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Mellow ML, Dumuid D, Olds T, Stanford T, Dorrian J, Wade AT, Fripp J, Xia Y, Goldsworthy MR, Karayanidis F, Breakspear MJ, Smith AE. Cross-sectional associations between 24-hour time-use composition, grey matter volume and cognitive function in healthy older adults. Int J Behav Nutr Phys Act 2024; 21:11. [PMID: 38291446 PMCID: PMC10829181 DOI: 10.1186/s12966-023-01557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Increasing physical activity (PA) is an effective strategy to slow reductions in cortical volume and maintain cognitive function in older adulthood. However, PA does not exist in isolation, but coexists with sleep and sedentary behaviour to make up the 24-hour day. We investigated how the balance of all three behaviours (24-hour time-use composition) is associated with grey matter volume in healthy older adults, and whether grey matter volume influences the relationship between 24-hour time-use composition and cognitive function. METHODS This cross-sectional study included 378 older adults (65.6 ± 3.0 years old, 123 male) from the ACTIVate study across two Australian sites (Adelaide and Newcastle). Time-use composition was captured using 7-day accelerometry, and T1-weighted magnetic resonance imaging was used to measure grey matter volume both globally and across regions of interest (ROI: frontal lobe, temporal lobe, hippocampi, and lateral ventricles). Pairwise correlations were used to explore univariate associations between time-use variables, grey matter volumes and cognitive outcomes. Compositional data analysis linear regression models were used to quantify associations between ROI volumes and time-use composition, and explore potential associations between the interaction between ROI volumes and time-use composition with cognitive outcomes. RESULTS After adjusting for covariates (age, sex, education), there were no significant associations between time-use composition and any volumetric outcomes. There were significant interactions between time-use composition and frontal lobe volume for long-term memory (p = 0.018) and executive function (p = 0.018), and between time-use composition and total grey matter volume for executive function (p = 0.028). Spending more time in moderate-vigorous PA was associated with better long-term memory scores, but only for those with smaller frontal lobe volume (below the sample mean). Conversely, spending more time in sleep and less time in sedentary behaviour was associated with better executive function in those with smaller total grey matter volume. CONCLUSIONS Although 24-hour time use was not associated with total or regional grey matter independently, total grey matter and frontal lobe grey matter volume moderated the relationship between time-use composition and several cognitive outcomes. Future studies should investigate these relationships longitudinally to assess whether changes in time-use composition correspond to changes in grey matter volume and cognition.
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Affiliation(s)
- Maddison L Mellow
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Timothy Olds
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Ty Stanford
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Jillian Dorrian
- Behaviour-Brain-Body Research Centre, Justice and Society, University of South Australia, Adelaide, Australia
| | - Alexandra T Wade
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Jurgen Fripp
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Queensland, Australia
| | - Ying Xia
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Queensland, Australia
| | - Mitchell R Goldsworthy
- Behaviour-Brain-Body Research Centre, Justice and Society, University of South Australia, Adelaide, Australia
- School of Biomedicine, University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Frini Karayanidis
- Functional Neuroimaging Laboratory, School of Psychological Sciences, College of Engineering, Science and the Environment, University of Newcastle, Callaghan, Australia
| | - Michael J Breakspear
- Functional Neuroimaging Laboratory, School of Psychological Sciences, College of Engineering, Science and the Environment, University of Newcastle, Callaghan, Australia
- Discipline of Psychiatry, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Ashleigh E Smith
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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Matricciani L, Dumuid D, Stanford T, Maher C, Bennett P, Bobrovskaya L, Murphy A, Olds T. Time use and dimensions of healthy sleep: A cross-sectional study of Australian children and adults. Sleep Health 2024:S2352-7218(23)00250-4. [PMID: 38199899 DOI: 10.1016/j.sleh.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/12/2023] [Accepted: 10/24/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Sleep is increasingly recognized as a multidimensional construct that occurs within the 24-hour day. Despite advances in our understanding, studies continue to consider the relationship between sleep, sedentary time and physical activity separately, and not as part of the 24-hour day. AIMS To determine the association between the 24-hour activity composition and dimensions of healthy sleep. METHODS This study examined data on 1168 children (mean age 12years; 49% female) and 1360 adults (mean age 44years; 87% female) collected as part of the Child Health CheckPoint study. Participants were asked to wear a GENEActiv monitor (Activinsights, Cambs, UK) on their nondominant wrist for eight consecutive days to measure 24-hour time-use. Compositional data analysis was used to examine the association between time use (actigraphy-derived sleep duration, sedentary time, light physical activity and moderate-vigorous physical activity) and dimensions of healthy sleep. Healthy sleep was conceptualized in terms of continuity/efficiency, timing, alertness/sleepiness, satisfaction/quality, and regularity. Time allocations were also examined. RESULTS The 24-hour activity composition was significantly associated with all objectively measured and self-report dimensions of healthy sleep in both children and adults. Allocating more time to sleep was associated with earlier sleep onsets, later sleep offsets, less efficient and more consistent sleep patterns for both children and adults. CONCLUSION This study highlights the integral relationship between daily activities and dimensions of sleep. Considering sleep within the 24-hour day activity composition framework may help inform lifestyle decisions to improve sleep health.
