[Show abstract][Hide abstract] ABSTRACT: Background: Very few Australian infants are exclusively breastfed to 6 months as recommended by the World Health Organization. There is strong empirical evidence that fathers have a major impact on their partner's decision to breastfeed and continuation of breastfeeding. Fathers want to participate in the breastfeeding decision making process and to know how they can support their partner to achieve their breastfeeding goals. The aim of the Parent Infant Feeding Initiative (PIFI) is to evaluate the effect on duration of any and exclusive breastfeeding of three breastfeeding promotion interventions of differing intensity and duration, targeted at couples but channelled through the male partner. The study will also undertake a cost-effectiveness evaluation of the interventions. Methods/design: The PIFI study is a factorial randomised controlled trial. Participants will be mothers and their male partners attending antenatal classes at selected public and private hospitals with maternity departments in Perth, Western Australia. Fathers will be randomly allocated to either the usual care control group (CG), one of two medium intensity (MI1 and MI2) interventions, or a high intensity (HI) intervention. MI1 will include a specialised antenatal breastfeeding education session for fathers with supporting print materials. MI2 will involve the delivery of an antenatal and postnatal social support intervention delivered via a smartphone application and HI will include both the specialised antenatal class and the social support intervention. Outcome data will be collected from couples at baseline and at six and 26 weeks postnatally. A total of 1600 couples will be recruited. This takes into account a 25 % attrition rate, and will detect at least a 10 % difference in the proportion of mothers breastfeeding between any two of the groups at 26 weeks at 80 % power and 5 % level of significance, using a Log-rank survival test. Multivariable survival and logistic regression analyses will be used to assess the effect of the treatment groups on the outcomes after adjusting for covariates. Discussion: The PIFI study will be the first Australian study to provide Level II evidence of the impact on breastfeeding duration of a comprehensive, multi-level, male-partner-focused breastfeeding intervention. Unique features of the intervention include its large sample size, delivery of two of the interventions by mobile device technology, a rigorous assessment of intervention fidelity and a cost-effectiveness evaluation.
[Show abstract][Hide abstract] ABSTRACT: More than three billion people continue to rely on solid fuels as their primary source of domestic energy which is associated with elevated concentrations of indoor air pollutants and increased morbidity and mortality both in adults and children. In Myanmar, solid fuel including coal and biomass (such as dung, crop and charcoal) is the main source of energy used in households. A community-based pilot study was conducted in rural Myanmar with the aim to determine the prevalence of childhood respiratory symptoms in association with the use of biomass for cooking. A total of eighty households were recruited and monitored for exposure to particulate matter with size less than 2.5 μm in aerodynamic diameter (PM2.5) and carbon monoxide (CO). In addition, mothers were interviewed to understand their cooking habits, some house characteristics and children’s respiratory health. The study found that PM2.5 and CO were significant contributors for the prevalence of acute respiratory infections and trouble breathing among young children. House characteristics including mosquito coil, associated with children’s respiratory health. The study confirms that domestic environments in developing countries, like Myanmar, continue to have significant health impacts on children.
Indoor and Built Environment 05/2015; DOI:10.1177/1420326X15586017 · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Testosterone replacement therapy (TRT) has been investigated in older men as a preventative treatment against Alzheimer's disease and dementia. However, previous studies have been contradictory. We assessed TRT physiological effects in 44 older men (aged 61 + 7.7 years) with subjective memory complaints using a double blind, randomized, cross-over, placebo-controlled study. Participants were randomized into 2 groups, one group received transdermal testosterone (50 mg) daily for 24 weeks, followed by a 4 week wash-out period, then 24 weeks of placebo; the other group received the reverse treatment. Blood evaluation revealed significant increases in total testosterone, free (calculated) testosterone, dihydrotestosterone, and a decrease in luteinizing hormone levels (p<0.001) following TRT. Although there were significant increases in red blood cell counts, hemoglobin and prostate specific antigen levels following TRT, they remained within normal ranges. No significant differences in plasma amyloid beta, estradiol, sex hormone binding globulin, insulin levels, body fat percentage, or body mass index were detected. This is the first carefully controlled study that has investigated the influence of TRT in Indonesian men on blood biomarkers linked to dementia risk. Our study suggests TRT is safe and well-tolerated in this Indonesian cohort, yet longitudinal studies with larger cohorts are needed to assess TRT further, and to establish whether TRT reduces dementia risk.
