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Purpose: Previous literature has demonstrated the mediating role of adiposity in the association between cardiorespiratory fitness (CRF) and cardiometabolic risk as well as the potential role of CRF in attenuating the adverse consequences associated with excess weight. This study aimed to evaluate the mediating role of CRF and adiposity in the possible association with cardiometabolic risk. Method: Observational 3-year longitudinal study that included 420 children and adolescents (10.50 [2.05] y of age at baseline; 56.2% girls). Body mass index (BMI) was calculated, and CRF was evaluated using field assessments. A clustered cardiometabolic risk score (cMetS) was calculated from glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, and triglycerides z scores. Analyses evaluated the mediating role of BMI in the association between CRF and cMetS as well as whether CRF mediated the association between BMI and cMetS. Results: BMI at baseline was directly associated with the cMetS at follow-up (0.102; 95% confidence interval, 0.020 to 0.181), independently of CRF, whereas CRF was only indirectly associated with cMetS at follow-up through BMI (−0.036; 95% confidence interval, −0.070 to −0.009), meaning that the association between CRF and cMetS was explained via the mediation role of BMI. Conclusions: BMI presented direct association with cMetS, whereas CRF exhibited indirect association with cMetS mediated via BMI. [ABSTRACT FROM AUTHOR]

Background: Understanding the relationship of social network use and addictive behaviors with adolescent psychosocial health is crucial in today's digital age. Aim: To verify the associations between social network use, messaging applications, and the addictive behaviors to social network with psychosocial health in Spanish adolescents. Methods: A cross-sectional study was developed with 632 adolescents, aged 12 to 17 years from the Region of Murcia, Spain. The assessment of social network use (Facebook, Twitter, Instagram, Snapchat, and TikTok) involved evaluating the frequency of use of each social network individually using a single-item scale with five response options. WhatsApp use (i.e., a messaging application) was evaluated in the same manner. The Short Social Networks Addiction Scale-6 Symptoms was employed to assess potential addictive behaviors to social network use. The psychosocial health was assessed using the Strengths and Difficulties Questionnaire. Generalized linear regression models were conducted, and predictive probabilities of having psychosocial health problems were calculated. Results: The predicted probability of presenting psychosocial health problems in the medium users and high users of social networks was 19.3% (95% confidence interval [CI] 13.0 to 27.7), and 16.2% (95% CI 10.2 to 24.6) higher compared to low users, respectively. High usage of Instagram, TikTok, Snapchat, and Facebook was associated with increased probabilities of psychosocial health problems, with Facebook showing the highest probabilities, at 31.3% (95% CI 14.8 to 54.2) for medium users and 51.9% (95% CI 26.5 to 76.3) for high users. Additionally, adolescents with addictive behaviors to social network use had from 19.0 to 25.2% probabilities of experiencing psychosocial health problems. Finally, the highest probabilities of having psychosocial health problems were identified in adolescents with high addictive behaviors when using social networks (28.9%; 95% CI 19.3 to 40.8%) and the lowest in those with low addictive behaviors (6.8%; 95% CI 3.3 to 13.6%). Conclusion: Adolescents who use social networks more frequently and exhibit more addictive behaviors related to their use are more likely to experience psychosocial health problems compared to those who do not. Facebook showed the strongest association, followed by Snapchat, Instagram, and TikTok. Our data also revealed that adolescents exhibit various signs of addictive behaviors to social network use. [ABSTRACT FROM AUTHOR]

To evaluate the simultaneous moderating role of sleep duration and screen time in the relationship between waist circumference (WC) and clustered cardiometabolic risk score (cMetS) according to children and adolescents' physical activity. A cross‐sectional study was conducted on 3072 children and adolescents (aged 6–17 years, 57.5% girls). Physical activity, sleep duration, and screen time were assessed through a self‐report questionnaire. The cMetS was determined by averaging the z‐scores of risk factors and dividing it by four. Moderation analyses were tested through multiple linear regression models. Among physically active individuals, sleep duration (p = 0.85) and screen time (p = 0.96) had no influence on the relationship between WC and cMetS. However, a positive interaction between WC x screen time and cMetS (p = 0.04) was observed for physically inactive participants. Concerning sleep duration, there was no interaction with WC. Participants who spent 60 min of screen time presented lower cMetS, even presenting high WC, compared to the higher tertiles of screen time (180 and 360 min). However, although the interaction between sleep duration and WC was not significant, it was observed that the lowest tertile of sleep duration (482 min) combined with 60 min of screen time presented lower cMetS even with the presence of high WC. Our findings encourage compliance with physical activity guidelines associated with the adoption of adequate screen time to minimize the influence of waist circumference on cMetS. Highlights: Sleep duration and screen time influence adiposity and cardiometabolic risk in physically inactive children and adolescents;Meeting the PA guidelines seems crucial in preventing cardiometabolic risk factors;In inactive individuals, the screen has a deleterious effect on cardiometabolic health. [ABSTRACT FROM AUTHOR]

