Kelly Shaw

Effects of calcium supplementation on bone density in healthy children: meta-analysis of randomised controlled trials.

Abstract Objectives To assess the effectiveness of calcium supplementation for improving bone mineral density in healthy children and to determine if any effect is modified by other factors and persists after supplementation stops. Design Meta-analysis. Data sources Electronic bibliographic databases, hand searching of conference proceedings, and contacting authors for unpublished data. Review methods We included randomised placebo controlled trials of calcium supplementation in healthy children that lasted at least three months and had bone outcomes measured after at least six months of follow-up. Two reviewers independently extracted data and assessed quality. Meta-analyses predominantly used fixed effects models with outcomes given as standardised mean differences. Results We included 19 studies involving 2859 children. Calcium supplementation had no effect on bone mineral density at the femoral neck or lumbar spine. There was a small effect on total body bone mineral content (standardised mean difference 0.14, 95% confidence interval 0.01 to 0.27) and upper limb bone mineral density (0.14, 0.04 to 0.24). This effect persisted after the end of supplementation only at the upper limb (0.14, 0.01 to 0.28). There was no evidence that sex, baseline calcium intake, pubertal stage, ethnicity, or level of physical activity modified the effect. Conclusions The small effect of calcium supplementation on bone mineral density in the upper limb is unlikely to reduce the risk of fracture, either in childhood or later life, to a degree of major public health importance.

Effects of vitamin D supplementation on bone density in healthy children: systematic review and meta-analysis

Objective To determine the effectiveness of vitamin D supplementation for improving bone mineral density in children and adolescents and if effects vary with factors such as vitamin D dose and vitamin D status. Design Systematic review and meta-analysis. Data sources Cochrane Central Register of Controlled Trials, Medline (1966 to present), Embase (1980 to present), CINAHL (1982 to present), AMED (1985 to present), and ISI Web of Science (1945 to present), last updated on 9 August 2009, and hand searching of conference abstracts from key journals. Study selection Placebo controlled randomised controlled trials of vitamin D supplementation for at least three months in healthy children and adolescents (aged 1 month to <20 years) with bone density outcomes. Two authors independently assessed references for inclusion and study quality and extracted data. Data synthesis Standardised mean differences of the percentage change from baseline in bone mineral density of the forearm, hip, and lumbar spine and total body bone mineral content in treatment and control groups. Subgroup analyses were carried out by sex, pubertal stage, dose of vitamin D, and baseline serum vitamin D concentration. Compliance and allocation concealment were also considered as possible sources of heterogeneity. Results From 1653 potential references, six studies, totalling 343 participants receiving placebo and 541 receiving vitamin D, contributed data to meta-analyses. Vitamin D supplementation had no statistically significant effects on total body bone mineral content or on bone mineral density of the hip or forearm. There was a trend to a small effect on lumbar spine bone mineral density (standardised mean difference 0.15, 95% confidence interval −0.01 to 0.31; P=0.07). Effects were similar in studies of participants with high compared with low serum vitamin D levels, although there was a trend towards a larger effect with low vitamin D for total body bone mineral content (P=0.09 for difference). In studies with low serum vitamin D, significant effects on total body bone mineral content and lumbar spine bone mineral density were roughly equivalent to a 2.6% and 1.7% percentage point greater change from baseline in the supplemented group. Conclusions It is unlikely that vitamin D supplements are beneficial in children and adolescents with normal vitamin D levels. The planned subgroup analyses by baseline serum vitamin D level suggest that vitamin D supplementation of deficient children and adolescents could result in clinically useful improvements, particularly in lumbar spine bone mineral density and total body bone mineral content, but this requires confirmation.

Cardiometabolic risk in younger and older adults across an index of ambulatory activity

BACKGROUND Pedometers are increasingly being used to assess population levels of physical activity and as motivational tools for individuals to increase their physical activity. To maximize their utility, a framework for classifying pedometer-determined activity into meaningful health-related categories is needed. PURPOSE This study investigated whether a pedometer step index proposed by Tudor-Locke and Bassett can effectively group younger and older adults according to cardiometabolic health status. METHODS Analyses (conducted in 2008) used cross-sectional data from the Childhood Determinants of Adult Health study (1793 adults aged 26-36 years; collected 2004-2006) and from the Tasmanian Older Adult Cohort study (1014 adults aged 50-80 years; collected 2002-2006). Participants wore a pedometer for 7 days and the prevalence of cardiometabolic health indicators, including the metabolic syndrome, elevated Pathobiological Determinants of Atherosclerosis in Youth risk scores, and elevated Framingham risk scores, was examined across the following step categories: sedentary (< 5000); low-active (5000-7499); somewhat active (7500-9999); active (10,000-12,499); and high-active (> or = 12,500). RESULTS With the exception of younger men, individuals achieving > or = 5000 steps had a substantially lower prevalence of adverse cardiometabolic health indicators than those obtaining fewer steps. Differences in the prevalence of adverse indicators were generally modest across higher steps-per-day categories. However, younger men and women in the high-active category had a substantially lower prevalence of some adverse health indicators. CONCLUSIONS In general, the proposed index for classifying pedometer activity effectively distinguishes cardiometabolic health risk. Pedometers may be a useful tool for objectively identifying inactive individuals at greatest risk for poor cardiometabolic health.

