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Objectives: To examine the association between metabolic syndrome (MetS) and frailty, and determine whether co-existent MetS and frailty affect disability-free survival (DFS), assessed through a composite of death, dementia or physical disability. Design: Longitudinal study. Setting and Participants: Community-dwelling older adults from Australia and the United States (n=18,264) from "ASPirin in Reducing Events in the Elderly" (ASPREE) study. Measurements: MetS was defined according to American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines (2018). A modified Fried phenotype and a deficit accumulation Frailty Index (FI) were used to assess frailty. Association between MetS and frailty was examined using multinomial logistic regression. Cox regression was used to analyze the association between MetS, frailty and DFS over a median follow-up of 4.7 years. Results: Among 18,264 participants, 49.9% met the criteria for MetS at baseline. Participants with Mets were more likely to be pre-frail [Relative Risk Ratio (RRR): 1.22; 95%Confidence Interval (CI): 1.14, 1.30)] or frail (RRR: 1.66; 95%CI: 1.32, 2.08) than those without MetS. MetS alone did not shorten DFS while pre-frailty or frailty alone did [Hazard Ratio (HR): 1.68; 95%CI: 1.45, 1.94; HR: 2.65; 95%CI:1.92, 3.66, respectively]. Co-existent MetS with pre-frailty/frailty did not change the risk of shortened DFS. Conclusions: MetS was associated with pre-frailty or frailty in community-dwelling older individuals. Pre-frailty or frailty increased the risk of reduced DFS but presence of MetS did not change this risk. Assessment of frailty may be more important than MetS in predicting survival free of dementia or physical disability. [ABSTRACT FROM AUTHOR]

COVID-19 symptoms range from severe respiratory failure to mild anorexia, cough and smell and taste alterations, adversely impacting nutritional intake. The aim of this paper was to establish malnutrition risk, Nutrition Impact Symptoms (NIS) and associations with reduced oral intake. A retrospective observational cohort of all people testing positive for COVID-19 was conducted. Malnutrition risk, nutritional status, weight, reduced oral intake and NIS on and during admission were collected. Dietetic consultation frequency and mode were captured. Some 80% (48/60) of participants reported at least one NIS, and 58% (25/60) reported two or more. Most frequent reported symptoms were cough (60%), sore throat (35%) and reduced appetite (28%). Significant associations existed between ≥2 NIS (p=0.006), reduced appetite (p=0.000) and reduced oral intake, with 20% requiring ongoing nutrition support and consultation. High NIS prevalence confirms systematised nutrition support pathways are indicated through incorporation into standard care across the healthcare continuum, including community care. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the study was to assess the utility of national Aboriginal survey data in a regional geospatial analysis of daily smoking prevalence for Aboriginal and Torres Strait Islander Australians and discuss the appropriateness of this analysis for policy and program impact assessment. Methods. Data from the last two Australian Bureau of Statistics (ABS) national surveys of Aboriginal and Torres Strait Islander people, the National Aboriginal and Torres Strait Islander Social Survey 2014-15 (n = 7022 adults) and the National Aboriginal and Torres Strait Islander Health Survey 2012-13 (n = 10 896 adults), were used to map the prevalence of smoking by Indigenous regions. Results. Daily smoking prevalence in 2014-15 at Indigenous regions ranges from 27.1% (95%CI 18.9-35.3) in the Toowoomba region in Queensland to 68.0% (95%CI 58.1-77.9) in the Katherine region in the Northern Territory. The confidence intervals are wide and there is no significant difference in daily smoking prevalence between the two time periods for any region. Conclusion. There are significant limitations with analysing national survey data at finer geographical scales. Given the national program for Indigenous tobacco control is a regional model, evaluation requires finer geographical analysis of smoking prevalence to inform public health progress, policy and program effects. Options to improve the data currently collected include increasing national survey sample sizes, implementing a smoking status question in census surveys, investing in current cohort studies focused on this population or implementing localised surveys. [ABSTRACT FROM AUTHOR]

To describe the prevalence, severity and nature of depression in a sample of prostate cancer ( PCa) survivors 10 years after diagnosis and treatment, 146 Australian patients from the RADAR trial who received their diagnosis 10 years previously completed the Zung Self-rating Depression Scale and a background questionnaire. Prevalence rates for clinically significant depression and severe depression were higher than those reported for the non- PCa men of the same age in Australia. The most common subtype of depression was Anhedonia, followed by Cognitive depression. Change in eating habits was the most powerful depression symptom predicting Anhedonia. By providing the first detailed documentation of major depression prevalence in PCa survivors, plus describing the nature of that depression, these data suggest that there is an ongoing need to provide treatments for these men and that those treatments should be focussed upon loss of previously available sources of enjoyment. [ABSTRACT FROM AUTHOR]

