Electoral Roll Research Articles

Dental visiting by insurance and oral health impact

The aim of this study was to explore whether oral health has an influence on the association between dental insurance and dental visiting. A random sample of adults aged 30-61 years living in Australia was drawn from the Australian Electoral Roll. Data were collected by mailed survey in 2009-2010, including age, gender, household income, dental insurance status, dental visiting and oral health impact. Responses were collected from n = 1096 persons (response rate = 39.1%). Dental insurance was positively associated with visiting a dentist in the last 12 months (prevalence ratio (PR) = 1.48; 95% CI: 1.31-1.67), while oral health impact was not associated with recent visiting PR = 1.01; 95% CI: 0.89-1.14). Visiting for the purpose of pain relief was less prevalent among insured participants (PR = 0.60; 95% CI: 0.44-0.81), but more prevalent among those with poor oral health (PR = 2.85; 95% CI: 2.15-3.76). It was found that oral health impact did not alter the relationship between dental insurance and visiting. Oral health impacts were not associated with recent dental visits, but were associated with visits for pain relief. Dental insurance was associated with a greater likelihood of recent visits and lower levels of relief of pain visits.

Association between hip and knee cartilage measured using radiographs and magnetic resonance imaging: the Tasmanian Older Adult Cohort Study

Cartilage loss is a key pathological feature of OA and can be assessed indirectly using radiography or directly through MRI. A number of cross-sectional studies have suggested that primary generalized osteoarthritis (PGOA) may be a distinct disease, but despite the high frequency of involvement of the hip and the knee joints in OA, very few studies have looked at the radiographic association between these two joints, and none has done so using MRI. The aim of this study was to examine the association of hip and knee cartilage measured by both radiography and MRI. We studied 151 participants from the Tasmanian Older Adult Cohort (TASOAC) study, who were selected randomly from the southern Tasmanian electoral rolls. MRI was used to assess hip and knee cartilage volume and radiography was used to assess joint space narrowing (JSN). Correlation analyses were used to compare cartilage volume measurements and JSN. In adjusted analysis, there was a consistent, positive association between knee and hip cartilage volume that was best for total knee cartilage volume (r = 0.16-0.40, all P < 0.05). In contrast, there was at best a weak correlation, depending on the site, between hip and knee JSN (r = -0.01 to 0.21). Hip and knee cartilage volume are more strongly associated than hip and knee JSN, suggesting a commonality of cartilage volume at different anatomic sites. The weaker radiographic association may reflect less measurement error with MRI or the contribution of multiple structures to joint space in the knee.

Autoimmune hepatitis: the role of environmental risk factors: a population-based study.

The etiology of autoimmune hepatitis (AIH) likely involves a complex interaction of genetic and environmental factors. We aim to investigate the associations between exposure to putative environmental factors and AIH and to quantify AIH risk in a first-degree relative. We conducted a population-based case-control study. Cases were AIH patients who were alive and resided in Canterbury, New Zealand, between 1 July 2011 and 30 June 2012. Controls were randomly selected from the Electoral Roll and were matched 2:1 to each case by age and gender. Self-reporting questionnaires that cover lifestyle factors, childhood factors and family history were used. 72 AIH cases and 144 controls were included. We found that exposure to antibiotics within 12months prior to AIH diagnosis (OR 12.98, 95% CI 2.49-67.67, p<0.01) was an independent risk factor for the development of AIH. Alcohol consumption (OR 0.43, 95% CI 0.28-0.68, p<0.01) and childhood home with wood heating (OR 0.30, 95% CI 0.14-0.63, p<0.01) were independently associated with reduced risks of later development of AIH. The crude risk of AIH in first-degree relatives of a patient with AIH was 0.2% (95% CI<0.1-2.0). We found that antibiotics are an independent risk factor for the development of AIH, whereas alcohol consumption and living in a childhood home with wood heating are independent protective factors against the later development of AIH.

Access to the Commonwealth electoral roll for medical research

In the 2010-11 financial 2013, there was a dramatic reduction in the approvals granted by the Australian Electoral Commission for access to samples of the adult population derived from the electoral roll for the purposes of public health research. Much time and effort has been expended in making applications without success. Researchers refused access to electoral roll samples must rely on sampling methods that are not as robust and that may produce less reliable data. We outline a set of recommendations that, if adopted, will result in a fairer system for obtaining access to the electoral roll for public health research.

