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Background: We aimed to investigate the incidence, precipitants, and outcomes of acute decompensated heart failure (ADHF) that develops during the inpatient stay.Methods: We undertook a case-control study in the medical, oncology, surgical, and orthopaedic wards of a tertiary referral hospital (February-May, 2016). Patients aged ≥18 years who developed ADHF during their inpatient stay were enrolled as cases. One control patient was matched to each case by age, gender, presenting complaint/surgery performed and co-morbidities. Multivariate regression was employed to determine variables associated with ADHF.Results: The incidence of ADHF was 1.0% of patients. Eighty cases were well-matched to 80 controls (p>0.05). ADHF precipitants comprised infection (30%), inappropriate intravenous (IV) fluid and medication management (23.8% and 8.8%, respectively), tachyarrhythmia (12.5%), ischaemic heart disease (8.8%), renal failure (1.3%), and other/unclear causes (15%). Three variables were associated with ADHF: not having English as the preferred language (OR 3.5, 95%CI 1.2-9.8), a history of ischaemic heart disease (OR 3.3, 95%CI 1.2-9.1), and the administration of >2000ml of IV fluid on the day before the ADHF (OR 8.3, 95%CI 1.5-48.0). The day before the ADHF, cases were administered significantly more IV fluids than controls (median 2,757.5 versus 975ml, p=0.001). Medication errors mostly related to failure to restart regular diuretics. Cases had significantly greater length of stay (median 15 versus 6 days, p<0.001) and mortality (12.5% versus 1.3%, p=0.01).Conclusions: New onset ADHF is common and a substantial proportion of cases are iatrogenic. Cases experience significantly increased length of hospital stay, morbidity, and mortality. [ABSTRACT FROM AUTHOR]

Objectives: Mind and Body Practice (MBP) use (e.g., chiropractic, acupuncture, meditation) among Emergency Department (ED) patients is largely unknown. We aimed to determine the period prevalence, nature of MBP use, and perceptions of MBP among adult ED patients. Design and Setting: We undertook a cross-sectional survey of a convenience sample of patients presenting to three EDs between February and June 2016. Subjects: Patients were eligible for inclusion if they were aged 18 years or more and had presented for medical treatment. Intervention: An anonymous, self-administered questionnaire, based upon a validated pediatric questionnaire, was completed by the patient, with assistance if required. Outcome measures: The primary outcome was the nature and 12 month period prevalence of MBP use. Secondary outcomes were variables associated with use and patient perceptions of MBP. Results: 674 patients were enrolled. In the previous 12 months, 500 (74.2%) patients had used at least one MBP. MBP users and nonusers did not differ in gender, ancestry, or chronic illness status (p > 0.05). However, users were significantly younger and more likely to have private health insurance (p < 0.001). A total of 2094 courses of 68 different MBP had been used including massage (75.0% of users), meditation (35.2%), chiropractic (32.6%), acupuncture (32.0%), and yoga (30.6%). Users were significantly more likely (p < 0.01) to believe that MBP prevented illness, treated illness, were more effective than prescription medicines, assisted prescription medications, and were safe and provided a more holistic approach. Forty-one (6.1%) patients used MBP for their ED presenting complaint. However, only 14 (34.1%) advised their ED physician of this. Conclusion: The period prevalence of MBP use among ED patients is high. Knowledge of the MBP used for a patient's presenting complaint may better inform the ED physician when making management decisions. [ABSTRACT FROM AUTHOR]

