Promoting the get healthy information and coaching service (GHS) in Australian-Chinese communities: facilitators and barriers

Obesity and being overweight are major public health concerns that health coaching can assist people to manage through encouraging self-management and behaviour change. The Get Healthy Information and Coaching Service (GHS) is a telephone health coaching service in Australia that has effectively improved the health of the general population but has had less participation of culturally and linguistically diverse (CALD) populations. The Chinese population is the largest migrant group in Australia with increased risk of diabetes but had reduced access to the GHS program due to communication barriers. The GHS developed a pilot program for Chinese (Mandarin and Cantonese-speaking) communities using bilingual coaches and translated material to address these barriers. Qualitative research was undertaken with Chinese stakeholders (14 interviews) and 11 program participants from the group which had completed the program (2 focus groups in Mandarin and Cantonese) to understand their experiences and the success of promotional activities. This research does not contain the experiences of the people that withdrew from the program. The bilingual program was culturally and linguistically appropriate and addressed risk factors for chronic conditions. Participants formed positive relationships with bilingual coaches who they preferred to interpreters. They felt the program promoted healthy eating, weight and physical activity. Although Chinese stakeholders had concerns about participants' ability to goal set, participants said they met their health goals and were committed to the GHS program. Strategies to enhance the program included promoting the bilingual GHS to the communities and stakeholders. Factors to consider beyond language in adapting the program to the Australian Chinese communities include meeting the heterogenous needs of the older population, ensuring community engagement and addressing cultural beliefs and practices.

Building a network for multicenter, prospective research of central nervous system infections in South America: Process and lessons learned

Multicenter collaborative networks are essential for advancing research and improving clinical care for a variety of conditions. Research networks are particularly important for central nervous system infections, which remain difficult to study due to their sporadic occurrence and requirement for collection and testing of cerebrospinal fluid. Establishment of long-term research networks in resource-limited areas also facilitates diagnostic capacity building, surveillance for emerging pathogens, and provision of appropriate treatment where needed. We review our experience developing a research network for encephalitis among twelve hospitals in five Peruvian cities since 2009. We provide practical suggestions to aid other groups interested in advancing research on central nervous system infections in resource-limited areas.

Symptoms of post-traumatic stress disorder, severe psychological distress, explosive anger and grief amongst partners of survivors of high levels of trauma in post-conflict Timor-Leste

BACKGROUND

Little is known about the mental health of partners of survivors of high levels of trauma in post-conflict countries.

METHOD

We studied 677 spouse dyads (n = 1354) drawn from a community survey (response 82.4%) in post-conflict Timor-Leste. We used culturally adapted measures of post-traumatic stress disorder (PTSD), psychological distress, explosive anger and grief.

RESULTS

Latent class analysis identified three classes of couples: class 1, comprising women with higher trauma events (TEs), men with intermediate TEs (19%); class 2, including men with higher TEs, women with lower TEs (23%); and class 3, comprising couples in which men and women had lower TE exposure (58%) (the reference group). Men and women partners of survivors of higher TE exposure (classes 1 and 2) had increased symptoms of explosive anger and grief compared with the reference class (class 3). Women partners of survivors of higher TE exposure (class 2) had a 20-fold increased rate of PTSD symptoms compared with the reference class, a pattern that was not evident for men living with women exposed to higher levels of trauma (class 1).

CONCLUSIONS

Men and women living with survivors of higher levels of trauma showed an increase in symptoms of grief and explosive anger. The manifold higher rate of PTSD symptoms amongst women living with men exposed to high levels of trauma requires replication. It is important to assess the mental health of partners when treating survivors of high levels of trauma in post-conflict settings.

Patterns of separation anxiety symptoms amongst pregnant women in conflict-affected Timor-Leste: Associations with traumatic loss, family conflict, and intimate partner violence

BACKGROUND

Adult separation anxiety (ASA) symptoms are prevalent amongst young women in low and middle-income countries and symptoms may be common in pregnancy. No studies have focused on defining distinctive patterns of ASA symptoms amongst pregnant women in these settings or possible associations with trauma exposure and ongoing stressors.

METHODS

In a consecutive sample of 1672 women attending antenatal clinics in Dili, Timor-Leste (96% response), we assessed traumatic events of conflict, ongoing adversity, intimate partner violence (IPV), ASA, post-traumatic stress disorder (PTSD) and severe psychological distress. Latent Class Analysis was used to identify classes of women based on their distinctive profiles of ASA symptoms, comparisons then being made with key covariates including trauma domains of conflict, intimate partner violence (IPV) and ongoing stressors.