Parental Divorce and Adult Family, Social and Psychological Outcomes: The Contribution of Childhood Family Adversity

Parental Divorce and Adult Family, Social and Psychological Outcomes: The Contribution of Childhood Family Adversity

Late-Onset Agoraphobia: General Population Incidence and Evidence for a Clinical Subtype

The purpose of this study was to estimate the general population incidence of late-life agoraphobia and to define its clinical characteristics and risk factors. A total of 1,968 persons ≥65 years old were randomly recruited from the electoral rolls of the district of Montpellier, France. Prevalent and incident agoraphobia diagnosed with a standardized psychiatric examination and validated by a clinical panel were assessed at baseline and over a 4-year follow-up. The 1-month baseline prevalence of agoraphobia was estimated to be 10.4%. Among persons with agoraphobia, 10.9% reported having their first episode at age 65 or above. During the 4-year follow-up, 11.2% of participants without agoraphobia at baseline had a first episode, resulting in an incidence rate of 32 per 1,000 person-years. These 132 incident late-onset cases were associated with higher incidence rates of anxiety disorders and suicidal ideation. Of the incident cases, only two were characterized by past or concurrent panic attacks, a rate that was not significantly different from that of the noncase group. The principal baseline risk factors for incident cases, derived from a multivariate model incorporating all significant risk factors, were younger age at onset (odds ratio=0.94, 95% CI=0.90-0.99), poorer visuospatial memory performance (odds ratio=1.60, 95% CI=1.02-2.49), severe depression (odds ratio=2.62, 95% CI=1.34-5.10), and trait anxiety (odds ratio=1.73, 95% CI=1.03-2.90). No significant association was found with cardiac pathologies. Agoraphobia has a high prevalence in the elderly, and unlike cases in younger populations, late-onset cases are not more common in women and are not associated with panic attacks, suggesting a late-life subtype. Severe depression, trait anxiety, and poor visuospatial memory are the principal risk factors for late-onset agoraphobia.

Brain Structural Change and Gait Decline: A Longitudinal Population‐Based Study

To investigate longitudinal associations between changes in brain structure and gait decline. Longitudinal. Population-based Tasmanian Study of Cognition and Gait. Two hundred twenty-five individuals aged 60 to 86 (mean age 71.4 ± 6.8) randomly selected from the electoral roll with baseline and follow-up data. Volumes of gray matter, white matter, hippocampi, and white matter lesions (WML) were estimated using automated segmentation from magnetic resonance imaging (MRI). Gait variables were measured using a computerized walkway. Linear regression was used to estimate the association between change in brain MRI measures and change in gait. Time between measurements, age, sex, BMI, education level, total intracranial volume, baseline infarcts, and medical history were used as baseline covariates. Mean follow-up was 30.6 months. White matter atrophy was associated with a decline in gait speed (P = .001), step length (P = .005), and cadence (P = .001). WML progression was associated with a decline in gait speed (P = .04), and its association with decline in step length was stronger with greater baseline age (P for interaction = .04). Hippocampal atrophy was associated with a decline in gait speed (P = .006) and step length (P = .001). Total gray matter atrophy was associated with decline in cadence in those with cerebral infarcts (P for interaction = .02). These are the first longitudinal data demonstrating the relative contributions of brain atrophy and WML progression to gait decline in older people. Effect modification according to age and infarcts suggests a contribution of reduced physiological and brain reserve. Interventions targeting brain health may be important in preventing mobility decline in older people.