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Affiliation(s)
- Lisa Matricciani
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia; Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia.
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia; Allied Health and Human Performance (AHHP), University of South Australia, Adelaide, South Australia, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Ty Stanford
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia; Allied Health and Human Performance (AHHP), University of South Australia, Adelaide, South Australia, Australia
| | - Paul Bennett
- School of Nursing and Midwifery, Griffith Health, Griffith University, Brisbane, Queensland, Australia
| | - Larisa Bobrovskaya
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Andrew Murphy
- Allied Health and Human Performance (AHHP), University of South Australia, Adelaide, South Australia, Australia
| | - Tim Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia; Allied Health and Human Performance (AHHP), University of South Australia, Adelaide, South Australia, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Kastelic K, Šarabon N, Stanford T, Dumuid D, Pedišić Ž. Are reallocations of time between physical activity, sedentary behaviour and sleep associated with low back pain? A compositional data analysis. BMJ Open Sport Exerc Med 2023; 9:e001701. [PMID: 38022760 PMCID: PMC10679988 DOI: 10.1136/bmjsem-2023-001701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives The aim of this cross-sectional study was to explore the associations of reallocating time between moderate- to vigorous-intensity physical activity (MVPA), light-intensity physical activity (LPA), sedentary behaviour (SB) and sleep with occurrence, frequency and intensity of low back pain (LBP) among adults using compositional isotemporal substitution analysis. Methods A total of 2333 participants from the general adult population completed the Daily Activity Behaviours Questionnaire asking about their time-use composition consisting of sleep, SB, LPA and MVPA, and they self-reported their frequency and intensity of LBP in the past year. Results Regression analyses adjusted for age, sex, body mass index, smoking, stress, education and socioeconomic status found that the time-use composition is associated with the frequency (p=0.009) and intensity of LBP (p<0.001). Reallocating time from SB or LPA to sleep was associated with lower frequency and intensity of LBP (p<0.05). Reallocating time from MVPA to sleep, SB or LPA and from SB to LPA was associated with a lower intensity of LBP (p<0.05). For example, reallocating 30 min/day from SB to sleep was associated with 5% lower odds (95% CI: 2% to 8%, p=0.001) of experiencing LBP more frequently, and 2% lower LBP intensity (95% CI: 1% to 3%, p<0.001). Conclusion LBP sufferers may benefit from getting additional sleep and spending more time in LPA, while engaging less in SB and MVPA. These reallocations of time may be meaningful from clinical and public health perspectives.
