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Background: It is known that South Australia (SA) has the highest rate of knee arthroscopy use of any state in Australia; however, Level 1 evidence demonstrates that knee arthroscopy in patients with uncomplicated knee osteoarthritis confers no benefit. In SA, which patients are presenting with knee pain and what treatments are they receiving? Aims: To determine the prevalence, persistence and treatment modalities of knee pain in SA. Methods: This study analysed data from the North‐West Adelaide Health Study (1999–2015), a longitudinal, population‐based cohort study of people aged 18 years and over (n = 4060), initially randomly selected from the north‐west region of Adelaide, SA. It incorporated clinic assessments, self‐completed questionnaires and telephone interviews to collect demographic, anthropometric and biochemical data over four main stages (1, 2, 3 and North‐West 15 (NW15)). Data were linked to Medical Benefits Scheme data. Results: In stages 3 and NW15 of the North‐West Adelaide Health Study, 30–35% of participants reported knee pain (n = 803, 452). Demographic variables associated with knee pain included older age and lower educational level, while risk factors included obesity and high waist circumference. In the 12 months preceding NW15, 33% of participants with knee pain/stiffness consulted a general practitioner for their knee pain, 10.2% an orthopaedic surgeon, and 12.6% a physiotherapist. Between 2011 and 2015, 3.0% the cohort underwent a knee arthroscopy, and 3.1% underwent knee magnetic resonance imaging. Conclusions: Knee pain affects large proportions of the SA population. Knee pain was persistent with underuse of non‐pharmacological treatments and high use of specialist referral. These data support the need for a national strategy to manage osteoarthritis effectively. [ABSTRACT FROM AUTHOR]

Objective: To assess trends of mortality attributable to child and maternal undernutrition (CMU), overweight/obesity and dietary risks of non-communicable diseases (NCD) in sub-Saharan Africa (SSA) using data from the Global Burden of Disease (GBD) Study 2015.Design: For each risk factor, a systematic review of data was used to compute the exposure level and the effect size. A Bayesian hierarchical meta-regression analysis was used to estimate the exposure level of the risk factors by age, sex, geography and year. The burden of all-cause mortality attributable to CMU, fourteen dietary risk factors (eight diets, five nutrients and fibre intake) and overweight/obesity was estimated.Setting: Sub-Saharan Africa.ParticipantsAll age groups and both sexes.Results: In 2015, CMU, overweight/obesity and dietary risks of NCD accounted for 826204 (95 % uncertainty interval (UI) 737346, 923789), 266768 (95 % UI 189051, 353096) and 558578 (95 % UI 453433, 680197) deaths, respectively, representing 10·3 % (95 % UI 9·1, 11·6 %), 3·3 % (95 % UI 2·4, 4·4 %) and 7·0 % (95 % UI 5·8, 8·3 %) of all-cause mortality. While the age-standardized proportion of all-cause mortality accounted for by CMU decreased by 55·2 % between 1990 and 2015 in SSA, it increased by 63·3 and 17·2 % for overweight/obesity and dietary risks of NCD, respectively.Conclusions: The increasing burden of diet- and obesity-related diseases and the reduction of mortality attributable to CMU indicate that SSA is undergoing a rapid nutritional transition. To tackle the impact in SSA, interventions and international development agendas should also target dietary risks associated with NCD and overweight/obesity. [ABSTRACT FROM AUTHOR]

Background: Diet is a major determining factor for many non-communicable chronic diseases (NCDs). However, evidence on diet-related NCD burden remains limited. We assessed the trends in diet-related NCDs in Australia from 1990 to 2015 and compared the results with other countries of the Organization for Economic Co-operation and Development (OECD). Methods: We used data and methods from the Global Burden of Disease (GBD) 2015 study to estimate the NCD mortality and disability-adjusted life years (DALYs) attributable to 14 dietary risk factors in Australia and 34 OECD nations. Countries were further ranked from the lowest (first) to highest (35th) burden using an age-standardized population attributable fraction (PAF). Results: In 2015, the estimated number of deaths attributable to dietary risks was 29,414 deaths [95% uncertainty interval (UI) 24,697 − 34,058 or 19.7% of NCD deaths] and 443,385 DALYs (95% UI 377,680–511,388 or 9.5% of NCD DALYs) in Australia. Young (25–49 years) and middle-age (50–69 years) male adults had a higher PAF of diet-related NCD deaths and DALYs than their female counterparts. Diets low in fruits, vegetables, nuts and seeds and whole grains, but high in sodium, were the major contributors to both NCD deaths and DALYs. Overall, 42.3% of cardiovascular deaths were attributable to dietary risk factors. The age-standardized PAF of diet-related NCD mortality and DALYs decreased over the study period by 28.2% (from 27.0% in 1990 to 19.4% in 2015) and 41.0% (from 14.3% in 1990 to 8.4% in 2015), respectively. In 2015, Australia ranked 12th of 35 examined countries in diet-related mortality. A small improvement of rank was recorded compared to the previous 25 years. Conclusions: Despite a reduction in diet-related NCD burden over 25 years, dietary risks are still the major contributors to a high burden of NCDs in Australia. Interventions targeting NCDs should focus on dietary behaviours of individuals and population groups. [ABSTRACT FROM AUTHOR]

Objectives: To compare the biomedical health profile and morbidity of adult carers with non-carers. Methods: The North West Adelaide Health Study (NWAHS) is a representative population-based longitudinal biomedical cohort study of 4056 participants aged 18 years and over at Stage One. Informal (unpaid) carers were identified in Stage 3 of the project (2008–2010). Risk factors, chronic medical conditions and biomedical, health and demographic characteristics using self-report and blood measured variables were assessed. Data were collected through clinic visits, telephone interviews and self-completed questionnaires. Risk factors included blood pressure, cholesterol/lipids, body mass index (BMI), smoking and alcohol intake. Chronic medical conditions included cardiovascular and respiratory diseases, diabetes, and musculoskeletal conditions. Blood measured variables were routine haematology, biochemistry, Vitamin D, and the inflammatory biomarkers high sensitivity C-Reactive Protein (hs-CRP), Tumor Necrosis Factor alpha (TNFα) and Interleukin-6 (Il-6). Results: The prevalence of carers aged 40 years and over was 10.7%, n = 191. Carers aged 40 years and over were more likely to assess their health status as fair/poor and report having diabetes, arthritis, anxiety and depression. They also reported insufficient exercise and were found to have higher BMI compared with non-carers. Significant findings from blood measured variables were lower serum Vitamin D and haemoglobin. Male carers had raised diastolic blood pressure, higher blood glucose, lower haemoglobin and albumin levels and slightly elevated levels of the inflammatory biomarkers TNFα and hs-CRP. Discussion and conclusions: This study confirms informal carers had different biomedical profiles to non-carers that included some chronic physical illnesses. It identifies that both female and male carers showed a number of risk factors which need to be considered in future caregiver research, clinical guidelines and policy development regarding carer morbidity. [ABSTRACT FROM AUTHOR]

Purpose: The relative advantages of dietary analysis methods, particularly in identifying dietary patterns associated with bone mass, have not been investigated. We evaluated principal component analysis (PCA), partial least-squares (PLS) and reduced-rank regressions (RRR) in determining dietary patterns associated with bone mass.Methods: Data from 1182 study participants (45.9% males; aged 50 years and above) from the North West Adelaide Health Study (NWAHS) were used. Dietary data were collected using a food frequency questionnaire (FFQ). Dietary patterns were constructed using PCA, PLS and RRR and compared based on the performance to identify plausible patterns associated with bone mineral density (BMD) and content (BMC).Results: PCA, PLS and RRR identified two, four and four dietary patterns, respectively. All methods identified similar patterns for the first two factors (factor 1, “prudent” and factor 2, “western” patterns). Three, one and none of the patterns derived by RRR, PLS and PCA were significantly associated with bone mass, respectively. The “prudent” and dairy (factor 3) patterns determined by RRR were positively and significantly associated with BMD and BMC. Vegetables and fruit pattern (factor 4) of PLS and RRR was negatively and significantly associated with BMD and BMC, respectively.Conclusions: RRR was found to be more appropriate in identifying more (plausible) dietary patterns that are associated with bone mass than PCA and PLS. Nevertheless, the advantage of RRR over the other two methods (PCA and PLS) should be confirmed in future studies. [ABSTRACT FROM AUTHOR]

