Electoral Roll Research Articles

'Physical activity at home (PAAH)', evaluation of a group versus home based physical activity program in community dwelling middle aged adults: rationale and study design

BackgroundIt is well recognised that the adoption and longer term adherence to physical activity by adults to reduce the risk of chronic disease is a challenge. Interventions, such as group and home based physical activity programs, have been widely reported upon. However few studies have directly compared these interventions over the longer term to determine their adherence and effectiveness. Participant preference for home based or group interventions is important. Some evidence suggests that home based physical activity programs are preferred by middle aged adults and provide better long term physical activity adherence. Physiotherapists may also be useful in increasing physical activity adherence, with limited research on their impact.Methods'Physical Activity at Home' is a 2 year pragmatic randomised control trial, with a non-randomised comparison to group exercise. Middle-aged adults not interested in, or unable to attend, a group exercise program will be targeted. Sedentary community dwelling 50-65 year olds with no serious medical conditions or functional impairments will be recruited via two mail outs using the Australian federal electoral roll. The first mail out will invite participants to a 6 month community group exercise program. The second mail out will be sent to those not interested in the group exercise program inviting them to take part in a home based intervention. Eligible home based participants will be randomised into a 6 month physiotherapy-led home based physical activity program or usual care. Outcome measures will be taken at baseline, 6, 12, 18 and 24 months. The primary outcome is physical activity adherence via exercise diaries. Secondary outcomes include the Active Australia Survey, accelerometry, aerobic capacity (step test), quality of life (SF-12v2), blood pressure, waist circumference, waist-to-hip ratio and body mass index. Costs will be recorded prospectively and qualitative data will be collected.DiscussionThe planned 18 month follow-up post intervention will provide an indication of the effectiveness of the group and home based interventions in terms of adherence to physical activity, health benefits and cost. If the physiotherapy-led home based physical activity program is successful it could provide an alternative option for physical activity program delivery across a number of settings.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000890932

Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study.

BackgroundHealth care disparity is a public health challenge. We compared the prevalence of diabetes, quality of care and outcomes between mental health clients (MHCs) and non-MHCs.MethodsThis was a population-based longitudinal study of 139,208 MHCs and 294,180 matched non-MHCs in Western Australia (WA) from 1990 to 2006, using linked data of mental health registry, electoral roll registrations, hospital admissions, emergency department attendances, deaths, and Medicare and pharmaceutical benefits claims. Diabetes was identified from hospital diagnoses, prescriptions and diabetes-specific primary care claims (17,045 MHCs, 26,626 non-MHCs). Both univariate and multivariate analyses adjusted for socio-demographic factors and case mix were performed to compare the outcome measures among MHCs, category of mental disorders and non-MHCs.ResultsThe prevalence of diabetes was significantly higher in MHCs than in non-MHCs (crude age-sex-standardised point-prevalence of diabetes on 30 June 2006 in those aged ≥20 years, 9.3% vs 6.1%, respectively, P < 0.001; adjusted odds ratio (OR) 1.40, 95% CI 1.36 to 1.43). Receipt of recommended pathology tests (HbA1c, microalbuminuria, blood lipids) was suboptimal in both groups, but was lower in MHCs (for all tests combined; adjusted OR 0.81, 95% CI 0.78 to 0.85, at one year; and adjusted rate ratio (RR) 0.86, 95% CI 0.84 to 0.88, during the study period). MHCs also had increased risks of hospitalisation for diabetes complications (adjusted RR 1.20, 95% CI 1.17 to 1.24), diabetes-related mortality (1.43, 1.35 to 1.52) and all-cause mortality (1.47, 1.42 to 1.53). The disparities were most marked for alcohol/drug disorders, schizophrenia, affective disorders, other psychoses and personality disorders.ConclusionsMHCs warrant special attention for primary and secondary prevention of diabetes, especially at the primary care level.