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Affiliation(s)
- Kaja Kastelic
- Department of Health Studies, Andrej Marušič Institute, University of Primorska, Koper, Slovenia
- InnoRenew CoE, Izola, Slovenia
| | - Nejc Šarabon
- InnoRenew CoE, Izola, Slovenia
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Ty Stanford
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Željko Pedišić
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
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Mouatt B, Smith AE, Parfitt G, Stanford T, McDade J, Smith RT, Stanton TR. What I see and what I feel: the influence of deceptive visual cues and interoceptive accuracy on affective valence and sense of effort during virtual reality cycling. PeerJ 2023; 11:e16095. [PMID: 37810786 PMCID: PMC10559878 DOI: 10.7717/peerj.16095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Background How we feel during exercise is influenced by exteroceptive (e.g., vision) and interoceptive (i.e., internal body signals) sensory information, and by our prior experiences and expectations. Deceptive visual cues about one's performance during exercise can increase work rate, without negatively impacting affective valence (good/bad responses) or perceived exertion. However, what is less understood is whether the perception of the exercise experience itself can be shifted, if work rate is held constant. Here we aimed to investigate whether deceptive vision-via illusory hills in a virtual reality (VR) cycling experience-alters affective valence and perceived exertion when physical effort is controlled. We also evaluated whether the accuracy with which one detects interoceptive cues influences the extent to which deceptive visual information can shift exercise experiences. Methods A total of 20 participants (10 female; 30.2 ± 11.2 yrs) completed three VR cycling conditions each of 10-min duration, in a randomised, counterbalanced order. Pedal resistance/cadence were individualised (to exercise intensity around ventilatory threshold) and held constant across conditions; only visual cues varied. Two conditions provided deceptive visual cues about the terrain (illusory uphill, illusory downhill; resistance did not change); one condition provided accurate visual cues (flat terrain). Ratings of affective valence (Feeling Scale) and of perceived exertion (Borg's RPE) were obtained at standardised timepoints in each VR condition. Interoceptive accuracy was measured via a heartbeat detection test. Results Linear mixed effects models revealed that deceptive visual cues altered affective valence (f2 = 0.0198). Relative to flat terrain, illusory downhill reduced affective valence (Est = -0.21, p = 0.003), but illusory uphill did not significantly improve affective valence (Est = 0.107, p = 0.14). Deceptive visual cues altered perceived exertion, and this was moderated by the level of interoceptive accuracy (Condition-Interoception interaction, p = 0.00000024, f2 = 0.0307). Higher levels of interoceptive accuracy resulted in higher perceived exertion in the illusory downhill condition (vs flat), while lower interoceptive accuracy resulted in lower perceived exertion in both illusory hill conditions (vs flat) and shifts of greater magnitude. Conclusions Deceptive visual cues influence perceptual responses during exercise when physical effort does not vary, and for perceived exertion, the weighting given to visual exteroceptive cues is determined by accuracy with which interoceptive cues are detected. Contrary to our hypotheses, deceptive visual cues did not improve affective valence. Our findings suggest that those with lower levels of interoceptive accuracy experience most benefit from deceptive visual cues, providing preliminary insight into individualised exercise prescription to promote positive (and avoid negative) exercise experiences.
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Affiliation(s)
- Brendan Mouatt
- IIMPACT in Health, Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Ashleigh E. Smith
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Gaynor Parfitt
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Ty Stanford
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jeremy McDade
- Wearable Computer Laboratory, Mawson Lakes Campus, University of South Australia, Adelaide, South Australia, Australia
| | - Ross T. Smith
- Wearable Computer Laboratory, Mawson Lakes Campus, University of South Australia, Adelaide, South Australia, Australia
| | - Tasha R. Stanton
- IIMPACT in Health, Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
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Mellow ML, Dumuid D, Wade AT, Stanford T, Olds TS, Karayanidis F, Hunter M, Keage HAD, Dorrian J, Goldsworthy MR, Smith AE. Corrigendum: Twenty-four-hour time-use composition and cognitive function in older adults: cross-sectional findings of the ACTIVate study. Front Hum Neurosci 2023; 17:1221303. [PMID: 37362948 PMCID: PMC10289155 DOI: 10.3389/fnhum.2023.1221303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fnhum.2022.1051793.].