[Show abstract][Hide abstract] ABSTRACT: Functional loss of blood-brain barrier (BBB) is suggested to be pivotal to pathogenesis and pathology of vascular-based neurodegenerative disorders such as Alzheimer's disease. We recently reported in wild-type mice maintained on standard diets, progressive deterioration of capillary function with aging concomitant with heightened neuroinflammation. However, the mice used in this study were relatively young (12 months of age) and potential mechanisms for loss of capillary integrity were not investigated per se. The current study therefore extended the previous finding to investigate the effect of aging on BBB integrity in aged mice at 24 months and its potential underlying molecular mechanisms.
Immunomicroscopy analyses confirmed significantly increased capillary permeability with heightened neuroinflammation in naturally aged 24-month old mice compared to young control at 3 months of age. Aged mice showed significant attenuation in the expression of BBB tight junction proteins, occludin-1 and to lesser extent ZO-1 compared to young mice. In addition, TNF-α in cerebral endothelial cells of aged mice was significantly elevated compared to controls and this was associated with heightened peripheral inflammation. The expression of ICAM-1 and VCAM-1 remained unelevated, and no sign of leukocyte recruitment was observed in aged mice.
The BBB breakdown that occurs during ordinary aging is associated with inflammation and disruption of tight junction complex assembly but not through leukocyte trafficking.
[Show abstract][Hide abstract] ABSTRACT: Introduction: This study examines platelet amyloid precursor protein (APP) isoform ratios of 120KDa to 110KDa (APPr) between mutation carriers (MC) carrying a mutation for autosomal dominant Alzheimer's disease (ADAD) and non-carriers (NC). Two previous studies reported no significant difference in APPr between ADAD MC and NC, which may have been due to the small sample size in both studies. The current study examines APPr in MC versus NC in a larger sample. In addition, it investigated whether APPr correlate with neuroimaging data, neuropsychological data and cerebrospinal fluid biomarkers in a cohort subset derived from the Dominantly Inherited Alzheimer Network (DIAN) study. Methods: APPr were quantified by western blotting. Fifteen MC (symptomatic and asymptomatic) were compared against twelve NC using univariate general linear model. All participants underwent neuroimaging and neuropsychological testing which were correlated with APPr using Pearson's correlation coefficient (r). Results: APPr were lower in MC compared to NC (p=0.003) while Mini-Mental State Examination (MMSE) scores were not significantly different (p>0.1). Furthermore, APPr inversely correlated with amyloid imaging in the Caudate Nucleus (r=-0.505; p<0.05) and Precuneus (r=-0.510; p<0.05). Conclusion: APPr are lower in ADAD MC compared to NC, and inversely correlated with brain amyloid load prior to significant differences in cognitive health. However, the use of APPr as a biomarker needs to be explored further.
Current Alzheimer Research 02/2015; 12(2). DOI:10.2174/1567205012666150204125732 · 3.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cognitive decline and dementia due to Alzheimer's disease (AD) have been associated with genetic, lifestyle, and environmental factors. A number of potentially modifiable risk factors should be taken into account when preventive or ameliorative interventions targeting dementia and its preclinical stages are investigated. Bone mineral density (BMD) and body composition are two such potentially modifiable risk factors, and their association with cognitive decline was investigated in this study. 164 participants, aged 34-87 years old (62.78 ± 9.27), were recruited for this longitudinal study and underwent cognitive and clinical examinations at baseline and after 3 years. Blood samples were collected for apolipoprotein E (APOE) genotyping and dual energy x-ray absorptiometry (DXA) was conducted at the same day as cognitive assessment. Using hierarchical regression analysis, we found that BMD and lean body mass, as measured using DXA were significant predictors of episodic memory. Age, gender, APOE status, and premorbid IQ were controlled for. Specifically, the List A learning from California Verbal Learning Test was significantly associated with BMD and lean mass both at baseline and at follow up assessment. Our findings indicate that there is a significant association between BMD and lean body mass and episodic verbal learning. While the involvement of modifiable lifestyle factors in human cognitive function has been examined in different studies, there is a need for further research to understand the potential underlying mechanisms.
