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Objectives: To assess the prevalence and associations of hand symptoms in a community setting. Methods: The North West Adelaide Health Study (NWAHS) is a longitudinal cohort study of people aged ≥≥ 18 years. Analysis was performed in participants who completed a telephone interview, a quality of life questionnaire [the 36--item short-form health survey, (SF-36)], and the Australian//Canadian (AUSCAN) Osteoarthritis (OA) Hand Index, and underwent grip strength measurement. Results: Overall, 477 (13.7%%) reported hand pain, aching, or stiffness. Of these, 169 (35.8%%) had been diagnosed with hand arthritis. Women were more likely to have hand symptoms than men, as were those aged ≥≥ 50 years (p < 0.001). Hand symptoms were associated with lower quality of life scores (p < 0.05). Participants with hand arthritis had more severe pain, stiffness, and poorer physical functioning as reflected by higher AUSCAN scores. Grip strength was reduced in those with hand symptoms and hand arthritis (p < 0.05) and inversely associated with mean AUSCAN subscores and SF-36 physical functioning scores (p < 0.001). Conclusions: Hand symptoms were present in 14%% of the population and were more common in women and those aged ≥≥ 50 years. Hand symptoms were associated with reduced grip strength and reduced quality of life. Hand arthritis was associated with higher AUSCAN scores. Hand symptoms and hand arthritis have a significant impact on physical functioning and quality of life. [ABSTRACT FROM AUTHOR]

Animal studies and one large cross-sectional study of 752 healthy Chinese men and women suggest that monosodium glutamate (MSG) may be associated with overweight/obesity, and these findings raise public concern over the use of MSG as a flavour enhancer in many commercial foods. The aim of this analysis was to investigate a possible association between MSG intake and obesity, and determine whether a greater MSG intake is associated with a clinically significant weight gain over 5 years. Data from 1282 Chinese men and women who participated in the Jiangsu Nutrition Study were analysed. In the present study, MSG intake and body weight were quantitatively assessed in 2002 and followed up in 2007. MSG intake was not associated with significant weight gain after adjusting for age, sex, multiple lifestyle factors and energy intake. When total glutamate intake was added to the model, an inverse association between MSG intake and 5% weight gain was found (P = 0.028), but when the model was adjusted for either rice intake or food patterns, this association was abolished. These findings indicate that when other food items or dietary patterns are accounted for, no association exists between MSG intake and weight gain. [ABSTRACT FROM AUTHOR]

