Falls in older aged adults in 22 European countries: incidence, mortality and burden of disease from 1990 to 2017.

INTRODUCTION: Falls in older aged adults are an important public health problem. Insight into differences in fall-related injury rates between countries can serve as important input for identifying and evaluating prevention strategies. The objectives of this study were to compare Global Burden of Disease (GBD) 2017 estimates on incidence, mortality and disability-adjusted life years (DALYs) due to fall-related injury in older adults across 22 countries in the Western European region and to examine changes over a 28-year period. METHODS: We performed a secondary database descriptive study using the GBD 2017 results on age-standardised fall-related injury in older adults aged 70 years and older in 22 countries from 1990 to 2017. RESULTS: In 2017, in the Western European region, 13 840 per 100 000 (uncertainty interval (UI) 11 837-16 113) older adults sought medical treatment for fall-related injury, ranging from 7594 per 100 000 (UI 6326-9032) in Greece to 19 796 per 100 000 (UI 15 536-24 233) in Norway. Since 1990, fall-related injury DALY rates showed little change for the whole region, but patterns varied widely between countries. Some countries (eg, Belgium and Netherlands) have lost their favourable positions due to an increasing fall-related injury burden of disease since 1990. CONCLUSIONS: From 1990 to 2017, there was considerable variation in fall-related injury incidence, mortality, DALY rates and its composites in the 22 countries in the Western European region. It may be useful to assess which fall prevention measures have been taken in countries that showed continuous low or decreasing incidence, death and DALY rates despite ageing of the population.

Quality of life in caregivers with and without chronic disease: Welsh Health Survey, 2013.

Background: The aim of the present study was to investigate and compare quality of life after regular care provision in people with and without currently treated chronic disease in a country-wide and population-based setting. Methods: Data were retrieved from Welsh Health Survey, 2013. Information on demographics, lifestyle factors, health conditions, regular care provision and quality of life was obtained by household interview. Chi-square test, t-test and survey-weighted multi-nominal regression modelling were performed. Results: Of 15 007 Welsh adults aged 16 and above, 2751 (19.1%) people reported that they have been giving care for any sick, disabled or frail person. They tended to be aged 40-74, being female, education 25, physically active, current smokers and living in second-hand smoking households. In caregivers with current chronic disease (n = 1562), they have experienced physical health limits, bodily pains, emotional problems, less calm and less cheerful. In caregivers without current chronic diseases (n = 1151), they have experienced physical health limits, bodily pains, less cheerful, downhearted and unhappiness. Conclusions: This is the first study to examine quality of life in caregivers both with and without currently treated chronic disease. Longitudinal monitoring and increasing education, training and support to lessen caregiving burden would be suggested.

Environmental risk factors for dementia: a systematic review.

BACKGROUND: Dementia risk reduction is a major and growing public health priority. While certain modifiable risk factors for dementia have been identified, there remains a substantial proportion of unexplained risk. There is evidence that environmental risk factors may explain some of this risk. Thus, we present the first comprehensive systematic review of environmental risk factors for dementia. METHODS: We searched the PubMed and Web of Science databases from their inception to January 2016, bibliographies of review articles, and articles related to publically available environmental data. Articles were included if they examined the association between an environmental risk factor and dementia. Studies with another outcome (for example, cognition), a physiological measure of the exposure, case studies, animal studies, and studies of nutrition were excluded. Data were extracted from individual studies which were, in turn, appraised for methodological quality. The strength and consistency of the overall evidence for each risk factor identified was assessed. RESULTS: We screened 4784 studies and included 60 in the review. Risk factors were considered in six categories: air quality, toxic heavy metals, other metals, other trace elements, occupational-related exposures, and miscellaneous environmental factors. Few studies took a life course approach. There is at least moderate evidence implicating the following risk factors: air pollution; aluminium; silicon; selenium; pesticides; vitamin D deficiency; and electric and magnetic fields. CONCLUSIONS: Studies varied widely in size and quality and therefore we must be circumspect in our conclusions. Nevertheless, this extensive review suggests that future research could focus on a short list of environmental risk factors for dementia. Furthermore, further robust, longitudinal studies with repeated measures of environmental exposures are required to confirm these associations.

Chronic diseases and life events accounted for 2-18 % population attributable risks for adult hearing loss: UK Adult Psychiatric Morbidity Survey, 2007.

Links between chronic diseases and hearing loss in adults have emerged. However, previous investigations were not complete, and the role of life events was unclear. Therefore, it was aimed to examine the relationships of common chronic diseases and life events and adult hearing loss in a country-wide and population-based study. Data were retrieved from UK Adult Psychiatric Morbidity Survey, 2007, being cross-sectional, including demographics, self-reported prior health conditions and hearing loss (ever and in the last 12 months), and several major life events. Analyses included Chi square test, t test, logistic regression model, and population attributable risk estimation. People who had prior health conditions including cancer, migraine, dementia, depression, cataracts, chronic bronchitis, allergy, bowel problem, bladder problem, arthritis, muscle problem or skin problem tended to report hearing loss than their counterparts. People who have experienced major life events including post-traumatic stress disorder, serious illness of close relatives, death of family, serious problems with friends, major financial crisis, valuables stolen, being bullied, violence at home, sexual abuse or running away from home were also more likely to experience ever hearing loss problem or that in the last 12 months. 2.0-13.1 % adult hearing loss could be delayed or prevented by managing chronic diseases while 4.1-18.1 % might be delayed or prevented by minimizing the negative effects of life events. Chronic diseases and life events were associated with hearing loss in adults. Better managing lifestyle to minimize detrimental impacts in future health and nursing programs would be suggested.

