The health-related quality of life burden of co-morbid cardiovascular disease and major depressive disorder in Australia : findings from a population-based, cross-sectional study

Purpose Health-related quality of life (HRQOL) can be significantly impaired by the presence of chronic conditions such as cardiovascular disease (CVD) and major depressive disorder (MDD). The aim of this paper was to (1) identify differences in HRQOL between individuals with CVD, MDD, or both, compared to a healthy reference group, (2) establish whether the influence of co-morbid MDD and CVD on HRQOL is additive or synergistic and (3) determine the way in which depression severity interacts with CVD to influence overall HRQOL.

Methods Population-based data from the 2007 Australian National Survey of Mental Health and Well-being (NSMHWB) (n = 8841) were used to compare HRQOL of individuals with MDD and CVD, MDD but not CVD, CVD but not MDD, with a healthy reference group. HRQOL was measured using the Assessment of Quality of Life (AQOL). MDD was identified using the Composite International Diagnostic Interview (CIDI 3.0).

Results Of all four groups, individuals with co-morbid CVD and depression reported the greatest deficits in AQOL utility scores (Coef: −0.32, 95% CI: −0.40, −0.23), after adjusting for covariates. Those with MDD only (Coef: −0.27, 95% CI: −0.30, −0.24) and CVD only (Coef: −0.08, 95% CI: −0.11, −0.05) also reported reduced AQOL utility scores. Second, the influence of MDD and CVD on HRQOL was shown to be additive, rather than synergistic. Third, a significant dose–response relationship was observed between depression severity and HRQOL. However, CVD and depression severity appeared to act independently of each other in impacting HRQOL.

Conclusions HRQOL is greatly impaired in individuals with co-morbid MDD and CVD; these conditions appear to influence HRQOL in an additive fashion. HRQOL alters with depression severity, therefore treating depression and improving HRQOL is of clinical importance.

Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006-7 : Australian orthopaedic association national joint replacement registry

Background The utilization of total hip replacement (THR) surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES) within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD) of Victoria, Australia.

Methods Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006–7, primary THR with a diagnosis of osteoarthritis (OA) among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk.

Results Females accounted for 46.9% of the 642 primary THR performed during 2006–7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70–79 years (males 6.1, and females 5.4 per 1,000 person years). Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups.

Conclusions Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.

Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement

Background The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability.

Questions/purposes We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans.

Methods Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced scaphoid fractures for the presence of displacement, using a web-based rating application. Before rating, observers were randomized to a training group (34 observers) and a nontraining group (30 observers). The training group received an online training module before the rating session, and the nontraining group did not. Interobserver reliability for training and nontraining was assessed by Siegel’s multirater kappa and the Z-test was used to test for significance.

Results There was a small, but significant difference in the interobserver reliability for displacement ratings in favor of the training group compared with the nontraining group. Ratings of radiographs and CT scans combined resulted in moderate agreement for both groups. The average sensitivity, specificity, and accuracy of diagnosing displacement of scaphoid fractures were, respectively, 83%, 85%, and 84% for the nontraining group and 87%, 86%, and 87% for the training group. Assuming a 5% prevalence of fracture displacement, the positive predictive value was 0.23 in the nontraining group and 0.25 in the training group. The negative predictive value was 0.99 in both groups.

Conclusions Our results suggest training can improve interobserver reliability and sensitivity, specificity and accuracy for the diagnosis of scaphoid fracture displacement, but the improvements are slight. These findings are encouraging for future research regarding interobserver variation and how to reduce it further.

Children's consumption of energy dense nutrient poor foods, fruit and vegetables; are they related? An analysis of data from a cross sectional survey

Issue addressed: Many children consume excessive amounts of energy-dense, nutrient-poor (EDNP) or 'extra' foods and low intakes of fruit and vegetables. The aim of this study was to examine the associations between EDNP foods and ascertain whether certain EDNP foods and beverages are more likely to be eaten in association with other EDNP foods.

