Healthy ageing: what role can physical activity play?
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Accidental Falls↗
Biomedical subjects
A E Bauman
Publications and source records attributed to A E Bauman.
Promoting physical activity in general practice: a controlled trial of written advice and information materials.
OBJECTIVE: To investigate the impact of a simple written prescription for physical activity given by a general practitioner and the effect of supplementing this with mailed information materials about physical activity. METHODS: A controlled trial was conducted in 27 general practices in New South Wales, Australia. Subjects were sequential routine care patients between 25 and 65 years old. Controls (n = 386) were recruited first, and intervention subjects two weeks later. Intervention subjects were randomised to receive a prescription only (n = 380) or a prescription plus a mailed booklet (n = 376). Self reported physical activity levels were measured by interview at baseline, 6-10 weeks, and seven to eight months. RESULTS: By intention to treat, the average changes in minutes of total physical activity did not differ significantly between the groups. Inactive people in the prescription plus supplementary booklet group were significantly more likely than controls to report an increase in their physical activity by at least 60 min/week after 6-10 weeks (odds ratio 1.58, 95% confidence interval 1.06 to 2.35). No significant short term improvements in self reported activity were shown in the prescription only group. In the supplemented group, the proportion reporting an increase in physical activity to 3,344 kJ/week at 6-10 weeks was not significant, and neither intervention group showed significant increases in any of the outcome measures at seven to eight months by intention to treat. Treatment received analysis showed greater improvements in intervention groups, especially the prescription plus booklet group, in which the odds of inactive people in this group reporting increased activity became significant at seven to eight months. CONCLUSIONS: A prescription for physical activity from a general practitioner, supplemented by additional written materials, can lead to modest short term improvements in self reported physical activity levels among inactive patients. A prescription alone was found not to be effective.
Adult↗
Asthma management plans: progress and problems.
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Aged↗
Retest reliability of recall measures of leisure-time physical activity in Australian adults.
BACKGROUND: Several studies have reported that short-term recall measures of physical activity participation have acceptable repeatability, but in most cases employed convenience samples and did not use optimal statistics. In this Australian study repeatability was assessed on participants recall of activity over two different time periods and over the same time period. METHODS: Two 14-day recall measures of physical activity participation were administered in two studies to randomly selected population samples of adults in Adelaide, South Australia. Intraclass correlation coefficients (ICC), 80% and 95% limits of agreement and the kappa statistic were calculated. RESULTS: For a continuous measure of energy expenditure the ICC was 0.86 using recall of the same 2-week period (N = 115), and was 0.58 for activity recalled over different 2-week period (N = 116). For categorized energy expenditure (inactive, low, Moderate and Vigorous categories), kappa was 0.76 for recall of the same period and was 0.36 for different recall periods. Similar results were observed for continuous and categorical forms of a measure of physical activity that recorded frequency of participation in vigorous and moderate activities and walking. The 80% limits of agreement were markedly smaller than 95% limits of agreement, but were still large. CONCLUSIONS: These data suggest that the variation in repeatability coefficients between recall of the same 2-week time period and activity recalled over different 2-week periods was due to actual variation in physical activity participation over different time periods, and not to poor recall or to poor measurement characteristics. The recall measures appear to have good repeatability for most respondents, but repeatability is poor for a substantial minority of the population.
Adult↗
Heat exhaustion in The Sun-Herald City to Surf fun run.
OBJECTIVE: To investigate the relationship between motivational factors and physical and biological causes of heat exhaustion in fun run entrants. DESIGN AND SETTING: Case-control study, The Sun-Herald City to Surf fun runs in Sydney in 1991 and 1992. PARTICIPANTS: There were 63,732 race entrants who completed the run and received a finishing time; 79 runners with heat exhaustion and 310 age, sex and performance matched controls were enrolled in the study. MAIN OUTCOME MEASURE: A diagnosis of heat exhaustion was made if a runner collapsed and, when first receiving medical care, had a rectal temperature of 38 degrees C or higher. RESULTS: Two readily identifiable groups of runners were at high risk of heat exhaustion--accomplished non-élite (preferred) runners and runners of good ability (Group A). The attack rate was highest among accomplished non-élite runners, but a combination of a relatively high rate and the large number of entrants in Group A runners accounted for most cases. Four major risk factors for heat exhaustion were identified: motivation to exceed previous performance targets; failure to drink fluids during the run; failure of trained runners to acclimatise for the race by training in the warmer parts of the day; and previous history of heat exhaustion. CONCLUSION: Information from this investigation will enable more effective targeting of educational prevention programs in The Sun-Herald City to Surf fun run and provide baseline data for monitoring the effectiveness of these programs to modify high risk behaviour by participants.