Background: cross-national comparisons can be used to explore therapeutic areas and identify potential medication issues. Methods: we used cross-sectional pharmacy supply data to explore medication use for nursing home residents in Australia (AU n = 26 homes, 1,560 residents) and the Netherlands (NL n = 6 homes, 2,037 residents). Binary logistic regression analysis was used to calculate the sex and aged adjusted odds ratios (OR) and associated 95% confidence intervals with a flexible Bonferroni-Holm procedure used to adjust for multiple hypothesis testing. Results: total use of antipsychotics (AU: 37.7%, NL: 40.3%; OR 0.91 (0.79-1.04, P = 0.16) and antibacterials (66.8% AU, 62.4% NL, OR 1.08 (0.93-1.24, P = 0.31) was similar, but choice of individual agents differed between the two countries. Differences were observed in the use of antithrombotics (46.7% AU, 64.7% NL, OR 0.48 (0.42-0.56, P > 0.01), ophthal-mologicals (44.3% AU, 22.1% NL, OR 2.80 (2.42-3.24, P < 0.001), laxatives (77.1% AU, 65.8% NL, OR 1.65 (1.41-1.92, P< 0.001). Conclusion: while the general prevalence of medication use in nursing home residents was similar across the two countries, distinct differences existed in the choice of agent among therapeutic groups. Comparing use between countries identified a number of potential medication related problem areas that need further exploration. [ABSTRACT FROM AUTHOR]

Objectives To assess the changes in the oral health-related quality of life ( OHRQoL) of 221 preschool children who presented to the emergency department with the consequences of untreated dental caries requiring dental extractions under general anaesthesia ( DEGA). Methods Two hundred and twenty-one healthy preschool children, who required emergency DEGA, were recruited over a period of 12 months. The same parent or caregiver completed the Early Childhood Oral Health Impact Scale ( ECOHIS) questionnaire; both, prior to the DEGA and at the 2-week post-treatment visit. Data were analysed using repeated anova with adjustments for multiple comparisons using the Bonferroni tests with the significance level set at 5%. Results One hundred and twenty-six participants, with a mean age of 4.02 and a mean dmft score of 8.27 ( SD = 4.13), completed the 2-week post-treatment questionnaires. The overall ECOHIS, CIS, and FIS scores decreased significantly ( P < 0.001) after emergency DEGA, demonstrating large effect sizes. The biggest decrease in prevalence after emergency DEGA was observed for the items of pain in teeth, trouble sleeping, being irritated or frustrated, difficulty drinking food, and parents being upset. Conclusions The OHRQoL of preschool children, who presented to the emergency department with the consequences of untreated dental caries, was significantly improved following emergency DEGA. [ABSTRACT FROM AUTHOR]

The purpose of this cross-sectional study was to identify the prevalence of incontinence and incontinence-associated dermatitis (IAD) in Australian acute care patients and to describe the products worn to manage incontinence, and those provided at the bedside for perineal skin care. Data on 376 inpatients were collected over 2 days at a major Australian teaching hospital. The mean age of the sample group was 62 years and 52% of the patients were male. The prevalence rate of incontinence was 24% (91/376). Urinary incontinence was significantly more prevalent in females (10%) than males (6%) ( χ2 = 4·458, df = 1, P = 0·035). IAD occurred in 10% (38/376) of the sample group, with 42% (38/91) of incontinent patients having IAD. Semi-formed and liquid stool were associated with IAD ( χ2 = 5·520, df = 1, P = 0·027). Clinical indication of fungal infection was present in 32% (12/38) of patients with IAD. Absorbent disposable briefs were the most common incontinence aids used (80%, 70/91), with soap/water and disposable washcloths being the clean-up products most commonly available (60%, 55/91) at the bedside. Further data are needed to validate this high prevalence. Studies that address prevention of IAD and the effectiveness of management strategies are also needed. [ABSTRACT FROM AUTHOR]