Dry eye disease in French elderly subjects: the Alienor Study

To describe dry eye disease in French elderly subjects. The Alienor Study is a population-based study on age-related eye disease in 963 residents of Bordeaux (France), aged 73 years or more. Self-reported dry eye disease and use of artificial tears were documented through face-to-face interview. Dry eye symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire and tear film stability by tear break-up time measurements (TBUT). Definite dry eye disease was defined as self-reported dry eye, confirmed by use of artificial tears and/or OSDI greater or equal to 22. Nine hundred and fifteen subjects, with mean age of 80 ± 4 years, returned the OSDI questionnaire. Of these, 271 (29.6%) subjects reported a dry eye disease and 135 (14.7%) were using artificial tears. An OSDI score > 22 was found in 359 (39.2%) subjects and a TBUT < 5 seconds in 335/746 (44.9%) subjects. Overall, definite dry eye affected 21.9% of subjects and was more frequent in women (27.1%) than in men (13.6%). After multivariate adjustment, dry eye disease was also significantly less frequent in subjects with high educational level (odds ratio (OR) = 0.49, 95% confidence interval (CI): 0.31-0.78 for long secondary school) and more frequent in subjects with ocular hypertension (OR = 1.61, 95% CI: 1.02-2.57) and those using anxiolytics (OR = 1.53, 95% CI: 1.02-2.29). This large observational study confirmed the high prevalence of dry eye symptoms among elderly subjects and confirmed some of the previously identified risk factors (in particular female gender and use of anxiolytics).

Hyperuricaemia and gout in New Zealand rural and urban Māori and non‐Māori communities

There are few current data on the prevalence of hyperuricaemia and gout in New Zealand, particularly among the indigenous Māori population. To determine the prevalence of gout and hyperuricaemia in rural and urban Māori and non-Māori community samples and describe the treatment and comorbidities of participants with gout. Participants aged 20-64 years were recruited by random selection from the electoral roll. Māori samples were selected from among those identified as being of Māori descent on the roll and who self-identified as being of Māori ethnicity at interview. Personal medical history, blood pressure, anthropometrics, fasting lipids, glucose, HbA1c and urate were recorded. There were 751 participants. Mean serum urate (SU) was 0.30 mmol/L (0.06-0.69 mmol/L). Māori had a significantly higher prevalence of hyperuricaemia (SU > 0.40 mmol/L) compared with non-Māori (17.0% vs 7.5%, P = 0.0003). A total of 57 participants had a history of gout, with a higher prevalence in Māori compared with non-Māori (10.3% vs 2.3%, P < 0.0001). Of the participants, 18/57 (31.6%) with gout were receiving urate-lowering therapy, but in 38.9%, SU was >0.36 mmol/L. Participants with gout were more likely to have metabolic syndrome, diabetes, cardiac disease or hypertension. Gout and hyperuricaemia were more prevalent in Māori, and participants with gout were more likely to have comorbidities. There was not a higher overall adjusted cardiovascular disease risk in Māori participants with gout. Despite the high prevalence of gout, management remains suboptimal.

Self-Reported Hearing Loss in Baby Boomers from the Busselton Healthy Ageing Study: Audiometric Correspondence and Predictive Value

The baby boomer population will become high users of the health-care system in coming years. Self-report of hearing loss at a primary health-care visit may offer timely referrals to audiological services, but there has been no population-based study of self-reported hearing loss in the baby boomer generation. To determine the clinical value and audiometric correspondence of self-reported hearing loss as a screening tool for the baby boomer population. A population-based study, Busselton Healthy Ageing Study (BHAS), surveying baby boomers born between 1946 and 1964 from the shire of Busselton, Western Australia. A randomized sample of noninstitutionalized baby-boomers listed on the electoral roll (n = 6690) and resident in the shire are eligible to participate. This study reports on data from the first 1004 attendees (53.5% female) with a mean age of 56.23 (SD = 5.43). Data from a self-report question on hearing loss and diagnostic pure tone audiometry was utilized for this study. Analysis included screening performance measures of self-report compared to audiometric cut-offs, receiver operator curve (ROC) to determine optimal level, analysis of variance to compare hearing status to self-report, and binary logistic regression to determine best audiometric predictors. Of the sample, 16% self-reported hearing loss (72.1% males). Logistic regression indicated 4000 Hz as the most important individual frequency related to self-report while the four-frequency average (500, 1000, 2000, and 4000 Hz) >25 dB in the worse ear was the most significant averaged cutoff with 68% sensitivity and 87% specificity. Of those who self-reported a hearing loss, 80% had either a four-frequency average hearing loss >25 dB in the worse ear or a high-frequency average (4000 and 8000 Hz) hearing loss greater than 35 dB in the worse ear. Baby boomer adults who self-report hearing impairment on direct inquiry are most likely to have a hearing loss. A simple question at a primary health care visit may facilitate a timely referral for audiological services in a baby boomer adult, who may be more amenable to rehabilitation.