Adolescent↗
A comparative study of the growth of South-East Asian children in south-west Sydney born in Australia and overseas.
The height and weight of two groups of South-East Asian children between the ages of 1 and 10 years living in south-west Sydney were compared to determine the effects of environment on growth and development. One group of these children was born overseas and the other in Australia. The children who were born in Australia were found to be significantly taller (1-2%) and heavier (10%) than those born overseas. This would suggest that ecological factors including health and nutrition contribute to these differences.
Asia, Southeastern↗
Evaluation of a community-based asthma management program in a population sample of schoolchildren.
OBJECTIVE: To assess the effect of a community-based management program, incorporating both education and treatment directed at children, parents, doctors, pharmacists, community nurses and school teachers. DESIGN: The effect of this intervention in a population sample of 65 children with a wide range of morbidity due to asthma was compared with a control group of 55 children living in a different area. Both groups were re-evaluated concurrently after three and six months. MAIN OUTCOME MEASURES: Forced expiratory volume in one second (FEV1); bronchial responsiveness to histamine measured as the provoking dose causing a 20% fall in FEV1 (PD20FEV1) and as dose-response ratio (DRR); Airflometer variability; symptom frequency; and knowledge of asthma. Morbidity was measured by parents using a self-administered questionnaire and included days absent from school and unscheduled doctor or emergency room visits. RESULTS: At three months, the intervention group had a significant improvement in knowledge of asthma compared with both their baseline and the control group's change in knowledge. Also, FEV1 improved in this group and symptoms which limit activity decreased significantly. However, the largest improvements were recorded at the six-month follow up. In the intervention group, bronchial responsiveness and night cough were reduced significantly and FEV1 was improved, compared with both baseline measurements and the control group. Knowledge of asthma also improved significantly from baseline, and unscheduled doctor or emergency room visits were reduced. CONCLUSION: These improvements in this group of children, many of whom had mild asthma, verify that community-based management programs can be effective in treating childhood asthma.
Asthma↗
The cost of asthma in New South Wales.
OBJECTIVE: To determine the economic cost of asthma to the New South Wales community. DESIGN: Direct costs (both health-care and non-health-care) plus indirect costs (loss of productivity) were estimated from various sources to assess retrospectively the dollar costs of asthma. Intangible costs (such as quality of life) were not included. SETTING: Estimates of costs were made at all levels of medical care of asthma patients, including inpatient and outpatient hospitalisations, emergency department visits, and visits to general practitioners and specialist physicians, plus costs of pharmaceuticals, nebulisers and home peak-flow monitoring devices. The cost of time lost by the patient attending for medical visits and loss of productivity due to absence from employment as a result of asthma were also included. RESULTS: The total cost of asthma in New South Wales was $209 million in 1989. This was made up of $142 million in direct health-care costs, $19 million in direct non-health-care costs and $48 million in indirect costs. CONCLUSION: Although we believe that our estimate is an underestimate of the true dollar cost of this disease to the community, it represents $769 per asthmatic person per year, assuming a current prevalence rate for asthma in New South Wales of 6%. The cost effectiveness of any new treatment of asthma should be estimated to ensure that the economic cost to the community does not rise unnecessarily.
Adult↗
Ocular histoplasmosis with retinitis in a patient with acquired immune deficiency syndrome.
