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Mesa-Castrillon CI, Simic M, Ferreira ML, Bennell KL, Luscombe GM, Gater K, Beckenkamp PR, Michell A, Bauman A, de Luca K, Bunker S, Clavisi O, Ferreira PH. Effectiveness of an eHealth-Delivered Program to Empower People With Musculoskeletal Pain in Rural Australia: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2024; 76:570-581. [PMID: 37984995 DOI: 10.1002/acr.25272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/08/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Our objective was to evaluate the effectiveness of a three-month physiotherapist-delivered eHealth physical activity program compared with usual care to improve function in adults with low back pain or knee osteoarthritis in rural Australia. METHODS This was a parallel, two-group, pragmatic, superiority, randomized controlled trial involving three- and six-month posttreatment follow-ups. There was a total of 156 adults with chronic nonspecific low back pain (n = 97) or knee osteoarthritis (n = 59) from rural Australia. The intervention involved an eHealth physical activity and an exercise program that included five to eight teleconsultations with a physiotherapist (primary time point three months) or usual care (eg, general practitioner, physiotherapy, and pain medication). The primary outcome was the Patient-Specific Functional Scale (0-30), with a three-point difference between groups being considered the minimum clinically important difference. RESULTS Participants receiving the eHealth intervention (n = 78) reported significantly greater and clinically worthwhile improvements in function (mean between-group difference 3.6; 95% confidence interval [CI] 1.3-5.9) compared to participants receiving usual care (n = 78). Small but statistically significantly greater improvements in disability (7.2 of 100; 95% CI 2.1-12.3) and quality of life (4.5 of 100; 95% CI 0.0-9.0) also favored the eHealth group. No clinical or statistical differences between groups were found for the secondary outcomes of pain, coping skills, and physical activity levels. CONCLUSION A physiotherapist-delivered eHealth intervention is effective and provides clinically meaningful improvements in function compared to usual care for people with musculoskeletal pain in rural communities. These findings highlight the potential for eHealth-based programs to improve access to evidence-based exercise interventions for people with musculoskeletal pain in rural communities.
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Affiliation(s)
- Carlos I Mesa-Castrillon
- University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Milena Simic
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Kim L Bennell
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Kristy Gater
- Dubbo Health Service, Dubbo, New South Wales, Australia
| | | | | | - Adrian Bauman
- University of Sydney, Sydney, New South Wales, Australia
| | - Katie de Luca
- Central Queensland University Brisbane, Queensland, Australia
| | | | | | - Paulo H Ferreira
- University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Dow M, Murrin C, O'Malley G, Brinkley A, Bel‐Serrat S. A qualitative study exploring the perceptions of health among pre-teen girls from disadvantaged communities in Dublin. CHILDREN & SOCIETY 2023; 37:579-597. [PMID: 37065771 PMCID: PMC10087344 DOI: 10.1111/chso.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/22/2022] [Accepted: 06/29/2022] [Indexed: 06/19/2023]
Abstract
There are disparities in health outcomes between youth from higher and lower socioeconomic backgrounds, and girls are especially vulnerable to changes in health-related behaviours as they develop. Therefore, this study explored how girls from disadvantaged communities in Dublin, Ireland, make sense of 'being healthy.' A phenomenological qualitative design was implemented. Three focus groups were conducted (n = 22, 10-12 years) and data were analysed using thematic analysis. Food and physical appearance featured prominently within the girls' definitions of health. Girls and their families from low-SES backgrounds may experience more difficulties with time scarcity as well as environmental barriers to a healthy lifestyle.