Background: The Questionnaire on Palliative Care for Advanced Dementia (qPAD) is increasingly being used to assess residential aged care workers' knowledge and attitudes about palliative care for people with dementia. The qPAD developers performed an exploratory factor analysis and assessed the internal consistency using a small sample. Aim: The aim of this study was to further assess the structural validity of the qPAD using a large sample of qPAD responses from staff who work in residential aged care homes in Australia. Methods: Data from 727 care staff who participated in an Australian dementia palliative care training project were used for exploratory factor analyses, assessment of internal consistency, and confirmatory factor analysis of the knowledge test and attitude scale components of the qPAD. Results: The exploratory factor analysis of the knowledge test produced a four‐factor solution. One item loaded weakly, and four items had cross‐loadings. Factor labels for the knowledge test were difficult to define. Factor analysis of the attitude scale produced a three‐factor structure with good internal consistency—Feeling valued and part of the care team (α = 0.88), Family and team engagement (α = 0.75) and Perceptions and beliefs (α = 0.83). Confirmatory factor analysis indicated improvements in model fit were needed for both the knowledge test and attitude scale. Conclusion: The findings of this factor analysis differed from the original study. The attitude scale produced a three‐factor structure, but the knowledge test requires further development due to weak and cross‐loadings of several items, inadequate internal consistency of factors and poor model fit. [ABSTRACT FROM AUTHOR]

The aim of the present study was to verify whether the amount of sleep duration, screen time, and physical activity moderate the relationship between FTO rs9939609 polymorphism and waist circumference (WC) in children and adolescents. This is a cross-sectional study conducted with 1338 children and adolescents, aged between 6 and 17 years. Lifestyle habits were assessed through self-reported questionnaire. WC was measured on the narrowest part of the trunk between the last rib and the iliac crest. FTO rs9939609 polymorphism was genotyped by real time polymerase chain reaction. The PROCESS macro for the SPSS was used for moderation analyses, through multiple linear regression models. Results indicated significant interactions were found between sleep duration and screen time X FTO rs9939609, showing that these lifestyle behaviours are moderators in the relationship between a genetic predisposition for obesity and higher WC. For physical activity, there was no significant interaction. Therefore, sleeping more than 564 min a day (i.e. 9.4 h) and spending no more than 233 min in front of screen may counteract the genetic predisposition to obesity in children and adolescents. Highlights A healthy lifestyle may counteract the genetic predisposition to central obesity; Children and adolescents should sleep more than approximately 9 h (564 min) per day and spend less than approximately 4 h (233 min) per day in front of screens in order to counteract the genetic predisposition to central obesity conferred by the FTO gene variant. It is fundamental to promote actions for the adoption of a healthy lifestyle, including the importance of presenting adequate sleep habits and low screen time for a better cardiometabolic health and reduction of obesity. [ABSTRACT FROM AUTHOR]

Dietary supplements have been increasingly used by gym users and are often consumed without the guidance of a health professional. Moreover, the indiscriminate supplements use can have adverse health effects, such as changes in liver and kidney function. The aim of this study was to verify the association between dietary supplements intake with alterations in the liver and kidney function among gym users. A cross-sectional study was conducted with 594 gym users (mean age 37 (sd 14) years, 55·2 % women) from a city in southern Brazil. A questionnaire was used to evaluate the use of dietary supplements. The markers of the liver (alanine aminotransferase, aspartate aminotransferase (AST), alkaline phosphatase, γ-glutamyltransferase) and renal (creatinine and urea) function were also evaluated on a subsample of the study population. Data were analysed by binary logistic regression, adjusted for sex, age and education. The prevalence of dietary supplement intake was 36·0 %. Individuals who intake dietary supplements showed a higher prevalence to present slight alterations in the AST enzyme and in the urea after adjustments for potential confounders. In conclusion, the use of dietary supplement was associated with slight alterations in AST enzyme and in the urea among gym users. These findings show the importance of using supplements correctly, especially with guidance from professionals trained to avoid possible risks to health. [ABSTRACT FROM AUTHOR]