Background Polycystic ovary syndrome (PCOS) affects around 15% of Indigenous women who are also a group at high risk of cardiometabolic disease. Aim To explore the impact of PCOS on metabolic syndrome in Indigenous women. Methods A cross-sectional reproductive health questionnaire, biochemical and anthropometric assessments, of 109 Indigenous women (35 with PCOS and 74 without PCOS) aged 15-44 years in and around Darwin between 2003 and 2005. PCOS was defined using the National Institutes of Health criteria, and metabolic syndrome (MetS) using the National Cholesterol Education Programme Adult Treatment Programme III criteria. The outcome was prevalence of MetS by PCOS status; relationship of PCOS with MetS before and after adjustment for markers of obesity and insulin resistance. Results Women with PCOS had a significantly higher body mass index (BMI) ( P = 0.0001) and MetS was more frequent in women with PCOS (51%) than those without PCOS (23%) ( P = 0.003). The most frequent components of MetS in both groups were a high density lipoprotein cholesterol ≤1.29 mmol/L (80% PCOS, 55% non-PCOS) and a waist circumference >88 cm (77% PCOS, 41% non-PCOS); these were significantly more frequent in women with PCOS ( P = 0.01). In logistic regression models, PCOS was significantly associated with MetS by itself but not after adjustment for BMI or sex hormone binding globulin. Conclusions While MetS was more common in Indigenous women with PCOS, PCOS was not an independent predictor of MetS. This may be because obesity and insulin resistance are integral parts of PCOS and are the mechanisms through which PCOS exerts metabolic effects. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To date, studies of stigma relating to eating disorders have been largely confined to surveys of the public. We sought to examine the prevalence and correlates of stigma as reported by individuals with eating disorders. Method An online survey designed to assess frequency of exposure to potentially stigmatizing attitudes and beliefs as well as the perceived impact of this on health and well-being was completed by a cross-national sample of 317 individuals with anorexia nervosa ( n = 165), bulimia nervosa ( n = 66), or Eating Disorder Not Otherwise Specified (EDNOS; n = 86). Results Participants rated two beliefs as both particularly common and particularly damaging, namely 'I should be able to just pull myself together' and 'I am personally responsible for my condition'. Participants with bulimia nervosa more commonly experienced the belief that they had 'no self-control' and male participants more commonly experienced the belief that they were 'less of a man'. More frequent stigmatization was associated with higher levels of eating disorder psychopathology, a longer duration of disorder, lower self-esteem, and more self-stigma of seeking psychological help. Discussion Stigma towards individuals with eating disorders, as experienced by sufferers, is common and associated with numerous adverse outcomes. The perceptions that eating disorders are trivial and self-inflicted should be a focus of destigmatization interventions. Efforts to reduce stigma towards individuals with bulimia nervosa may need to focus on perceptions of self-control, whereas efforts to reduce stigma towards males with eating disorders may need to focus on perceptions of masculinity/manhood. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:767-774) [ABSTRACT FROM AUTHOR]

This paper reports on a prospective study investigating the prevalence of maternal postpartum fatigue and sleepiness and highlights the potential increased crash risk faced by mothers when driving in the postpartum period. Twenty-four mothers from across Australia completed a sleep and driving diary for seven consecutive days at three time points; when their baby was 6, 12 and 18 weeks old. The results showed that the mothers’ sleep varied within the sample; however, on average sleep disruption and lack of sleep consolidation was experienced. A high proportion of the mothers reported fatigue and sleepiness impacting their functioning early in the postpartum period, with sleepiness being more enduring throughout the period. Of concern, a high proportion of driving journeys undertaken by the mothers were during high levels of sleepiness, particularly early in the postpartum period and during late night and early hours of the day. These findings have highlighted the need to educate mothers about the potential increased safety risk of driving during the postpartum period and identified key information that should be conveyed. [ABSTRACT FROM PUBLISHER]