Background: Many patients with low-back disorders persisting beyond 6 weeks do not recover. This study investigates whether individualised physiotherapy plus guideline-based advice results in superior outcomes to advice alone in participants with low-back disorders.Methods: This prospective parallel group multicentre randomised controlled trial was set in 16 primary care physiotherapy practices in Melbourne, Australia. Random assignment resulted in 156 participants receiving 10 sessions of physiotherapy that was individualised based on pathoanatomical, psychosocial and neurophysiological barriers to recovery combined with guideline-based advice, and 144 participants receiving 2 sessions of physiotherapist-delivered advice alone. Primary outcomes were activity limitation (Oswestry Disability Index) and numerical rating scales for back and leg pain at 5, 10, 26 and 52 weeks postbaseline. Analyses were by intention-to-treat using linear mixed models.Results: Between-group differences showed significant effects favouring individualised physiotherapy for back and leg pain at 10 weeks (back: 1.3, 95% CI 0.8 to 1.8; leg: 1.1, 95% CI 0.5 to 1.7) and 26 weeks (back: 0.9, 95% CI 0.4 to 1.4; leg: 1.0, 95% CI 0.4 to 1.6). Oswestry favoured individualised physiotherapy at 10 weeks (4.7; 95% CI 2.0 to 7.5), 26 weeks (5.4; 95% CI 2.6 to 8.2) and 52 weeks (4.3; 95% CI 1.4 to 7.1). Responder analysis at 52 weeks showed participants receiving individualised physiotherapy were more likely to improve by a clinically important amount of 50% from baseline for Oswestry (relative risk (RR=1.3) 1.5; 95% CI 1.2 to 1.8) and back pain (RR 1.3; 95% CI 1.2 to 1.8) than participants receiving advice alone.Conclusions: 10 sessions of individualised physiotherapy was more effective than 2 sessions of advice alone in participants with low-back disorders of ≥6 weeks and ≤6 months duration. Between-group changes were sustained at 12 months for activity limitation and 6 months for back and leg pain and were likely to be clinically significant.Clinical Trial Registration: ACTRN12609000834257. [ABSTRACT FROM AUTHOR]

Evidence of health effects following early life exposure to short-to-medium duration of high pollution levels is extremely limited. We aimed to evaluate the associations between: 1. intrauterine exposure to fine particulate matter (PM 2.5) from coal mine fire emissions and the frequencies of general practitioner attendances and dispensations of prescribed asthma inhalers, steroid skin creams, and antibiotics during the first year of life; 2. infant exposure and those outcomes during the year following the fire. All participants were recruited from the Latrobe Valley of Victoria, Australia. Participants' 24-h average and hourly peak mine fire-specific PM 2.5 exposures from 09/02/2014 to 31/03/2014 were estimated using chemical transport modelling. Outcome data were obtained from the Australian Medicare Benefits Schedule and Pharmaceutical Benefits Scheme from each child's birth to 31/12/2016. We used negative binomial and logistic regression models to independently assess risks of the outcomes associated with every 10 and 100 μg m−3 increase in average or peak PM 2.5 exposure, respectively, while adjusting for potential confounders. We included 286 of 311 children whose parents consented to be linked, comprising 77 with no exposure, 88 with intrauterine exposure and 121 with exposure in infancy. 10- and 100- μg m−3 increases in average and peak PM 2.5 exposure during infancy were associated with greater incidence of antibiotics being dispensed during the year following the fire: the adjusted incidence rate ratios were 1.24 (95% CI 1.02, 1.50, p = 0.036) and 1.14 (1.00, 1.31, p = 0.048) respectively. No other significant associations were observed. Exposure to coal mine fire emissions during infancy was associated with increased dispensing of antibiotics. This could reflect increased childhood infections or increased prescriptions of antibiotics in the year following the fire. Image 1 • Evidence on long-term health effects following early life air pollution is scarce. • We assessed the health impact of perinatal fire smoke exposure on 286 children. • Infant exposure was associated with increased antibiotic dispensation. Main findings: Infant exposure to air pollution from coal mine fire emissions might be associated with increased childhood infections. [ABSTRACT FROM AUTHOR]