Violent victimisation is more common among people with schizophrenia-spectrum disorders than among the general population

Question: Do rates of recorded violent and non-violent victimisation differ among people with schizophrenia-spectrum disorders compared with the general population and have recorded rates changed over a 30-year period? Population:...

‘Ecstasy’ and the use of sleep medications in a general community sample: a 4‐year follow‐up

Animal models show that a single dose of 3,4-methylenedioxymethamhetamine (MDMA; 'ecstasy') can result in long-term disruption of sleep. We evaluated the relationship between ecstasy consumption and the use of sleep medications in humans after controlling for key factors. The Personality and Total Health Through Life project uses a longitudinal cohort with follow-up every 4 years. This study reports data from waves 2 and 3. Participants were recruited from the electoral roll in the Australian Capital Territory and Queanbeyan, New South Wales, Australia. Participants were aged 20-24 years at wave 1 (1999-2000). The study collected self-reported data on ecstasy, meth/amphetamine, cannabis, alcohol, tobacco and use of sleeping medications (pharmaceutical or other substances). Depression was categorized using the Brief Patient Health Questionnaire (BPHQ). Other psychosocial measures included life-time traumas. We used generalized estimating equations to model outcomes. Ecstasy data were available from 2128 people at wave 2 and 1977 at wave 3: sleeping medication use was reported by 227 (10.7%) respondents at wave 2 and 239 (12.1%) at wave 3. Increased odds ratios (OR) for sleeping medication use was found for those with depression [OR = 1.88, 95% confidence interval (CI): 1.39, 2.53], women (OR = 1.44, 95% CI: 1.13, 1.84), and increased by 19% for each life-time trauma. Ecstasy use was not a significant predictor, but ≥monthly versus never meth/amphetamine use increased the odds (OR = 3.03, 95% CI 1.30, 7.03). The use of ecstasy appears to be associated with the use of sleeping medications but this association can be accounted for by other factors.