Physically equivalent temperature and mental and behavioural disorders in Germany in 2009-2011.

BACKGROUND: We aimed to understand the relationships of the weather as biometeorological and hospital admissions due to common mental and behavioural disorders in a national setting in recent years. METHODS: This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified F01-F51 mental ad behavioural disorders by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations covering 13 German States including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). We then plotted two-way fractional-polynomial regression. RESULTS: For the most subtypes, the highest admissions were recorded in spring. There were small peaks in autumn or late winter for a few subtypes as well. Admissions of delirium peaked when PET was at 0 °C. Admissions of personality disorders peaked at the coldest - when PET was at -10 °C. Admissions of schizophrenia and nonorganic sleep disorder peaked when PETs were between 0 and -10 °C while admissions of eating disorders dropped when PETs were above 10 °C. Admissions of depression and anxiety disorder did not vary much across PETs. Moreover, admissions of reaction to stress and dissociate disorder peaked when PETs were between 0 and 10 °C as well. CONCLUSIONS: More medical resources could have been needed for mental health on days when PETs were <10 °C than on other days.

A pilot study of quality of life in German prehospital emergency care physicians.

BACKGROUND: Quality of life in patients represents an important area of assessment. However, attention to health professionals should be equally important. The literature on the quality of life (QOL) of emergency physicians is scarce. This pilot study investigated QOL in emergency physicians in Germany. MATERIALS AND METHODS: We conducted a cross-sectional study from January to June in 2015. We approached the German Association of Emergency Medicine Physicians and two of the largest recruitment agencies for emergency physicians in Germany and invited their members to participate. We used the WHO Q-BREF to obtain QOL scores in four domains that included physical, mental, social, and environmental health. RESULTS: The 478 German emergency physicians included in the study held board certifications in general medicine (n = 40; 8.4%), anesthesiology (n = 243; 50.8%), surgery (n = 63; 13.2%), internal medicine (n = 81; 17.0%), or others (n = 51; 10.7%). The women surveyed tended to report a better QOL but worse general health than the men. Regarding specific domains, women scored worse in physical health, particularly energy during everyday work (relative risk ratio [RRR]: 1.98 [1.21-3.24]). Both men and women scored worse in psychological health than general health, particularly young women. Women were also more likely to view their safety (RRR: 1.87 [1.07-3.28]) and living place (RRR: 2.51 [1.10-5.73]) as being poor than their male counterparts. CONCLUSION: QOL in German prehospital emergency care physicians is satisfactory for the included participants; however, there were some negative effects in the psychological health domain. This is particularly obvious in young female emergency physicians.

Relationship of environmental exposures and ankylosing spondylitis and spinal mobility: US NHAENS, 2009-2010.

It was aimed to study the relationships of different sets of urinary environmental chemical concentrations and ankylosing spondylitis in a national and population-based setting. Data were extracted from United States National Health and Nutrition Examination Surveys, 2009-2010. Information on demographics was obtained by household interview and ankylosing spondylitis clinical measures and urines were taken at examination. People with abnormal occiput-to-wall distance were found to have higher urinary cadmium (OR 2.17, 95 % CI 1.34-3.52, p = 0.004), antimony (OR 1.74, 95 % CI 1.15-2.62, p = 0.012), tungsten (OR 1.91, 95 % CI 1.39-2.64, p = 0.001), uranium (OR 1.49, 95 % CI 1.03-2.15, p = 0.036), and trimethylarsine oxide (OR 5.01, 95 % CI 2.34-10.71, p < 0.001) concentrations. Moreover, people who resided in older households tended to have abnormal ankylosing spondylitis clinical measures, compared to those who resided in households that were built in 1990 or after. The odds were 1.74 for households built in 1978-1989 and 1.81 for those built in 1940 or earlier.

Assessing quality of life in Welsh carers with and without back pain.

BACKGROUND: The author aimed to study the prevalence and characteristics of care provision in Welsh adults with and without back pain, as well as their quality of life. The study used a country-wide and population-based setting from an independent dataset. METHOD: Data were retrieved from and analysed in the Welsh Health Survey 2013. Information on demographics, lifestyle factors, regular care provision, and quality of life was obtained from household interviews. Chi-square tests, t-tests, and survey-weighted multinomial regression modelling were performed. RESULTS: Of 15,007 Welsh adults aged 16 years and above, 2751 (18.3%) reported they had been caring for a sick, disabled, or frail person. The carers tended to be between 40-74 years, female, had not obtained a bachelor's degree, with a body mass index>25, physically active, smokers, and living in indoor secondhand smoke households. People who lived in mid and western Wales tended to give care, compared with those who lived in southeast and north Wales. Carers with back pain experienced slight physical health and emotional problems, whereas carers without back pain experienced worse physical health and emotional problems, which could disrupt normal life. CONCLUSION: Nearly one in five Welsh adults, with or without back pain, have provided care for other people. Future socioeconomic structure, health policy, and nursing programmes to reinvest in long-term care, such as a national psychiatric care initiative, should be encouraged, to lessen mental suffering alongside chronic pains and to optimise adult mental health and quality of life in all people, with or without back pain.