To investigate the cross-national relevance of community health promotion, this paper compared community variation in alcohol use and risk and protective factors for adolescents in Australia (State of Victoria, 2009) and the Netherlands (2007/2008). Multi-level analyses examined community variation in heavy episodic (binge) alcohol use [≥5 drinks in a session ≥once in the prior fortnight (>63 ml of ethanol)] and associations with predictors. Representative community samples of adolescents (12–17 years) were recruited. The participants were 7812 students from 36 Australian communities and 15 082 adolescents from 124 Dutch communities. Predictors included adolescent reports of family, school, peer and neighbourhood environments and community predictors (rural, disadvantage). The overall prevalence of alcohol use prevalence was similar in both nations. Australia had higher use at younger ages and no difference between genders. In the Netherlands older adolescents and males used alcohol at significantly higher rates. Although individual predictors were mostly similar, binge drinking was more strongly associated with poor family management, friends' use of drugs and community disorganization in Australia. Significant community variation in adolescent heavy alcohol use was observed in both countries, but was higher in the Netherlands [inter class correlation 6.1%, (95% CI: 4.5–8.3%)] than Australia (ICC 2.4%, 1.3–4.5%). Youth from rural areas drank at a higher level, especially in the Netherlands. Targeting community level adolescent alcohol use appears feasible in both countries. Although behavioural patterns and risk and protective influences are similar in the Netherlands and Australia, important differences should be taken into account in tailoring community interventions. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance in midlife women has been studied extensively, although less is known about sleep after menopause. This study examined the relative impact of sociodemographics, modifiable lifestyle factors, and health status on sleep disturbance in postmenopausal women from Queensland, Australia. Methods: The longitudinal Healthy Aging of Women (HOW) Study examines health-related quality of life (HRQOL measured by the 12-item Short Form [SF-12®] survey [Medical Outcomes Trust, Hanover, CA]); chronic illness; modifiable lifestyle factors, such as physical activity, alcohol consumption, smoking; and sleep disturbance (General Sleep Disturbance Scale [GSDS] (Lee, San Francisco, CA) ≥43 represents poor sleep) in midlife and older women from low- and high-socioeconomic rural and urban areas of South East Queensland, Australia. This article presents cross-sectional data from the 322 women, aged 60-70 years, participating in the HOW study in 2011. Results: For women in this study, sleep disturbance was relatively common, with 23% ( n=83) reporting poor sleeping (GSDS ≥43). Sleep-disturbance scores were strongly correlated with being unemployed or on a disability support pension (β=18.69, p<0.01), sedentary lifestyle (β=23.84, p<0.01), and lower mental (β=−0.60, p<0.01) and physical HRQOL scores (β=−0.32, p=0.01), and these variables explained almost one-third of variance in sleep-disturbance scores (ηρ2=29%). Conclusions: Multivariable analysis revealed that sleep disturbance was correlated with physical and mental HRQOL, disability, and sedentary lifestyle but not other lifestyle and sociodemographic characteristics. It may be, however, that modifiable lifestyle factors may indirectly impact sleep by influencing health status. [ABSTRACT FROM AUTHOR]

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BackgroundAlthough numerous studies have examined the latent structure of major depression, less attention has focused on mania. This paper presents the first investigation outside the USA to evaluate the psychometric properties of the DSM-IV criterion B mania symptoms using item response theory (IRT).MethodData were drawn from the Australian 2007 National Survey of Mental Health and Well-Being (NSMHWB, n = 8841). The psychometric performance of the mania symptoms was evaluated using a two-parameter logistic model. Because substance use disorders (SUDs) frequently co-occur with mania and can influence manic symptom expression, differential item functioning (DIF) between mania respondents with/without a SUD diagnosis was also assessed.ResultsFactor analysis supported a unidimensional trait underlying mania. The grandiosity symptom displayed the highest discrimination whereas discrimination was lowest for decreased need for sleep. Relatively speaking, grandiosity tapped the severe end and increased goal-oriented activities tapped the mild end of the mania severity continuum. The symptoms generally performed equivalently between those with/without a SUD diagnosis, with one exception; the activities with painful consequences symptom was endorsed at lower levels of severity, and hence more frequently, by those with a SUD diagnosis versus those without a SUD diagnosis.ConclusionsAccurate conceptualization of latent structure has crucial theoretical, statistical and clinical implications. The symptoms generally performed well in distinguishing between respondents with differing levels of liability, but others did not, suggesting modification is warranted to ensure optimal use in epidemiological samples. Given the dearth of psychometric evaluation studies of mania, further research replicating these results is necessary. [ABSTRACT FROM PUBLISHER]

Objective. To assess the prevalence, clinical and laboratory characteristics, and short-term outcomes of poststroke hip fracture (HF). Methods. A cross-sectional study of 761 consecutive patients aged ≥60 years (82.3 ± 8.8 years; 75% females) with osteoporotic HF. Results. The prevalence of poststroke HF was 13.1% occurring on average 2.4 years after the stroke. The poststroke group compared to the rest of the cohort had a higher proportion of women, subjects with dementia, history of TIA, hypertension, coronary artery disease, secondary hyperparathyroidism, higher serum vitamin B12 levels (>350 pmol/L), walking aid users, and living in residential care facilities. The majority of poststroke HF patients had vitamin D insufficiency (68%) and excess bone resorption (90%).This group had a 3-fold higher incidence of postoperative myocardial injury and need for institutionalisation. In multivariate analysis, independent indicators of poststroke HF were female sex (OR 3.6), history of TIA (OR 5.2), dementia (OR 4.1), hypertension (OR 3.2), use of walking aid (OR 2.5), and higher vitamin B12 level (OR 2.3). Only 15% of poststroke patients received antiosteoporotic therapy prior to HF. Conclusions. Approximately one in seven HFs occurs in older stroke survivors and are associated with poorer outcomes. Early implementation of fracture prevention strategies is needed. [ABSTRACT FROM AUTHOR]