Calcium Supplements in Healthy Children Do Not Affect Weight Gain, Height, or Body Composition

Objective: Calcium intake is a potential factor influencing weight gain and may reduce body weight, but the evidence for this in children is conflicting. The aim of this study was to use data from randomized controlled trials to determine whether calcium supplementation in healthy children affects weight or body composition.

Dual energy X-ray absorptiometry body composition and aging in a population-based older cohort

Objective:The aims of this cross-sectional study were (1) to examine the effect of age on body composition in older adults using dual-energy X-ray absorptiometry (DXA) and (2) to evaluate the agreement of DXA with standard indirect anthropometric measures (body mass index (BMI), waist circumference and waist-to-hip ratio (WHR)).Research methods and procedures:A population-based sample of 731 adults aged between 50 and 79 years underwent measurement of BMI, waist circumference, WHR, DXA total body fat mass, DXA % total body fat, DXA % trunk fat and DXA lean body mass. Linear regression was used to test for trend in measures of body composition between age categories in men and women. Partial correlations and Bland–Altman analysis were used to examine the agreement of DXA measures with indirect measures.Results:DXA lean body mass decreased significantly with increasing age in both sexes (P<0.05). In males, BMI (P=0.01) and body weight (P<0.01) decreased with age, and in females, WHR (P=0.05), DXA % total fat (P=0.02) and DXA % trunk fat (P=0.05) increased with age. There was good agreement between DXA measures of fatness and indirect anthropometric measures, except for WHR, which showed greater variability in its comparisons with DXA.Conclusion:Using the highly sensitive and direct DXA method of measuring body composition, a decline in lean body mass and an increase in adiposity was observed with aging. Except for WHR, indirect anthropometric measures generally showed high levels of agreement with DXA fat measures in this older cohort.

Factors relating to home telehealth acceptance and usage compliance

Aim This paper investigates the acceptance of in-home telehealth by frail older adults and carers of the Transition Care Program (TCP), and evaluates telehealth acceptance as a predictor for usage compliance. Method A stratified random sample of participants was allocated to one of five groups: either a control group or to receive telehealth monitoring of their vital signs for a period of 12 or 24 weeks; with or without a medical alarm pendant. Results Before being trained in and using telehealth, the majority of participants and carers demonstrated acceptance of the technology by reporting that they perceived it would be “useful” and “easy to use.” This acceptance was also reported post-TCP (up to 12 weeks of usage). The “perceived ease of use” of the telehealth equipment increased significantly from pre-telehealth training and usage to post-TCP (up to 12 weeks of usage) (P = 0.001). There was no change, (pre-training and usage to post-TCP) in the “perceived usefulness” of the telehealth equipment. The telehealth acceptance constructs of “ease of use” and “usefulness,” at pre-telehealth training and usage, approached statistical significance as a predictor of future compliance (P = 0.06). “Perceived ease of use,” at pre-training and usage, had a positive relationship with future compliance (P = 0.02). Conclusion There is currently limited knowledge about the influences and determinants of home telehealth compliance in frail older people and their carers, potentially a significant user group for the technology into the future. This study’s finding that frail older people and their carers perceive that home telehealth is useful and easy to use demonstrates their acceptance of home telehealth as a therapeutic tool. Further, perceived ease of use of home telehealth is a significant predictor of compliance with frail older people and their carers’ use of home telehealth. Additional research is required in order to identify other influences and determinants of home telehealth compliance with this group. Knowledge about the influences and determinants of home telehealth compliance may assist the development of targeted interventions aimed at encouraging high compliance with users who are recording lower reading rates.

