colorectal and obesity‐related cancers. BMI, WC and HC were associated with PM breast cancer and no significant associations were seen for prostate cancer. Strongest associations were observed for WC across all outcomes, excluding PM breast cancer for which HC was strongest. WC had greater discrimination compared to BMI for overall and colorectal cancer in men and women with c‐statistics ranging from 0.70 to 0.71. We show all anthropometric measures are associated with the overall, colorectal, PM breast and obesity‐related cancer in men and women, but not prostate cancer. WC discriminated marginally better than BMI. However, all anthropometric measures were similarly moderately predictive of cancer risk. We do not recommend one anthropometric marker over another for assessing an individuals' risk of cancer.
What's New?
The accumulation of excess fat around the abdomen is a well‐known risk factor for cardiovascular and metabolic diseases and is associated with a variety of cancers. While measures that reflect central adiposity, namely waist circumference (WC) and waist‐to‐hip ratio (WHR), are strongly associated with cardiometabolic disease risk, their ability to predict cancer risk is unclear. In this study, overall cancer risk and risk of colorectal and obesity‐related cancers were associated with multiple anthropometric measures—not only WC or WHR. An exception was prostate cancer, which was not significantly associated with any anthropometric marker.
Social disadvantage may contribute to increased prevalence of sarcopenia and obesity. This study investigated if socioeconomic factors are associated with obesity, sarcopenia, or sarcopenic obesity ...(SO), in community-dwelling older adults.
This was a cross-sectional analysis of data from the Tasmanian Older Adult Cohort study. Obesity was defined by body fat percentage (Men: ≥25%; Women: ≥35%) and sarcopenia was defined as the lowest 20% of sex-specific appendicular lean mass (ALM)/height (m2) and handgrip strength. Socioeconomic factors investigated were education (tertiary degree, secondary or no secondary school), occupation (high skilled white-collar, low skilled white-collar, or blue-collar) and residential area (advantaged or disadvantaged area). Multinomial logistic regression analyses yielding odds ratios (95% confidence intervals) were performed and adjusted for potential confounders. Mediation analysis was performed.
1099 older adults (63.0 ± 7.5 years; 51.1% women) participated. Older adults with a tertiary degree were significantly less likely to have obesity (0.68; 0.47, 0.98) and SO (0.48; 0.24, 0.94) compared with those who had no secondary schooling. No associations were found for occupation. Similarly, older adults living in advantaged areas were significantly less likely to have obesity (0.61; 0.39, 0.95). Steps per day mediated the association between residential area and body fat percentage by 51%.
Lower educational attainment, but not occupation, was associated with increased likelihood for both obesity and SO in community-dwelling older adults. Low physical activity levels in disadvantaged areas substantially contributed to higher obesity prevalence in this population. Further research is necessary to confirm whether similar associations exist in populations with greater levels of social disadvantage and to design effective community-based interventions.
•Lower education is associated with increased risk of obesity and sarcopenic obesity.•Occupation types were not associated with obesity, sarcopenia or sarcopenic obesity.•Disadvantaged area of residence is associated with increased risk of obesity.•Physical activity mediated the association of area of residence with obesity.
Abstract
Objective
Although negative back beliefs are associated with high-intensity low back pain (LBP)/disability, whether they influence incident high-intensity LBP/high disability over the ...long-term is unknown. This study aimed to investigate whether negative back beliefs were associated with developing high-intensity LBP and/or high disability over 10 years in men.
Methods
Men with no or low-intensity LBP and/or disability attending the Geelong Osteoporosis Study between 2006 and 2010 were included. Data on age, body mass index, mobility, education, back beliefs (Back Beliefs Questionnaire), LBP and disability (Graded Chronic Pain Scale) were collected between 2006 and 2010. Beliefs, LBP and disability were re-assessed in 2016–2021. Binary logistic regression was used to examine the association between negative back beliefs and incident high-intensity pain and/or high disability, adjusting for age, body mass index, mobility and education.
Results
At baseline, 705 participants (mean age 53.8 years) had no or low LBP and no or low disability; 441 (62.6%) participants completed a 10-year follow-up. Of these, 37 (8.4%) developed high-intensity pain and/or high disability. In multivariate analyses, participants with more negative back beliefs at baseline were more likely to develop high-intensity pain and/or high disability (odds ratio 1.05; 95% CI: 1.00, 1.11). Developing more negative back beliefs was also associated with incident high-intensity pain and/or high disability (odds ratio 1.20; 95% CI: 1.12, 1.30).