Introduction: Hyperuricemia is related to health issues among children and adolescents, once the uric acid concentration is associated with metabolic syndrome, hypertension, insulin resistance, obesity, and dyslipidemia. However, few studies are addressing uric acid levels and food uptake in this age group. Aim: To verify the association between food consumption and uric acid in children and adolescents. Methods: This is a cross-sectional study developed with 2335 children and adolescents of both genders aged 6–17 years old. Blood collection was performed after 12 h of fasting. Uric acid values were classified according to tertiles, in which the highest tertile was considered as hyperuricemia. Food consumption was evaluated by weekly consumption frequency questionnaire. Pearson correlation and logistic binary regressions were used for statistical analysis. Models were adjusted for age, systolic blood pressure, body mass index (BMI), and skin color/ethnicity. Results: It was found an association between red meat consumption and hyperuricemia only in boys in the crude model (OR = 1.56; 95% CI 1.12; 2.18). Also, there was an association between pasta (OR = 1.52; 95% CI 1.11; 2.10) with hyperuricemia in boys, when adjusted age, systolic blood pressure, BMI, and skin color/ethnicity. Conclusion: The knowledge of food patterns which are predisposing factors for the increase in serum uric acid levels is important for the implementation of strategies and public health policies for health promotion among children and adolescents. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the present study was to explore nurse perceptions of safety climate in acute Australian hospitals. Methods. Participants included 420 nurses who have worked on 24 acute wards from six Australian hospitals. The Safety Attitudes Questionnaire (SAQ) Short Form was used to quantify nurse perceptions of safety climate and benchmarked against international data. Generalised linear mixed models were used to explore factors that may influence safety climate. Results. On average, 53.5% of nurses held positive attitudes towards job satisfaction followed by teamwork climate (50.5%). There was variability in SAQ domain scores across hospitals. The safety climate and perceptions of hospital management domains also varied across wards within a hospital. Nurseswhohad worked longer at a hospital were more likely to have poorer perceptions of hospital management (β = -5.2; P = 0.014). Overall, nurse perceptions of safety climate appeared higher than international data. Conclusions. The perceptions of nurses working in acute Victorian and New South Wales hospitals varied between hospitals as well as across wards within each hospital. This highlights the importance of surveying all hospital wards and examining the results at the ward level when implementing strategies to improve patient safety and the culture of safety in organisations. [ABSTRACT FROM AUTHOR]

High muscular fitness (MF) and high adherence to the Southern European Atlantic Diet (the SEADiet) have been associated with several positive metabolic outcomes. The purpose of the present study was two-fold: (i) to explore the independent associations between MF and C-reactive protein (CRP) levels; and (ii) to investigate the combined impact of MF and SEADiet on the CRP levels in a sample of adolescents. A cross-sectional school-based study was conducted on 463 adolescents (272 girls) aged 15–18 years, from the Portuguese Azorean Archipelago. Anthropometric indicators (stature, body mass, waist circumference (WC)) were measured by standardized protocols and pubertal stages were assessed by Tanner criteria. Blood samples were taken after an overnight fast. MF was assessed by the curl-up and push-up tests (from the Fitnessgram test battery). Adherence to the SEADiet was assessed with a semi-quantitative food frequency questionnaire. Linear regression models showed that MF was inversely associated with hs-CRP (unstandardizedB = −0.127;p < .009), after adjustments for age, sex, and pubertal stage, adherence of SEADiet, total energy intake and low-energy reporter and WC. Analysis of covariance (ANCOVA) showed a significant difference between the low adherence of SEADiet with low MF group and those with a high adherence of SEADiet and high MF (p < .05) (F(5, 453) = 2.238,p = .040). Our results showed that MF is inversely associated with hs-CRP. In addition, the adolescents with Low adherence of SEADiet/Low MF group had high levels of hs-CRP compared those who with high adherence of SEADiet/high MF group. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility of Pilates exercise in older people to decrease falls risk and inform a larger trial. Design: Pilot Randomized controlled trial. Setting: Community physiotherapy clinic. Participants: A total of 53 community-dwelling people aged ⩾60 years (mean age, 69.3 years; age range, 61–84). Interventions: A 60-minute Pilates class incorporating best practice guidelines for exercise to prevent falls, performed twice weekly for 12 weeks. All participants received a letter to their general practitioner with falls risk information, fall and fracture prevention education and home exercises. Main outcome measure(s): Indicators of feasibility included: acceptability (recruitment, retention, intervention adherence and participant experience survey); safety (adverse events); and potential effectiveness (fall, fall injury and injurious fall rates; standing balance; lower limb strength; and flexibility) measured at 12 and 24 weeks. Results: Recruitment was achievable but control group drop-outs were high (23%). Of the 20 participants who completed the intervention, 19 (95%) attended ⩾75% of the classes and reported classes were enjoyable and would recommend them to others. The rate of fall injuries at 24 weeks was 42% lower and injurious fall rates 64% lower in the Pilates group, however, was not statistically significant (P = 0.347 and P = 0.136). Standing balance, lower-limb strength and flexibility improved in the Pilates group relative to the control group (P < 0.05). Estimates suggest a future definitive study would require 804 participants to detect a difference in fall injury rates. Conclusion: A definitive randomized controlled trial analysing the effect of Pilates in older people would be feasible and is warranted given the acceptability and potential positive effects of Pilates on fall injuries and fall risk factors. Trial Registration: The protocol for this study is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN1262000224820). [ABSTRACT FROM AUTHOR]