Objective: The Australian Pharmaceutical Benefits Scheme (PBS) expanded the criteria for eligibility for subsidised lipid-lowering therapy (LLT) in 2006. The aim of this study was to determine the use of LLT in a representative Australian population in relation to cardiovascular disease (CVD) risk, and the effectiveness of the therapy in meeting target levels. Design: Cross-sectional biomedical study with telephone interviews, questionnaires, clinical measurements, and PBS dispensing data. Subjects: Representative population sample of 4060 urban adults aged ? 18 years attending for the biomedical examination in 2001. Results: Of the 406 who qualified for PBS-subsidised LLT at that time, only 88 (21.5%) were actually on LLT. National Heart Foundation of Australia (NHF) recommended low-density lipoprotein cholesterol (LDL-C) levels of < 2.5 mmol/L were recorded in only 13% (528) of the population, and in 46.8% of those on LLT. Of those on LLT, 76% had total cholesterol < 5.5 mmol/L, but over 80% had total cholesterol levels above NHF-recommended levels of 4.0 mmol/L. Of the 842 classified at the highest CVD risk, only 26% were using LLT. Those aged > 60 years and on low incomes were significantly more likely to use LLT. The new PBS criteria will expand eligibility to include nearly 20% of adults. Conclusions: The majority of people at high risk of CVD were not receiving LLT, and LLT is not being used to its full effectiveness. People with low incomes or on government benefits or pensions were not less likely to use LLT than others under the PBS scheme. Whether higher copayments for those on low incomes who do not qualify for concessional payments is a significant barrier to LLT use needs further research. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare Medicare-related costs and service utilisation of people with diagnosed diabetes, asthma or chronic obstructive pulmonary disease (COPD) to those who were previously undiagnosed, and those without these conditions. DESIGN, SETTING AND PARTICIPANTS: Representative cross-sectional study of people (18+ years) living in the north-west area of Adelaide. Participants were recruited by telephone interviews. Biomedical and self-report data for 2352 participants were linked to Medicare Australia Medicare Benefits Schedule (MBS) data from 1997 to 2002. MAIN OUTCOME MEASURES: Mean number and cost (benefit paid) of MBS services for people with diagnosed and previously undiagnosed diabetes, asthma, and COPD, and those without these conditions. RESULTS: Mean (+/- SD) MBS costs were significantly greater for people diagnosed with diabetes ($4205 +/- 2596), asthma ($3307 +/- 2542), or COPD ($3779 +/- 2529) than for those without these conditions. MBS costs for people with asthma or COPD that had not yet been diagnosed were also significantly higher than for those without these conditions, although this was inconsistent across financial years. CONCLUSIONS: Diabetes, asthma, and COPD are costly conditions in terms of health service use. Costs associated with undiagnosed asthma and COPD are similar to their diagnosed states. Prevention of progression along each chronic disease continuum is likely to reduce costs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Age-related change in body composition is associated with adverse health outcomes, including functional decline, disability, morbidity, and early mortality. Prevention of age-related changes requires a greater understanding of the associations among age, lifestyle factors, and body composition. OBJECTIVE: We aimed to comprehensively determine lifestyle factors associated with age-related differences in body composition assessed by using dual-energy X-ray absorptiometry. DESIGN: We analyzed baseline (cross-sectional) data collected from 2002 to 2005 for approximately 1200 men in the Florey Adelaide Male Aging Study, a regionally representative cohort of Australian men aged 35-81 y. RESULTS: Mean values for whole-body lean mass (LM) and areal bone mineral density (aBMD) decreased, whereas mean values for abdominal fat mass (FM) and whole-body and abdominal percentage FM (%FM) increased with age. No significant age-related differences were found for whole-body FM. Multiple adjusted odds of being in the highest tertiles for whole-body and abdominal %FM decreased for smokers (63-71%) but increased with age group and for lowest energy (43-50%), carbohydrate (92-107%), and fiber (107%) intake tertiles. Multiple adjusted odds of being in the highest aBMD tertile decreased for lowest body mass (92%) and carbohydrate intake (63%) tertiles and for men aged > or = 75 y (78%) but increased for Australian birth (58%) and for participation in vigorous physical activities (82%). CONCLUSIONS: Age-related differences in body composition indicate that whole-body FM remains stable but increases viscerally and that whole-body %FM is confounded by LM, whereas aBMD decreases with age. Age-related differences in %FM and aBMD are associated with demographic and lifestyle factors. Copyright © 2008 American Society for Nutrition [ABSTRACT FROM AUTHOR]

These recommendations for human immunodeficiency virus (HIV) testing are intended for all health-care providers in the public and private sectors, including those working in hospital emergency departments, urgent care clinics, inpatient services, substance abuse treatment clinics, public health clinics, community clinics, correctional health-care facilities, and primary care settings. The recommendations address HIV testing in health-care settings only. They do not modify existing guidelines concerning HIV counseling, testing, and referral for persons at high risk for HIV who seek or receive HIV testing in nonclinical settings (e.g., community-based organizations, outreach settings, or mobile vans). The objectives of these recommendations are to increase HIV screening of patients, including pregnant women, in health-care settings; foster earlier detection of HIV infection; identify and counsel persons with unrecognized HIV infection and link them to clinical and prevention services; and further reduce perinatal transmission of HIV in the United States. These revised recommendations update previous recommendations for HIV testing in health-care settings and for screening of pregnant women (CDC. Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings. MMWR 1993;42[No. RR-2]:1--10; CDC. Revised guidelines for HIV counseling, testing, and referral. MMWR 2001;50[No. RR-19]:1--62; and CDC. Revised recommendations for HIV screening of pregnant women. MMWR 2001;50[No. RR-19]:63--85).Major revisions from previously published guidelines are as follows:For patients in all health-care settingsHIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).Persons at high risk for HIV infection should be screened for HIV at least annually.Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings.For pregnant womenHIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening).Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women. [ABSTRACT FROM AUTHOR]

Objective: Reports of the prevalence and impact of comorbid conditions among people with asthma have been limited to certain population groups or convenience samples. Our aim was to examine the prevalence of major comorbidity in asthma and associations with quality of life and functional status in the general population.Study Design/setting: The WANTS Health and Well-being Survey is a cross-sectional representative population household telephone interview survey in three Australian states.Participants: Representative sample of noninstitutionalized adults in three Australian states.Measurement and Results: From the available sample of 10,080 patients, 7,619 interviews were completed (participation rate, 74.8%), with 834 people reporting current doctor-diagnosed asthma (11.2%). People with asthma were more likely to report one of the selected comorbid conditions: diabetes, arthritis, heart disease, stroke, cancer, osteoporosis (adjusted odds ratio, 1.9; 95% confidence interval, 1.5 to 2.2). Among people with asthma, there were statistically and clinically significant decreases in usual activity levels and in Short Form-12 physical component summary scores when another chronic condition was also present. For those with any of the chronic conditions, the additional presence of asthma was associated with significant further impairment in quality of life in those aged > 35 years but not in younger adults.Conclusion: The significant reduction in quality of life associated with comorbidity in asthma has implications for disease management and organization of care, as well as for the design and external validity of single-disease clinical trials. [ABSTRACT FROM AUTHOR]

