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Background: Increasing levels of risky alcohol consumption in older men observed in many countries, combined with trends for increased alcohol-related misuse by men during COVID, indicate a need to examinealcohol use by older men during the pandemic. Aim: To examine the prevalence and predictors of increased and hazardous alcohol consumption in older South Australian men during COVID-19 restrictions. Method: Data collected in the latest (eighth) wave of the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) cohort study were interrogated. Participants were 746 community-dwelling older men (mean age 69 years) who completed a self-report survey on mental health, coping, COVID-related worries, and alcohol consumption during pandemic restrictions. Alcohol-related items asked about changes to overall consumption (analysed as increased vs. decreased/same) and number of standard drinks per occasion (analysed as

Introduction: The rise in telehealth adoption due to the emergence of COVID-19 may have had implications for men who experience barriers to accessing traditional forms of healthcare. This study sought to explorehow a sample of older men interacted with telehealth during the pandemic. Method: Data sourced from a cross-sectional, population-based questionnaire (completed from October 2020 to March 2021) were used to analyze the characteristics of older men’s (a) use of telehealth services, and (b) perceptions of telehealth in comparison to in-person healthcare using Andersen’s Behavioral Model of Health Services Use. Results: Of the 731 participants (mean age = 69 years; SD = 9.6), 241 (32.9%) had used telehealth services during pandemic restrictions. Most of them who had used telehealth (63.1%; 152/241) thought it was “just as good” as in-person, 4.1% (10/241) believed it was “better,” and 25.7% (62/241) thought it was “worse.” Men with more chronic conditions were more likely to (a) have used telehealth (odds ratio [OR], 1.44 [95% CI, 1.21–1.71]) and (b) perceived telehealth as “better” or “just as good” as in-person healthcare (OR, 1.63 [95% CI, 1.17–2.29]). Men with clinically significant depressive symptoms were more likely to view telehealth as worse than in-person care (OR, 0.32 [95% CI, 0.12–0.88]). Conclusion: While telehealth is acceptable to the majority of middle-aged and older men who have used it during the pandemic, attitudes may vary according to their current health issues. Men with more chronic conditions are more likely to feel positive about telehealth, while those with clinically significant depression symptoms are more likely to view it negatively. Healthcare providers should consider men’s needs and preferences when offering telehealth services.

To determine any relationship of diet with breast cancer risk.The case-control study was conducted at Aga Khan University Hospital and the Karachi Institute of Radiation and Nuclear Medicine, Karachi, from February 2015 to July 2017, and comprised of cases with a confirmed diagnosis of breast cancer and healthy controls. Data was collected using the Alternate Healthy Eating Index 2010, which was modified according to the particular cultural patterns of diet in the Pakistani population. Data was analysed using SPSS 21.Of the 1124 subjects, 374(33.3%) were breast cancer cases and 750(66.7%) were controls. High intake of grains, both whole and refined including white rice, was associated with breast cancer (odds ratio: 2.53; 95% confidence interval: 1.69-3.79; p0.001). There was no association of breast cancer with Alternate Healthy Eating Index 2010 score (odds ratio: 1.85; 95% confidence interval: 0.61-1.17; p=0.291).There was found a need for awareness of a healthy diet based on more of whole grains and brown rice replacement with refined grains and white rice, respectively. Limiting refined carbohydrate intake might be a useful public health message and may reduce breast cancer incidence in the long term.

While ostensibly relying on the dynamic of inclusion, the tourism industry also capitalises on the allure of difference, with racial difference in particular being central to some destinations’ app...

BACKGROUND: The aims of our study were two-fold. Firstly, to determine if there is an association between gout and OSA in a representative Australian adult population. Secondly, to explore associations between gout and patient reported sleep outcomes. METHODS: A cross-sectional national online survey of a representative sample of Australian adults > 18 years assessed self-reported doctor-diagnosed OSA, insomnia and patient reported sleep outcomes. Possible undiagnosed OSA was estimated using self-reported frequent loud snoring and witnessed apnoeas. Participants self-reported physician-diagnosed gout and other health conditions. Multivariable logistic regression analyses were performed for both objectives. Odds ratios with 95% confidence intervals were reported.RESULTS: There were 1948 participants of whom 126 (6.5%) had gout and 124 (6.4%) had diagnosed sleep apnoea. After adjusting for age, body mass index (BMI), sex, alcohol intake and the presence of arthritis, those with obstructive sleep apnoea diagnosed on polysomnography were twice as likely to report having gout compared to those without. (OR=2.6, 95% CI 1.5 - 4.6). Additionally, participants with symptoms suggestive of sleep apnoea were also twice as likely to have gout compared to those without (OR=2.8, 95%CI 1.6 - 5.1). There was also a higher likelihood of restless legs syndrome, insomnia and worry about sleep in patients with gout. CONCLUSION: Diagnosed and suspected OSA are associated with higher likelihood of gout. Participants with gout are also more likely to report suffering from restless legs syndrome, insomnia and worry about their sleep. Given the morbidity associated with sleep problems, we should be vigilant regarding sleep health in our patients with gout.