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Affiliation(s)
- Maddison L. Mellow
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Alexandra T. Wade
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Ty Stanford
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Timothy S. Olds
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Frini Karayanidis
- Functional Neuroimaging Laboratory, School of Psychological Sciences, The University of Newcastle, Newcastle, NSW, Australia
- Healthy Minds Research Program, Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - Montana Hunter
- Functional Neuroimaging Laboratory, School of Psychological Sciences, The University of Newcastle, Newcastle, NSW, Australia
- Healthy Minds Research Program, Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - Hannah A. D. Keage
- Behaviour-Brain-Body Research Centre, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Jillian Dorrian
- Behaviour-Brain-Body Research Centre, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Mitchell R. Goldsworthy
- Lifespan Human Neurophysiology Group, School of Biomedicine, University of Adelaide, Adelaide, SA, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Ashleigh E. Smith
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Mellow ML, Dumuid D, Wade AT, Stanford T, Olds TS, Karayanidis F, Hunter M, Keage HAD, Dorrian J, Goldsworthy MR, Smith AE. Twenty-four-hour time-use composition and cognitive function in older adults: Cross-sectional findings of the ACTIVate study. Front Hum Neurosci 2022; 16:1051793. [PMID: 36504624 PMCID: PMC9729737 DOI: 10.3389/fnhum.2022.1051793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Physical activity, sedentary behaviour and sleep are associated with cognitive function in older adults. However, these behaviours are not independent, but instead make up exclusive and exhaustive components of the 24-h day. Few studies have investigated associations between 24-h time-use composition and cognitive function in older adults. Of these, none have considered how the quality of sleep, or the context of physical activity and sedentary behaviour may impact these relationships. This study aims to understand how 24-h time-use composition is associated with cognitive function across a range of domains in healthy older adults, and whether the level of recreational physical activity, amount of television (TV) watching, or the quality of sleep impact these potential associations. Methods 384 healthy older adults (age 65.5 ± 3.0 years, 68% female, 63% non-smokers, mean education = 16.5 ± 3.2 years) participated in this study across two Australian sites (Adelaide, n = 207; Newcastle, n = 177). Twenty-four-hour time-use composition was captured using triaxial accelerometry, measured continuously across 7 days. Total time spent watching TV per day was used to capture the context of sedentary behaviours, whilst total time spent in recreational physical activity was used to capture the context of physical activity (i.e., recreational accumulation of physical activity vs. other contexts). Sleep quality was measured using a single item extracted from the Pittsburgh Sleep Quality Index. Cognitive function was measured using a global cognition index (Addenbrooke's Cognitive Examination III) and four cognitive domain composite scores (derived from five tests of the Cambridge Neuropsychological Test Automated Battery: Paired Associates Learning; One Touch Stockings of Cambridge; Multitasking; Reaction Time; Verbal Recognition Memory). Pairwise correlations were used to describe independent relationships between time use variables and cognitive outcomes. Then, compositional data analysis regression methods were used to quantify associations between cognition and 24-h time-use composition. Results After adjusting for covariates and false discovery rate there were no significant associations between time-use composition and global cognition, long-term memory, short-term memory, executive function, or processing speed outcomes, and no significant interactions between TV watching time, recreational physical activity engagement or sleep quality and time-use composition for any cognitive outcomes. Discussion The findings highlight the importance of considering all activities across the 24-h day against cognitive function in older adults. Future studies should consider investigating these relationships longitudinally to uncover temporal effects.