Reduced Quality of Life in Internet-Panel Controls

To the Editor: The recruitment of controls from the Internet is appealing, in that it is cheaper and faster than random digit dialing (RDD) or random sampling from the electoral roll. However, the psychosocial profile of Internet-panel controls may not be representative of the general population. We explored the representativeness of Internet-panel controls by comparing their scores on health-related quality of life and psychological distress with population norms. We assessed a set of controls recruited in February 2011 from an Internet panel of 29,000 Australians as part of a study of testicular cancer survivors. Health-related quality of life was assessed using the SF-36v2, and psychological distress was assessed with the Depression Anxiety Stress Scales short-form. There are Australian population norms for these measures,1,2 which allowed us to compare the Internet-panel controls with the general population. We used one-sample t tests to compare norm-based scores of Internet-panel controls with age-adjusted Australian general population norms.2 We could not adjust for other demographic characteristics, as none was available for these normative data. Two hundred ten Internet-panel members completed an online questionnaire for controls and received AU$4. Response rate could not be calculated as the survey was disabled once the recruitment target was reached. We excluded 16 respondents who completed the 104-item questionnaire in 5 minutes or less. The eAppendix Table (https://links.lww.com/EDE/A672) shows the demographic features of the 194 eligible participants. Internet-panel controls had substantially worse scores than the general population for all domains of health-related quality of life (Table). The differences in physical aspects of health-related quality of life were generally small, while differences in mental aspects were larger. Internet-panel controls also reported higher levels of depression and anxiety than the general population, although differences were small (Table).TABLE: Norm-based Quality of Life Scores on the SF-36v2 and Psychological Distress Scores on the Depression Anxiety Stress Scales Short-form (DASS21) for Web-Panel Controls and the Age-Adjusted General PopulationOur results are consistent with accumulating evidence that suggests Internet-panel respondents are systematically different from the general population. For example, Internet-panel respondents report significantly worse post-traumatic stress symptomatology and less social support than RDD respondents.4 One possible explanation for the low social support is that men who volunteer for Internet panels are more frequent Internet users.4 High-frequency Internet use in men is associated with increased social anxiety,5 which may lead to (or reflect) social isolation, reduced health-related quality of life, and psychological impairments. The apparent impairments of Internet-panel respondents could also be a product of unreliable responses to rushed online questionnaires. One study found that Internet-panel respondents completed a survey faster than phone respondents.6 Repeated measures testing 3 months later found that the responses of participants who originally spent under four minutes completing the online questionnaire shifted 10% versus 5% in those who had taken six minutes or more.6 The same study found 80% of panelists preferred completing a less interesting survey for £2 than a more interesting survey with no reward.6 This casts doubt on the reliability of responses from Internet-panel participants who may hurry to maximize their rate of pay. In summary, levels of health-related quality of life and psychological distress reported by Internet-panel controls may not be representative of the general population, possibly due to higher levels of social isolation or rushed responses to online surveys. Caution should be taken in recruiting controls through the Internet for studies of psychosocial outcomes. ACKNOWLEDGMENTS We thank Tim Luckett for assisting with study development, and the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (G. Toner, M. Stockler, E. Hovey, H. Gurney, S. Turner, G. Hruby, M. Alam, J. Bucci, R. Eek, D. Thomson, B. Koczwara, G. Pranavan, N. Pavlakis, N. Singhal, and J. Stubbs) for assisting with study development, funding and recruitment. Allan ‘Ben’ Smith Psycho-oncology Co-operative Research Group The University of Sydney New South Wales, Australia [email protected] Madeleine King Psycho-oncology Co-operative Research Group The University of Sydney Australian New Zealand Urogenital and Prostate Cancer Trials Group New South Wales, Australia Phyllis Butow Psycho-oncology Co-operative Research Group The University of Sydney New South Wales, Australia Peter Grimison Australian New Zealand Urogenital and Prostate Cancer Trials Group Sydney Cancer Centre, Sydney New South Wales, Australia Ian Olver Cancer Council Australia, Sydney New South Wales, Australia

Impact of age, phenotype and cardio‐renal function on plasma C‐type and B‐type natriuretic peptide forms in an adult population

In contrast to the cardiac hormones, atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP), variations in plasma concentrations of C-type natriuretic peptide (CNP) in healthy adults are ill-defined, limiting their clinical application. Our objective was to define the effect of age, phenotype (gender, height, BMI), and cardiac and renal function on plasma CNPs in an adults population without renal or cardiovascular disease. This was a prospective cross-sectional observational study of adult volunteers, aged 21-80years, randomly selected from the electoral roll. Plasma CNP and its associated aminoterminal propeptide (NTproCNP) were measured in 258 subjects and related to age, gender, height and plasma creatinine. Subgroup analyses seeking associations with cardiac function (plasma BNP and NTproBNP) and bone turnover bone-specific alkaline phosphatase (bALP) were also determined. Plasma concentrations of CNPs in men continued to decline from adolescent values to reach a nadir in the 5th decade after which values increased. Similar but less marked changes occurred in women. In both sexes, NTproCNP was inversely and independently correlated with height. In contrast to B-type natriuretic peptides (BNPs), NTproCNP was higher in men, significantly related to creatinine and positively related to bALP. Gender- and age-specific changes affect CNPs in adults. Inverse associations of NTproCNP with adult height, positive correlation with creatinine - and in contrast to CNP - no association with BNP are further unique findings distinguishing NTproCNP, which need to be considered in future studies.