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Affiliation(s)
- Mckenzie Dow
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports ScienceUniversity College DublinDublinIreland
- W82GO Child and Adolescent Weight Management ServiceChildren's Health IrelandDublinIreland
| | - Celine Murrin
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports ScienceUniversity College DublinDublinIreland
| | - Grace O'Malley
- W82GO Child and Adolescent Weight Management ServiceChildren's Health IrelandDublinIreland
- Obesity Research and Care Group, School of PhysiotherapyRCSI University of Medicine and Health SciencesDublinIreland
| | - Aoife Brinkley
- W82GO Child and Adolescent Weight Management ServiceChildren's Health IrelandDublinIreland
- Childrens Health Ireland at ConnollyDublinIreland
| | - Silvia Bel‐Serrat
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports ScienceUniversity College DublinDublinIreland
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Shoari N, Beevers S, Brauer M, Blangiardo M. Towards healthy school neighbourhoods: A baseline analysis in Greater London. ENVIRONMENT INTERNATIONAL 2022; 165:107286. [PMID: 35660953 DOI: 10.1016/j.envint.2022.107286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Creating healthy environments around schools is important to promote healthy childhood development and is a critical component of public health. In this paper we present a tool to characterize exposure to multiple urban environment features within 400 m (5-10 min walking distance) of schools in Greater London. We modelled joint exposure to air pollution (NO2 and PM2.5), access to public greenspace, food environment, and road safety for 2,929 schools, employing a Bayesian non-parametric approach based on the Dirichlet Process Mixture modelling. We identified 12 latent clusters of schools with similar exposure profiles and observed some spatial clustering patterns. Socioeconomic and ethnicity disparities were manifested with respect to exposure profiles. Specifically, three clusters (containing 645 schools) showed the highest joint exposure to air pollution, poor food environment, and unsafe roads and were characterized with high deprivation. The neighbourhood of the most deprived cluster of schools had a median of 2.5 ha greenspace, 29.0 µg/m3 of NO2, 19.3 µg/m3 of PM2.5, 20 fast food retailers, and five child pedestrian crashes over a three-year period. The neighbourhood of the least deprived cluster of schools had a median of 21.8 ha greenspace, 15.6 µg/m3 of NO2, 15.1 µg/m3 of PM2.5, 2 fast food retailers, and one child pedestrian crash over a three-year period. To have a school-level understanding of exposure levels, we then benchmarked schools based on the probability of exceeding the median exposure to various features of interest. Our study accounts for multiple exposures, enabling us to highlight spatial distribution of exposure profile clusters, and to identify predominant exposure to urban environment features for each cluster of schools. Our findings can help relevant stakeholders, such as schools and public health authorities, to compare schools based on their exposure levels, prioritize interventions, and design local policies that target the schools most in need.
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Affiliation(s)
- Niloofar Shoari
- MRC Centre for Environment & Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
| | - Sean Beevers
- MRC Centre for Environment & Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Marta Blangiardo
- MRC Centre for Environment & Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
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Physical Activity and Food Environments in and around Schools: A Case Study in Regional North-West Tasmania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106238. [PMID: 35627775 PMCID: PMC9140536 DOI: 10.3390/ijerph19106238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023]
Abstract
A better understanding of the physical activity (PA) infrastructure in schools, the walkability of neighborhoods close to schools, and the food environments around schools, particularly in rural, socioeconomically challenged areas such as the North-West (NW) of Tasmania, could be important in the wider effort to improve the health of school-age children. Accordingly, this research aimed to assess PA resources, walkability, and food environments in and around schools in three socioeconomically disadvantaged, regional/rural Local Government Areas (LGAs) of Tasmania, Australia. A census of schools (including assessment of the PA infrastructure quality within school grounds), a walkability assessment, and a census of food outlets surrounding schools (through geospatial mapping) were executed. Most of the schools in the study region had access to an oval, basketball/volleyball/netball court, and free-standing exercise equipment. In all instances (i.e., regardless of school type), the quality of the available infrastructure was substantially higher than the number of incivilities observed. Most schools also had good (i.e., within the first four deciles) walkability. Numerous food outlets were within the walking zones of all schools in the study region, with an abundance of food outlets that predominantly sold processed unhealthy food.
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Hunt ET, Armstrong B, Turner-McGrievy BM, Beets MW, Weaver RG. Differences by School Location in Summer and School Monthly Weight Change: Findings from a Nationally Representative Sample. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111610. [PMID: 34770133 PMCID: PMC8583544 DOI: 10.3390/ijerph182111610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine changes in accelerations of Body Mass Index (BMI), age-and-sex specific body mass index (zBMI), and 95th percentile of BMI (%BMIp95) during the summer months and school year by school location designation (i.e., urban, suburban, exurban). This study utilized the Early Childhood Longitudinal Study Kindergarten Class of 2010-2011. METHODS Of the 18,174 children in the ECLS-K:2011 dataset, I restricted participants to those with at least two consecutive measures that occurred August/September or April/May. Mixed-effect regression analyses estimated differences in monthly change in BMI, zBMI, and %BMIp95 between the summer and school year while accounting for the ECLS-K complex sampling design. Models also examined differences in the magnitude of BMI, zBMI, and %BMIp95 change between the summer and school year by school location. Post-hoc Benjamini-Hochberg (BH) procedure set at 10% false discovery was incorporated to account for multiple comparisons. RESULTS A total of 1549 children (48% female, 42% White) had at least two consecutive measures that occurred in August/September or April/May. Among all locale classifications (i.e., urban, suburban, and exurban), children from high-income households comprised the largest proportions for each group (31%, 39%, and 37%), respectively. Among urban and suburban locations, Hispanic children comprised the largest proportions for both groups (43% and 44%), respectively. Among exurban locale classifications, White children comprised the largest proportion of children (60%). Children from suburban and exurban schools experienced significantly less accelerations in monthly zBMI gain when compared to their urban counterparts -0.038 (95CI = -0.071, -0.004) and -0.045 (95CI = -0.083, -0.007), respectively. Children from exurban schools experienced significantly less acceleration in monthly %BMIp95 during the summer months when compared to the school year -0.004 (95CI = -0.007, 0.000). CONCLUSIONS This is one of the first studies to examine summer weight gain by school location. Summer appears to impact children more negatively from urban schools when compared to their suburban and exurban counterparts.