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Affiliation(s)
- Maddison L. Mellow
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Alexandra T. Wade
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Ty Stanford
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Timothy S. Olds
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Frini Karayanidis
- Functional Neuroimaging Laboratory, School of Psychological Sciences, The University of Newcastle, Newcastle, NSW, Australia
- Healthy Minds Research Program, Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - Montana Hunter
- Functional Neuroimaging Laboratory, School of Psychological Sciences, The University of Newcastle, Newcastle, NSW, Australia
- Healthy Minds Research Program, Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - Hannah A. D. Keage
- Behaviour-Brain-Body Research Centre, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Jillian Dorrian
- Behaviour-Brain-Body Research Centre, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Mitchell R. Goldsworthy
- Lifespan Human Neurophysiology Group, School of Biomedicine, University of Adelaide, Adelaide, SA, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Ashleigh E. Smith
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Hillen JB, Stanford T, Ward M, Roughead EE, Kalisch Ellett L, Pratt N. Rituximab and Pyoderma Gangrenosum: An Investigation of Disproportionality Using a Systems Biology-Informed Approach in the FAERS Database. Drugs Real World Outcomes 2022; 9:639-647. [PMID: 35933497 DOI: 10.1007/s40801-022-00322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Studies have found an increased risk of pyoderma gangrenosum associated with rituximab. The structural properties and pharmacological action of rituximab may affect the risk of pyoderma gangrenosum. Additionally, pyoderma gangrenosum is associated with autoimmune disorders for which rituximab is indicated. OBJECTIVE We aimed to determine whether rituximab is disproportionally associated with pyoderma gangrenosum using a systems biology-informed approach. METHODS Adverse event reports were extracted from the US Food and Drug Administration Adverse Event Reporting System (FAERS, 2013-20). The Bayesian Confidence Propagation Neural Network Information Component was used to test for disproportionality. Comparators used to determine potential causal pathways included all other medicines, all medicines with a similar structure (monoclonal antibodies), all medicines with the same pharmacological target (CD20 antagonists) and all medicines used for the same indication(s) as rituximab. RESULTS Thirty-two pyoderma gangrenosum cases were identified, 62.5% were female, with a median age of 48 years. There was an increased association of pyoderma gangrenosum with rituximab compared with all other medicines (exponentiated Information Component 6.75, 95% confidence interval (CI) 4.66-9.23). No association was observed when the comparator was either monoclonal antibodies or CD20 antagonists. Conditions for which an association of pyoderma gangrenosum with rituximab was observed were multiple sclerosis (6.68, 95% CI 1.63-15.15), rheumatoid arthritis (2.67, 95% CI 1.14-4.80) and non-Hodgkin's lymphoma (2.94, 95% CI 1.80-3.73). CONCLUSIONS Pyoderma gangrenosum was reported more frequently with rituximab compared with all other medicines. The varying results when restricting medicines for the same condition suggest the potential for confounding by indication. Post-market surveillance of biologic medicines in FAERS should consider a multi-faceted approach, particularly when the outcome of interest is associated with the underlying immune condition being treated by the medicine of interest.
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Affiliation(s)
- Jodie Belinda Hillen
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Playford Building Level 6, Frome Rd, Adelaide, SA, 5000, Australia
| | - Ty Stanford
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Playford Building Level 6, Frome Rd, Adelaide, SA, 5000, Australia
| | - Michael Ward
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Playford Building Level 6, Frome Rd, Adelaide, SA, 5000, Australia.,Pharmacy Education, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - E E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Playford Building Level 6, Frome Rd, Adelaide, SA, 5000, Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Playford Building Level 6, Frome Rd, Adelaide, SA, 5000, Australia
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Playford Building Level 6, Frome Rd, Adelaide, SA, 5000, Australia.
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Hillen J, Ward M, Slee M, Stanford T, Roughead E, Kalisch Ellett L, Pratt N. Utilisation of disease modifying treatment and diversity of treatment pathways in relapsing remitting multiple sclerosis. Mult Scler Relat Disord 2021; 57:103412. [PMID: 34856498 DOI: 10.1016/j.msard.2021.103412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is minimal information on the utilisation of Disease Modifying Treatment (DMTs) for multiple sclerosis. The appropriate and safe use of medicines is informed by utilisation studies. Outcomes can inform health interventions to improve appropriate use of medicines and post marketing surveillance activities to improve safety. OBJECTIVE To evaluate utilisation and treatment patterns of disease modifying treatments (DMTs) for relapsing remitting multiple sclerosis (RRMS). METHODS A representative sample of the Australian pharmaceutical benefits scheme data were analysed (2006-2016). Demographics of incident users and trends in incident and prevalent users were determined. Individual patient treatment pathways were determined by sequential initiation of medicines in two different periods (2006-2013 and 2014-2019). RESULTS There were 20,660 patients with at least one dispensing of a DMT for RRMS during the study period (median age 41 years, 75% female). Incident and prevalent use increased by 20% and 88%, respectively. The market was responsive to 13 new listings of DMTs over the study period. Sequential treatment was found for 66% of initiators in 2006-2013 and 28.5% of initiators in 2014-2019. Diverse treatment pathways were found, with 278 and 93 unique sequences in 2006-2013 and 2014-2019, respectively. CONCLUSION The availability of new DMTs has influenced both initial treatment choice and prevalence of users. Individualised treatment patterns and exposure to multiple medicines over time will challenge traditional pharmacovigilance systems.