Introduction Most prior research into relationships between sleep and health and daytime functioning have focused on average sleep duration or efficiency and ignored individual differences in sleep need. This study tested if sleep need is more strongly correlated with self-rated health and daytime function than sleep duration. Methods Data were drawn from the 2019 Sleep Health Foundation online survey of adult Australians (N=2,044, aged 18-90 years). Hierarchical multiple regressions assessed variance explained (R2 and R2 change) by demographics (Model 1: age, sex, BMI), self-reported sleep duration (Model 2: Model 1 + weighted variable of typical weekday/weekend sleep duration), and individual sleep need (Model 3: Model 2+ rating on a 5-point scale to ‘how often you get enough sleep to feel your best the next day’) on daytime function items for fatigue, concentration, motivation, and overall self-rated health (visual-analog scale from 0-100). Results Sleep need explained an additional 17.5–18.7% of the variance in fatigue, concentration, motivation, and health rating (all p < 0.001 for R2 change) in Model 3. In contrast, Model 2 showed that sleep duration alone only explained an additional 2.0–4.1% variance in these outcomes after accounting for demographic variables. Findings were similar when stratified by sex. Sleep need also explained greater variance for older adults than for younger and middle-aged adults, especially on health rating (Model 3: R2 change = 0.11 for ages 18-24y, 0.14 for 45-54y, 0.27 for 75y+). Conclusion Sleep need appears to explain considerably more variance in daytime function and self-rated health than sleep duration. The effect of sleep need on other daytime consequences, and in clinical populations, needs further exploration. Validated assessments of sleep need are also needed to elucidate its importance for understanding the effect of sleep on health and functioning. Support (If Any) The 2019 Sleep Health Foundation online survey was supported by the not-for-profit Sleep Health Foundation using an unrestricted grant from Merck Sharp & Dohme (Australia) which did not inform nor restrict study design, methodology, or presentation.

Purpose Reduced hand grip strength (HGS) is associated with poorer health in chronic conditions, yet there has been little research examining the association with hand grip strength and obstructive sleep apnea (OSA). Further, these studies have not examined, nor adjusted, for muscle mass. The aim of this study was to determine associations between OSA indices, HGS, muscle mass, and fat mass. Participants and Methods A total of 613 participants (age range 41–88, BMI 28.6 ± 4.3) from the population-based Men Androgen Inflammation Lifestyle Environment and Stress Study underwent in-home overnight polysomnography, assessment of dominant and non-dominant HGS, and dual x-ray absorptiometry to determine whole body muscle mass and fat mass. Linear models determined cross-sectional associations of polysomnographic-derived OSA indices with hand grip strength, muscle mass, and fat mass, whilst adjusting for lifestyle information (income, smoking status, diet, self-reported physical activity), blood sample derived testosterone and systemic inflammation (C-reactive protein), cardiometabolic health (cardiovascular disease, hypertension, type 2 diabetes), and depression. Results In adjusted models, reduced dominant HGS was associated with lower oxygen nadir (unstandardised β [B] = 0.19, 95% confidence interval [CI] 0.08 to 0.29), greater time spent below 90% oxygen saturation (B = −0.08, 95% CI −0.14 to −0.02), and increased apnea duration (B = −0.3, 95% CI −0.23 to −0.02). By contrast, there were no associations between HGS and both AHI and REM AHI. Fat mass was consistently associated with worsening OSA indices, whereas muscle mass demonstrated no associations with any OSA index. Conclusion Our findings suggest impairments in HGS may be related to fat infiltration of muscle, hypoxemia-induced reductions in peripheral neural innervation, or even endothelial dysfunction, which is a common outcome of hypoxemia. Longitudinal data are needed to further examine these hypotheses and establish if reduced grip strength in patients with OSA is associated with long-term adverse health outcomes.

Background Over the past decade, there has been significant growth in the awareness and understanding of fragility among orthopaedic surgeons in the context of osteoporotic fractures and with it, improvements in the recognition and management of fragility fractures. Emerging as a major clinical and research focus in aged care is the concept of frailty and its associations with fragility, sarcopenia, falls and rehabilitation. Currently, research is lacking on how orthopaedic surgeons perceive frailty and the role of frailty screening. A baseline understanding of these perceptions is needed to inform integration of frailty identification and management for patient optimization in orthopaedic practices, as well as research and education efforts of patients and healthcare professionals in orthopaedic contexts. Methods We used an exploratory design guided by qualitative description to conduct 15 semi-structured telephone and in-person interviews across three orthopaedic surgeon subgroups (Registrars, Junior and Senior Consultants). Data collection and analysis occurred iteratively and was guided by thematic saturation. Results Orthopaedic surgeons have a disparate understanding of frailty. Between colleagues, frailty is often referred to non-specifically to suggest a general state of risk to the patient. Frailty screening is regarded positively but its specific utility in orthopaedic environments is questioned. Easy-to-administer frailty screening tools that are not exclusive assessments of functional status are viewed most satisfactorily. However these tools are rarely used. Conclusions There is little understanding among orthopaedic surgeons of frailty as a phenotype. Beliefs around modifiability of frailty were dissimilar as were the impact of related risk factors, such a cognitive status, chronic disease, social isolation, and environmental influences. This in turn may significantly impact on the occurrence and treatment outcomes of fragility fracture, a common orthopaedic problem in older populations. This study highlights need for knowledge translation efforts (e.g. education) to achieve cohesive understanding of frailty among health professionals.