Background: Identifying dietary patterns that consider the overall eating habits, rather than focusing on individual foods or simple counts of consumed foods, better helps to understand the combined effects of dietary components. Therefore, this study aimed to use dietary patterns, as an alternative method to dietary diversity scores (DDSs), and investigate their associations with childhood stunting in Ethiopia.Methods: Mothers and their children aged under 5 years (n = 3788) were recruited using a two-stage random cluster sampling technique in two regions of Ethiopia. Socio-demographic, dietary and anthropometric data were collected. Dietary intake was assessed using standardized dietary diversity tools. Household, maternal and child DDSs were calculated and dietary patterns were identified by tetrachoric (factor) analysis. Multilevel linear and Poisson regression analyses were applied to assess the association of DDSs and dietary patterns with height-for-age z score (HAZ) and stunting, respectively.Results: The overall prevalence of stunting among children under-five was 38.5% (n = 1459). We identified three dietary patterns each, for households ("fish, meat and miscellaneous", "egg, meat, poultry and legume" and "dairy, vegetable and fruit"), mothers ("plant-based", "egg, meat, poultry and legume" and "dairy, vegetable and fruit" and children ("grain based", "egg, meat, poultry and legume" and "dairy, vegetable and fruit"). Children in the third tertile of the household "dairy, vegetable and fruit" pattern had a 0.16 (β = 0.16; 95% CI: 0.02, 0.30) increase in HAZ compared to those in the first tertile. A 0.22 (β = 0.22; 95% CI: 0.06, 0.39) and 0.19 (β = 0.19; 0.04, 0.33) increase in HAZ was found for those in the third tertiles of "dairy, vegetable and fruit" patterns of children 24-59 months and 6-59 months, respectively. Those children in the second (β = -0.17; 95% CI: -0.31, -0.04) and third (β = -0.16; 95% CI: -0.30, -0.02) tertiles of maternal "egg, meat, poultry and legume" pattern had a significantly lower HAZ compared to those in the first tertile. No significant associations between the household and child "egg, meat, poultry and legume" dietary patterns with HAZ and stunting were found. Statistically non-significant associations were found between household, maternal and child DDSs, and HAZ and stunting.Conclusion: A higher adherence to a "dairy, vegetable and fruit" dietary pattern is associated with increased HAZ and reduced risk of stunting. Dietary pattern analysis methods, using routinely collected dietary data, can be an alternative approach to DDSs in low resource settings, to measure dietary quality and in determining associations of overall dietary intake with stunting. [ABSTRACT FROM AUTHOR]

Purpose: To our knowledge, no studies have examined the association of diet quality and plant-based diets (PBD) with inflammatory-related mortality in obesity. Therefore, this study aimed to determine the joint associations of Healthy Eating Index-2015 (HEI-2015), plant-based dietary index (PDI), healthy PDI (hPDI), unhealthy PDI (uPDI), pro-vegetarian dietary index (PVD), and systemic inflammation with all-cause, cardiovascular disease (CVD), and cancer mortality risks by obesity status. Methods: Participants from NHANES were included in cross-sectional (N = 27,915, cycle 1999–2010, 2015–2018) and longitudinal analysis (N = 11,939, cycle 1999–2008). HEI-2015, PDI, hPDI, uPDI, and PVD were constructed based on the 24-h recall dietary interview. The grade of inflammation (low, moderate, and high) was determined based on C-reactive protein (CRP) values and multivariable ordinal logistic regression was used to determine the association. Cox proportional hazard models were used to determine the joint associations of diet and inflammation with mortality. Results: In the fully adjusted model, HEI-2015 (ORT3vsT1 = 0.76, 95% CI 0.69–0.84; p-trend = < 0.001), PDI (ORT3vsT1 = 0.83, 95% CI 0.75–0.91; p trend = < 0.001), hPDI (ORT3vsT1 = 0.79, 95% CI 0.71–0.88; p trend = < 0.001), and PVD (ORT3vsT1 = 0.85, 95% CI 0.75–0.97; p trend = 0.02) were associated with lower systemic inflammation. In contrast, uPDI was associated with higher systemic inflammation (ORT3vsT1 = 1.18, 95% CI 1.06–1.31; p-trend = 0.03). Severe inflammation was associated with a 25% increase in all-cause mortality (ORT3vsT1 = 1.25, 95% CI 1.03–1.53, p trend = 0.02). No association was found between PDI, hPDI, uPDI, and PVD with mortality. The joint association, between HEI-2015, levels of systemic inflammation, and all-cause, CVD and cancer mortality, was not significant. However, a greater reduction in mortality risk with an increase in HEI-2015 scores was observed in individuals with low and moderate inflammation, especially those with obesity. Conclusion: Higher scores of HEI-2015 and increased intake of a healthy plant-based diet were associated with lower inflammation, while an unhealthy plant-based diet was associated with higher inflammation. A greater adherence to the 2015 dietary guidelines may reduce the risk of mortality associated with inflammation and may also benefit individuals with obesity who had low and moderate inflammation. [ABSTRACT FROM AUTHOR]

Background There is growing policy emphasis on self-management as an essential component of musculoskeletal chronic care models. Underpinning this drive is the assumption that with correct 'informational' framing people will better manage their condition's progression and thereby maintain quality of life. Objective To assess associations between self-management behaviours and health-related quality of life for people with chronic musculoskeletal conditions. Design Using survey data from health census and follow-up structured telephone interviews, linear regression (cumulatively adjusted for potential confounders) and logistic regression examined associations between use of specific self-management behaviours and quality of life. Setting and participants A total of 885 respondents (2012) who indicated still having a musculoskeletal condition reported in a 2010 health census (Port Lincoln, South Australia). Variables Specific self-management activities, age, sex, education, marital status, smoking, comorbidities and pain. Outcome measure EQ-5D-5L. Results Exercise (63%) and diet (19%) were the most commonly reported self-management activities used to manage musculoskeletal conditions. About 24% reported not using any specific self-management activities. Involvement in self-management showed no association with quality of life, with and without adjustment for confounders. Diet had a negative association with quality of life as did use of formal support (self-management course or community group support). Discussion Taking a real-world perspective, these findings raise important questions about how people currently engage with self-management activities and the kinds of outcomes that can be expected from undertaking these activities. The timing of people's uptake of self-management within the musculoskeletal disease continuum is an issue requiring further attention in both research and practice. [ABSTRACT FROM AUTHOR]

Background: The ongoing need for an availability of informal carers is taking on greater relevance as the global burden of disease transitions from acute fatal diseases to long term morbidity. Growing evidence suggests that extra burden on family carers may further impact on their health and ability to provide care. Important as it is to monitor the prevalence of those conditions which influence the burden of disease, it is also important to monitor the prevalence and health profiles of those who provide the informal care. The aim of this study was to demonstrate the prevalence and demographics of adult carers aged 15 and over in the state of South Australia over 20 years between 1994 and 2014. Methods: Data from nine representative, cross-sectional population surveys, conducted in South Australia, Australia were used, (total N = 26,788 and n = 1,504 carers). The adjusted prevalence estimate of carers and their demographic characteristics were determined. So as to examine whether there were any generational effects on the prevalence of carers, an Age-Period Cohort (APC) analysis was undertaken. Results: The prevalence estimates of carers increased during the two decades from 3.7% in 1994 to 6.7% by 2014. Large increases in the proportion of retired carers, those aged 70 years and over, those carers employed, and those with higher educational qualifications were observed. There were also larger proportions of respondents with a country of birth other than Australia, UK, Ireland and European counties. The APC analysis illustrated an increasing prevalence rate over each decade for carers aged 20–80 years, especially for those over the age of 60 years. Conclusions: The results illustrate changing carer characteristics and carer prevalence estimates in South Australia as new generations of carers take on the caring role. There is a need to include questions regarding informal carers within ongoing mainstream population surveys, particularly at state levels, so as to plan for their future health care and home support. [ABSTRACT FROM AUTHOR]