Aim: International research has shown that the characteristics of areas such as neighbourhood socioeconomic disadvantage, are associated with mental health; however, multilevel modelling approaches have shown that little variance in depression scores is explained at the area level. This study investigated the distribution of depression across suburbs in the Canberra and surrounding region of Australia, and the influence of area- and individual-level measures of socioeconomic position. Subject and methods: Analysis of data is taken from Wave 3 of the Personality and Total Health (PATH) through Life study with 3,342 respondents aged 28-32 years or 48-52 years who were residents of Canberra and Queanbeyan. Depression was assessed with the Patient Health Questionnaire. Multilevel logistic regression models were used to evaluate variance components and compare suburb measures of socioeconomic circumstances and respondent-reported household income. Results: Less than 1% of variance in the distribution of depression was explained at the area level. While area-level socioeconomic measures were associated with depression; this effect was weak and largely explained by the inclusion of individual-level income. Further analysis did demonstrate a non-linear relationship between area-level socioeconomic measures and depression, with some evidence of an association between the most disadvantaged suburbs and greater prevalence of depression over and above the effect of individual characteristics. Conclusion: We found little evidence of variance in depression at the area level but did find that the prevalence of depression was elevated in the most disadvantaged suburbs. Individual risk factors appear to have the strongest influence on depression. [ABSTRACT FROM AUTHOR]

In Australia, HIV prevalence estimates among gay men have been mainly based on self-reported HIV status collected in annual behavioural surveys. We measured biological HIV prevalence among gay men in Melbourne, Australia, using a facility based sampling method. We calculated HIV prevalence and used logistic regression to assess correlates of a positive HIV test. A total of 639 gay men were recruited completed a survey and provided oral fluid for HIV testing from seven venues in 2008. The median age of the participants was 35 years (range 18-75 years). Overall biological HIV prevalence was 9.5% (95% CI 7.5-12.0%) compared with 6.3% (95% CI 4.5-8.4%) for self-reported HIV positive status. We found a significant discrepancy between test detected biological and self-report HIV status in our study, with 19 men (31.1%) unaware of their HIV infection. These results highlight the importance of repeatable biological estimates to inform and evaluate HIV prevention strategies. [ABSTRACT FROM AUTHOR]

Objective: To examine differences between university students, vocational education and training (VET) students, tertiary students combined and non-students in the prevalence of psychological distress and the socio-demographic and economic characteristics associated with psychological distress.Method: The Kessler Psychological Distress Scale was used to estimate the prevalence of moderate (16–21) and high (22–50) distress with data from three national surveys: the 2007 Household, Income and Labour Dynamics in Australia (HILDA) survey, the 2007–08 National Health Survey (NHS), and the 2007 National Survey of Mental Health and Wellbeing (NSMHWB). Multinomial logistic regression models were also estimated using the HILDA survey to examine any differences in the characteristics associated with moderate and high distress between the groups.Results: There was evidence of a higher prevalence of moderate distress in tertiary students than non-students in the HILDA survey (27.1% vs 21.2%, p < 0.05) and the NSMHWB (27.4% vs 19.5%, p < 0.05), but not the NHS (26.1% vs 22.5%, p > 0.05). However, standardized rates for age and gender attenuated the difference in moderate distress in the HILDA survey and the NSMHWB. The prevalence of high distress was similar between the groups in all three surveys. The multinomial regression analyses using the HILDA survey showed the following subgroups of students to be at a greater risk of high distress relative to those with low distress: younger university students, and university and VET students with financial problems. Compared to VET students and non-students, younger university students and those who worked 1–39 hours per week in paid employment were at a greater risk of high distress.Conclusions: There is evidence that tertiary students have a greater prevalence of moderate, but not high distress than non-students. Financial factors increase the risk of high distress and are likely to take on more importance as the participation rate of socio-economically disadvantaged students increases. [ABSTRACT FROM PUBLISHER]

The article reports a study which was conducted to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient’s hospital admission. Drug charts of 200 patients from three hospitals in Australia and 1 in New Zealand were evaluated. The results revealed that the medication charts for 672/715 patients contained at least one simple error during the initial period of their hospital admission. At least one prescribing error was present on the charts of all patients prescribed more than 18 drugs. The frequency of error types differed across the four sites. The study demonstrated that simple errors and poor documentation of allergy are common but can be improved with the involvement of clinical pharmacists.