The relationship between maternal exposure to air pollution and birth outcomes is not well characterised where ambient air pollution is relatively low. We aimed to explore the association between maternal exposure to ambient nitrogen dioxide (NO 2) and fine particulate matter (PM 2.5) and a range of birth outcomes in Victoria, Australia. Secondary aims were to explore whether obstetric conditions, such as gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy, were effect modifiers in observed relationships. We included all singleton births occurring in Victoria, Australia from 1st March 2012 to 31st December 2015 using routinely collected government data. Outcomes included birth weight, small for gestational age (SGA), term low birth weight (tLBW), large for gestational age (LGA), and spontaneous preterm birth (sPTB). We estimated exposure to annual ambient NO 2 and PM 2.5 concentrations, assigned to maternal residence at time of birth. Confounders included maternal, meteorological and temporal variables. Multivariable linear regression and log-binomial regression were used for continuous and dichotomous outcomes, respectively. There were 285,594 births during the study period. Average NO 2 exposure was 6.0 parts per billion (ppb, median 5.6; interquartile range (IQR) 3.9) and PM 2.5 was 6.9 μg/m3 (median 7.1, IQR 1.3). IQR increases in ambient NO 2 and PM 2.5 were associated with fetal growth restriction, including decrements in birth weight (NO 2 β −22.8 g; 95%CI -26.0, −19.7; PM 2.5 β −14.8 g; 95%CI -17.4, −12.2) and increased risk of SGA (NO 2 RR 1.08; 95%CI 1.06, 1.10; PM 2.5 RR 1.05; 95%CI 1.04, 1.07) and tLBW (NO 2 RR 1.06; 95%CI 1.01, 1.10; PM 2.5 RR 1.04; 95%CI 1.03, 1.08). Women with GDM and hypertensive disorders of pregnancy had greater decrements in birth weight in association with pollutant exposure. In this exploratory study using an annual metric of exposure, maternal exposure to low-level ambient air pollution was associated with fetal growth restriction, which carries substantial public health implications. • Ambient air pollution is associated with adverse birth outcomes. • Less is known about the importance of maternal exposure to low-level air pollution. • Low-level exposure to NO 2 and PM 2.5 was associated with fetal growth restriction. • Harms were observed at levels below guidelines (mean NO 2 6.0 ppb; PM 2.5 6.9 μg/m3). • Mothers with gestational diabetes and hypertensive disorders were more susceptible. [ABSTRACT FROM AUTHOR]

Aim: To examine associations of neighborhood greenery, air pollution and walkability with cardiometabolic disease in adults aged ≥45 years in the Frankston-Mornington Peninsula region, Victoria, Australia., Methods: A cross-sectional, ecological study design was used. We assessed mean annual neighborhood greenery using the Normalized Difference Vegetation Index; air pollution (fine particulate matter of diameter ≤2.5 μm [PM 2.5 ] and NO 2 ) using land-use regression models; and walkability using Walk Score (possible values 0-100). Medically diagnosed diabetes (~95% type-2), heart disease and stroke were self-reported in the Australian Census (2021). Multivariable regression was used to model associations between environmental exposures and area-level (neighborhood) cardiometabolic disease prevalence (age group ≥45 years), with socioeconomic status, age and sex as covariates. Air pollution was examined as a mediator of associations between greenery and disease prevalence., Results: Our sample comprised 699 neighborhoods with the following mean (SD) values: Normalized Difference Vegetation Index 0.47 (0.09), PM 2.5 , 8.5 (0.6) μg/m 3 and NO 2 , 5.2 (1.6) ppb. Disease prevalences were: heart disease, mean 8.9% (4.5%); diabetes, mean 10.3% (4.7%); and stroke, median 1.2% (range 0-10.9%). Greenery was negatively associated with diabetes (β = -5.85, 95% CI -9.53, -2.17) and stroke prevalence (β = -1.26, 95% CI -2.11, -0.42). PM 2.5 and NO 2 were positively associated with diabetes (β = 1.59, 95% CI 1.00, 2.18; β = 0.42, 95% CI 0.22, 0.62) and stroke prevalence (β = 0.15, 95% CI 0.01, 0.29; β = 0.06, 95% CI 0.01, 0.10). The association between greenery and diabetes was partially mediated by PM 2.5 (mediated effect -5.38, 95% CI -7.84, -3.03)., Conclusions: Greenery and air pollutants were associated with lower and higher prevalence, respectively, of self-reported diabetes and, to a lesser extent, stroke. These ecological findings require further exploration with stronger, longitudinal study designs to inform public health policy and directions. Geriatr Gerontol Int 2024; 24: 208-214., (© 2023 The Authors. Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