Background: Feeling angry about their health status may influence disease progression in individuals, creating a greater burden on the health care system. Identifying associations between different variables and feeling angry about health status may assist health professionals to improve health outcomes. This study used path analysis to explore findings from a population-based survey, informed by qualitative descriptions obtained from focus groups, to determine the prevalence of health-related anger within the community and variables associated with reporting health-related anger.Methods: A population-based Computer Assisted Telephone Interview (CATI) survey of 3003 randomly selected adults Australia-wide was conducted to examine the prevalence of health-related anger. A wide range of other covariates were included in the survey. Multivariable logistic regression and path analysis were undertaken to identify the relationships between different variables associated with feeling angry about the health status of people, to explore the direction of these associations and as a consequence of the results, consider implications for health service use and delivery.Results: Overall, 18.5 % of the population reported feeling angry about their health "some of the time", "most of the time" or "all of the time". People who felt angry about their health were more likely to have a severe health condition, at least one chronic condition, high psychological distress, fair to poor health status, and needed to adjust their daily lives because of a health condition. Having a tertiary level education was protective. Receiving some form of social support, usually from a support group, and not always doing as advised by a doctor, were also associated with a higher likelihood of being angry about their health.Conclusions: People living with significant health problems are more likely to feel angry about their health. The path between illness and anger is, however, complex. Further research is needed to understand the extent that feeling angry influences the progression of health problems and, if necessary, how to minimise this progression. What also needs examining is whether identifying people who feel angry in the general population could be a predictor of persons most likely to develop significant health problems. [ABSTRACT FROM AUTHOR]

Background: Foot pain has been shown to be prevalent across all age groups. The presence of foot pain may reduce mobility and impact on the ability to undertake activities of daily living. The aim of this study was to determine factors that are predictive of foot pain in a community based sample of the general population. Methods: This study analysed data from the North West Adelaide Health Study, a cohort study located in the northwestern suburbs of Adelaide, South Australia. Data were obtained between 2004-2006 and 2008-2010, using a self-completed questionnaire, computer assisted telephone interviewing, and a clinical assessment. The sensitivity, specificity and positive predictive values of variables were determined and generalised linear models ascertained the variables associated with the highest relative risk of self-reporting foot pain in 2008-2010 based on the data obtained in 2004-2006. Results: The prevalence of foot pain in 2004-2006 was 14.9 % (95 % CI 13.6-16.4) and in 2008-2010, 29.9 % (95 % CI 27.5-32.5). Variables with the highest sensitivity were: female sex, ever having back pain, self-reported arthritis, body mass index (BMI) classified as obese and having foot pain in 2004-2006, while most variables demonstrated high specificity. Those with the highest risk of reporting foot pain in 2008-2010 were those with depressive symptoms, self-reported arthritis, high BMI, self-reported upper limb pain and foot pain (in general or in specific regions of the foot) in 2004-2006. Conclusion: Foot pain is common in the general population and those with the greatest risk of foot pain potentially represent a high level of chronicity and potential burden on the health system. Addressing the factors that predict foot pain, as well as the provision of targeted messages to highlight the importance of managing foot pain, may help reduce the impact on the population. [ABSTRACT FROM AUTHOR]

Background: Case definition has long been an issue for comparability of results obtained for musculoskeletal pain prevalence, however the test-retest reliability of questions used to determine joint pain prevalence has not been examined. The objective of this study was to determine question reliability and the impact of question wording, ordering and the time between questions on responses.Methods: A Computer Assisted Telephone Interviewing (CATI) survey was used to re-administer questions collected as part of a population-based longitudinal cohort study. On two different occasions questions were asked of the same sample of 203 community dwelling respondents (which were initially randomly selected) aged 18 years and over at two time points 14 to 27 days apart (average 15 days). Reliability of the questions was assessed using Cohen's kappa (κ) and intraclass correlation coefficient (ICC) and whether question wording and period effects existed was assessed using a crossover design.Results: The self-reported prevalence of doctor diagnosed arthritis demonstrated excellent reliability (κ = 0.84 and κ = 0.79 for questionnaires 1 and 2 respectively). The reliability of questions relating to musculoskeletal pain and/or stiffness ranged from moderate to excellent for both types of questions, that is, those related to ever having joint pain on most days for at least a month (κ = 0.52 to κ = 0.95) and having pain and/or stiffness on most days for the last month (κ = 0.52 to κ = 0.90). However there was an effect of question wording on the results obtained for hand, foot and back pain and/or stiffness indicating that the area of pain may influence prevalence estimates.Conclusions: Joint pain and stiffness questions are reliable and can be used to determine prevalence. However, question wording and pain area may impact on estimates with issues such as pain perception and effect on activities playing a possible role in the recall of musculoskeletal pain. [ABSTRACT FROM AUTHOR]

A literary criticism of books "Eslanda: The Large and Unconventional Life of Mrs. Paul Robeson" by Barbara Ransby, and "Harlem Nocturne: Women Artists and Progressive Politics During World War II" by Farah Jasmine Griffin, is presented. It analyzes the narratives about African American women's importance in the black freedom struggle through global and artistic activism.

Aim The aim of this study was to determine the prevalence of structural shoulder pathology using magnetic resonance imaging ( MRI) in three groups of older people: those with current shoulder pain, those with a previous history of shoulder pain and those with no history of shoulder pain, within a community-based sample. Methods Thirty subjects (10 within each of the three groups) participated in the study. Subjects were recruited by telephone and underwent a clinical examination of shoulder and neck range of movement (to ensure pain was not referred from the neck). Subjects completed the Shoulder Pain and Disability Index ( SPADI) and underwent MRI and X-ray of the relevant shoulder. The X-rays and MRI were read independently by two experienced musculoskeletal radiologists blinded to each participant's symptoms. The MRIs were read using a structured reporting system. Results The mean range of shoulder movement on both the right and left sides was lower for the current pain group compared to both the no and previous pain groups. On X-ray, there was no significant difference between groups in terms of glenohumeral and/or acromioclavicular degenerative changes. Tendinosis and tears of the rotator cuff were present in the majority of participants in each group. Labral abnormalities were rare among all groups. Conclusion Shoulder pathology is apparent in both symptomatic and asymptomatic shoulders and clinical symptoms may not match radiological findings. The cost burden of ordering MRI scans is significant and the relevance of the findings are questionable when investigating shoulder pain. [ABSTRACT FROM AUTHOR]

Background: Levels of vitamin D in the population have come under increasing scrutiny, however there are only a few studies in Australia which measure levels in the general population. The aim of this study was to measure the levels of vitamin D within a large population cohort and examine the association with seasons and selected demographic and health risk factors. Methods: A longitudinal cohort study of 2413 participants in the northwest suburbs of Adelaide, South Australia conducted between 2008 and 2010 was used to examine serum levels of 25-hydroxy vitamin D (25(OH)D) in relation to demographic characteristics (age, sex, income, education and country of birth), seasons, the use of vitamin D supplements and selected health risk factors (physical activity, body mass index and smoking). Both unadjusted and adjusted mean levels of serum 25(OH)D were examined, as were the factors associated with the unadjusted and adjusted prevalence of serum 25(OH)D levels below 50 and 75 nmol/L. Results: Overall, the mean level of serum 25(OH)D was 69.2 nmol/L with 22.7% of the population having a serum 25(OH)D level below 50 nmol/L, the level which is generally recognised as vitamin D deficiency. There were significantly higher levels of 25(OH)D among males compared to females (t = 4.65, p < 0.001). Higher levels of 25 (OH)D were also measured in summer and autumn compared with winter and spring. Generally, mean levels of 25 (OH)D were lower in those classified as obese. Smokers and those undertaking no or less than 150 minutes/week of physical activity also had lower levels of serum vitamin D. Obesity (as classified by body mass index), season and undertaking an insufficient level of physical activity to obtain a health benefit were significantly associated with the prevalence of vitamin D deficiency. Conclusions: Vitamin D deficiency is prevalent in South Australia, affecting almost one quarter of the population and levels are related to activity, obesity and season even when adjusted for confounding factors. Improved methods of addressing vitamin D levels in population are required. [ABSTRACT FROM AUTHOR]