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Affiliation(s)
- J Hillen
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia.
| | - M Ward
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia; Pharmacy Education, Clinical and Health Sciences, University of South Australia, Australia
| | - M Slee
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - T Stanford
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia
| | - E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia
| | - L Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia
| | - N Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia
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Stanton TR, Braithwaite FA, Butler D, Moseley GL, Hill C, Milte R, Ratcliffe J, Maher C, Tomkins-Lane C, Pulling BW, MacIntyre E, Esterman A, Stanford T, Lee H, Fraysse F, Metcalf B, Mouatt B, Bennell K. The EPIPHA-KNEE trial: Explaining Pain to target unhelpful pain beliefs to Increase PHysical Activity in KNEE osteoarthritis - a protocol for a multicentre, randomised controlled trial with clinical- and cost-effectiveness analysis. BMC Musculoskelet Disord 2021; 22:738. [PMID: 34454458 PMCID: PMC8401372 DOI: 10.1186/s12891-021-04561-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022] Open
Abstract
Background Despite well-established benefits of physical activity for knee osteoarthritis (OA), nine of ten people with knee OA are inactive. People with knee OA who are inactive often believe that physical activity is dangerous, fearing that it will further damage their joint(s). Such unhelpful beliefs can negatively influence physical activity levels. We aim to evaluate the clinical- and cost-effectiveness of integrating physiotherapist-delivered pain science education (PSE), an evidence-based conceptual change intervention targeting unhelpful pain beliefs by increasing pain knowledge, with an individualised walking, strengthening, and general education program. Methods Two-arm, parallel-design, multicentre randomised controlled trial involving 198 people aged ≥50 years with painful knee OA who do not meet physical activity guideline recommendations or walk regularly for exercise. Both groups receive an individualised physiotherapist-led walking, strengthening, and OA/activity education program via 4x weekly in-person treatment sessions, followed by 4 weeks of at-home activities (weekly check-in via telehealth), with follow-up sessions at 3 months (telehealth) and 5 and 9 months (in-person). The EPIPHA-KNEE group also receives contemporary PSE about OA/pain and activity, embedded into all aspects of the intervention. Outcomes are assessed at baseline, 12 weeks, 6 and 12 months. Primary outcomes are physical activity level (step count; wrist-based accelerometry) and self-reported knee symptoms (WOMAC Total score) at 12 months. Secondary outcomes are quality of life, pain intensity, global rating of change, self-efficacy, pain catastrophising, depression, anxiety, stress, fear of movement, knee awareness, OA/activity conceptualisation, and self-regulated learning ability. Additional measures include adherence, adverse events, blinding success, COVID-19 impact on activity, intention to exercise, treatment expectancy/perceived credibility, implicit movement/environmental bias, implicit motor imagery, two-point discrimination, and pain sensitivity to activity. Cost-utility analysis of the EPIPHA-KNEE intervention will be undertaken, in addition to evaluation of cost-effectiveness in the context of primary trial outcomes. Discussion We will determine whether the integration of PSE into an individualised OA education, walking, and strengthening program is more effective than receiving the individualised program alone. Findings will inform the development and implementation of future delivery of PSE as part of best practice for people with knee OA. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12620001041943 (13/10/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04561-6.
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Affiliation(s)
- Tasha R Stanton
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.