Disseminated histoplasmosis is one of the life-threatening opportunistic infections associated with acquired immune deficiency syndrome (AIDS). A 29-year-old man with AIDS and disseminated histoplasmosis complained of a hazy spot in the vision of his left eye. Results of examination showed distinct creamy white intraretinal and subretinal infiltrates in both eyes. The patient died within a month from pulmonary infection with Histoplasma capsulatum and cytomegalovirus. Examination with light microscopy showed that the right and left eyes contained histoplasma yeast cells in lesions of retinitis, optic neuritis, and uveitis. These lesions contained variable numbers of lymphocytes and histiocytes. Electron microscopy of the histoplasma in tissue showed characteristic features. This case illustrates the funduscopic appearance and histopathology of histoplasmic retinitis, an uncommon although important ophthalmologic complication of AIDS.
Acquired Immunodeficiency Syndrome↗
Echo Doppler assessment of cardiac output and its relation to growth in normal infants.
In a study of 38 normal infants, serial measurements of systemic (n = 169) and pulmonary (n = 143) blood flow were undertaken from the ages of 2 weeks to 12 months by 2-dimensional, M-mode and pulsed Doppler echocardiography. Cardiac output changed linearly (cardiac output = 0.3 X height -0.99 liter/min), and cardiac index was validated as a means for standardizing cardiac output in infants younger than 10 to 13 months of age. Infants younger than 2 months had lower cardiac indexes and stroke volume indexes (2.6 +/- 0.7 liters/min/m2 and 19 +/- 5 ml/m2, respectively) compared with those aged 12 months (3.2 +/- 0.7 liter/min/m2 and 25 +/- 5 ml/m2, respectively). Changes in cardiac output in individual infants over time suggest nonmorphometric modulating factors for cardiovascular function.
Age Factors↗
Epidemiology of sudden infant death syndrome in American Indians.
A 7-year retrospective study of sudden infant death syndrome in Oklahoma Indians failed to support previous observations of a markedly elevated rate among the American Indians compared with the white population. The rate of sudden infant death syndrome in Oklahoma Indians was 2.32/1,000 live births. The rates of sudden infant death syndrome among white infants (1.8/1,000) and black infants (3.11/1,000) were similar to those reported in previous studies. Males had consistently higher rates of sudden infant death syndrome regardless of race.
Black or African American↗
The use of magnetic resonance imaging in the evaluation of retinoblastoma.
We examined a 4-year-old boy who had a painful blind eye, rubeosis iridis, and leukokoria. Ultrasonography and computed tomography (CT) detected intraocular calcification and other features suggestive of retinoblastoma. The CT scan showed extraocular extension along the optic nerve. Intracranial extension of the tumor could not be definitely excluded by CT scan with intrathecal metrizamide infusion. Magnetic resonance imaging (MRI) and CT performed after radiation and chemotherapy were useful in excluding intracranial spread of malignant cells, thereby aiding the selection of a surgical approach to ensure complete removal of the involved portion of the optic nerve.
Child, Preschool↗
The sources of risk factor information for general practitioners: is physical activity under-recognised?
OBJECTIVE: To identify and compare the amount of material on physical activity and the management of smoking, hypertension and hypercholesterolaemia in medical journals and magazines frequently read by general practitioners. METHOD: Qualitative study assessing the total number of articles and advertisements to which Australian GPs are exposed in journals and medical magazines they are likely to read. RESULTS: Only 6% of articles about cardiovascular disease (CVD) risk factors in the Medline search and 5% in the medical magazine search discussed exercise prescription or how to start and maintain an exercise program. Most CVD risk factor articles were on the pharmacological treatment of hypertension (42%), followed by hypercholesterolaemia (32%) and smoking cessation (20%). A review of medical magazines found similarly ranked results, and a count of advertisements indicated 67% related to hypertension, 26% to hypercholesterolaemia and 7% to smoking cessation. CONCLUSIONS: GPs are less well informed by the medical media about physical activity than about other traditional CVD risk factors, although the epidemiological evidence for their health benefits is similar. Strategies should be developed to inform doctors about the evidence of benefits from regular moderate physical activity, and for GPs to recommend exercise in most clinical encounters.
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