RESULTS

LCA yielded three classes, comprising a core ASA (4%), a limited ASA (25%) and a low symptom class (61%). The core ASA class reported exposure to multiple traumatic losses and IPV and showed a pattern of comorbidity with PTSD; the limited ASA class predominantly reported exposure to ongoing stressors and was comorbid with severe psychological distress; the low symptom class reported relatively low levels of exposure to trauma and stressors.

LIMITATIONS

The study is cross-sectional, cautioning against inferring causal inferences.

CONCLUSIONS

The core ASA group may be in need of immediate intervention given the high rate of exposure to IPV amongst this class. A larger number of women experiencing a limited array of non-specific ASA symptoms may need assistance to address the immediate stressors of pregnancy.

Are gait characteristics and ground reaction forces related to energy cost of running in elite Kenyan runners?

The aim of this study was to determine whether gait cycle characteristics are associated with running economy in elite Kenyan runners. Fifteen elite Kenyan male runners completed two constant-speed running sets on a treadmill (12 km ·h^-1 and 20 km ·h^-1). VO₂ and respiratory exchange ratio values were measured to calculate steady-state oxygen and energy cost of running. Gait cycle characteristics and ground contact forces were measured at each speed. Oxygen cost of running at different velocities was 192.2 ± 14.7 ml· kg^-1· km^-1 at 12 km· h^-1 and 184.8 ± 9.9 ml· kg^-1· km^-1 at 20 km· h^-1, which corresponded to a caloric cost of running of 0.94 ± 0.07 kcal ·kg^-1·km^-1 and 0.93 ± 0.07 kcal· kg^-1· km^-1. We found no significant correlations between oxygen and energy cost of running and biomechanical variables and ground reaction forces at either 12 or 20 km· h^-1. However, ground contact times were ~10.0% shorter (very large effect) than in previously published literature in elite runners at similar speeds, alongside an 8.9% lower oxygen cost (very large effect). These results provide evidence to hypothesise that the short ground contact times may contribute to the exceptional running economy of Kenyan runners.

Six-year trajectories of post-traumatic stress and severe psychological distress symptoms and associations with timing of trauma exposure, ongoing adversity and sense of injustice: a latent transition analysis of a community cohort in conflict-affected Timor-Leste

OBJECTIVES

To identify the 6-year trajectories of post-traumatic stress symptoms (PTSS) and psychological distress symptoms, and examine for associations with timing of trauma exposure, ongoing adversity and with the sense of injustice in conflict-affected Timor-Leste.

SETTING

A whole-of-household survey was conducted in 2004 and 2010 in Dili, the capital of Timor-Leste.

PARTICIPANTS

1022 adults were followed up over 6 years (retention rate 84.5%). Interviews were conducted by field workers applying measures of traumatic events (TEs), ongoing adversity, a sense of injustice, PTS symptoms and psychological distress.

RESULTS

Latent transition analysis supported a 3-class longitudinal model (psychological distress, comorbid symptoms and low symptoms). We derived 4 composite trajectories comprising recovery (20.8%), a persisting morbidity trajectory (7.2%), an incident trajectory (37.2%) and a low-symptom trajectory (34.7%). Compared with the low-symptom trajectory, the persistent and incident trajectories reported greater stress arising from poverty and family conflict, higher TE exposure for 2 historical periods, and a sense of injustice for 2 historical periods. The persistent trajectory was unique in reporting greater TE exposure in the Indonesian occupation, whereas the incident trajectory reported greater TE exposure during the later internal conflict that occurred between baseline and follow-up. Compared with the low-symptom trajectory, the incident trajectory reported a greater sense of injustice relating to the periods of the Indonesian occupation and independence. The persistent trajectory was characterised by a sense of injustice relating to the internal conflict and contemporary times. The recovery trajectory was characterised by the absence of these risk factors, the only difference from the low-symptom trajectory being that the former reported a sense of injustice for the period surrounding independence.

CONCLUSIONS

Our findings suggest that the timing of both TE exposure and the focus of a sense of injustice may differentiate those with persisting and new-onset mental health morbidity in settings of recurrent conflict.