| | - Felicity A Braithwaite
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - David Butler
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.,NOIgroup Pty Ltd, Adelaide, South Australia
| | - G Lorimer Moseley
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Catherine Hill
- Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Rachel Milte
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
| | - Brian W Pulling
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Erin MacIntyre
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Adrian Esterman
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Ty Stanford
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Rehabilitation Research in Oxford (RRIO), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Francois Fraysse
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Ben Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Brendan Mouatt
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia
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Meyer T, Qi X, Stanford T, Constantinidis C. Effects of training on the organization of spatial and feature visual responses in the lateral prefrontal cortex. J Vis 2010. [DOI: 10.1167/8.6.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Sexton SA, Walter WL, Jackson MP, De Steiger R, Stanford T. Ceramic-on-ceramic bearing surface and risk of revision due to dislocation after primary total hip replacement. ACTA ACUST UNITED AC 2009; 91:1448-53. [PMID: 19880888 DOI: 10.1302/0301-620x.91b11.22100] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dislocation is a common reason for revision following total hip replacement. This study investigated the relationship between the bearing surface and the risk of revision due to dislocation. It was based on 110 239 primary total hip replacements with a diagnosis of osteoarthritis collected by the Australian Orthopaedic Association National Joint Replacement Registry between September 1999 and December 2007. A total of 862 (0.78%) were revised because of dislocation. Ceramic-on-ceramic bearing surfaces had a lower risk of requiring revision due to dislocation than did metal-on-polyethylene and ceramic-on-polyethylene surfaces, with a follow-up of up to seven years. However, ceramic-on-ceramic implants were more likely to have larger prosthetic heads and to have been implanted in younger patients. The size of the head of the femoral component and age are known to be independent predictors of dislocation. Therefore, the outcomes were stratified by the size of the head and age. There is a significantly higher rate of revision for dislocation in ceramic-on-ceramic bearing surfaces than in metal-on-polyethylene implants when smaller sizes (< or = 28 mm) of the head were used in younger patients (< 65 years) (hazard ratio = 1.53, p = 0.041) and also with larger (> 28 mm) and in older patients (> or = 65 years) (hazard ratio = 1.73, p = 0.016).
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Affiliation(s)
- S A Sexton
- Sydney Hip and Knee Surgeons, Mater Clinic, 3-9 Gillies Street, Sydney, NSW 2060, Australia.
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Bollt EM, Stanford T, Lai YC, Zyczkowski K. Validity of threshold-crossing analysis of symbolic dynamics from chaotic time series. Phys Rev Lett 2000; 85:3524-3527. [PMID: 11030937 DOI: 10.1103/physrevlett.85.3524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2000] [Revised: 08/07/2000] [Indexed: 05/23/2023]
Abstract
A practical and popular technique to extract the symbolic dynamics from experimentally measured chaotic time series is the threshold-crossing method, by which an arbitrary partition is utilized for determining the symbols. We address to what extent the symbolic dynamics so obtained can faithfully represent the phase-space dynamics. Our principal result is that such a practice can lead to a severe misrepresentation of the dynamical system. The measured topological entropy is a Devil's staircase-like, but surprisingly nonmonotone, function of a parameter characterizing the amount of misplacement of the partition.
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Affiliation(s)
- EM Bollt
- Mathematics Department, 572 Holloway Road, U.S. Naval Academy, Annapolis, Maryland 21402-5002, USA
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Plemons J, Stanford T. Scaling and root planing: effective therapeutic modalities. Interview by Phillip Bonner. Dent Today 1996; 15:62, 64-5. [PMID: 9567842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Stanford T. Eliminating complacency. Emergency 1988; 20:42-3, 56-8. [PMID: 10285238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Stanford T. SOPS--who needs them? Emergency 1986; 18:40-1, 43. [PMID: 10278496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Stanford T, Pollack RH. Configuration color vision tests: the interaction between aging and the complexity of figure-ground segregation. J Gerontol 1984; 39:568-71. [PMID: 6332128 DOI: 10.1093/geronj/39.5.568] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A cross-sectional study comparing response time and the percentage of items correctly identified in three color vision tests (Pflügertrident, HRR-AO pseudoisochromatic plates, and AO pseudoisochromatic plates) was carried out on 72 women (12 in each decade) ranging from ages 20 to 79 years. Overall, time scores increased across the age groups. Analysis of the correctness scores indicated that the AO pseudoisochromatic plates requiring the identification of numbers was more difficult than the other tests which consisted of geometric forms or the letter E. This differential difficulty increased as a function of age. There was no indication of color defect per se which led to the conclusion that figure complexity may be the key variable determining performance. The results were similar to those obtained by Lee and Pollack (1978) in their study of the Embedded Figures Test.
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