Objective: To determine the prevalence of undiagnosed vitamin B12 deficiency among residential aged care facility residents in southern Tasmania, Australia, and to identify associated risk factors. Design and Setting: Cross-sectional study of residents from five southern Tasmanian residential aged care facilities. Participants: Two hundred and fifty-nine residents without a prior diagnosis of vitamin B12 deficiency or recorded serum B12 level within the past 6 months were approached to have their serum B12 level tested. One hundred and sixty (61%) residents consented and their doctors were contacted for further consent. A total of 130 (50%) residents completed the study. Measurements: Clinical and demographic characteristics, and serum B12 level. Results: Of the 130 residents tested, 18 residents (14%) were considered vitamin B12 deficient (serum level <150 pmol/L), 47 (36%) were equivocal (150 pmol/L to 250 pmol/L) and 65 (50%) had normal serum B12 levels (>250 pmol/L). There was a weak negative correlation between age and serum B12 level in those residents not taking a multivitamin (n=120, r=−0.19, p<0.05). The use of a multivitamin or antipsychotic drug were associated with altered mean serum B12 levels (+137 pmol/L, p<0.001 and −70 pmol/L, p<0.001 respectively). Conclusion: As vitamin B12 deficiency can manifest in a range of symptoms that are frequently misdiagnosed, the finding of undetected deficiency in 14% of residents is a cause for concern. Oral multivitamin supplementation may help prevent deficiency, and potentially treat existing deficiencies in older institutionalised people. [ABSTRACT FROM AUTHOR]

Background: Estimates of the prevalence of paraproteinaemia vary, from 1% in persons aged over 25 years to 10% in those aged over 80 years, although there are limited data from well-defined populations. We sought to determine the prevalence of paraproteinaemia in Australians aged 50 years and over, and to determine risks factors for its presence. Methods: We performed a population-based, cross-sectional study using data and serum collected in the Blue Mountains Eye Study. Serum samples from 2933 patients were analysed by capillary zone electrophoresis and, where indicated, immunosubtraction, which allowed for both quantitation and isotype detection. Results: A paraprotein was detected in 134 of the 2933 samples, giving an overall prevalence of 4.6% (95% confidence interval, 3.8-5.3%). The presence of a paraprotein was strongly age-related ( Ptrend= 0.001), with a prevalence of 2.8% in persons aged 50-59 years, rising steadily to 9.1% in those aged 80 years and over. The prevalence was significantly higher in men (5.9%) compared with women (4.0%) ( P= 0.03). Conclusion: We conclude that approximately one in 20 Australians aged 50 years or over harbours a paraprotein, a prevalence that appears higher than from similar cohorts in other countries. [ABSTRACT FROM AUTHOR]

Armfield JM. A comparison of three continuous scales used to determine the prevalence of clinically significant dental fear. Community Dent Oral Epidemiol 2011; 39: 554-563. © 2011 John Wiley & Sons A/S Abstract - Objective: To assess the level of agreement and concordance of three different dental anxiety and fear scales and determine whether using commensurate cut-points reduces discrepancies in the estimated prevalence of high dental fear. Methods: A representative sample of the Australian adult population completed a computer-assisted telephone interview (CATI) with additional data obtained on a random sample of 25% of those completing the CATI. Participants completed three measures of dental anxiety and fear: the Dental Anxiety Scale, the Index of Dental Anxiety and Fear, and a single-item question. Cut-points were determined to equivalize the range of possible score responses defining a case of high dental fear for each scale. Results: A total of 1084 people completed the CATI and returned a questionnaire (response rate = 71.4%). Prevalence estimates ranged from 7.3% to 28.4% depending upon both the scale and cut-point used. The overall percent agreement between the scales was high, but the overlap between the scales in those people determined to have high dental fear was considerably lower. Using different cut-points to define a case significantly altered the sensitivity and specificity of the scale in predicting dental avoidance, problem-oriented visiting and fear of lack of control. Conclusions: Equivalizing scale cut-points does reduce variation in prevalence estimates of high dental fear across scales, but variation remains because of differences in the nature of, and content covered by, each scale. Dichotomizing scores on continuous scales to obtain prevalence estimates of high dental fear should be appropriately justified, correctly interpreted and supplemented by results describing the distribution of scores. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the effectiveness of a tailored footwear programme on lower-limb comfort in professional rugby league players. The study was conducted over 30 weeks and involved two professional teams (n = 59 players) from the Australian National Rugby League competition. One team was assigned to a footwear programme (intervention), while players from the control group continued usual practices of self-selected footwear. The tailored footwear programme consisting of player education, prescription of footwear, and frequent rotation of footwear resulted in a lower incidence of injury and higher comfort ratings. The intervention group had fewer lower-limb injuries (P = 0.005; Cohen d = 0.72) and higher comfort ratings (P < 0.001, Cohen d = 1.24) than the control group. Specifically, the intervention group reported a lower incidence of poor comfort events (mean = 3.8, s = 2.7) than the control group (mean = 7.9, s = 3.7). Observations also included fewer time loss events in the intervention (mean = 6.3, s = 4.8) than the control group (mean = 11.0, s = 6.3) and reduced injuries per 1000 h in the intervention (24.79/1000) than the control group (30.76/1000). These findings should help medical advisers improve footwear comfort in sportspeople and so reduce the incidence of related injuries. [ABSTRACT FROM PUBLISHER]