Methods: A cross-sectional representative population survey of children in preschool (n=764), and of school students in Years K, 2 and 4 (n=1,560) and in Years 6, 8 and 10 (n=1,685) residing in the Hunter New England region of New South Wales, Australia. Dietary data were collected using a short food frequency questionnaire. Multivariate logistic regression models examined the association between EDNP foods and fruit and vegetable intake. Data were stratified by sex and age cohort.

Results: More frequent consumption of some EDNP food types was significantly associated with more frequent consumption of other EDNP foods. Fast food and soft drinks consumption were associated with each other as well as with fried potato and salty snacks; and with lower intakes of fruit and vegetables in some but not all age groups.

Conclusion: The positive associations found between EDNP foods point towards the existence of a high-risk group of children who frequently consume a variety of EDNP foods and drinks.

Sex-related differences in the organismal and cellular stress response in juvenile salmon exposed to treated bleached kraft mill effluent

Exposure of fish to stressors can elicit biochemical and organismal changes at multiple levels of biological organization collectively known as stress responses. The organismal (plasma glucose and cortisol levels) and cellular (hepatic hsp70) stress responses in fish have been studied in several species, but little is known about sex-related differences in these responses. In this study, we exposed sexually immature juvenile chinook salmon (Oncorhynchus tshawytscha) to bleached kraft mill effluent (BKME: 0%, 1%, and 10% v/v) for 30 days and then measured components of their organismal and cellular stress responses. Males exposed to 1% BKME had higher levels of plasma glucose than females. Plasma cortisol levels were unaffected in females exposed to BKME, but males exposed to 10% BKME had significantly higher levels of plasma cortisol relative to non-exposed males. While exposure to BKME did not affect hsp70 levels in males, females exposed to 1% BKME had higher levels of hsp70 relative to non-exposed and 10% BKME groups. Within any given treatment, females had higher levels of hsp70 relative to males. This study demonstrates that sex-related differences exist in commonly used indicators of stress in fish, and points out the importance of considering the sex of the fish in stress research.

Conceptualizing teamwork and group-work in architecture and related design disciplines

This paper reports on the early findings of an Australian Learning Teaching Council (ALTC/OLT) funded project – “Enhancing and Assessing Group and Team Learning in Architecture and Related Design Contexts.” This is a two-year project investigating good practice in Australian higher education for the teaching of teamwork in the design disciplines, with a focus on architecture. Drawing upon a review of the literature and discussions with teachers and practitioners, the paper considers how teamwork is conceived in the context of the design disciplines. The paper explores notions of team and group design activities in the literature, identifying the key elements and characteristics of effective teams and groups. While a great deal of research exists on effective teamwork in organizational, management and general education literature, this research found a clear gap in knowledge relating to teaching teamwork in architecture and related design contexts. Suggestions are made about the ways in which theories on effective teamwork in organisations might elucidate teaching and assessment of effectively functioning student design teams. The literature review prompted five key questions, outlined here, around the conceptualisation of teamwork in design education that were subsequently discussed with educators and practitioners, thus allowing the identification of issues, problems and solutions common to all fields of design.

Rural living and health-related quality of life in Australians with Parkinson's disease

Introduction: The motor and non-motor symptoms associated with idiopathic Parkinson’s disease (PD) may compromise the health-related quality of life (HRQOL) of some individuals living with this debilitating condition. Although growing evidence suggests that PD may be more prevalent in rural communities, there is little information about the life quality of these individuals. This study examines whether HRQOL ratings vary in relation to rural and metropolitan life settings.
Methods: An analytic cross-sectional study was conducted to compare the HRQOL of two separate samples of people with PD living in metropolitan Melbourne and rural Victoria. The metropolitan sample consisted of 210 individuals who had participated in the baseline assessment for an existing clinical trial. The rural sample comprised 24 participants who attended community-based rehabilitation programs and support groups in rural Victoria. Health-related quality of life was quantified using the Parkinson’s Disease Questionnaire-39 (PDQ-39).
Results: The HRQOL of participants in rural Australia differed from individuals living in a large metropolitan city (p=0.025). Participants in rural Australia reported worse overall HRQOL, after controlling for differences in disease duration. Their overall HRQOL was lower than for city dwellers. Rural living was also found to be a significant negative predictor of HRQOL (β=0.14; 95% CI -1.27 to -0.08; _p=0.027).
Conclusion: The findings of this study suggest that some people with PD living in rural Victoria perceive their HRQOL to be relatively poor. In order to minimise the debilitating consequences of this disease, further studies examining the factors that may contribute to the HRQOL of individuals living in rural and remote areas are required.