[Show abstract][Hide abstract] ABSTRACT: Physical exercise interventions and cognitive training programs have individually been reported to improve cognition in the healthy elderly population; however, the clinical significance of using a combined approach is currently lacking. This study evaluated whether physical activity (PA), computerized cognitive training and/or a combination of both could improve cognition. In this nonrandomized study, 224 healthy community-dwelling older adults (60-85 years) were assigned to 16 weeks home-based PA (n=64), computerized cognitive stimulation (n=62), a combination of both (combined, n=51) or a control group (n=47). Cognition was assessed using the Rey Auditory Verbal Learning Test, Controlled Oral Word Association Test and the CogState computerized battery at baseline, 8 and 16 weeks post intervention. Physical fitness assessments were performed at all time points. A subset (total n=45) of participants underwent [(18)F] fluorodeoxyglucose positron emission tomography scans at 16 weeks (post-intervention). One hundred and ninety-one participants completed the study and the data of 172 participants were included in the final analysis. Compared with the control group, the combined group showed improved verbal episodic memory and significantly higher brain glucose metabolism in the left sensorimotor cortex after controlling for age, sex, premorbid IQ, apolipoprotein E (APOE) status and history of head injury. The higher cerebral glucose metabolism in this brain region was positively associated with improved verbal memory seen in the combined group only. Our study provides evidence that a specific combination of physical and mental exercises for 16 weeks can improve cognition and increase cerebral glucose metabolism in cognitively intact healthy older adults.
Translational Research 12/2014; 4(e487). DOI:10.1038/tp.2014.122 · 4.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
We conducted an independent external validation of three cardiovascular risk score models (Framingham risk score model and SCORE risk charts developed for low-risk regions and high-risk regions in Europe) on a prospective cohort of 4487 Australian women with no previous history of heart disease, diabetes or stroke. External validation is an important step to evaluate the performance of risk score models using discrimination and calibration measures to ensure their applicability beyond the settings in which they were developed.
Ten year mortality follow-up of 4487 Australian adult women from the National Heart Foundation third Risk Factor Prevalence Study with no baseline history of heart disease, diabetes or stroke. The 10-year risk of cardiovascular mortality was calculated using the Framingham and SCORE models and the predictive accuracy of the three risk score models were assessed using both discrimination and calibration.
The discriminative ability of the Framingham and SCORE models were good (area under the curve > 0.85). Although all models overestimated the number of cardiovascular deaths by greater than 15%, the Hosmer-Lemeshow test indicated that the Framingham and SCORE-Low models were calibrated and hence suitable for predicting the 10-year cardiovascular mortality risk in this Australian population. An assessment of the treatment thresholds for each of the three models in identifying participants recommended for treatment were found to be inadequate, with low sensitivity and high specificity resulting from the high recommended thresholds. Lower treatment thresholds of 8.7% for the Framingham model, 0.8% for the SCORE-Low model and 1.3% for the SCORE-High model were identified for each model using the Youden index, at greater than 78% sensitivity and 80% specificity.
Framingham risk score model and SCORE risk chart for low-risk regions are recommended for use in the Australian women population for predicting the 10-year cardiovascular mortality risk. These models demonstrate good discrimination and calibration performance. Lower treatment thresholds are proposed for better identification of individuals for treatment.
BMC Women's Health 09/2014; 14(1):118. DOI:10.1186/1472-6874-14-118 · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Unhealthy dietary behaviours are one of the key risk factors for many lifestyle-related diseases worldwide. This randomised controlled trial aimed to increase the level of fruit, vegetable and fibre intake and decrease the fat and sugar consumption of mothers with young children (0¿5 years) via the playgroup setting.Methods
Playgroups located in 60 neighbourhoods in Perth, Western Australia were randomly assigned to an intervention (n¿=¿249) or control group (n¿=¿272). Those in the intervention group received a 6-month multi-strategy primarily home-based physical activity and nutrition program (data is only presented on dietary behaviours). Data on dietary consumption was collected via the Fat and Fibre Barometer and frequency of serves of fruit and vegetable and cups of soft drink, flavoured drink and fruit juice. The effects of the intervention on continuous outcome measures were assessed using analysis of variance (ANOVA), after adjusting for mother¿s age and the corresponding variables.ResultsThe outcomes of the intervention were positive with the intervention group showing statistically significant improvements, when compared to the control group in the overall consumption of fat and fibre (p¿<¿0.0005); of fibre (p¿<¿0.0005) ¿ fruit and vegetables (p¿<¿0.0005), wholegrain (p¿=¿0.002): and fat (p¿=¿0.005) ¿ dairy products (p¿=¿0.006) and lean meat and chicken (p¿=¿0.041). There were no significant changes in the consumption of sweet drinks.Conclusions
This intervention was successful in improving dietary intake in the intervention group participants. The moderate positive outcomes indicate that playgroups potentially provide quite a viable setting to recruit, engage and retain this hard to reach group of mothers of young children in programs that support the adoption of health-enhancing behaviours. This adds valuable information to this under researched area.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12609000718246.