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Affiliation(s)
- Ethan T. Hunt
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, Austin Campus, Austin, TX 78701, USA
- Correspondence: ; Tel.: +1-512-391-1356
| | - Bridget Armstrong
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA; (B.A.); (M.W.B.); (R.G.W.)
| | - Brie M. Turner-McGrievy
- Department of Health Education & Behavior, University of South Carolina, Columbia, SC 29208, USA;
| | - Michael W. Beets
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA; (B.A.); (M.W.B.); (R.G.W.)
| | - Robert G. Weaver
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA; (B.A.); (M.W.B.); (R.G.W.)
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Claesen JLA, Wheeler AJ, Klabbers G, Gonzalez DD, Molina MA, Tham R, Nieuwenhuijsen M, Carver A. Associations of traffic-related air pollution and greenery with academic outcomes among primary schoolchildren. ENVIRONMENTAL RESEARCH 2021; 199:111325. [PMID: 34000269 DOI: 10.1016/j.envres.2021.111325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND There is preliminary evidence that greenery/greenspace around schools may be positively associated with children's cognitive development and academic outcomes, whereas traffic-related air pollution (TRAP) may have a detrimental effect. Few studies have examined pathways between both exposures and academic outcomes. This study aimed to assess associations between greenery, road traffic density (a proxy for TRAP) surrounding primary (elementary) schools, and academic achievement of primary schoolchildren in Melbourne, Australia. METHODS This cross-sectional study examined mean academic scores in Years 3 and 5 for primary schools (n = 851) in Greater Melbourne. Scores were from the 2018 'National Assessment Program - Literacy and Numeracy' (NAPLAN) in five domains: 'Reading'; 'Writing'; 'Spelling'; 'Grammar & Punctuation' and 'Numeracy'. Greenery was measured within school boundaries and surrounding Euclidean buffers (100, 300, 1000 and 2000 m) using the Normalized Difference Vegetation Index (NDVI). Measured TRAP proxies were weighted road density (WRD) within the buffers and distance to a major road. Generalised Linear Models were used to examine associations of greenery and TRAP with academic scores (adjusted for school socio-educational status), and to identify mediating pathways. RESULTS Greenery was positively associated with Reading scores in Year 3 (all buffers except 2000 m) and in Year 5 (all buffers), with Numeracy in Years 3 and 5 (all buffers) and with Grammar & Punctuation in Year 5 (all buffers). WRD was inversely associated with Reading scores in Year 5 (all buffers), with Numeracy in Year 3 (all buffers) and Year 5 (300 and 1000 m buffers), and with Grammar & Punctuation in Year 3 (100 and 300 m buffers) and Year 5 (all buffers). Distance to a major road was not associated with any score. TRAP partially mediated associations of greenery within 300 m with Numeracy in Year 3 and Grammar & Punctuation in Year 5, and within 2000 m for Reading in Year 5. CONCLUSIONS Preliminary evidence indicated that greenery around primary schools was positively associated with Reading, Numeracy and Grammar & Punctuation scores, with TRAP mediating some associations. Further research is required to improve TRAP exposure assessment around schools to verify these findings and inform town/school planners and educators regarding optimal school locations and environments for promoting learning.
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Affiliation(s)
- Joep L A Claesen
- Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Amanda J Wheeler
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Gonnie Klabbers
- Department of Health Ethics and Society, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - David Donaire Gonzalez
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Miguel Alvarado Molina
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Rachel Tham
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Mark Nieuwenhuijsen
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Department of Health Ethics and Society, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alison Carver
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.
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