Background: The Safety Attitudes Questionnaire (SAQ) is commonly used to assess staff perception of safety climate within their clinical environment. The psychometric properties of the SAQ have previously been explored with confirmatory factor analysis and found to have some issues with construct validity. This study aimed to extend the psychometric evaluations of the SAQ by using Rasch analysis.Methods: Assessment of internal construct validity included overall fit to the Rasch model (unidimensionality), response formats, targeting, differential item functioning (DIF) and person-separation index (PSI).Results: A total of 420 nurses completed the SAQ (response rate 60 %). Data showed overall fit to a Rasch model of expected item functioning for interval scale measurement. The questionnaire demonstrated unidimensionality confirming the appropriateness of summing the items in each domain. Score reliabilities were appropriate (internal consistency PSI 0.6-0.8). However, participants were not using the response options on the SAQ in a consistent manner. All domains demonstrated suboptimal targeting and showed compromised score precision towards higher levels of safety climate (substantial ceiling effects).Conclusion: There was general support for the reliability of the SAQ as a measure of safety climate although it may not be able to detect small but clinically important changes in safety climate within an organisation. Further refinement of the SAQ is warranted. This may involve changing the response options and including new items to improve the overall targeting of the scale.Trial Registration: This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000332921 (21 March 2011). [ABSTRACT FROM AUTHOR]

Background: an emergency department (ED) visit is a sentinel event for an older person, with increased likelihood of adverse outcomes post-discharge including early re-presentation. Objectives: to determine factors associated with early re-presentation. Methods: prospective cohort study conducted in the ED of a large acute Melbourne tertiary hospital. Community-dwelling patients >65 years were interviewed including comprehensive assessment of cognitive and functional status, and mood. Logistic regression was used to identify risk factors for return within 30 days. Results: nine hundred and fifty-nine patients, median age 77 years, were recruited. One hundred and forty patients (14.6%) represented within 30 days, including 22 patients (2.3%) on ≥2 occasions and 75 patients (7.8%) within 7 days. Risk factors for representation included depressive symptoms, cognitive impairment, co-morbidity triaged as less urgent (ATS 4) and attendance in the previous 12 months, with a decline in risk after 85 years of age. Logistic regression identified chronic obstructive pulmonary disease (OR 1.78, 95% CI 1.02-3.11), moderate cognitive impairment (OR 2.07, 95% CI 1.09-3.90), previous ED visit (OR 2.11, 95% CI 1.43-3.12) and ATS 4 (OR 2.34, 95% CI 1.10-4.99) as independent risk factors for re-presentation. Age ≥85 years was associated with reduced risk (OR 0.81, 95% CI 0.70-0.93). Conclusion: older discharged patients had a high rate of early re-presentation. Previously identified risk factors--increased age, living alone, functional dependence and polypharmacy--were not associated with early return in this study. It is not clear whether these inconsistencies represent a change in patient case-mix or strategies implemented to reduce re-attendance. This remains an important area for future research. [ABSTRACT FROM AUTHOR]