The relationship between maternal exposure to ambient air pollution and pregnancy complications is not well characterized. We aimed to explore the relationship between maternal exposure to ambient nitrogen dioxide (NO 2 ) and fine particulate matter (PM 2.5 ) and hypertensive disorders of pregnancy, gestational diabetes mellitus (GDM) and placental abruption. Using administrative data, we defined a state-wide cohort of singleton pregnancies born between 1 March 2012 and 31 December 2015 in Victoria, Australia. Annual average NO 2 and PM 2.5 was assigned to maternal residence at the time of birth. 285,594 singleton pregnancies were included. An IQR increase in NO 2 (3.9 ppb) was associated with reduced likelihood of hypertensive disorders of pregnancy (RR 0.89; 95%CI 0.86, 0.91), GDM (RR 0.92; 95%CI 0.90, 0.94) and placental abruption (RR 0.81; 95%CI 0.69, 0.95). Mixed observations and smaller effect sizes were observed for IQR increases in PM 2.5 (1.3 µg/m 3 ) and pregnancy complications; reduced likelihood of hypertensive disorders of pregnancy (RR 0.95; 95%CI 0.93, 0.97), increased likelihood of GDM (RR 1.02; 95%CI 1.00, 1.03) and no relationship for placental abruption. In this exploratory study using an annual metric of exposure, findings were largely inconsistent with a priori expectations and further research involving temporally resolved exposure estimates are required.

Background: Designing healthy, liveable cities is a global priority. Current liveability indices are aggregated at the city-level, do not reflect spatial variation within cities, and are often not aligned to policy or health., Objectives: To combine policy-relevant liveability indicators associated with health into a spatial Urban Liveability Index (ULI) and examine its association with adult travel behaviours., Methods: We developed methods to calculate spatial liveability indicators and the ULI for all residential addresses in Melbourne, Australia. Associations between the address-level ULI and adult travel behaviours from the 2012-2014 Victorian Integrated Survey of Travel and Activity (VISTA) (n = 12,323) were analysed using multilevel logistic regression. Sensitivity analyses to evaluate impact of methodological choices on distribution of liveability as assessed by the ULI and associations with travel mode choice were also conducted., Results: Liveability estimates were calculated for 1,550,641 residential addresses. ULI scores were positively associated with active transport behaviour: for each unit increase in the ULI score the estimated adjusted odds ratio (OR) for: walking increased by 12% (95% Credible Interval: 9%, 15%); cycling increased by 10% (4%, 17%); public transport increased by 15% (11%, 19%); and private vehicle transport decreased by 12% (- 9%, - 15%)., Conclusions: The ULI provides an evidence-informed and policy-relevant measure of urban liveability, that is significantly and approximately linearly associated with adult travel behaviours in the Melbourne context. The ULI can be used to evaluate progress towards implementing policies designed to achieve more liveable cities, identify spatial inequities, and examine relationships with health and wellbeing.

Background: Low back disorders are a common and costly cause of pain and activity limitation in adults. Few treatment options have demonstrated clinically meaningful benefits apart from advice which is recommended in all international guidelines. Clinical heterogeneity of participants in clinical trials is hypothesised as reducing the likelihood of demonstrating treatment effects, and sampling of more homogenous subgroups is recommended. We propose five subgroups that allow the delivery of specific physiotherapy treatment targeting the pathoanatomical, neurophysiological and psychosocial components of low back disorders. The aim of this article is to describe the methodology of a randomised controlled trial comparing specific physiotherapy treatment to advice for people classified into five subacute low back disorder subgroups., Methods/design: A multi-centre parallel group randomised controlled trial is proposed. A minimum of 250 participants with subacute (6 weeks to 6 months) low back pain and/or referred leg pain will be classified into one of five subgroups and then randomly allocated to receive either physiotherapy advice (2 sessions over 10 weeks) or specific physiotherapy treatment (10 sessions over 10 weeks) tailored according to the subgroup of the participant. Outcomes will be assessed at 5 weeks, 10 weeks, 6 months and 12 months following randomisation. Primary outcomes will be activity limitation measured with a modified Oswestry Disability Index as well as leg and back pain intensity measured on separate 0-10 Numerical Rating Scales. Secondary outcomes will include a 7-point global rating of change scale, satisfaction with physiotherapy treatment, satisfaction with treatment results, the Sciatica Frequency and Bothersomeness Scale, quality of life (EuroQol-5D), interference with work, and psychosocial risk factors (Orebro Musculoskeletal Pain Questionnaire). Adverse events and co-interventions will also be measured. Data will be analysed according to intention to treat principles, using linear mixed models for continuous outcomes, Mann Whitney U tests for ordinal outcomes, and Chi-square, risk ratios and risk differences for dichotomous outcomes., Discussion: This trial will determine the difference in outcomes between specific physiotherapy treatment tailored to each of the five subgroups versus advice which is recommended in guidelines as a suitable treatment for most people with a low back disorder., Trial Registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609000834257.