Determining Levels of Fecal Incontinence in the Community: A New Zealand Cross-Sectional Study

Fecal incontinence is a socially stigmatized condition, and its prevalence in the community has been problematic to quantify because of difficulty with its definition. This study estimates the community prevalence of fecal incontinence in New Zealand by 3 scales of measurement: patient perceptions of a "problem with bowel control," their symptoms, and their quality of life. DESIGN/MAIN OUTCOME MEASURES: A postal survey of 2000 people, aged >18, randomly selected from the national electoral roll, was performed. This used a validated, reliability-tested, anonymous questionnaire, the Comprehensive Fecal Incontinence Questionnaire, incorporating the identification of a "problem with bowel control," the Fecal Incontinence Severity Index, and the Fecal Incontinence Quality of Life Scale. The response rate was 68.7%. A total of 14.7% (95% CI: 12.6-16.7) of participants "felt they had a problem with bowel control" and 12.4% (95% CI: 10.5-14.5) had fecal incontinence when defined using the Fecal Incontinence Severity Index table as "leakage of liquid or solid stool ≥ 1/month." In terms of quality of life, 26.8% of the population (95% CI: 24.2-29.4) noted some impairment on the Fecal Incontinence Quality of Life Scale. In total, 155 (13.2%) participants reported at least 2 of the 3 possible diagnostic measures, and this may provide a way to incorporate the 3 measures into a new definition of fecal incontinence. This study incorporated a new "generic" question enquiring about an individual's perception of a bowel control problem and also introduced a "cutoff" value for Fecal Incontinence Quality of Life Scale to attempt to identify those with any impairment "due to accidental bowel leakage." This study helps to highlight some of the challenges involved with suitably identifying those who have fecal incontinence within the community. The prevalence rate of 13.2% represents a realistic measure of the burden of fecal incontinence in the general population, and further research in this area is recommended.

Health-Related Quality of Life Among Long-Term Survivors of Colorectal Cancer: A Population-Based Study

The number of long-term colorectal cancer survivors is increasing. Cancer and its treatment can cause physical and psychological complications, but little is known about how it impacts quality of life (QOL) over the long term-5, 10, and 15 years after diagnosis. Cancer survivors were randomly selected from three tumor registries in France, diagnosed in 1990 (±1 year), 1995 (±1 year), and 2000 (±1 year). Controls were randomly selected from electoral rolls, stratifying on gender, age group, and residence area. Participants completed two QOL questionnaires, a fatigue questionnaire, an anxiety questionnaire, and a life conditions questionnaire. An analysis of variance was used to compare QOL scores of cancer survivors by period of diagnosis (5, 10, and 15 years) with those of controls, adjusted for sociodemographic data and comorbidities. We included 344 colon cancer and 198 rectal cancer survivors and 1,181 controls. In a global analysis, survivors reported a statistically and clinically significant lower score in social functioning 5 years after diagnosis and higher scores in diarrhea symptoms 5 and 10 years after diagnosis. In subgroup analyses, rectal cancer affected QOL in the physical dimensions at 5 years and in the fatigue dimensions at 5 and 10 years. Survivors of colorectal cancer may experience the effects of cancer and its treatment up to 10 years after diagnosis, particularly for rectal cancer. Clinicians, psychologists, and social workers must pay special attention to rectal cancer survivors to improve overall management.

The impact of mental illness on potentially preventable hospitalisations: a population-based cohort study