BackgroundThe National Bowel Cancer Screening Program (NBCSP) is apopulation-based screening program based on a mailedscreening invitation and immunochemical faecal occult bloodtest. Initial published evidence from the NBCSP concurs withinternational evidence on similar colorectal cancer screeningprograms about the unequal participation by differentpopulation sub-groups. The aim of the paper is to present across-sectional analysis of participation in the NBCSP forAdelaide, in order to identify geographical areas andpopulation groups which may benefit from targetedapproaches to increase participation rates in colorectal cancerscreening.MethodDe-identified data from the NBCSP (February 2007 to July2008) were provided by Medicare Australia. Mapping andanalysis of the NBCSP data was performed using ESRI ArcGISsoftware, MapInfo, Microsoft Access and Microsoft Excel.Data was aggregated to postcode and participation was thenmapped according to overall participation rates, sex and age.ResultsThe overall participation rate was 46.9%, although thisdiffered by age, gender and geographical location. Mapsprovided in the paper reveal a socio-economic patterningof participation in the NBCSP, whereby areas with higherparticipation rates are also more affluent, whereas areaswith lower participation rates tend to be moredisadvantaged.ConclusionFindings from this study suggest inequities in participationin the NBCSP on the basis of gender, geographicallocation, and socio-economic status.

This paper reviews different perspectives of the changing nature of childhood, comparing these to state responses that seek to improve children's well-being. Unlike previous generations of children, children today spend much of their time under cover and under the watchful eyes of adults. It is likely that this change has had a negative impact on children's well-being. The paper explores possible styles of state intervention, arguing that a broader approach is needed in the UK than is currently being considered.

Reports on the results of a national survey conducted in Australia, in 2000. The objectives were to determine national estimates of influenza vaccination coverage for each state and territory of Australia, to obtain information related to attitudes towards and influences on immunisation decisions and explain the factors involved with failure to immunise.The survey was conducted using the Computer Assisted Telephone Interview (CATI) system. The overall participation rate for the survey was 88.6% and the final number of completed interviews across Australia was n = 10,505.Two target groups, those aged 65 years and over and those "at risk" of influenza aged between 40 and 64 years were defined. The overall immunisation rates in these two groups were 74% and 32% resp. The rate of immunisation among females generally exceeded that of males. A multivariate model provided the best joint set of explanatory variables for not getting immunised. These include sex, income, general practitioner recommendation, and general perceptions regarding the influenza injection.This study identified important issues in the decisions of people to immunise. It also highlighted the need to target the findings in effective immunisation policies and strategies to improve health outcomes for those at risk of adverse influenza events.

To examine the association between rice intake, staple food patterns (measured by percentage of rice in staple food (PRS)), weight change and the risk of the metabolic syndrome development.We followed 1231 adults, aged 20 and older, from 2002 to 2007. Food intake was assessed using a food frequency questionnaire. Body weight, height, waist circumference, blood pressure and fasting plasma glucose and lipids were measured. The metabolic syndrome was defined according to the International Diabetes Federation definition.Rice consumption of=401 g/day was associated with less weight gain (-2.08 kg, 95%CI: -2.75, -1.41, p0.001), and 42% less risk of hypertension, as compared to rice consumption of200 g/day (p=0.024). A strong linear association between rice intake and hyperglycemia was found: the odd ratios for incident hyperglycemia across rice intake200, 201-400,=401 g/day were: 1, 1.96, 2.50 (95%CI: 1.37, 4.57) (p for trend 0.005). A positive association between rice intake and incident abnormal high-density lipoprotein was observed. There was no association between rice intake and incident high triglycerides. Every 10% increase in PRS was associated with a 0.28 kg less in weight gain, 22% increase in hyperglycemia risk and 9% decrease in hypertension risk. Rice intake and PRS were not associated with the risk of the metabolic syndrome.Rice intake and PRS were inversely associated with weight gain, and PRS was inversely associated with hypertension, but positively associated with fasting blood glucose elevation. No association between rice intake and PRS with the metabolic syndrome was found.