This study aims to contribute to the body of knowledge about post-adoption functioning of international adoptees by examining patterns of anxiety among young children adopted from China by Australian families. The study had two objectives: to examine anxiety in children adopted from China comparing this sample to available normative data and to examine the associations among child anxiety and child (e.g., age at adoption) and parent (e.g., age, education level) factors. Parents of 59 children adopted from China completed online a number of measures of child anxiety, temperament, and parent psychological well-being. Results indicated a high prevalence of anxiety symptoms among the adopted children when compared with available data from normative samples, particularly related to separation contexts. A number of factors, including inhibited temperament and younger age of parents, were associated with child anxiety. Clinical and research implications are discussed. [ABSTRACT FROM PUBLISHER]

To examine associations between self-reported television (TV) viewing time and overall sitting time with the metabolic syndrome and its components. Cross-sectional. Population-based sample of older men and women living in Australia. One thousand nine hundred fifty-eight participants from the Australian Diabetes, Obesity and Lifestyle (AusDiab) study (aged≥60, mean age 69, 54% women). Self-reported television viewing time and overall sitting time were collected using an interviewer-administered questionnaire. The metabolic syndrome was defined according to the revised International Diabetes Federation criteria. Compared with those in the lowest quartile, the odds ratios (ORs) of the metabolic syndrome in the highest quartile of television viewing time were 1.42 (95% confidence interval (CI)=0.93-2.15) for men and 1.42 (95% CI=1.01-2.01) for women and in the highest quartile of overall sitting time were 1.57 (95% CI=1.02-2.41) for men and 1.56 (95% CI=1.09-2.24) for women. Television viewing time was associated with lower high-density lipoprotein cholesterol (HDL-C) levels and glucose intolerance in women. Overall sitting time was detrimentally associated with greater risk of high triglyceride levels in men and women, abdominal obesity in women, and low HDL-C levels in men. All models were adjusted for age, education, physical activity, self-rated health, employment, diet, smoking, and alcohol intake and for hormone replacement therapy and estrogen use in women. For older adults, high levels of sedentary behavior were associated with greater prevalence of the metabolic syndrome; reducing prolonged overall sitting time may be a feasible way to improve metabolic health. [ABSTRACT FROM AUTHOR]

Clinical prediction rules form an integral component of guidelines on the diagnostic approach to pulmonary embolism (PE). The Wells Score is commonly used but is subjective, while the newer Revised Geneva Score is based entirely on objective variables. The aim of this study was to compare the diagnostic accuracy of the Wells and Revised Geneva Scores for the diagnosis of PE. Patients presenting to the emergency department with clinically suspected PE and referred for CT pulmonary angiogram or ventilation/perfusion scintigraphy were evaluated. The Wells and Revised Geneva Scores were calculated on the same cohort of patients and dichotomized into low and intermediate/high probability groups. The sensitivities and specificities were compared using McNemar's test. Overall accuracy was determined using receiver operator characteristic curve analysis. A total of 98 consecutive patients was included. The overall prevalence of PE was 15.3%. The frequency of PE in the low, intermediate and high probability groups was similar for both clinical prediction rules. Compared with the Revised Geneva Score, the Wells Score showed a lower sensitivity with borderline significance (46.7% vs 80.0%, P= 0.06) and a significantly higher specificity (67.5% vs 47.0%, P= 0.002). The overall accuracy of both rules was similar ( P= 0.617). Using the accepted guidelines in which a high pretest probability leads to further imaging and a low probability leads to a D-dimer blood test, use of the more specific Wells Score could safely reduce the number of unnecessary scans. This would need to be confirmed with larger, prospective trials. [ABSTRACT FROM AUTHOR]