Objectives To describe the burden of bone and joint problems (BJP) in a defined regional population, and to identify characteristics and service-usage patterns. Methods In 2010, a health census of adults aged ≥15 years was conducted in Port Lincoln, South Australia. A follow-up computer-assisted telephone interview provided more specific information about those with BJP. Results Overall, 3350 people (42%) reported current BJP. General practitioners (GP) were the most commonly used provider (85%). People with BJP were also 85% more likely to visit chiropractors, twice as likely to visit physiotherapists and 34% more likely to visit Accident and Emergency or GP out of hours (compared with the rest of the population). Among the phenotypes, those with BJP with co-morbidities were more likely to visit GP, had a significantly higher mean pain score and higher levels of depression or anxiety compared with those with BJP only. Those with BJP only were more likely to visit physiotherapists. Conclusions GP were significant providers for those with co-morbidities, the group who also reported higher levels of pain and mental distress. GP have a central role in effectively managing this phenotype within the BJP population including linking allied health professionals with general practice to manage BJP more efficiently. What is known about the topic? As a highly prevalent group of conditions that are likely to impact on health-related quality of life and are a common cause of severe long-term disability, musculoskeletal conditions place a significant burden on individuals and the health system. However, far less is known about access and usage of musculoskeletal-related health services and programs in Australia. What does this paper add? As a result of analysing the characteristics of the overall BJP population, as well as phenotypes within it, a greater understanding of patterns of health service interactions, care pathways and opportunities for targeted improvements in delivery of care may be identified. The results emphasise that participants with BJP utilised the services of a narrow range of providers, which may have workforce implications for these sectors. The funding models for physiotherapists and chiropractors in Australia involve a mix of private and fees for service, which limits access to those who have private health insurance or can pay directly for these services. What are the implications for practitioners? These analyses indicate the importance of linking allied health professionals with general practice to manage BJP more efficiently. Alternative and appropriate care pathways need to be more strongly developed and identified for effective management of these conditions rather than relying on a traditional range of practitioners. Alternatively, greater ease of access to allied health practitioners may enable more effective treatment and improved quality of life for those with BJP. There is an urgent need to develop an effective population-based model of integrated care for BJP within regional Australia. [ABSTRACT FROM AUTHOR]

Background: The North West Adelaide Health Study is a representative longitudinal cohort study of people originally aged 18 years and over. The aim of this study was to describe normative data for hand grip strength in a community-based Australian population. Secondary aims were to investigate the relationship between body mass index (BMI) and hand grip strength, and to compare Australian data with international hand grip strength norms. Methods: The sample was randomly selected and recruited by telephone interview. Overall, 3 206 (81% of those recruited) participants returned to the clinic during the second stage (2004-2006) which specifically focused on the collection of information relating to musculoskeletal conditions. Results: Following the exclusion of 435 participants who had hand pain and/or arthritis, 1366 men and 1312 women participants provided hand grip strength measurement. The study population was relatively young, with 41.5% under 40 years; and their mean BMI was 28.1 kg/m2 (SD 5.5). Higher hand grip strength was weakly related to higher BMI in adults under the age of 30 and over the age of 70, but inversely related to higher BMI between these ages. Australian norms from this sample had amongst the lowest of the hand grip strength of the internationally published norms, except those from underweight populations. Conclusions: This population demonstrated higher BMI and lower grip strength in younger participants than much of the international published, population data. A complete exploration of the relationship between BMI and hand grip strength was not fully explored as there were very few participants with BMI in the underweight range. The age and gender grip strength values are lower in younger adults than those reported in international literature. [ABSTRACT FROM AUTHOR]

Aim: To determine the prevalence, correlates and impact of shoulder pain in a population-based sample. Methods: The North West Adelaide Health Study is a representative longitudinal cohort study of people aged 18 years and over. The original sample was randomly selected and recruited by telephone interview. Overall, 3206 participants returned to the clinic during the second stage (2004–2006) and were asked to report whether they had pain, aching or stiffness on most days in either of their shoulders. Data was also collected on body mass index; shoulder range of motion, lifestyle and socioeconomic factors; the Shoulder Pain and Disability Index and the Medical Outcomes Study Short Form 36 (SF36) was used. Results: Overall, 22.3% of participants indicated that they had pain, aching or stiffness in either of their shoulders. Women, those aged 50 years and over, current smokers and those classified as obese were all significantly more likely to report shoulder pain. Respondents with shoulder pain scored lower on all domains of the SF36. In those with shoulder symptoms, women had more severe pain and worse shoulder function than men, and older people had worse shoulder function than younger people. Conclusion: Shoulder pain affects almost a quarter of people in the Australian community, with a significant detrimental impact on health-related quality of life and physical functioning. [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 socioeconomic status and health literacy. [ABSTRACT FROM AUTHOR]

Objectives: To use representative population chronic disease and risk factor data to investigate the relationship between asthma and social factors in school-age children. Methods: Representative cross-sectional data for children 5 to 15 years of age were collected from 2002 to June 2007 (n = 4,611) in the South Australian Monitoring and Surveillance System (SAMSS) using Computer-Assisted Telephone Interviews (CATI). Univariate and multivariate analyses were conducted to investigate the variables that were associated with asthma among children. Results: The overall prevalence of self-reported asthma among children 5 to 15 years of age was 18.6% (95% CI = 17.5-19.8). Children with asthma were more likely to have been treated for a mental health problem, have been unhappy at school, have been absent from school in the last month, have fair or poor overall health and well-being, have ongoing pain or chronic illness, and less likely to have a group of friends to play with. Asthma was also more prevalent among males and less likely to occur in children from households where the gross annual income was greater than $AU80,000. Conclusions: Children with asthma were more likely to be treated for a mental health problem and demonstrate more negative social outcomes as well as poorer overall health and well-being. Asthma management plans need to be sensitive to these psychosocial factors for adequate care of these vulnerable young patients. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this paper is to determine the trend in influenza vaccine coverage among community dwelling adults in South Australia aged 65 years and over and compare this prevalence with national and international influenza vaccine coverage. Immunisation prevalence has been measured in South Australia (SA) since 1993 using face to face surveys and Computer Assisted Telephone Interviewing (CATI). There has been an increasing trend in influenza immunisation in South Australia over the last 12 years among community dwelling adults aged 65 years and over. This indicates that policies and campaigns have impacted positively on influenza vaccine uptake. [Copyright &y& Elsevier]

Previous studies using clinic or convenience samples have indicated that not only patients with arthritis are at increased risk of depression, but there may also be a link between depression and disability in people with arthritis. We examined the prevalence of psychological distress in a population sample with and without arthritis and the association with health-related quality of life. The WANTS Health and Well-being Survey was a population household telephone interview survey of adults (age ≥18 years) in three states of Australia. Data obtained were weighted to provide population-representative estimates. The survey included questions regarding arthritis, SF-12, the Kessler 10 index of psychological distress and presence of mental health conditions. A total of 7,473 interviews providing information on arthritis were completed, with 1,364 (18.3%) reporting arthritis. Self-reported mental health conditions were more frequent in those with arthritis (14.9 vs 12.0%, p = 0.004), and a higher proportion were at a medium or high risk for anxiety or depression (39.0 vs 31.0%, p < 0.001). People with arthritis had significantly lower scores on the SF-12 physical component summaries compared to those without arthritis. Among those with arthritis, those with coexisting psychological distress had significantly lower scores on the SF-12 physical component summary than those without psychological distress. Psychological distress is common among people with arthritis in the community. In arthritis, psychological distress makes a significant additional negative impact on the physical well-being. Physicians need to recognize and address this additional impact on physical functioning in patients with arthritis. [ABSTRACT FROM AUTHOR]

Objective: To determine, using a random telephone survey, the prevalence of various gambling activities among South Australian adults, the prevalence of adult problem gamblers using the South Oaks Gambling Screen (SOGS) instrument, and to examine the problem gamblers by demographic and health-related risk factors.Method: A random representative sample of South Australian adults selected from the Electronic White Pages. Overall, 6045 interviews were conducted (73.1% response rate) using Computer Assisted Telephone Interviewing (CATI) technology.Results: Overall, 75.6% (95% CI: 74.5-76.7) of respondents had participated in at least one gambling activity during the last 12 months and 2.0% (95% CI: 1.7-2.4) were identified to be problem gamblers. A wide range of factors was associated with problem gambling at a univariate level, when compared to frequent gamblers. The logistic regression analysis highlighted that problem gamblers were more likely to speak a language other than English, be employed part time and a smoker when compared to frequent gamblers. Problem gamblers were also more likely to have a mental health condition (according to the Kessler 10), have had suicidal thoughts and know of services for gambling problems.Conclusion: There is a wide range of characteristics associated with problem gambling in South Australia. All of these factors need addressing during policy development to assist problem gamblers. [ABSTRACT FROM AUTHOR]