BackgroundEmerging evidence indicates an association between mental illness and poor quality of physical health care. To test this, we compared mental health clients (MHCs) with non-MHCs on potentially preventable hospitalisations (PPHs) as an indicator of the quality of primary care received.MethodsPopulation-based retrospective cohort study of 139,208 MHCs and 294,180 matched non-MHCs in Western Australia from 1990 to 2006, using linked data from electoral roll registrations, mental health registry (MHR) records, hospital inpatient discharges and deaths. We used the electoral roll data as the sampling frame for both cohorts to enhance internal validity of the study, and the MHR to separate MHCs from non-MHCs. Rates of PPHs (overall and by PPH category and medical condition) were compared between MHCs, category of mental disorders and non-MHCs. Multivariate negative binomial regression analyses adjusted for socio-demographic factors, case mix and the year at the start of follow up due to dynamic nature of study cohorts.ResultsPPHs accounted for more than 10% of all hospital admissions in MHCs, with diabetes and its complications, adverse drug events (ADEs), chronic obstructive pulmonary disease (COPD), convulsions and epilepsy, and congestive heart failure being the most common causes. Compared with non-MHCs, MHCs with any mental disorders were more likely to experience a PPH than non-MHCs (overall adjusted rate ratio (ARR) 2.06, 95% confidence interval (CI) 2.03-2.09). ARRs of PPHs were highest for convulsions and epilepsy, nutritional deficiencies, COPD and ADEs. The ARR of a PPH was highest in MHCs with alcohol/drug disorders, affective psychoses, other psychoses and schizophrenia.ConclusionsMHCs have a significantly higher rate of PPHs than non-MHCs. Improving primary and secondary prevention is warranted in MHCs, especially at the primary care level, despite there may be different thresholds for admission in people with established physical disease that is influenced by whether or not they have comorbid mental illness.

Iraq’s Last Window: Diffusing the Risks of a Petro-State

Although Iraq’s oil industry is 80 years old, it has an opportunity to introduce an oil dividend based on the expansion of production currently being undertaken. Even assuming a conservative price for crude, the resulting predicted rise in revenues will allow the government to allocate a significant dividend which halves poverty, helps diversify the economy by creating demand at all income levels for goods and services, and stimulates capital formation — all without cutting into the government’s capital spending plans. A dividend, starting at $220 per capita in October 2012 and rising with expanded production, could also cement the affiliation of all citizens to Iraqi territorial integrity, act as a powerful disincentive to secession in oil-producing regions, and create popular pressure among all sections of the population to discourage acts by the ongoing insurgency which disrupt economic reconstruction. Logistically, dividends could be mapped onto the nationwide and universal rationing system, as the electoral roll has been, and combined with Iraq’s ubiquitous mobile phone networks and new biometric ID cards. A partial dividend would create a strong domestic political constituency for transparency to reinforce international technical efforts to help the government manage oil revenues and create efficient management structures. It would also help Iraq develop an alternative economic model to a future, which the country’s present trajectory now threatens, of a bloated state as the country’s only significant employer, with all the attendant problems of patronage networks, politicization of the civil service, and outright corruption. Support for an oil dividend policy is growing among some politicians, notably those seeking votes among the Iraqi poor such as the Sadrists and Fadhila party. International support could help the government structure a dividend which functions well and in the public interest.

The risk of coronary thrombosis with cyclo‐oxygenase‐2 inhibitors does not vary with polymorphisms in two regions of the cyclo‐oxygenase‐2 gene

To investigate whether polymorphisms of the cyclo-oxygenase-2 (COX-2) gene modify the adverse cardiovascular effects of COX-2 inhibitors. A case control study was conducted in the Hunter Region of New South Wales, Australia. Cases (n= 460) were hospitalized with acute coronary syndrome (ACS). Controls (n= 640) were recruited from the electoral rolls. Structured interviews gathered information on variables including recent ingestion of non-steroidal anti-inflammatory drugs (NSAIDs). Targeted genotyping of rs 20417(G > C) and rs5275 (T > C) polymorphisms was performed by real-time polymerase chain reaction using allele-specific probes. Ingestion of any NSAID in the week prior to interview was associated with an elevated risk for ACS: adjusted odds ratio 1.8 (1.2, 2.5). The rs 20417 and rs 5275 polymorphisms were not singly associated with risk for ACS: adjusted odds ratios 1.1 (0.80, 1.5) and 1.2 (0.88, 1.5), respectively. Individually, the polymorphisms did not modify the risk of ACS with the drugs. When analyses were conducted by haplotype, the adjusted odds ratio with celecoxib or rofecoxib in individuals who had one or two copies of the 'low risk' haplotype (no GT) was 1.2 (0.29, 5.0), compared with 2.1 (1.1, 4.0) with the 'high risk' haplotype (one or two copies of GT). We found little evidence of a gene/drug interaction. We found a statistically non-significant trend toward a lower risk of coronary events with NSAIDs in the presence of the 'low risk' haplotype. Even if confirmed, the clinical utility of the finding would be limited as this haplotype is carried by a minority of the population.