Background: Palliative care focuses on supporting patients diagnosed with advanced, incurable disease; it is 'family centered', with the patient and their family (the unit of care) being core to all its endeavours. However, approximately 30-50 % of carers experience psychological distress which is typically under recognised and consequently not addressed. Family meetings (FM) are recommended as a means whereby health professionals, together with family carers and patients discuss psychosocial issues and plan care; however there is minimal empirical research to determine the net effect of these meetings and the resources required to implement them systematically. The aims of this study were to evaluate: (1) if family carers of hospitalised patients with advanced disease (referred to a specialist palliative care in-patient setting or palliative care consultancy service) who receive a FM report significantly lower psychological distress (primary outcome), fewer unmet needs, increased quality of life and feel more prepared for the caregiving role; (2) if patients who receive the FM experience appropriate quality of end-of-life care, as demonstrated by fewer hospital admissions, fewer emergency department presentations, fewer intensive care unit hours, less chemotherapy treatment (in last 30 days of life), and higher likelihood of death in the place of their choice and access to supportive care services; (3) the optimal time point to deliver FM and; (4) to determine the cost-benefit and resource implications of implementing FM meetings into routine practice. Methods: Cluster type trial design with two way randomization for aims 1-3 and health economic modeling and qualitative interviews with health for professionals for aim 4. Discussion: The research will determine whether FMs have positive practical and psychological impacts on the family, impacts on health service usage, and financial benefits to the health care sector. This study will also provide clear guidance on appropriate timing in the disease/care trajectory to provide a family meeting. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12615000200583 . [ABSTRACT FROM AUTHOR]

Objectives. The study aimed to develop a set of clinical indicators to minimise the risk and adverse outcomes of functional decline in older hospitalised people. Methods. Existing Australian and international clinical indicators relevant to cognition and emotional health, mobility, vigour and self care, continence, nutrition, skin integrity, person-centred care, assessment and medication management were identified by literature and electronic website review. A multidisciplinary expert advisory group used modified Delphi methods, including two anonymous voting rounds and a group discussion, to gain consensus for a prioritised set of clinical indicators. For each indicator, experts voted on a scale of 1 (low level of prioritisation) to 9 (high level of prioritisation) based on measurement attributes and utility for use at the level of clinical teams, hospital managers and jurisdictional policy makers. Results. There were 55 existing clinical indicator sets identified, from which 63 relevant indicators were extracted. The final prioritised set covered all domains and included 19 indicators of which 17 were process indicators and 2 were outcome indicators. Scores for scientific measurement attributes and practicality for implementation were only moderate. Conclusion. These clinical indicators offer a consistent basis for monitoring hospital performance and improving care of older people in Victoria and other jurisdictions. INSET: What is known about the topic?. [ABSTRACT FROM AUTHOR]

hutchinson a.f., thompson m.a., brand c.a., black j., anderson g.p. & irving l.b. (2010) Community care assessment of exacerbations of chronic obstructive pulmonary disease. Journal of Advanced Nursing 66(11), 2490-2499. Aim. The aim of this study was to develop a clinical algorithm to assess chronic obstructive pulmonary disease exacerbation severity in a community setting. Background. An important aspect of community management of exacerbations is assessing patient safety. Although researchers have investigated risk factors for rapid deterioration, there is a lack of evidence validating clinical measures of exacerbation severity. Methods. This was a prospective, community-based cohort study of patients enrolled in the Melbourne Longitudinal Chronic Obstructive Pulmonary Disease Cohort. The outreach team collected data on symptom severity at baseline and exacerbation onset using the Medical Research Council Dyspnoea Scale, St George Quality-of-Life Questionnaire and Symptom Severity Index. Results. Ninety-two patients were monitored from 2003 to 2005. There were 148 exacerbations: 121 (82%) were treated at home and 27 (17·5%) required hospitalization. An ordinal logistic regression model demonstrated that a combination of chronic obstructive pulmonary disease severity with dyspnoea and wheeze severity at exacerbation onset could differentiate severe from milder episodes [(OR 7·69, 95%CI: 3·9-11·5, P < 0·01), area under the receiver operating characteristics curve 0·75 (95%CI: 0·65-0·86)]. Conclusion. The majority of chronic obstructive pulmonary disease exacerbations can be safely managed in a community setting, but clinical assessment alone may not be sufficient to identify all patients who will develop complications such as respiratory failure. Further research is needed to validate clinical assessment and decision-making algorithms for community-management of chronic obstructive pulmonary disease exacerbations. [ABSTRACT FROM AUTHOR]