Background: Research on older people’s perception regarding their quality of life and services and supports needed to maintain their independence was identified as a priority for the South Australian Department of Health in 2000–2001. This population survey was conducted to examine issues that older persons considered important in the areas of housing, transport, finances and information provision. Objective: The aim of this article is to present the characteristics of community-dwelling older adults who reported falling in the previous 12 months. Method: A random representative sample of community-dwelling adults, living in South Australia, and aged 65 years and over were selected based on a sample from the electronic white pages telephone directory. Overall, 2,619 interviews were conducted (70.5% response rate) using Computer-Assisted Telephone Interviewing technology. Results: Approximately 30% of older adults had experienced a fall in the previous 12 months. The characteristics of people who had fallen included those in the older age groups, with fair or poor general health, whose health had worsened in the last 12 months, with lower socioeconomic status, those born in an English-speaking country, needing assistance at home, and with a home in need of repair. Of the respondents who had experienced a fall in the previous 12 months, 71.8% did not consider that they were at risk of having another fall. Conclusion: There is a wide range of characteristics associated with community-dwelling older adults over the age of 65 who report falling in the previous 12 months. Perceptions of the risk of falling also vary. All factors need to be considered when targeting interventions to reduce the risk of both initial and multiple falls. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to determine the relationships between ultra-processed food (UPF) consumption and risk of mortality due to chronic respiratory diseases (CRDs) overall, chronic obstructive pulmonary disease (COPD), and lung cancer. Methods: A total of 96,607 participants aged 55 years and over were included from the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer trial. Dietary intake was measured using food frequency questionnaire. Cox regression was fitted to estimate the risk of all-cause mortality and mortality due to CRDs overall, COPD and lung cancer associated with UPF intake. Competing risk regression was used to account for deaths from other causes and censoring. Results: During the follow-up of 1,379,655.5 person-years (median 16.8 years), 28,700 all-cause, 4092 CRDs, 2015 lung cancer and 1,536 COPD mortality occurred. A higher intake of UPF increased the risk of mortality from CRDs overall by 10% (HR 1.10; 95% CI 1.01, 1.22) and COPD by 26% (HR 1.26; 95% CI 1.06, 1.49) but not associated with lung cancer mortality risk (HR 0.97; 95% CI 0.84, 1.12). However, the risk of lung cancer increased by 16% (HR 1.16; 95% CI 1.01, 1.34) in the highest UPF intake after multiple imputation. Dose–response relationships existed for CRDs and COPD mortality but not lung cancer. Conclusion: UPF consumption was associated with an increased risk of CRD mortality. The association between UPF consumption and lung cancer mortality is inconclusive and only significant when multiple imputation was applied. [ABSTRACT FROM AUTHOR]

Background: An understanding of the average range of movement of the shoulder that is normally achievable is an important part of treatment for shoulder disorders. The average range of active shoulder flexion, abduction and external rotation was measured in a population cohort aged 20 years and over without shoulder pain and/or stiffness in order to provide normative shoulder range data.Methods: Cross-sectional analysis using participants in a community-based longitudinal cohort study. There have been three stages of data collection - Stage 1 (1999-2003), Stage 2 (2004-2006) and Stage 3 (2008-2010). Each stage has consisted a of broad ranging computer assisted telephone interview, a self-complete questionnaire and a clinic assessment. Participants in this study are those who undertook assessments in Stage 2. The main outcome measures were active shoulder range of movement (flexion, abduction and external rotation) measured as part of the clinic assessment using a Plurimeter V inclinometer. Mean values were determined and analyses to examine differences between groups (sex and age) were undertaken using non-parametric tests.Results: There were 2404 participants (51.5% male), mean age 45.8 years (SD 17.3, range 20-91). The average range of active right shoulder flexion was 161.5° for males and 158.5° for females, and active right shoulder abduction was 151.5° and 149.7° for males and females respectively. Shoulder range of movement declined with age, with mean right active shoulder flexion decreasing by 43° in males and 40.6° in females and right active shoulder abduction by 39.5° and 36.9° respectively. External rotation range also declined, particularly among females.Conclusion: To our knowledge this is the largest community-based study providing normative data for active shoulder range of movement. This information can be used to set realistic goals for both clinical practice and clinical trials. [ABSTRACT FROM AUTHOR]

Background Recent operational definitions of sarcopenia have not been replicated and compared in Australia and New Zealand (ANZ) populations. We aimed to identify sarcopenia measures that discriminate ANZ adults with slow walking speed (<0.8 m/s) and determine the agreement between the Sarcopenia Definitions and Outcomes Consortium (SDOC) and revised European Working Group for Sarcopenia in Older People (EWGSOP2) operational definitions of sarcopenia. Methods Eight studies comprising 8 100 ANZ community-dwelling adults (mean age ± standard deviation, 62.0 ± 14.4 years) with walking speed, grip strength (GR), and lean mass data were combined. Replicating the SDOC methodology, 15 candidate variables were included in sex-stratified classification and regression tree models and receiver operating characteristic curves on a pooled cohort with complete data to identify variables and cut points discriminating slow walking speed (<0.8 m/s). Agreement and prevalence estimates were compared using Cohen's Kappa (CK). Results Receiver operating characteristic curves identified GR as the strongest variable for discriminating slow from normal walking speed in women (GR <20.50 kg, area under curve [AUC] = 0.68) and men (GR <31.05 kg, AUC = 0.64). Near-perfect agreement was found between the derived ANZ cut points and SDOC cut points (CK 0.8–1.0). Sarcopenia prevalence ranged from 1.5% (EWGSOP2) to 37.2% (SDOC) in women and 1.0% (EWGSOP2) to 9.1% (SDOC) in men, with no agreement (CK <0.2) between EWGSOP2 and SDOC. Conclusions Grip strength is the primary discriminating characteristic for slow walking speed in ANZ women and men, consistent with findings from the SDOC. Sarcopenia Definitions and Outcomes Consortium and EWGSOP2 definitions showed no agreement suggesting these proposed definitions measure different characteristics and identify people with sarcopenia differently. [ABSTRACT FROM AUTHOR]

Background: There is increasing evidence that women who experience placenta-mediated pregnancy complications and gestational diabetes mellitus (GDM) are at higher risk for the development of coronary artery disease (CAD) later in life. We hypothesized that there is an association between placenta-mediated pregnancy complications, GDM, and risk of premature CAD (PCAD). Methods: This research project involved a data linkage approach merging three databases of South Australian cohorts by using a retrospective, age-matched case–control study design. Cases (n = 721) were ascertained from the Coronary Angiogram Database of South Australia (CADOSA). Women <60 years from CADOSA were linked to South Australian Perinatal Statistics Collection (SAPSC) to ascertain their prior pregnancy outcomes. Controls (n = 194) were selected from North West Adelaide Health Study (NWAHS) and comprised women who were healthy or had other health conditions unrelated to CAD, age-matched to CADOSA (±5 years), and linked to SAPSC to determine their pregnancy outcomes. PCAD was defined as >50% stenosis in one or more coronary arteries at coronary angiography. Results: Compared with women without a history of PCAD, women who were diagnosed with PCAD were more likely to have experienced the placenta-mediated pregnancy complications of preterm birth (adjusted odds ratio [OR] = 2.46, 95% confidence interval [CI]: 1.21–5.00) or low-birth weight (adjusted OR = 2.44, 95% CI: 1.22–4.88), or have been diagnosed with active asthma during pregnancy (adjusted OR = 3.52, 95% CI: 1.05–11.76). Conclusion: Placenta-mediated pregnancy complications should be recognized as clear risk markers for future PCAD. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery candidates have a high prevalence of foot pain, depression and elevated plantar pressures. There is, however, limited research into how these factors interact pre- and post-surgery. The aims of this study were therefore to investigate the mechanical and non-mechanical factors associated with foot pain severity before, and the change after, surgery. Methods: Bariatric surgery candidates underwent baseline and six-month follow-up measures. Foot pain was measured with the Manchester-Oxford Foot Questionnaire. Mechanical measures included body mass index (BMI), dynamic plantar pressures, radiographic foot posture, and hindfoot range of motion. Depressive symptoms, the non-mechanical measure, were assessed by questionnaire. Multivariable linear regression was used to determine which variables were associated with foot pain at baseline and at follow-up. Multilevel repeated models assessed the associations between foot pain and plantar pressure, adjusting for the interaction between group and follow-up time. Results: Forty-five participants (84% female), with mean (SD) age of 45.7 (9.4) years were recruited. Twenty-nine participants had bariatric surgery and 16 participants remained on the waiting list (controls). Following bariatric surgery, foot pain reduced significantly by - 35.7 points (95% CI -42.2 to - 28.8), while depressive symptoms and whole foot peak pressures had a significant mean change of - 5.9 points (95% CI -10.3 to - 1.5) and - 36 kPa (95% CI -50 to - 22), respectively. In multivariable analysis, depressive symptoms were associated with foot pain at baseline β = 0.7 (95% CI 0.2 to 1.2) after controlling for age, gender, BMI, foot posture and plantar pressure. Depressive symptoms were also associated with foot pain at follow-up in those undergoing bariatric surgery, β = 1.2 (95% CI 0.8 to 1.7). Foot posture and hindfoot range of motion did not change following surgery and a change in plantar pressures was not associated with a change in foot pain. Conclusions: Foot pain severity in bariatric surgery candidates was associated with depressive symptoms at baseline. Reduced foot pain following bariatric surgery was associated with an improvement in depressive symptoms, without a significant change in foot posture or foot function. Foot pain severity in bariatric candidates may be mediated by non-mechanical or non-local factors before and following surgery. [ABSTRACT FROM AUTHOR]