Conclusion
In a male community-based population, negative beliefs regarding the consequences of LBP were associated with an increased likelihood of developing high-intensity pain and/or high disability. Addressing negative back beliefs in the community may reduce the incidence of high-intensity pain and/or high disability over 10 years in men.
To derive dietary patterns and examine their longitudinal associations with sociodemographic and lifestyle factors in the Tasmanian Older Adult Cohort.
This is a corrected analysis of a retracted ...paper. We followed 1098 adults aged ≥50 years for 5 years. Dietary intake was assessed using a validated food frequency questionnaire. Baseline dietary patterns were identified using exploratory factor analysis and scores at each time point calculated using the weighted sum score method. Associations of energy-adjusted dietary pattern scores with participant characteristics were assessed using linear mixed-effects models.
The four dietary patterns identified were: fruit and vegetable (vegetables, potatoes, fruits); animal protein (poultry, red meats, fish); snack (snacks, sweets, nuts); western (meat pies, hamburgers, pizzas). Fruit and vegetable pattern scores were lower in men and current smokers at baseline. Animal protein scores were lower in older and retired people but higher in men and smokers at baseline. The sex difference in animal protein score increased over time (p = 0.012). At baseline, snack score was positively associated with age and physical activity, but lower in men and current smokers. The effect of age on snack score lessened over time (p = 0.035). Western scores were lower in older people but higher in men, current smokers and those living in disadvantaged areas at baseline. The effect of age on western score reduced over time (p = 0.001).
The higher scores for healthy and/or lower scores for unhealthy patterns in men, smokers, retirees and those experiencing social disadvantage suggest these could be target groups for interventions to improve diet quality in older adults.
Objectives
To examine associations of education and occupation with handgrip strength (HGS), lower limb strength (LLS) and appendicular lean mass (ALM).
Methods
Measures of HGS, LLS and ALM ...(dual‐energy X‐ray absorptiometry) were ascertained at baseline in 1090 adults (50‐80 years, 51% women), ~3 and 5 years. Education and occupation were self‐reported, the latter categorised as high‐skilled white collar (HSWC), low‐skilled white collar (LSWC) or blue collar. Separate general estimating equations were performed.
Results
The highest education group had greater HGS than the middle (0.33 psi) and lowest (0.48 psi) education groups, and 0.34 kg greater ALM than the lowest education group. HGS was 0.46 psi greater for HSWC than LSWC groups. Compared to LSWC groups, LLS was 5.38 and 7.08 kg greater in HSWC and blue‐collar groups. Blue‐collar and HSWC groups each had ~ 0.60‐0.80kg greater ALM than LSWC.
Conclusion
Progressive muscle loss can be prevented by targeted intervention; thus, we suggest clinical attention be directed towards specific social groups.
Previously we have demonstrated an association between maternal serum 25-hydroxyvitamin D (25(OH)D) during pregnancy and knee-heel length in offspring at birth. However, it is unknown whether ...maternal serum 25(OH)D is associated with bone measures in childhood. Thus, we aimed to examine associations between 25(OH)D at two stages of pregnancy and offspring bone measures at 11 years.
Women were recruited from a single antenatal clinic in Victoria, Australia before 16 weeks gestation and provided two serum samples to determine 25(OH)D status at recruitment and 28–32 weeks gestation. Children and their mothers were followed up at 11 years of age. Children undertook dual energy X-ray absorptiometry scans at the lumbar spine and total body.
Maternal 25(OH)D at recruitment (before 16 weeks gestation) was positively associated with the children's bone mineral content and density in boys, but not girls. In boys, a 10 nmol/L (4 ng/mL) increase in maternal 25(OH)D was associated with a median 0.5 g (95% CI 0.1,0.8) and 0.009 g/cm2 (95% CI 0.001,0.017) increase in bone mineral content and density at the spine, respectively, and a median 0.006 g/cm2 (95% CI 0.001,0.011) increase in at the total body. There was no sustained associations with 25(OH)D at the later timepoint (28–32 weeks) with any outcome.
At age 11 years, maternal 25(OH)D levels during early pregnancy, but not late were positively associated with bone measures in boys, but not girls.
•Maternal 25(OH)D in early pregnancy was associated with offspring bone measures at 11 years in a sexually dimorphic manner•Maternal 25(OH)D in early pregnancy was positively associated with bone density and content in boys, but not girls.•There were no clear maternal 25(OH)D cutpoints, though there appeared to be greater effect in those with 25(OH)D <28nmol/L
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