A high-risk group of pregnant women with elevated levels of conflict-related trauma, intimate partner violence, symptoms of depression and other forms of mental distress in post-conflict Timor-Leste

Women in low-income, post-conflict (LI-PC) [Corrected] countries are at risk of exposure to the traumatic events (TEs) of war and intimate partner violence (IPV), forms of stress that are known to lead to depression and other adverse mental health outcomes. We aimed to assess an index of exposure to these two forms of trauma to identify pregnant women attending antenatal clinics in conflict-affected Timor-Leste at high risk of depression and other forms of stress. A large, cross-sectional study of women in the second trimester of pregnancy was conducted in the four main government antenatal clinics in Dili district of Timor-Leste, between May 2014, and January 2015. The sample consisted of 1672 consecutive women, 3 to 6 months pregnant, with a response rate of 96%. We applied the Edinburgh Postnatal Depression Scale, the Kessler-10 psychological distress scale and the Harvard Trauma Questionnaire. IPV was assessed by the World Health Organisation measure. Composite categories of conflict-related TEs and severity of IPV showed a dose-response relationship with depressive symptoms: for exposure to four or more conflict-related TEs and severe psychological IPV, the adjusted odds ratio (AOR) was 3.95 (95% confidence interval (CI) 2.10-7.40); for four or more TEs and physical abuse, AOR 8.16 (95% CI 3.53-18.85); and for four or more TEs and severe psychological and physical abuse, AOR 9.78 (95% CI 5.31-18.02). For any mental distress, the AOR for four or more TEs and severe psychological abuse was 3.60 (95% CI 2.08-6.23); for four or more TEs and physical abuse 7.03 (95% CI 3.23-15.29); and for four or more TEs and severe psychological and physical abuse the AOR was 10.45 (95% CI 6.06-18.01). Of 184 women (11% of the sample) who reported ⩾ 4 TEs and either physical abuse alone or in combination with severe psychological abuse, 78 (42%) reached threshold for depressive symptoms and 93 (51%) for any mental distress, a 10-fold increase in depressive and other mental health symptoms. Priority should be directed to providing urgent mental health and social interventions for this group of women. Our findings offer a framework for a tiered approach to detection, guiding prevention and intervention strategies for IPV and associated mental health problems in low-income post-conflict countries.

Effect on Oxygen Cost of Transport from 8-Weeks of Progressive Training with Barefoot Running

Popular interest in barefoot running has emerged as a result of its alleged performance and injury prevention benefits. Oxygen cost of transport (COT) improvements from barefoot running, however, remains equivocal. The aim of this study was to determine the influence of an 8-week progressive barefoot training program on COT and associated spatiotemporal variables. 15 male runners participated in this study. Variables such as oxygen uptake, biomechanical and spatiotemporal characteristics of gait, including ground contact (GC) and swing time; stride length and frequency and ankle plantar-dorsiflexion were measured pre- and post-intervention. The COT did not differ between barefoot and shod running either pre- or post-training. Improved barefoot COT (p<0.05) but not shod was found between pre- and post-training. Biomechanical differences between barefoot and shod conditions persisted over the training period. A decrease in barefoot COT was associated with a decrease in GC time (p=0.003, r=0.688) and a small increase in stride frequency (p=0.030; r=0.569). Ground contact time and stride frequency, previously associated with COT, only partly contribute (32% - Stride frequency and 47% - GC time) to a decrease in COT after barefoot training. Thus other physiological and biomechanical variables must influence the improvement in COT after a barefoot training intervention.

OBLA is a better predictor of performance than Dmax in long and middle-distance well-trained runners

AIM

The main purpose of this study was to investigate if the lactate threshold estimated by the maximal deviation method (LTDmax) and the onset of blood lactate accumulation speed (LTOBLA) are good correlates of middle- and long-distance running performance in well-trained endurance runners.

METHODS

Eleven long- and eleven middle-distance runners participated in this study. All participants completed a maximal incremental running test on a treadmill to determine maximal physiological variables and velocities corresponding to LTDmax and LTOBLA (4 mmol·L-1 of lactate concentration). The relationships between LTDmax, LTOBLA and the best 10-km (S10km) and 3-km (S3km) race pace were analyzed in the long- and middle distance runners, respectively.

RESULTS

The velocities for LTDmax and LTOBLA were 17.0±0.7 km·h-1 and 17.5±1.3 km·h-1 for the long-distance runners and 16.9±1.1 km·h-1 and 17.4±1.3 km·h-1 for the middle-distance runners. A positive linear relationship was found between LTDmax and S10km (r=0.873, P<0.001), as well as between LTOBLA and S10km (r=0.919, P<0.001) in the long-distance runners. Similarly, LTDmax and LTOBLA were significantly correlated with S3km in the middle-distance runners (r=0.825, P<0.01 and r=0.849, P<0.001, respectively).