International Journal of Behavioral Nutrition and Physical Activity 09/2014; 11(1):120. DOI:10.1186/s12966-014-0120-1 · 3.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study were to determine whether the cross-sectional associations between anthropometric obesity measures, body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR), and calculated 10-year cardiovascular disease (CVD) risk using the Framingham and general CVD risk score models, are the same for women of Australian, UK and Ireland, North European, South European and Asian descent. This study would investigate which anthropometric obesity measure is most predictive at identifying women at increased CVD risk in each ethnic group.
BMJ Open 05/2014; 4(5):e004702. DOI:10.1136/bmjopen-2013-004702 · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the role of body adiposity index (BAI) in predicting cardiovascular disease (CVD) and coronary heart disease (CHD) mortality, in comparison with body mass index (BMI), waist circumference (WC), and the waist circumference to hip circumference ratio (WHR). This study was a prospective 15 year mortality follow-up of 4175 Australian males, free of heart disease, diabetes and stroke. The Framingham Risk Scores (FRS) for CHD and CVD death were calculated at baseline for all subjects. Multivariable logistic regression was used to assess the effects of the measures of obesity on CVD and CHD mortality, before adjustment and after adjustment for FRS. The predictive ability of BAI, though present in the unadjusted analyses, was generally not significant after adjustment for age and FRS for both CVD and CHD mortality. BMI behaved similarly to BAI in that its predictive ability was generally not significant after adjustments. Both WC and WHR were significant predictors of CVD and CHD mortality and remained significant after adjustment for covariates. BAI appeared to be of potential interest as a measure of % body fat and of obesity, but was ineffective in predicting CVD and CHD.
PLoS ONE 04/2014; 9(4):e94560. DOI:10.1371/journal.pone.0094560 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although elevated cardiovascular disease (CVD) risk factors are associated with a higher risk of developing heart conditions across all ethnic groups, variations exist between groups in the distribution and association of risk factors, and also risk levels. This study assessed the 10-year predicted risk in a multiethnic cohort of women and compared the differences in risk between Asian and Caucasian women.
Information on demographics, medical conditions and treatment, smoking behavior, dietary behavior, and exercise patterns were collected. Physical measurements were also taken. The 10-year risk was calculated using the Framingham model, SCORE (Systematic COronary Risk Evaluation) risk chart for low risk and high risk regions, the general CVD, and simplified general CVD risk score models in 4,354 females aged 20-69 years with no heart disease, diabetes, or stroke at baseline from the third Australian Risk Factor Prevalence Study. Country of birth was used as a surrogate for ethnicity. Nonparametric statistics were used to compare risk levels between ethnic groups.
Asian women generally had lower risk of CVD when compared to Caucasian women. The 10-year predicted risk was, however, similar between Asian and Australian women, for some models. These findings were consistent with Australian CVD prevalence.
In summary, ethnicity needs to be incorporated into CVD risk assessment. Australian standards used to quantify risk and treat women could be applied to Asians in the interim. The SCORE risk chart for low-risk regions and Framingham risk score model for incidence are recommended. The inclusion of other relevant risk variables such as obesity, poor diet/nutrition, and low levels of physical activity may improve risk estimation.
International Journal of Women's Health 03/2014; 6:259-67. DOI:10.2147/IJWH.S55225
[Show abstract][Hide abstract] ABSTRACT: It is important to ascertain which anthropometric measurements of obesity, general or central, are better predictors of cardiovascular disease (CVD) risk in women. 10-year CVD risk was calculated from the Framingham risk score model, SCORE risk chart for high-risk regions, general CVD and simplified general CVD risk score models. Increase in CVD risk associated with 1 SD increment in each anthropometric measurement above the mean was calculated, and the diagnostic utility of obesity measures in identifying participants with increased likelihood of being above the treatment threshold was assessed.
Cross-sectional data from the National Heart Foundation Risk Factor Prevalence Study.
Population-based survey in Australia.
4487 women aged 20-69 years without heart disease, diabetes or stroke.