Background: Shoulder pain is a distressing but under-reported and poorly managed symptom in people with motor neurone disease. Objectives: This study aimed to assess the efficacy of suprascapular nerve block for the management of shoulder pain in patients with motor neurone disease. Methods: A total of 27 patients with motor neurone disease and shoulder pain were offered a suprascapular nerve block. Ten of these patients had bilateral shoulder pain and both were injected, making a total of 37 shoulders. The patients were followed up for a total of 3 months, or until death. Shoulder pain was measured using the pain scale (out of 100) of the shoulder pain and disability index and compared with baseline scores and a placebo control group from an earlier study using the same methodology (ACTRN12619000353190). Results: Following the nerve block there was a significant improvement of pain scores from baseline (58.4) at week 1 (20.8, p < 0.000), week 6 (17.6, p < 0.000) and week 12 (30.4, p = 0.001) and a significant improvement compared with the control group across each time interval. Conclusion: Suprascapular nerve block is a safe, effective therapy for patients with chronic shoulder pain. [ABSTRACT FROM AUTHOR]

Objective: This study examines the difference in medication use between baby boomers (born between 1946–1965) and older people (born before 1946) to determine the proportion of people combining over-the-counter (OTC) medicines and complementary and alternative medicines (CAM) use with prescription medicine use. Design: A clustered, multistage, systematic, random, self-weighting area sample was obtained and a face-to-face interview was conducted to examine the difference in use in prescription medicines, OTC, and CAM and factors associated with the use between baby boomers and older people. Setting: South Australia. Participants: Respondents aged 15 years and over participated in surveys conducted in autumn (March to May) of 2004 (n = 3015) and 2008 (n = 3,034) in which all respondents were asked to list their current medications. This study focuses on those participants whose age was in the range defined by baby boomers and older people. Main outcome measures: Proportion in each age group taking prescription medicine, OTC medicine, and CAM were determined. Multivariable logistic regression analyses were performed to investigate the relationships between medication use and demographic variables. Results: The results showed that older people were not only the higher users of prescriptions medicines but also OTC medicines and CAM. Gender and education were associated with the use of CAM. Conclusions: Due to the high use of CAM and OTC, it is important for the prescriber to take a full history of medication use before prescribing to reduce potential problems associated with drug interactions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Tobacco control in Asia," by J. Mackay, B. Ritthiphakdee, and K. S. Reddy in the 2013 issue.

Background: Chronic diseases are highly prevalent and cluster in individuals (multimorbidity). This study investigated the association between multimorbidity and Health-Related Quality of Life (HRQoL), assessing the combination of chronic diseases highly correlated with this outcome.Methods: We conducted a household survey in 2015 in a random sample of 2912 South Australian adults (48.9 ± 18.1 years; 50.9% females), obtaining information on sociodemographics, lifestyle, and 17 chronic conditions clustered in four different groups (metabolic, cardiovascular, gastrointestinal, and musculoskeletal). Information on physical (PCS) and mental components scores (MCS) of HRQoL were assessed using the SF-12 questionnaire. Multivariable linear regression models considering individual diseases (mutually adjusted) and clusters within- and between-groups were used to test the associations.Results: Only 41% of the sample was negative for all the investigated diseases. The most prevalent conditions were osteoarthritis, obesity and hypertension, which affected one in every four individuals. PCS was markedly lower among those reporting stroke, heart failure, and osteoarthritis, but they were not associated with MCS. Direct-trend relationships were observed between the number of chronic conditions (clusters within- and between-groups) and PCS, but not with MCS. The strongest association with PCS was for musculoskeletal conditions (difference between those affected by 2+ conditions and those free of these conditions -6.7 95%CI -8.5;-5.4), and lower PCS were observed in any combination of clusters between-group including musculoskeletal diseases.Conclusion: In the context of multimorbidity, musculoskeletal diseases are a key determinant group of PCS, amplifying the association of other chronic conditions on physical but not on mental health. [ABSTRACT FROM AUTHOR]

Background: Levels of vitamin D in the population have come under increasing scrutiny, however there are only a few studies in Australia which measure levels in the general population. The aim of this study was to measure the levels of vitamin D within a large population cohort and examine the association with seasons and selected demographic and health risk factors.Methods: A longitudinal cohort study of 2413 participants in the northwest suburbs of Adelaide, South Australia conducted between 2008 and 2010 was used to examine serum levels of 25-hydroxy vitamin D (25(OH)D) in relation to demographic characteristics (age, sex, income, education and country of birth), seasons, the use of vitamin D supplements and selected health risk factors (physical activity, body mass index and smoking). Both unadjusted and adjusted mean levels of serum 25(OH)D were examined, as were the factors associated with the unadjusted and adjusted prevalence of serum 25(OH)D levels below 50 and 75 nmol/L.Results: Overall, the mean level of serum 25(OH)D was 69.2 nmol/L with 22.7% of the population having a serum 25(OH)D level below 50 nmol/L, the level which is generally recognised as vitamin D deficiency. There were significantly higher levels of 25(OH)D among males compared to females (t = 4.65, p < 0.001). Higher levels of 25(OH)D were also measured in summer and autumn compared with winter and spring. Generally, mean levels of 25(OH)D were lower in those classified as obese. Smokers and those undertaking no or less than 150 minutes/week of physical activity also had lower levels of serum vitamin D. Obesity (as classified by body mass index), season and undertaking an insufficient level of physical activity to obtain a health benefit were significantly associated with the prevalence of vitamin D deficiency.Conclusions: Vitamin D deficiency is prevalent in South Australia, affecting almost one quarter of the population and levels are related to activity, obesity and season even when adjusted for confounding factors. Improved methods of addressing vitamin D levels in population are required. [ABSTRACT FROM AUTHOR]

Background: We quantified the individual and joint contribution of contemporaneous causal behavioural exposures on the future burden of oesophageal and stomach cancers and their subtypes and assessed whether these burdens differ between population groups in Australia, as such estimates are currently lacking. Methods: We combined hazard ratios from seven pooled Australian cohorts (N = 367,058) linked to national cancer and death registries with exposure prevalence from the 2017–2018 National Health Survey to estimate Population Attributable Fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death. Results: Current and past smoking explain 35.2% (95% CI = 11.7–52.4%), current alcohol consumption exceeding three drinks/day 15.7% (95% CI = 0.9–28.4%), and these exposures jointly 41.4% (95% CI = 19.8–57.3%) of oesophageal squamous cell carcinomas in Australia. Current and past smoking contribute 38.2% (95% CI = 9.4–57.9%), obesity 27.0% (95% CI = 0.6–46.4%), and these exposures jointly 54.4% (95% CI = 25.3–72.1%) of oesophageal adenocarcinomas. Overweight and obesity explain 36.1% (95% CI = 9.1–55.1%), current and past smoking 24.2% (95% CI = 4.2–40.0%), and these exposures jointly 51.2% (95% CI = 26.3–67.8%) of stomach cardia cancers. Several population groups had a significantly higher smoking-attributable oesophageal cancer burden, including men and those consuming excessive alcohol. Conclusions: Smoking is the leading preventable behavioural cause of oesophageal cancers and overweight/obesity of stomach cancers. [ABSTRACT FROM AUTHOR]