CONCLUSION

These results indicate that both LTOBLA and LTDmax are highly associated to running performance according to S10km and S3km in well-trained long- and middle-distance runners. Thus, we conclude that competitive middle- and long-distance athletes may find these measures useful to monitor running performance within 3 weeks of laboratory testing.

Interaction effects of stride angle and strike pattern on running economy

This study aimed to investigate the relationship between stride angle and running economy (RE) in athletes with different foot strike patterns. 30 male runners completed 4 min running stages on a treadmill at different velocities. During the test, biomechanical variables such as stride angle, swing time, contact time, stride length and frequency were recorded using an optical measurement system. Their foot strike pattern was determined, and VO2 at velocities below the lactate threshold were measured to calculate RE. Midfoot/forefoot strikers had better RE than rearfoot strikers (201.5±5.6 ml · kg(-1) · km(-1) vs. 213.5±4.2 ml · kg(-1) · km(-1)respectively; p=0.019). Additionally, midfoot/fore-foot strikers presented higher stride angles than rearfoot strikers (p=0.043). Linear modelling analysis showed that stride angle is closely related to RE (r=0.62, p<0.001) and that the effect of stride angle on RE was different in the 2 groups. From an arbitrary value of 4°, a rearfoot strike pattern is likely to be more economical, whereas at any lower degree, the midfoot/forefoot strike pattern appears to be more desirable. A biomechanical running technique characterised by high stride angles and a midfoot/forefoot strike pattern is advantageous for a better RE. Athletes may find stride angle useful for improving RE.

Differences in ground contact time explain the less efficient running economy in north african runners

The purpose of this study was to investigate the relationship between biomechanical variables and running economy in North African and European runners. Eight North African and 13 European male runners of the same athletic level ran 4-minute stages on a treadmill at varying set velocities. During the test, biomechanical variables such as ground contact time, swing time, stride length, stride frequency, stride angle and the different sub-phases of ground contact were recorded using an optical measurement system. Additionally, oxygen uptake was measured to calculate running economy. The European runners were more economical than the North African runners at 19.5 km · h(-1), presented lower ground contact time at 18 km · h(-1) and 19.5 km · h(-1) and experienced later propulsion sub-phase at 10.5 km · h(-1),12 km · h(-1), 15 km · h(-1), 16.5 km · h(-1) and 19.5 km · h(-1) than the European runners (P < 0.05). Running economy at 19.5 km · h(-1) was negatively correlated with swing time (r = -0.53) and stride angle (r = -0.52), whereas it was positively correlated with ground contact time (r = 0.53). Within the constraints of extrapolating these findings, the less efficient running economy in North African runners may imply that their outstanding performance at international athletic events appears not to be linked to running efficiency. Further, the differences in metabolic demand seem to be associated with differing biomechanical characteristics during ground contact, including longer contact times.

Perceived exertion influences pacing among ultramarathon runners but post-race mood change is associated with performance expectancy

Objectives. This study investigated whether post-race mood changes among ultramarathon runners are associated with perceived exertion or the discrepancy between their actual and predicted performance times.Methods. Eight runners completed the Puffer ultramarathon, which is a challenging 73 km mountainous race across Table Mountain National Park in South Africa. Each runner completed a series of profile of mood state questionnaires (POMS) 2 days before the race (baseline), on the morning of the race (pre-race) and immediately after the race (post-race). Ratings of perceived exertion (RPE) were measured at 13 points during the race using the Borg 6-20 scale. The accuracy of performance expectationswas measured as the difference between runners’ actual and predicted race times.Results. Average completion time was 11:31:36±00:26:32 (h :mm:ss), average running speed was 6.4±2.2 km.hr-1 and averageRPE was 14.1±2.0. Increased POMS confusion was found before the race (33.30.7 v. 37.1±5.2, p=0.014; baseline v. pre-race). Post-race increases in POMS total mood disturbance (TMD) were found (168.3±20 v. 137.5±6.3, p=0.001; post race v. baseline) characterised by decreased vigour (43.3±4.0 v. 33.5±7.0, p=0.008; baseline v. post race), increased confusion (33.3±0.7 v. 38.5±4.8, p=0.006; baseline v. post race) and increased fatigue (37.8±4.8 v. 53.8±7.3, p=0.0003; baseline v. post race). A linear increase in RPE was found during the race (r=0.737, p=0.002).The magnitude of their post-race mood change (r=-0.704, p=0.026) was not found to be associated with runners’ average RPE but was found to be negatively correlated with accuracy of the performance predictions. A time series analysis indicated that POMS TMD would have taken 142±89 min to recover. Conclusions. The results show that RPE influences the wayultramarathon runners pace themselves more than performance expectancy but performance expectations have a greater influence on post-race mood. The magnitude of post-race mood change is associated with the extent of discrepancy between runners’ predicted and actual performance. This has implications for designing appropriate goals and pacing strategies for ultraendurance athletes. 