Summary Recently, we have found that the neuropeptide alpha-melanocyte stimulating hormone (α-MSH) not only suppresses IFN-γ production, but also induces TGF-β1 production by activated effector T cells. These α-MSH- treated effector T cells function as regulatory T cells in that they suppress IFN-γ production and hypersensitivity mediated by other effector T cells. Experimental autoimmune uveoretinitis (EAU) was suppressed in its severity and incidence in mice that were injected with primed T cells activated in vitro by APC and antigen in the presence of α-MSH. Moreover, it appeared that α-MSH had converted a population of effector T cells polarized to mediate hypersensitivity into a population of T cells that now mediated immunoregulation. To characterize these α-MSH- treated T cells, primed T cells were TCR-stimulated in the presence of α-MSH in vitro and their lymphokine profile was examined. Such effector T cells displayed enhanced levels of TGF-β1 production and no IFN-γ or IL-10, with IL-4 levels remaining unchanged in comparison with inactivated T cells. In addition, if soluble TGF-β receptor II was added to cocultures of α-MSH-treated T cells and activated Th1 cells, the α-MSH-treated T cells could not suppress IFN-γ production by the Th1 cells. These results suggest that α-MSH induces T cells with a regulatory lymphokine pattern, and that through their production of TGF-β1 these cells suppress other effector T cells. Examination of the α-MSH-treated T cells showed that α-MSH did not alter the phosphorylation of CD3 molecules following TCR engagement. Primed T cells express the melanocortin 5 receptor (MC5r), a receptor that is linked to an intracellular signalling pathway shared by other cytokine receptors. Blocking the receptor with antibody prevented α-MSH from suppressing IFN-γ production by the activated regulatory T cells, suggesting that... [ABSTRACT FROM AUTHOR]

Background: This study measured the prevalence of hearing impairment, and major demographic factors that influence the prevalence, in a representative South Australian adult population sample aged > or = 15 years.Methods: The study group was recruited from representative population surveys of South Australians. Participants in these surveys who reported a hearing disability were then recruited to an audiological study which measured air and bone conduction thresholds. In addition a sample of those people who reported no hearing disability were recruited to the audiological study.Results: The data reported in this study are the first in Australia to assess the prevalence of hearing impairment from a representative population survey using audiological methods. The data show that 16.6% of the South Australian population have a hearing impairment in the better ear at > or = 25 dBHTL and 22.2% in the worse ear at the same level. The results obtained in this representative sample compare well with those obtained in the British Study of Hearing, although some differences were observed.Conclusions: Overall, there are only a few studies worldwide that have audiologically assessed the impairment of hearing from a representative population sample. The overall prevalence of hearing impairment in Australia is similar to that found in Great Britain, although there are some differences between the estimates of severity of impairment and some sex differences. The corroboration of the two studies reinforces the status of hearing impairment as the most common disability of adulthood. The present study also showed that there are a large number of Australians who may benefit from a more systematic community-based rehabilitation programme including the fitting of hearing aids. Secondly, the study identified the need for health goals and targets for hearing to be based on an epidemiological approach to the problem. [ABSTRACT FROM AUTHOR]

Purpose One of the prognostically bad parameters in uveal melanoma is the presence of an inflammatory phenotype, characterized by an increased expression of HLA antigens and an immunologic infiltrate. We wondered whether the presence of specific chemokines and cytokines in the aqueous humor (AqH) from uveal melanoma‐containing eyes is associated with this inflammatory phenotype, with the presence of macrophages, and/or with survival. Methods Directly following enucleation, AqH was obtained from 37 eyes containing uveal melanoma. Samples were stored at ‐80 °C till use. Using a multiplex bead array, 15 different cytokines were measured. Determination of intratumoral macrophages was performed by immunohistochemistry and immunofluorescence. The presence of specific cytokines was compared to histopathological, genetic and clinical tumor characteristics, as well as patient survival. Results Several cytokines showed a significantly higher expression in the AqH from uveal melanoma‐containing eyes compared to the AqH from eyes undergoing cataract surgery. Only MCP‐3 was associated with the presence of macrophages and the tumor promoting M2‐type macrophage in uveal melanoma patients. Hardly any correlations were found between cytokine levels and known prognostic factors for uveal melanoma. Also, cytokine levels were not of predictive value for survival. Conclusion Although increased levels of inflammation‐related cytokines are present in the AqH of uveal melanoma‐containing eyes, hardly any associations with the presence of macrophages and their subtypes, with clinical and histopathological parameters, and prognosis were found. [ABSTRACT FROM AUTHOR]