The 6-PACK programme to decrease falls and fall-related injuries in acute hospitals : protocol for an economic evaluation alongside a cluster randomised controlled trial

Background Falls are a common hospital occurrence complicating the care of patients. From an economic perspective, the impact of in-hospital falls and related injuries is substantial. However, few studies have examined the economic implications of falls prevention interventions in an acute care setting. The 6-PACK programme is a targeted nurse delivered falls prevention programme designed specifically for acute hospital wards. It includes a risk assessment tool and six simple strategies that nurses apply to patients classified as high-risk by the tool.
Objective To examine the incremental cost-effectiveness of the 6-PACK programme for the prevention of falls and fall-related injuries, compared with usual care practice, from an acute hospital perspective.
Methods and design The 6-PACK project is a multicentre cluster randomised controlled trial (RCT) that includes 24 acute medical and surgical wards from six hospitals in Australia to investigate the efficacy of the 6-PACK programme. This economic evaluation will be conducted alongside the 6-PACK cluster RCT. Outcome and hospitalisation cost data will be prospectively collected on approximately 16 000 patients admitted to the participating wards during the 12-month trial period. The results of the economic evaluation will be expressed as ‘cost or saving per fall prevented’ and ‘cost or saving per fall-related injury prevented’ calculated from differences in mean costs and effects in the intervention and control groups, to generate an incremental cost-effectiveness ratio (ICER).
Discussion This economic evaluation will provide an opportunity to explore the cost-effectiveness of a targeted nurse delivered falls prevention programme for reducing in-hospital falls and fall-related injuries. This protocol provides a detailed statement of a planned economic evaluation conducted alongside a cluster RCT to investigate the efficacy of the 6-PACK programme to prevent falls and fall-related injuries.

Age-related differences revealed in Australian fur seal Arctocephalus pusillus doriferus gut microbiota

The gut microbiota of Australian fur seals (Arctocephalus pusillus doriferus) was examined at different age classes using fluorescent in situ hybridisation (FISH) and 16S rRNA gene pyrosequencing. The FISH results indicated that in the fur seal groups, the predominant phyla are Firmicutes (22.14-67.33%) followed by Bacteroidetes (3.11-15.45%) and then Actinobacteria (1.4-5.9%) consistent with other mammals. Phylum Proteobacteria had an initial abundance of 1.8% in the 2-month-old pups, but < 1% of bacterial numbers for the other fur seal age groups. Significant differences did occur in the abundance of Clostridia, Lactobacilli and Bifidobacteria between 2 months pups and 9 months pups and adult fur seals. Results from the 16S rRNA gene pyrosequencing supported the FISH data and identified significant differences in the composition of Firmicutes, Bacteroidetes, Actinobacteria, Proteobacteria, Verrucomicrobia and Fusobacteria at all ages. Class Clostridia in phylum Firmicutes dominates the microbiota of the 2 months and 9 months seal pups, whilst class Bacilli dominates the 6 months pups. In addition, a high level of dissimilarity was observed between all age classes. This study provides novel insight into the gut microbiota of Australian fur seals at different age classes.

Physical activity, activity change, and their correlates in a population-based sample of colorectal cancer survivors

Background: Physical activity can provide benefits to cancer survivors, including reduced symptoms and treatment side effects, improved overall quality of life, and decreased risk of other chronic diseases.

Purpose: The aim of the study was to describe physical activity before and after diagnosis of colorectal cancer and to examine the associations with sociodemographic and disease-related variables.