Work-related stress and asthma: results from a workforce survey in New Zealand

ObjectivesWe assessed the association between work-related stress and asthma in a cross-sectional workforce survey in New Zealand.MethodsMen and women randomly selected from the Electoral Roll were invited to take part...

Chronic disease and use of dental services in Australia

Chronic disease and use of dental services in Australia

To have or not to have? Australian women’s childbearing desires, expectations and outcomes

Australia’s low fertility rate is commonly attributed to deliberate decisions by women to avoid having children. Existing theoretical explanations of fertility decision-making mostly view childbearing as a rational, voluntary process and focus on the ‘costs’ to women of having children. Although this may help explain why women do not have children, it contributes very little to understanding why women do have children. This study describes childbearing desires, expectations and outcomes in a population-based sample of 569 30–34-years-old Australian women recruited from the Australian Electoral Roll in 2005. Most women surveyed wanted to have children, and their childbearing outcomes were associated with biological, psychological and social factors including the lack of a partner and adverse health conditions. The factors and their relative importance varied by parity. Most women had fewer children than they desired, and many would have children, or more children, if their circumstances were different. These data challenge prevailing assumptions about women’s childbearing behaviour that women are able to choose when and if they have a child. Based on the findings, a conceptual framework of childbearing behaviour is proposed which builds on existing theoretical explanations to explain why women do and do not have children, differences by parity, and the role of circumstances in women’s childbearing behaviour. The findings and conceptual framework have implications for public policies, and indicate that multiple approaches are required which are sensitive to and address the barriers women face in family formation.

Work-Related Stress and Asthma: Results from a Workforce Survey in New Zealand

Objective. We assessed the association between work-related stress and asthma in a cross-sectional workforce survey in New Zealand. Methods. Men and women randomly selected from the Electoral Roll were invited to take part in a telephonic interview, which collected information on current workplace exposures and respiratory symptoms. Participants rated how stressful they found their current job on a five-point scale. We conducted unconditional logistic regression to calculate prevalence odds ratios (OR) and 95% confidence intervals (CI) for job stress and both current and adult-onset asthma, adjusting for age, sex, smoking, and deprivation. Analyses were also stratified by sex, smoking status, body mass index, and age group. Results. Results were based on 2903 interviews. Participants with very or extremely stressful jobs were twice as likely to have current asthma (OR = 1.98; 95% CI = 1.52–2.58) and 50% more likely to have adult-onset asthma (OR = 1.50; 95% CI = 1.05–2.15) compared to those with not at all or mildly stressful jobs. This association was evident for both sexes and was not explained by either occupation, age, body mass index, or smoking, although the results did differ by smoking status. Conclusion. Our study adds to the sparse evidence on the relationship between work-related stress and asthma in adult working populations.

P2-168 Mental illness related disparities in potentially preventable hospitalisations: a population-base cohort study from 1990 to 2006

IntroductionEmerging evidence indicates the association between mental illness and poor quality of physical healthcare. To test this, we compared mental health clients (MHCs) with non-MHCs for the quality of primary...

P2-169 Do mental health clients lack access to general practitioner services?

IntroductionEmerging evidence indicates an association between mental illness and low-intensity of physical healthcare. To test this, we compared rates of visits to a general practitioner (GP) between mental health clients...