Background: "Arthritis" is a common musculoskeletal condition but the knowledge of what type of arthritis people have, may be limited but may have changed over time in response to campaigns, increased awareness and improved health literacy. This paper describes people who did not know what type of arthritis they had, by a range of relevant demographic and socioeconomic variables, and assesses changes over time in the proportion of people who report having arthritis but do not know what type, using representative population surveillance data.Methods: Data were collected using the South Australian Monitoring and Surveillance System (SAMSS), a risk factor surveillance system where each month, a representative random sample of South Australians is selected from the Electronic White Pages, with interviews conducted using computer assisted telephone interviewing (CATI). Data were used for the period January 2006 to December 2008 (n = 16465) for respondents aged 18 years and over.Results: Overall, the proportion of respondents who did not know what type of arthritis they had, among people aged 18 years and over, for 2006 to 2008 was 6.5% (95% CI 6.1-6.9). When considering only those respondents reporting that they had been told by a doctor that they had arthritis, 30.1% did not know what type of arthritis they had. Multivariate analysis indicated that males, those with have a trade, certificate or diploma or secondary level of education, who spoke a language other than English at home, were widowed and earned $20,001 to $60,000, more than $80,000 or did not state their income were more likely to maintain that they did not know what type of arthritis they had.Conclusions: Population ageing and an increase in arthritis prevalence in the future will further increase the burden of arthritis. These increases in prevalence are not inevitable, especially if investments are made in public health prevention programs, particularly those addressing cultural and linguistic diversity and differences in socio-economic status and health literacy. [ABSTRACT FROM AUTHOR]

Background: An increasing proportion of Australia's chronic disease burden is carried by the ageing male. The aim of this study was to determine the prevalence of asthma, cancer, diabetes, angina and musculoskeletal conditions and their relationship to behavioural and socio-demographic factors in a cohort of Australian men.Methods: Self-reports of disease status were obtained from baseline clinic visits (August 2002-July 2003 & July 2004-May 2005) from 1195 randomly selected men, aged 35-80 years and living in the north-west regions of Adelaide. Initially, relative risks were assessed by regression against selected variables for each outcome. Where age-independent associations were observed with the relevant chronic disease, independent variables were fitted to customized multiadjusted models.Results: The prevalence of all conditions was moderately higher in comparison to national data for age-matched men. In particular, there was an unusually high rate of men with cancer. Multiadjusted analyses revealed age as a predictor of chronic conditions (type 2 diabetes mellitus, angina, cancer & osteoarthritis). A number of socio-demographic factors, independent of age, were associated with chronic disease, including: low income status (diabetes), separation/divorce (asthma), unemployment (cancer), high waist circumference (diabetes), elevated cholesterol (angina) and a family history of obesity (angina).Conclusion: Socio-demographic factors interact to determine disease status in this broadly representative group of Australian men. In addition to obesity and a positive personal and family history of disease, men who are socially disadvantaged (low income, unemployed, separated) should be specifically targeted by public health initiatives. [ABSTRACT FROM AUTHOR]

Background: Measurement of socioeconomic position (SEP) over the life course in population health surveillance systems is important for examining differences in health and illness between different population groups and for monitoring the impact of policies and interventions aimed at reducing health inequities and intergenerational disadvantage over time. While face-to-face surveys are considered the gold standard of interviewing techniques, computer-assisted telephone interviewing is often preferred for cost and convenience. This study compared recall of parents' highest level of education in telephone and face-to-face surveys.Methods: Questions about father's and mother's highest education level were included in two representative population health surveys of South Australians aged 18 years and over in Spring 2004. A random sample selected from the electronic white pages (EWP) responded to a computer-assisted telephone interview (n = 2999), and a multistage clustered area sample responded to a face-to-face interview (n = 2893). A subsample of respondents in the face-to-face sample who owned a telephone that was listed in the EWP (n = 2206) was also compared to the telephone interview sample.Results: The proportion of respondents who provided information about their father's and mother's highest education level was significantly higher in the face-to-face interview (86.3% and 87.8%, respectively) than in the telephone interview (80.4% and 79.9%, respectively). Recall was also significantly higher in the subsample of respondents in the face-to-face interview who had a telephone that was listed in the EWP. Those with missing data for parents' education were more likely to be socioeconomically disadvantaged regardless of the survey mode.Conclusion: While face-to-face interviewing obtained higher item response rates for questions about parents' education, survey mode did not appear to influence the factors associated with having missing data on father's or mother's highest education level. [ABSTRACT FROM AUTHOR]