Comparison of Health-Related Quality of Life, Work Status, and Health Care Utilization and Costs According to Hip and Knee Joint Disease Severity: A National Australian Study

No population-based studies have investigated how the impact of hip and knee joint disease may vary with increasing severity. The purpose of this study was to evaluate health-related quality of life (HRQoL), work status, and health service utilization and costs according to severity of hip and knee joint disease. A national cross-sectional survey was conducted. Five thousand individuals were randomly selected from the Australian electoral roll and invited to complete a questionnaire to screen for doctor-diagnosed hip arthritis, hip osteoarthritis (OA), knee arthritis, and knee OA. Severity was classified by means of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (range=0-100): <7=asymptomatic, 7-38=mild-moderate, and ≥39=severe. Health-related quality of life was evaluated by means of the Assessment of Quality of Life (AQoL) instrument (range=-0.04 to 1.00; scored worst-best). Self-reported data on work status and health service utilization were collected, with health care costs estimated with the use of government data. Data were available for 1,157 participants, with 237 (20%) reporting hip or knee joint disease. Of these, 16% (n=37) were classified as asymptomatic, 51% (n=120) as mild-moderate, and 27% (n=64) as severe. The severe group reported very low HRQoL (adjusted mean AQoL=0.43, 95% confidence interval [95% CI]=0.38-0.47) compared with the mild-moderate group (adjusted mean AQoL=0.72, 95% CI=0.69-0.75) and the asymptomatic group (adjusted mean AQoL=0.80, 95% CI=0.74-0.86). Compared with the asymptomatic group, the severe group was >3 times less likely to undertake paid work (adjusted odds ratio=0.28, 95% CI=0.09-0.88) and >4 times less likely to undertake unpaid work (adjusted odds ratio=0.24, 95% CI=0.10-0.62). Although physical therapy services were used infrequently, primary and specialist care utilization and costs were highest for the severe group. Other costs (including physical therapy consultations) were unavailable. A clear pattern of worsening HRQoL, reduced work participation, and higher medical care utilization was seen with increasing severity of joint disease.

Potentially inappropriate medicines in a cohort of community‐dwelling older people in New Zealand

To examine independent factors associated with potentially inappropriate medicines (PIM) among 316 community-dwelling people aged ≥75 years living in Dunedin. People aged ≥75 years living in the community in Dunedin, New Zealand, taking ≥1 prescription medicines, randomly sampled from the electoral roll, were interviewed about their medicine-taking practices. A medication inventory comprising prescription and non-prescription medicines was taken from each participant at the time of the interview. Participants used a median of seven prescription medicines (range 1-19) and one non-prescription medicine (0-14). PIM were identified using the updated 2012 Beers criteria. PIM were identified in 42.7% (n = 135) older people. A total of 23 (7.2%) took two PIM, five (1.5%) took three PIM, four (1.2%) took four PIM and one (0.3%) took five PIM. Of the 184 total PIM identified, the top three drug classes were non-COX-selective non-steroidal anti-inflammatory drugs (24.0%), tricyclic antidepressants (16.8%) and benzodiazepines (14.6%). Polypharmacy (adjusted odds ratio [OR] 2.06, 95% confidence interval [CI] 1.03-4.12) and the use of any psychotropic drug use (OR 22.05, 95% CI 5.80-83.84) were associated with PIM exposure. In the Poisson regression model, the risk of taking a PIM significantly decreased with age (OR 0.95, CI 0.91-0.99) and increased as the number of drugs prescribed increased (OR 1.11, CI 1.08-1.15). The prevalence of PIM is relatively high in community-dwelling older people aged ≥75 years living in New Zealand. PIM defined by the Beers criteria might be a useful initial screening tool, before efforts to stop unsafe medication use or replace with safer alternatives are initiated.

Driving Behaviors and On-Duty Road Accidents: A French Case-Control Study

Objectives: A case-control study was carried out to identify driving behaviors associated with the risk of on-duty road accident and to compare driving behaviors according to the type of journey (on duty, commuting, and private) for on-duty road accident victims. Methods: Cases were recruited from the Rhône Road Trauma Registry between January 2004 and October 2005 and were on duty at the time of the accident. Control subjects were recruited from the electoral rolls of the case subjects’ constituencies of residence. Cases’ and controls’ driving behavior data were collected by self-administered questionnaire. A logistic regression was performed to identify behavioral risk factors for on-duty road accidents, taking into account age, sex, place of residence, road accident risk exposure, socio-occupational category, and type of road user. A second analysis focused specifically on the case subjects, comparing their self-assessed usual behaviors according to the type of journey. Results: Significant factors for multivariate analysis of on-duty road accidents were female gender, history of on-duty road accidents during the previous 10 years, severe time pressure at work, and driving a vehicle not belonging to the driver. On-duty road accident victims reported behavioral risk factors more frequently in relation to driving for work than driving for private reasons or commuting: nonsystematic seat belt use, cell phone use at least once daily while driving, and history of accidents with injury during the previous 10 years. Conclusions: This study provides knowledge on behavioral risk factors for on-duty road accidents and differences in behavior according to the type of journey for subjects who have been on-duty road accident victims. These results will be useful for the design of on-duty road risk prevention.