Methods: Telephone interviews were conducted with 1,996 colorectal cancer survivors recruited through a cancer registry.

Results: In comparison to prediagnosis activity levels, there were 21% fewer participants meeting the physical activity and health guideline (150 min of moderate-intensity physical activity per week) postdiagnosis. Meeting the guideline postdiagnosis was associated with being male, living outside of the state capital city, having a higher education, having a healthy body mass index, not smoking, having had surgery only, and no reported fatigue. Attributes associated with a decrease in physical activity following diagnosis were being female, living within the state capital city, having a lower level of education, having a stoma, having adjuvant therapy, and experiencing fatigue.

Conclusions: There is considerable scope for targeted interventions to increase the physical activity of colorectal cancer survivors, particularly for those groups that we have identified as being less active and/or have reduced their activity.

Australian Mothers' notions of risk and uncertainty in relation to their pre-teen children

In this article we examine the ways discourses of risk manifested and played out within and across two groups of Australian mothers living in two large urban centres in Australia: the first comprised of mothers who had a pre-teen child diagnosed with an eating disorder (n = 13); the second of mothers who had a pre-teen child without the symptoms or diagnosis of an eating disorder (n = 13). In 2011 and 2012, we conducted in-depth interviews with the mothers in their homes on their ideas about health and their relationships with their children. An analysis of the data collected from these interviews indicated that having a pre-teen child diagnosed with an eating disorder had a decisive impact on how the mothers constituted and responded to risk. For mothers, who had a pre-teen child with an eating disorder, risk was intensified by bio-medical discourses. The particular intensifications of risk limited the ways in which mothers could act and often threatened to undermine their abilities as competent carers. By contrast, the mothers who did not have a pre-teen child with an eating disorder spoke about risk less directly, and with less sense of immediacy. Where these mothers acknowledged risk discourses particularly in regard to health, they were in a stronger position to negotiate them. Our analysis indicates that the ways in which mothers responded to risk is contingent on circumstances and contexts. Mothers’ responses to risk were related to the calculability of the risk and their perceived capacity to manage it.

Job strain exposures vs. stress-related workers’ compensation claims in Victoria, Australia: developing a public health response to job stress

We present a comparative analysis of patterns of exposure to job stressors and stress-related workers’ compensation (WC) claims to provide an evaluation of the adequacy of claims-driven policy and practice. We assessed job strain prevalence in a 2003 population-based survey of Victorian [Australia] workers and compared these results with stress-related WC statistics for the same year. Job strain prevalence was higher among females than males, and elevated among lower vs. higher occupational skill levels. In comparison, claims were higher among females than males, but primarily among higher skill-level workers. There was some congruence between exposure and WC claims patterns. Highly exposed groups in lower socio-economic positions were underrepresented in claims statistics, suggesting that the WC insurance perspective substantially underestimates the job stress problems for these groups. Thus to provide a sufficient evidence base for equitable policy and practice responses to this growing public health problem, exposure or health outcome data are needed as an essential complement to claims statistics.

Relationship between Clinical Macular Changes and Retinal Function in Age-Related Macular Degeneration

Purpose

Different patterns of Australian adults' knowledge of foods and nutrients related to metabolic disease risk

A nationwide survey of 2022 consumers was conducted in Australia in late 2011. A short list of questions about knowledge of the nutrient composition of common foods was administered along with questions about the respondents’ food attitudes, demographics, school education and dieting practices. Overall, the results showed that nutrition knowledge was relatively high. Latent class analysis showed two groups of consumers with ‘high’ and ‘low’ knowledge of nutrition. Higher knowledge was positively associated with age, female sex, university education, experience of home economics or health education at school, having a chronic disease, and attitudes to food issues, and negatively with type 1 diabetes or the use of diabetes-control diets. The implications of the findings for nutrition communication are discussed.

The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review

Background
Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families.

Methods
Searches of major electronic databases identified articles published from 1993–2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity.

Results
Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m2 to -0.54 kg/m2 for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3–5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery.

Conclusion
There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required.