P2-167 Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study in Western Australia from 1990 to 2006

IntroductionTo compare the prevalence of diabetes, quality of care and outcomes between mental health clients (MHCs) and non-MHCs.MethodsPopulation-based longitudinal study of 139 208 MHCs and 294 180 matched non-MHCs in...

Faster Self-Reported Speed of Eating Is Related to Higher Body Mass Index in a Nationwide Survey of Middle-Aged Women

This study is the first nationwide population survey to explore the association between speed of eating and degree of obesity. The objective was to cross-sectionally examine the relationship between self-reported speed of eating and body mass index (BMI; calculated as kg/m 2) in a nationally representative sample of New Zealand women. In May 2009, a sample of 2,500 New Zealand women aged 40 to 50 years was randomly selected from the nationwide electoral rolls. A 66% participation rate was achieved. Potential participants were mailed a self-administered questionnaire containing questions on self-reported speed of eating, demographics, health conditions, menopause status, physical activity, height, and weight. Univariate models were used to examine the associations between demographic, health and behavioral variables, and BMI, while a multivariate model was developed to investigate the relationship between self-reported speed of eating and BMI. After adjusting for age, smoking status, menopause status, thyroid condition, ethnicity, socioeconomic status, and physical activity, BMI statistically significantly increased by 2.8% (95% confidence interval: 1.5% to 4.1%; P<0.001) for each category increase in self-reported speed of eating. Although the direction of causality requires confirmation in longitudinal and randomized intervention studies, the results suggest that faster eating is associated with higher BMI in middle-aged women.

Prevalence of musculoskeletal symptoms in relation to gender, age, and occupational/industrial group

Although musculoskeletal symptoms (MSS) are common worldwide, little is known about its prevalence amongst the working population in relation to gender, age, and occupational/industrial group. This paper describes the prevalence of MSS in a sample of 3003 men and women aged 20–64 randomly selected from the New Zealand Electoral Roll. MSS experienced during the previous 12 months in 10 body regions was assessed in telephone interviews using a modified version of the Nordic Musculoskeletal Questionnaire (NMQ). MSS prevalence was 92% (for any body region). The highest prevalence was for low back (54%), neck (43%), and shoulders (42%). Females reported a statistically significantly higher prevalence of MSS in the neck, shoulders, wrist/hands, upper back and hips/thighs/buttocks regions compared to males while males reported more symptoms of the elbows, low back and knees. There were no statistically significant differences in prevalence among age groups. In general, participants with heavy physical workloads had significantly higher prevalence of symptoms in most body regions than those with light physical workloads although women with light physical workloads reported more neck symptoms. The study indicates that the New Zealand working population has a high prevalence of MSS and that exposure in the workplace plays a role. Relevance to industry The findings of this study imply that efforts to reduce MSS in the workplace should focus on females and employees with high physical workloads.

Socio-economic differences in takeaway food consumption among adults

To examine socio-economic differences in the frequency and types of takeaway foods consumed. A cross-sectional postal survey. Participants were asked about their usual consumption of overall takeaway food (<4 times/month or ≥4 times/month) and of twenty-two specific takeaway food items (<1 time/month or ≥1 time/month); these latter foods were grouped into 'healthy' and 'less healthy' choices. Socio-economic position was measured on the basis of educational level and equivalised household income, and differences in takeaway food consumption were assessed by calculating prevalence ratios using log binomial regression. Adults aged 25-64 years from Brisbane, Australia, were randomly selected from the electoral roll (n 903; 63·7 % response rate). Compared with their more educated counterparts, the least educated were more regular consumers of overall takeaway food and fruit or vegetable juice and less regular consumers of sushi. For the 'less healthy' items, the least educated more regularly consumed potato chips, savoury pies, fried chicken and non-diet soft drinks; however, the least educated were less likely to consume curry. Household income was not associated with overall takeaway consumption. The lowest-income group was a more regular consumer of fruit or vegetable juice compared with the highest-income group. Among the 'less healthy' items, the lowest-income group was a more regular consumer of fried fish, ice cream and milk shakes, whereas curry was consumed less regularly. The frequency and types of takeaway foods consumed by socio-economically disadvantaged groups may contribute to inequalities in overweight or obesity and to chronic disease.