Public health policies and management strategies for genital Chlamydia trachomatis infection

Genital Chlamydia trachomatis is a sexually transmissible bacterial infection that is asymptomatic in the majority of infected individuals and is associated with significant short-term and long-term morbidity. The population prevalence of the infection appears to be increasing. C. trachomatis is of public health significance because of the impacts of untreated disease on reproductive outcomes, transmission of other sexually acquired infections, and the costs to health systems. At the individual level, C. trachomatis infection is readily treatable with antibiotics, although antibiotic resistance appears to be increasing. At the population level, public health control of spread of infection is more problematic. Approaches to control include primary preventive activities, increased access to testing and treatment for people with or at risk of infection, partner notification and treatment, and screening either opportunistically or as part of an organized population screening program. A combination of all of the above approaches is likely to be required to have a significant effect on the burden of disease associated with genital chlamdyia infection and to reduce population prevalence. The development of a vaccine for genital chlamydia infection could significantly reduce the public health burden associated with infection; however a vaccine is not expected to be available in the near future.

Role of the general practitioner in testing for genital Chlamydia trachomatis infection: an analysis of enhanced surveillance data

BACKGROUND To examine the relationship between genital chlamydia testing by healthcare providers and patient demographic characteristics in Tasmania, Australia, from 2001 to 2007. METHODS Analysis of enhanced surveillance data for genital Chlamydia trachomatis infections notified to the Tasmanian Communicable Diseases Prevention Unit between 1 January 2001 and 31 December 2007. RESULTS General practitioners identify most cases of genital chlamydia infection, irrespective of patient age, gender, indigenous status or urban status. Tests that are performed for screening purposes identify the largest number of cases in females, particularly in very young females. In males, tests performed due to the presence of clinical symptoms identify the majority of cases. However, tests performed for the purposes of contact tracing also identify a substantial burden of genital chlamydia infection, particularly in males. CONCLUSIONS The present study demonstrates the critical role the general practitioner has in the identification of genital chlamydia infection. Opportunistic screening for genital chlamydia, including in the context of contact tracing, is an essential clinical activity that results in the identification of substantial numbers of cases of infection. Policy makers and public health practitioners should support general practice screening initiatives and remove the barriers to genital chlamydia screening in general practice.

Factors Affecting Provision of Successful Monitoring in Home Telehealth

Aim: To investigate acceptance and usage issues in relation to Telehealth products as used by frail older clients of the Transition Care Program and their carers. Method: The study design was a quasi-randomised controlled clinical trial. A stratified random sample of participants was allocated to one of five groups using a random number table. Study participants who were already in possession of a pendant alarm provided by the study service provider at study commencement, or were assessed as needing a pendant alarm, were allocated to the first number out of 1 (control group), 4 or 5 (home Telehealth monitoring with a pedant alarm up to 12 or 24 weeks) on the random number table list. If they were in possession of a pendant alarm that was not from the study service provider they were automatically allocated to the control group. If they were assessed as not needing a pendant alarm they were allocated to the first number on the list out of 2 or 3 (home Telehealth monitoring up to 12 or 24 weeks). In all instances, when a participant was allocated to the first applicable number on the list, that number was crossed off the list. Results: A total of 43 participants who commenced the study used Teleheath equipment. There was a 13% Telehealth reading failure rate. There was no significant difference between clients with and clients without carers for the reading failure rate. This non-significant difference was consistent across all of the identified reasons for why readings failed including staff not following up, participant non-compliance (with and without carer), equipment failure, participants not returning a call from the staff investigating non-reading and user error. Conclusion: If the health of the client requires high reading rate reliability, the fact that the client has a carer to assist them cannot be assumed to increase the safe usage of the Telehealth equipment for reading rate reliability. As such staff should ensure that they are diligent in monitoring in-home Telehealth regardless of the presence or absence of a carer.

Value Co-creation with Stakeholders Using Action Research as a Meta-methodology in a Funded Research Project

A large applied research study is a challenging exercise in project management and is often unpredictable because of its complexity. In the beginning, funding bodies, ethics committees, and participating organizations expect a plan of what is intended. As the research evolves, researchers must meet the expectations of stakeholders while being responsive to the emergent reality that the research faces and partly uncovers. This article describes action research used as an umbrella process that enabled us to manage the research project. We used action research as a meta-methodology—that is, a process that can subsume multiple subprocesses and under which these contradicting demands can be satisfied. In particular, two characteristics enable action research to do this. One is its cyclic process, iteratively tracing out a rhythm of planning, acting, and observing the results. The other is the nesting of its cycles, applied at scales ranging from the overall study to the moment-by-moment facilitation. We illustrate this use of action research with examples from a long-term applied study of leadership in faith-based, not-for-profit organizations.