Summary: Research with 'good sleepers' is ubiquitous, yet there are no standardised criteria to identify a 'good sleeper'. The present study aimed to create and validate a questionnaire for identifying good sleepers for use in research studies known as the Good Sleeper Scale‐15 items (GSS‐15). Data were derived from a population‐based survey of Australian adults (n = 2,044). A total of 23 items were chosen for possible inclusion. An exploratory factor analysis (EFA) was conducted on ~10% of the survey dataset (n = 191) for factor identification and item reduction. A confirmatory factor analysis (CFA) was conducted on the remaining data (n = 1,853) to test model fit. Receiver operating characteristic curves and correlations were conducted to derive cut‐off scores and test associations with sleep, daytime functioning, health, and quality‐of‐life. The EFA identified six factors: 'Sleep Difficulties', 'Timing', 'Duration', 'Regularity', 'Adequacy', and 'Perceived Sleep Problem'. The CFA showed that model fit was high and comparable to other sleep instruments, χ2 (63) = 378.22, p < 0.001, root mean square error of approximation = 0.05, with acceptable internal consistency (α = 0.76). Strong correlations were consistently found between GSS‐15 global scores and outcomes, including 'a good night′s sleep' (r = 0.7), 'feeling un‐refreshed' (r = −0.59), and 'experienced sleepiness' (r = −0.51), p < 0.001. Cut‐off scores were derived to categorise individuals likely to be a good sleeper (GSS‐15 score ≥40) and those very likely to be a good sleeper (GSS‐15 score ≥45). The GSS‐15 is a freely available, robust questionnaire that will assist in identifying good sleepers for the purpose of sleep research. Future work will test relationships with other sleep measures in community and clinical samples. [ABSTRACT FROM AUTHOR]

Body composition and poor mental health are risk factors for developing foot pain, but the role of different fat deposits and psychological features related to chronic pain are not well understood. The aim of this study was to investigate the association between body composition, psychological health and foot pain. Eighty-eight women participated in this study: 44 with chronic, disabling foot pain (mean age 55.3 SD 7.0 years, BMI 29.5 SD 6.7 kg/m), and 44 age and BMI matched controls. Disabling foot pain was determined from the functional limitation domain of the Manchester Foot Pain and Disability Index. Body composition was measured using dual X-ray absorptiometry and psychological health (catastrophisation, central sensitisation and depression) was measured using three validated questionnaires. Between-group analyses found that foot pain was not significantly associated with body composition variables, but was significantly associated with all psychological health measures ( P < 0.001-0.047). Within-group analyses found that the severity of foot pain was significantly correlated with body composition measures: fat mass (total, android, gynoid, and visceral), fat-mass ratios [visceral/subcutaneous (VAT/SAT), visceral/android], fat-mass index (FMI), and depression. In multivariable analysis, VAT/SAT ( β 1.27, 95% CI 0.28-2.27), FMI ( β 0.14, 95% CI 0.02-0.25) and depression ( β 0.06, 95% CI 0.00-0.12) were independently associated with foot pain severity. Psychological health, not body composition, was associated with prevalent foot pain. For women with foot pain, VAT/SAT, FMI and depression were associated with severity. Further work is needed to determine if a reduction in fat mass reduces the severity of foot pain. [ABSTRACT FROM AUTHOR]

Summary: The few studies assessing the relationship between mental health and a multidimensional measure of sleep have been conducted in samples of almost exclusively women. In the present study, we therefore assessed associations of multidimensional sleep health with mental well‐being in Australian adults. A cross‐sectional, national online survey of sleep health was conducted in 2019 in 2,044 community dwelling adults aged 18–90 years. Composite scores of self‐reported healthy sleep were based on Ru‐SATED (R‐SATED) dimensions of satisfaction, alertness, timing, efficiency and duration scored 0 (never/rarely), 1 (sometimes) or 2 (usually/always), and regularity (social jet lag) was scored 0 (≥1 hr) or 1 (<1 hr). Mental well‐being was identified by a report of no problem on the EuroQol (European quality of life) five dimension five level scale (EQ‐5D‐5L) anxiety/depression scale, as well as absence of six chronic depressive symptoms. Ordinal logistic regression analyses determined associations of mental well‐being with sleep dimensions, and total R‐SATED (range 0–11) and SATED scores (0–10), adjusted for sociodemographic and health factors. In males and females, healthy categories of SATED dimensions (but not regularity) were associated with mental well‐being. A 1 unit increase in the total SATED score (mean [SD] 6.6 [2.1]) was associated with less problems on the EQ‐5D‐5L (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.08–1.14) and fewer chronic depressive symptoms (OR 1.20, 95% CI 1.17–1.23). These estimates did not differ when the total R‐SATED score was considered. Sleep health promotion focussing solely on traditional messaging around healthy sleep duration may limit mental health gains. Rather, a more holistic approach to public health messaging to improve sleep health literacy may be beneficial for mental well‐being. [ABSTRACT FROM AUTHOR]

• Little is known regarding changes in primary health care utilisation following LTC entry. • After hours and urgent after hours GP attendances increased almost 2-fold after LTC entry. • Only a third of residents received a GP health assessments or care planning after LTC entry. • Utilisation of pain, palliative and geriatric specialist medicine attendances were low (<3%). • There is an opportunity to improve the utilisation of primary health care services to ensure that residents' complex care needs are adequately met. To examine utilisation of primary health care services (subsidised by the Australian Government, Medicare Benefits Schedule, MBS) before and after entry into long-term care (LTC) in Australia. A retrospective cohort study of older people (aged ≥65 years) who entered LTC in Australia between 2012 and 2016 using the Historical Cohort of the Registry of Senior Australians. MBS-subsidised general attendances (general practitioner (GP), medical and nurse practitioners), health assessment and management plans, allied health, mental health services and selected specialist attendances accessed in 91-day periods 12 months before and after LTC entry were examined. Adjusted relative changes in utilisation 0–3 months before and after LTC entry were estimated using risk ratios (RR) calculated using Generalised Estimating Equation Poisson models. 235,217 residents were included in the study with a median age of 84 years (interquartile range 79–89) and 61.1% female. In the first 3 months following LTC entry, GP / medical practitioner attendances increased from 86.6% to 95.6% (aRR 1.10 95%CI 1.10–1.11), GP / medical practitioner urgent after hours (from 12.3% to 21.1%; aRR 1.72, 95%CI 1.70–1.74) and after-hours attendances (from 18.5% to 33.8%; aRR 1.83, 95%CI 1.81–1.84) increased almost two-fold. Pain, palliative and geriatric specialist medicine attendances were low in the 3 months prior (<3%) and decreased further following LTC admission. There is an opportunity to improve the utilisation of primary health care services following LTC entry to ensure that residents' increasingly complex care needs are adequately met. [ABSTRACT FROM AUTHOR]

Background: On-call research and guidance materials typically focus on 'traditional' on-call work (e.g., emergency services, healthcare). However, given the increasing prevalence of non-standard employment arrangements (e.g., gig work and casualisation), it is likely that a proportion of individuals who describe themselves as being on-call are not included in current on-call literature. This study therefore aimed to describe the current sociodemographic and work characteristics of Australian on-call workers. Methods: A survey of 2044 adults assessed sociodemographic and work arrangements. Of this population, 1057 individuals were workforce participants, who were asked to provide information regarding any on-call work they performed over the last three months, occupation type, weekly work hours, and the presence or absence of non-standard work conditions. Results: Of respondents who were working, 45.5% reported working at least one day on-call in the previous month. There was a high prevalence of on-call work in younger respondents (63.1% of participants aged 18–24 years), and those who worked multiple jobs and more weekly work hours. Additionally, high prevalence rates of on-call work were reported by machinery operators, drivers, community and personal service workers, sales workers, and high-level managers. Conclusions: These data suggest that on-call work is more prevalent than previously recorded and is likely to refer to a broad set of employment arrangements. Current classification systems may therefore be inadequate for population-level research. A taxonomy for the classification of on-call work is proposed, incorporating traditional on-call work, gig economy work, relief, or unscheduled work, and out of hours work. [ABSTRACT FROM AUTHOR]