Depression history, depressive symptoms and incident dementia: The 3C study

Depression and dementia are highly prevalent conditions among elderly but the nature of their relationship remains a matter of debate. The aim of our study was to investigate whether depression assessed by different markers predicts the risk of incident dementia in elderly individuals. Data was derived from the 3C cohort study conducted in community-dwelling individuals aged 65 years and over, randomly recruited from electoral rolls of three French areas and followed up for four years (1999-2001 through 2004) with assessments every 2 years. The study sample comprised 7989 dementia-free individuals (mean age, 74.0 years; 61% women) assessed at baseline for current or past Major Depressive Episodes (MDE) based on MDE module of the Mini International Neuropsychiatric Interview, self-reported lifetime treated depression, and level of depressive symptoms using the Center for Epidemiologic Studies-Depression (CES-D) Scale. Fully adjusted Cox proportional hazards models were applied to examine the risk of incident dementia associated with these markers of depression. MDE and self-reported lifetime treated depression did not increase incident dementia risk. Conversely, high level of depressive symptoms at baseline was associated with a 50% increased risk of dementia (adjusted Hazard Ratio [HR], 1.5; 95% Confidence interval [CI], 1.2-2.2). This result was driven by a five-fold increased risk of vascular dementia (HR, 4.8; 95% CI, 2.2-10.7; p < 0.0001), whereas there was no increased risk of Alzheimer disease (1.0; 0.7-1.6). In elderly individuals, high level of depressive symptoms is predictive of vascular dementia within a few years. This close temporal association suggests that depression is less a risk factor for than a prodromal symptom of vascular dementia. This should urge clinicians to reinforce monitoring of both depressive symptoms and subsequent cognitive decline and to control vascular factors to possibly slow down the dementing process. High Depressive Symptoms at baseline and risk of dementia by type

Role of permanent atrial fibrillation (AF) on long-term mortality in community-dwelling elderly people with and without chronic heart failure (CHF)

Permanent AF is characterized by an increased mortality in elderly subjects with CHF. Moreover, AF increased the risk of mortality also in elderly subjects without CHF. Thus, we examined long-term mortality in community-dwelling elderly people with and without CHF. A total of 1332 subjects aged 65 and older were selected from the electoral rolls of Campania, a region of southern Italy. The relationship between AF and mortality during a 12-year follow-up in 125 subjects with CHF and in 1.143 subjects without CHF were studied. Elderly subjects showed a higher mortality in those with respect to those without AF (72.1% vs. 51.8%; p<0.01). Similarly, elderly subjects without CHF showed a higher mortality in those with respect to those without AF (61.8% vs. 49.8%; p<0.05). In contrast, elderly subjects with CHF showed a similar mortality in those with respect to those without AF (74.7% vs. 82.4%; p=0.234). Multivariate analysis shows that AF was predictive of mortality in all elderly subjects (Hazard Risk=HR=1.39, 95% confidence interval (CI)=1.25–2.82; p<0.001). When the analysis was conducted considering the presence and the absence of CHF, AF was strongly predictive of mortality in elderly subjects without CHF (HR=1.95, 95%CI=1.25–4.51; p<0.001) but not in those with CHF (HR=1.12, 95%CI=0.97–3.69; p=0.321). We concluded that AF is able to predict long-term mortality in elderly subjects. Moreover, AF is strongly predictive of long-term mortality in the absence but not in the presence of CHF.

‘I shut my eyes and picture our place’: gardens, farm landscapes and working-class dreams in 1930s–1940s south-eastern Australia

In spring 1937, ‘Peanuts’ wrote to the ‘Women's Bureau’ of the Weekly Times, a rural newspaper in south-eastern Australia: I would love to take you folk who are not fortunate enough to live in the ...