The AusD Study: A Population-based Study of the Determinants of Serum 25-Hydroxyvitamin D Concentration Across a Broad Latitude Range

Observational studies suggest that people with a high serum 25-hydroxyvitamin D (25(OH)D) concentration may have reduced risk of chronic diseases such as osteoporosis, multiple sclerosis, type 1 diabetes, cardiovascular disease, and some cancers. The AusD Study (A Quantitative Assessment of Solar UV Exposure for Vitamin D Synthesis in Australian Adults) was conducted to clarify the relationships between ultraviolet (UV) radiation exposure, dietary intake of vitamin D, and serum 25(OH)D concentration among Australian adults residing in Townsville (19.3°S), Brisbane (27.5°S), Canberra (35.3°S), and Hobart (42.8°S). Participants aged 18-75 years were recruited from the Australian Electoral Roll between 2009 and 2010. Measurements were made of height, weight, waist:hip ratio, skin, hair, and eye color, blood pressure, and grip strength. Participants completed a questionnaire on sun exposure and vitamin D intake, together with 10 days of personal UV dosimetry and an associated sun-exposure and physical-activity diary that was temporally linked to a blood test for measurement of 25(OH)D concentration. Ambient solar UV radiation was also monitored at all study sites. We collected comprehensive, high-quality data from 1,002 participants (459 males, 543 females) assessed simultaneously across a range of latitudes and through all seasons. Here we describe the scientific and methodological issues considered in designing the AusD Study.

The Sydney Centenarian Study: methodology and profile of centenarians and near-centenarians

The study of exceptionally long-living individuals can inform us about the determinants of successful aging. There are few population-based studies of centenarians and near-centenarians internationally, but none in Australia. Individuals 95 years and older were recruited from seven electoral districts in Sydney using the electoral roll, Medicare lists, and multiple other strategies to obtain a representative sample. Physical and mental health and cognitive status were assessed using standard instruments in multiple sessions, with assessments individually adapted. An informant was interviewed, and participants were invited to donate a blood sample, undergo an MRI scan, and enrol into the brain donation program. Preliminary data on the first 200 participants are reported. Mean age was 97.4 years (range 95-106), with 29.5% being men, and 58.5% living in a private dwelling. Rates of heart disease and diabetes were lower than in octogenarians, but hearing and visual deficits were common. The mean mini-mental state examination (MMSE) score was 21.1, with men performing better. Rates of psychological distress were low and satisfaction with life high (mean 5.91 out of a maximum of 7); 54% scored <24 on MMSE; 39.5% were impaired on both MMSE and a functional measure; and 20% had previous diagnosis of dementia. This is a preliminary report describing the methodology of the study. It provides further evidence that dementia is not inevitable at this age and independent living is common. The study provides an excellent resource to determine the genetic and environmental contributions to long and successful cognitive aging.

Electoral Fraud, Strategic Oversight and Development

Does electoral fraud affect development? In a weak institutional environment the answer is not obvious. This paper demonstrates that electoral fraud can lower development and this effect is mediated through the partisan control of electoral institutions and the resultant ability of the incumbent to reshape electoral constituencies (strategic use of weak institutions). This paper identifies a form of electoral fraud in India in which parties register non-citizens as voters closer to the international border. Electoral constituencies are reshaped because the oversight of electoral roll cleaning is strategic; lax in a border state where the incumbent national party and the state party are allies and strict in a border state where the incumbent national party and the state party are non-allies. Finally the paper indicates poorer development outcomes in regions where non-citizens are used for electoral support.