Intestinal microbiota balance modulates host susceptibility to infection with enteric pathogenss

Background: During our lifetimes we develop a very complex set of interactions with the multitude of microorganisms colonizing our bodies. In the gastrointestinal system, the microbiota is highly important for morphological development, nutrition, and protection against infectious diseases. The gastrointestinal pathogens, enterohemorrhagic and enteropathogenic Escherichia coli (EHEC and EPEC) and Salmonella enterica serovar Typhimurium (ST) are food-borne pathogens that cause much morbidity and mortality worldwide. Citrobacter rodentium (Cr) is a mouse pathogen that is used in small animal models to mimic EHEC and EPEC infections. Methods: We began to characterize the contribution of intestinal microbiota to the progression of these infections. Two main phyla comprise the majority of mouse intestinal microbiota: Bacteroidetes and Firmicutes. Bacteria from a number of additional phyla are also present in smaller numbers; among them γ-Proteobacteria class, belonging to Proteobacteria phylum, is note-worthy as this class harbours many intestinal pathogens, such as ST and Cr. The mouse intestinal microbiota was perturbed using tetracycline (Tet) and streptomycin (Sm) to increase the proportion of Bacteroidetes in the colonic microbiota, and using vancomycin (Vanc) to create a predominance of Firmicutes. The mice with this perturbed microbiota were infected with ST to investigate the resultant pathology and virulence characteristics, and any additional shifts in microbiota as a result of infection. Results: Treatment of mice with Sm and Vanc was found to decrease the resistance of mice to colonization with ST, while Tet-treated mice exhibited unchanged colonization resistance. Treatment of mice with gradually increasing doses of Sm, which gradually augmented the proportion of CFB bacteria in the microbiota, resulted in progressively increasing colonization of mice by ST, as well as a step-wise increase in the ST-induced typhlitis, associated with higher levels of inflammatory markers IL-6 and KC. The increasing levels of ST colonization following both Sm and Vanc treatment were associated with an increase in the proportion of γ-Proteobacteria in the cecal and colonic microbiota, as well as a decrease in the total bacterial numbers in both organs. Conclusions: It is evident that the intestinal microbiota plays a significant role in the host’s response to infection with enteric pathogens, and its composition and numbers are also affected by the offending bacteria. Elucidation of the details regarding the contribution of the microbiota to infectious disease progression will offer novel targets for the future design of superior prevention and treatment methods.

Fine needle aspiration in plastic surgery outpatients: a retrospective study

A survey suggested that fine needle aspiration cytology of masses in plastic surgery outpatient clinics was suboptimal. A cytopathologist gave training in the technique and the effectiveness of this intervention was audited. A total of 236 aspirates were taken from 147 patients in the earlier time period and 215 from 149 in the later period. The overall inadequate aspirate rate remained constant at 43%. The most common reasons for poor aspirates were excess blood, unrepresentative adipose tissue and insufficient cellular material. When the specimen was adequate after training, the sensitivity and specificity of the investigation were 96% and 100%, respectively. We present methods for sample optimization. Alternative strategies may be to limit aspiration to one clinician or to refer the patient to a cytopathologist experienced in the technique.

The role of tobacco smoke, iron ore mine dusts, viruses, and chemicals in experimental cancer

Assessment of long-term studies on the carcinogenic potential of certain environmental agents has indicated that all of the following appear to activate and/or promote the inherent tumors of the host strains of the animals used irrespective of the extent of additional immunological modulation accompanying the agents: tobacco smoke inhalation, the implantation and inhalation of the respirable fraction of iron ore mine dusts, acute neonatal reovirus 3 infection, urethane, and tobacco smoke inhalation following urethane treatment. It is proposed that these environmental agents function at the onc-gene level as promoters/activators rather than carcinogens, and that this now requires an understanding of the means by which certain environmental agents function at the onc-gene level.