Objective: To determine if screening for undiagnosed type 2 diabetes mellitus (T2DM) and pre-diabetes is feasible in an Australian ED; to estimate the prevalence of T2DM and pre-diabetes in the Australian ED population. Methods: Prospective cross-sectional prevalence survey in the ED of St Vincent's Hospital, Melbourne, an adult, tertiary referral centre seeing approximately 40 000 patients annually. A convenience sample of adult patients was screened with finger-prick random blood glucose and glycosylated haemoglobin (HbA1c); those over 6.0 mmol/L and 6.0% were referred for oral glucose tolerance test (OGTT). Diagnoses of T2DM and pre-diabetes were made according to World Health Organization definitions. Those not attending for OGTT were contacted by phone, and interviewed about their reasons. Results: Seven hundred and twenty-five patients were recruited; 135 (18.6%; 95% confidence intervals [CI] 15.9-21.6%) had known T2DM, leaving 590 screened, of whom 210 screened positive. Of the 192 referred for OGTT, 147 (77%) did not attend despite several telephone reminders. Of the 45 (23%) completing OGTT, pre-diabetes was present in eight (17.8%; 95% CI 9.0-31.6%) and T2DM in six (13.3%; 95% CI 5.9-26.6%). Many people interviewed (18/86, 21%) did not attend for OGTT on the advice of their doctors. Conclusions: This inner city tertiary ED has a high prevalence of T2DM, diagnosed and undiagnosed, with as much as half our population possibly affected. Although ED screening might have a high yield, opportunistic screening is not feasible, with difficulties in staff engagement and patient follow up for diagnostic testing. Future studies might consider finger-prick fasting blood glucose through a patient's general practitioner for diagnosis. [ABSTRACT FROM AUTHOR]

Objectives. Water fluoridation is one of the most effective public health programs of the past century. However, efforts to extend water fluoridation into currently non-fluoridated areas are often thwarted. Despite considerable evidence regarding the effectiveness of water fluoridation at an individual level, published national community-based studies are rare. This study compared children's decay experience and prevalence between areas with and without water fluoridation in Australia. Methods. Oral health data were obtained from clinical examinations of 128,990 5- to 15-year-old children attending for a regular visit with their respective Australian state or territory School Dental Service in 2002. Water fluoridation status, residence remoteness, and socioeconomic status (SES) were obtained for each child's recorded residential postcode area. Results. Children from every age group had greater caries prevalence and more caries experience in areas with negligible fluoride concentrations in the water (<0.3 parts per million [ppm]) than in optimally fluoridated areas (&0.7 ppm). Controlling for child age, residential location, and SES, deciduous and permanent caries experience was 28.7% and 31.6% higher, respectively, in low-fluoride areas compared with optimally fluoridated areas. The odds ratios for higher caries prevalence in areas with negligible fluoride compared with optimal fluoride were 1.34 (95% confidence interval [CI] 1.29, 1.39) and 1.24 (95% CI 1.21, 1.28) in the deciduous and permanent dentitions, respectively. Conclusions. This study demonstrates the continued community effectiveness of water fluoridation and provides support for the extension of this important oral health intervention to populations currently without access to fluoridated water. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aims to investigate the impact of tobacco smoking on longer-term outcomes following a first episode of psychosis. METHODS: Data on 193 individuals were collected as part of a prospective follow-up visit of a cohort of patients after a mean of 7.5 years (SD = 0.8) after first treatment presentation. Primary outcome measures were positive and negative psychotic symptoms, depressive symptoms, quality of life, and global functioning at the 7.5 year follow-up. RESULTS: Using unadjusted analyses, smoking status was linked to male gender, longer duration of untreated psychosis, more problem illicit drug use, and problem alcohol use. After adjustment for these potential confounders, smoking at baseline was not associated with poorer long-term outcomes on the primary outcome variables of interest but was associated with drug and alcohol abuse or dependence. CONCLUSIONS: These findings suggest that smoking does not appear to be associated with worse clinical and functional outcomes in psychosis. (Journal of Dual Diagnosis, 6:212-234, 2010) [ABSTRACT FROM AUTHOR]

The article presents a study that evaluates the effectiveness and acceptability of anorectal swabs (ARS) a Likert scale and standardized questionnaire in the 36-week antenatal visit. It outlines the result of the study which suggests that ARS helps enhance GBS positive rate and subjects have found the test acceptable.