Purpose: Psychological distress encompasses anxiety and depression with the previous studies showing that psychological distress is unequally distributed across population groups. This paper explores the mechanisms and processes which may affect the distribution of psychological distress, including a range of individual and community level socioeconomic determinants. Methods: Representative cross-sectional data was collected for respondents aged 16+ from July 2008 to June 2009, as a part of the South Australian Monitoring and Surveillance System (SAMSS) using Computer Assisted Telephone Interviews (CATI). Univariate and multivariate analyses ( n = 5,763) were conducted to investigate the variables that were associated with psychological distress. Results: The overall prevalence of psychological distress was 8.9%. In the multivariate model, females, those aged 16-49, respondents single with children, unable to work or unemployed, with a poorer family financial situation, earning $20,000 or less, feeling safe in their home some or none of the time, feeling as though they have less then total control over life decisions and sometimes experiencing problems with transport, were significantly more likely to experience psychological distress. Conclusions: This paper has demonstrated the relationship between low-income, financial pressure, less than optimal safety and control, and high-psychological distress. It is important that the groups highlighted as vulnerable be targeted in policy, planning, and health promotion and prevention campaigns. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity, the simultaneous occurrence of two or more chronic conditions, is usually associated with older persons. This research assessed multimorbidity across a range of ages so that planners are informed and appropriate prevention programs, management strategies and health service/health care planning can be implemented. Methods: Multimorbidity was assessed across three age groups from data collected in a major biomedical cohort study (North West Adelaide Health Study). Using randomly selected adults, diabetes, asthma, and chronic obstructive pulmonary disease were determined clinically and cardio-vascular disease, osteoporosis, arthritis and mental health by self-report (ever been told by a doctor). A range of demographic, social, risk and protective factors including high blood pressure and high cholesterol (assessed bio-medically), health service use, quality of life and medication use (linked to government records) were included in the multivariate modelling. Results: Overall 4.4% of the 20-39 year age group, 15.0% of the 40-59 age group and 39.2% of those aged 60 years of age or older had multimorbidity (17.1% of the total). Of those with multimorbidity, 42.1% were aged less than 60 years of age. A variety of variables were included in the final logistic regression models for the three age groups including family structure, marital status, education attainment, country of birth, smoking status, obesity measurements, medication use, health service utilisation and overall health status. Conclusions: Multimorbidity is not just associated with older persons and flexible care management support systems, appropriate guidelines and care-coordination programs are required across a broader age range. Issues such as health literacy and polypharamacy are also important considerations. Future research is required into assessing multimorbidity across the life course, prevention of complications and assessment of appropriate self-care strategies. [ABSTRACT FROM AUTHOR]

Background: There is limited information on sleep duration and obesity among Australian children. The objective of the study is to cross-sectionally examine the relationship between sleep duration and obesity in Australian children aged 5 to 15 years. Methods: Data were collected using the South Australian Monitoring and Surveillance System between January 2004 and December 2008. Each month a representative random sample of South Australians are selected from the Electronic White Pages with interviews conducted using Computer Assisted Telephone Interviewing (CATI). Within each household, the person who was last to have a birthday was selected for interview. Parents reported the number of hours their children slept each day. Obesity was defined according to the International Obesity Task Force (IOTF) definition based on BMI calculated from reported body weight and height. Results: Overall, parents of 3495 children aged 5-15 years (mean 10.7 years, 50.3% boys) were interviewed. The prevalence of obesity was 7.7% (8.9% in boys, 6.6% in girls). In multivariate analysis after adjusting for sociodemographic variables, intake of fruit and vegetables, physical activity and inactivity, the odds ratio (OR) for obesity comparing sleeping <9 hours with ≥10 hours was 2.23 (95% CI 1.04-4.76) among boys, 1.70(0.78-3.73) among girls, and 1.97(1.15-3.38) in both genders. The association between short sleep (<9 hours) and obesity was stronger in the younger age group. No significant association between short sleep and obesity was found among children aged 13-15. There was also an additive interaction between short sleep and low level of physical activity. Conclusion: Short sleep duration is associated with increased obesity in children especially among younger age groups and boys. [ABSTRACT FROM AUTHOR]

Background Systemic inflammation is a precursor of many chronic diseases that contributes to morbidity and mortality. In this study, we examined the joint association of systemic inflammation and diet quality with all-cause mortality. Methods A total of 27,305 adults (mean age = 50 years, male: 50.6%) from the National Health and Nutrition Examination Survey (1999-2010 and 2015-2018) were included in the study. A serum inflammatory marker, C-reactive protein (CRP), was measured. The Healthy Eating Index-2015 (HEI-15) was computed. Multivariable logistic regression analysis was used to determine the cross-sectional association between HEI-15 and inflammation. Multivariable Cox proportional hazard models were performed to assess the risk of all-cause mortality associated with the joint classification of inflammation and diet quality. Results In the cross-sectional study, a higher tertile of HEI-15 was associated with reduced odds of inflammation (OR = 0.85, 95% CI: 0.78-0.93) in all participants. Similar results were observed in obese and non-obese groups. In the prospective study (median follow-up = 9.4 years), a higher adherence to HEI-15 was associated with a reduced risk of mortality. Compared to non-obese group, obese participants with high levels of inflammation had a higher risk of all-cause mortality (HR = 1.26, 95% CI: 1.08-1.47; HR = 1.60, 95% CI: 1.19-2.17, respectively). Conclusions A higher adherence to HEI-15 was associated with reduced inflammation. Higher diet quality may reduce mortality risks associated with inflammation, particularly in non-obese groups and obese participants with moderate inflammation. Key messages Adhering to a high quality diet may mitigate the mortality risk associated with increased inflammation. [ABSTRACT FROM AUTHOR]

Background: Analysis was undertaken on data from randomly selected participants of a biomedical cohort study to assess representativeness. The research hypotheses was that there was no difference in participation and non-participations in terms of health-related indicators (smoking, alcohol use, body mass index, physical activity, blood pressure and cholesterol readings and overall health status) and selected socio-demographics (age, sex, area of residence, education level, marital status and work status). Methods: Randomly selected adults were recruited into a bio-medical representative cohort study based in the north western suburbs of the capital of South Australia -- Adelaide. Comparison data was obtained from cross-sectional surveys of randomly selected adults in the same age range and in the same region. The cohort participants were 4060 randomly selected adults (18+ years). Results: There were no major differences between study participants and the comparison population in terms of current smoking status, body mass index, physical activity, overall health status and proportions with current high blood pressure and cholesterol readings. Significantly more people who reported a medium to very high alcohol risk participated in the study. There were some demographic differences with study participants more likely to be in the middle level of household income and education level. Conclusion: People with risky behaviours participated in this health study in the same proportions as people without these risk factors. [ABSTRACT FROM AUTHOR]

Discharge planning endeavours to assist the transition of patients from the acute hospital setting into the community. We examined the quality of discharge planning from the perspective of the carer. Spouses were the most common carers for the elderly patients in our study. Many carers were also elderly, with their own health problems. Using a new instrument (entitled PREPARED) (K. Grimmer and J. Moss, Int J Qual Health Care (in press)), carers rated the quality of planning for discharge much lower than did the patient, indicating that their needs were often not met when discharge was being planned. In free text responses, carers expressed their dissatisfaction over communication about how the family would cope once the patient went home. Carers generally had lower summary mental quality of life scores than the Australian norms (as measured by the SF-36 health survey (J. Ware and R. Sherbourne, Med Care 1992; 30: 473-483)), suggesting that the caring role may have impacted upon their emotional wellbeing. The rate of use of community services in the first week post-discharge was low, suggesting that carers and patients carried the majority of the burden immediately after discharge. We suggest that planning for hospital discharge requires more consideration of the carer. [ABSTRACT FROM AUTHOR]