Anthropometric obesity measures that demonstrated the greatest increase in CVD risk as a result of incremental change, 1 SD above the mean, and obesity measures that had the greatest diagnostic utility in identifying participants above the respective treatment thresholds of various risk score models.
Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio had larger effects on increased CVD risk compared with body mass index (BMI). These central obesity measures also had higher sensitivity and specificity in identifying women above and below the 20% treatment threshold than BMI. Central obesity measures also recorded better correlations with CVD risk compared with general obesity measures. WC and WHR were found to be significant and independent predictors of CVD risk, as indicated by the high area under the receiver operating characteristic curves (>0.76), after controlling for BMI in the simplified general CVD risk score model.
Central obesity measures are better predictors of CVD risk compared with general obesity measures in women. It is equally important to maintain a healthy weight and to prevent central obesity concurrently.
BMJ Open 01/2014; 4(2):e004138. DOI:10.1136/bmjopen-2013-004138 · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The role of physical activity in preventing CVD has been highlighted by Professor Jerry Morris in the 1950's. We report outcome of a 15-year prospective study with the aim to identify whether physical activity showed cardiovascular benefit independent of common risk factors and of central obesity. Baseline data of 8662 subjects, with no previous history of heart disease, diabetes or stroke, were obtained from an age- and gender- stratified sample of adults in Australian capital cities and were linked with the National Death Index to determine the causes of death of 610 subjects who had died to 31 December 2004. The study consisted of 4175 males (age 42.3±13.1 years) and 4487 females (age 42.8±13.2 years). Fasting serum lipid levels, systolic and diastolic blood pressure and smoking habits at baseline were recorded. The Framingham Risk Scores of 15-year mortality due to CHD and CVD were calculated using established equations. Subjects were also asked if they engaged in vigorous exercise, less vigorous exercise or walk for recreation and exercise in the past 2 weeks. Subjects in the high recreational physical activity category were 0.16 (0.06-0.43; p<0.001) and 0.12 (0.03-0.48; p = 0.003) times as likely as subjects in the low category for CVD and CHD mortality respectively. After adjusting for both the Framingham Risk Score and central obesity (Waist circumference to Hip circumference Ratio), those in the high recreational physical activity group were 0.35 (0.13-0.98) times less likely compared to the low category for CVD mortality. Recreational physical activity independently predicted reduced cardiovascular mortality over fifteen years. A public health focus on increased physical activity and preventing obesity is required to reduce the risk of CVD and CHD.
PLoS ONE 12/2013; 8(12):e83435. DOI:10.1371/journal.pone.0083435 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Knee replacement (KR) is expensive and invasive. To date no predictive algorithms have been developed to identify individuals at high risk of surgery. This study assessed whether patient self-reported risk factors predict 10-year KR in a population-based study of 1,462 women aged over 70 years recruited for the Calcium Intake Fracture Outcome Study (CAIFOS). Complete hospital records of prevalent (1980-1998) and incident (1998-2008) total knee replacement were available via the Western Australian Data Linkage System. Potential risk factors were assessed for predicative ability using a modeling approach based on a pre-planned selection of risk factors prior to model evaluation. There were 129 (8.8%) participants that underwent KR over the 10 year period. Baseline factors including; body mass index, knee pain, previous knee replacement and analgesia use for joint pain were all associated with increased risk, (P < 0.001). These factors in addition to age demonstrated good discrimination with a C-statistic of 0.79 ± 0.02 as well as calibration determined by the Hosmer-Lemeshow Goodness-of-Fit test. For clinical recommendations, three categories of risk for 10-year knee replacement were selected; low < 5%; moderate 5 to < 10% and high ≥ 10% predicted risk. The actual risk of knee replacement was; low 16 / 741 (2.2%); moderate 32 / 330 (9.7%) and high 81 / 391 (20.7%), P < 0.001. Internal validation of this 5-variable model on 6-year knee replacements yielded a similar C-statistic of 0.81 ± 0.02, comparable to the WOMAC weighted score; C-statistic 0.75 ± 0.03, P = 0.064. In conclusion 5 easily obtained patient self-reported risk factors predict 10-year KR risk well in this population. This algorithm should be considered as the basis for a patient-based risk calculator to assist in the development of treatment regimens to reduce the necessity for surgery in high risk groups such as the elderly.
PLoS ONE 12/2013; 8(12):e83665. DOI:10.1371/journal.pone.0083665 · 3.23 Impact Factor