Prevalence and psychiatric correlates of neighbourhood satisfaction and its impact on adolescent behaviours: UK understanding society cohort, 2011-2012.

BACKGROUND: Studies looking into neighbourhood satisfaction including prevalence, risk correlates, and impacts are very scarce. Therefore, it was aimed to provide recent evidence on prevalence and psychiatric correlates of neighbourhood satisfaction and its impact on individual behaviours and life aspects in adolescents in a national and population-based setting. METHOD: Data were retrieved and analysed in the UK Longitudinal Household Survey in 2011-2012. Information on demographics, lifestyle factors, urbanisation level, and behavioural and emotional development was obtained by household interview. Analyses included descriptive statistics, chi-square test and usual and multi-level logistic regression modelling. RESULTS: Of 491 (11.2%) out of 4427 adolescents were dissatisfied with their neighbourhoods and 6.8% (n=297) were classified as having abnormal psychiatric state. Smoking status (both current and past) and alcohol status (both current and past) were associated with neighbourhood dissatisfaction but not sex, urbanisation level or country of residence. Compared to people who were classified as normal, others with borderline or abnormal mental state tended to express dissatisfaction toward their current neighbourhoods. In addition, these people reported more "troublesome" individual behaviours for about 18 types out of 24 types in total and had poor perception toward life in many aspects including family, friends, school, and even personal appearance. CONCLUSION: One in five adolescents were dissatisfied with their current neighbourhoods leading to worrying individual behaviours and negative impacts on life. Neighbourhood renewal strategy or place-making to facilitate self-efficacy could be considered as priority to be integrated into future public health programs and/or put onto public health policy agenda.

Higher urinary heavy metal, arsenic, and phthalate concentrations in people with high blood pressure: US NHANES, 2009-2010.

BACKGROUND: A link between environmental chemicals and human health has emerged but not complete in risk factors. This work aimed to study the relationships of different sets of urinary environmental chemical concentrations and risk of high blood pressure (BP) in a national, population-based study. METHODS: Data was retrieved from United States National Health and Nutrition Examination Surveys, 2009-2010, including demographics, BP readings and urinary environmental chemical concentrations. Analyses included t-test and survey-weighted logistic regression models. RESULTS: Urinary mercury concentrations were not associated with high BP (OR = 1.19, 95% CI 0.97-1.48, p = 0.095). Urinary cobalt (OR = 1.35, 95% CI 1.01-1.81, p = 0.044), lead (OR = 1.77, 95% CI 1.31-2.38, p = 0.001), antimony (OR = 1.37, 95% CI 1.09-1.72, p = 0.010) and tungsten (OR = 1.52, 95% CI 1.27-1.81, p < 0.001) concentrations were observed to increase the risk of high BP. There are no clear associations between environmental parabens and high BP. The effect of environmental bisphenol A (OR = 1.14, 95% CI 1.00-1.30, p = 0.051) disappeared after additionally adjusting for subsample weighting (OR = 1.12, 95% CI 0.93-1.35, p = 0.225). People with higher urinary mono-2-ethyl-5-carboxypentyl phthalate (OR = 1.26, 95% CI 1.00-1.58, p = 0.051), mono-n-butyl phthalate (OR = 1.19, 95% CI 1.01-1.41, p = 0.042) and mono-n-methyl phthalate metabolites (OR = 1.16, 95% CI 1.03-1.32, p = 0.021) tended to have high BP. Moreover, urinary o-phenyl phenol concentrations (OR = 1.49, 95% CI 1.25-1.77, p < 0.001) and dimethylarsonic acid concentrations (OR = 1.35, 95% CI 1.06-1.73, p = 0.019) were also seen to be associated with high BP. CONCLUSIONS: Urinary environmental chemical concentrations were associated with risk of high BP, although the causal effect cannot be established. Elimination of environmental chemicals in humans would need to be continued.

Effects of ambient air pollution from shipping on mortality: A systematic review.

BACKGROUND: Shipping contributes to air pollution causing adverse health effects. We conducted for the first time a systematic review on the health and economic impacts of ambient air pollution from shipping emissions. METHODS: We performed a systematic search in PubMed, Web of Science, EBSCO (Medline), and Scopus of all time up to December 2023. We then inter-compared semi-quantitatively the results of the included eligible studies. RESULTS: We identified 23 eligible studies, 22 applying health impact assessment, and 1 using epidemiological methods. These studies used different methods for the evaluation of emissions, dispersion, and exposure, and for the exposure-mortality risk functions for exposure to shipping emissions for 1-2 years. The estimated excess global all-cause mortality from six studies ranged between 1 and 5 deaths per 100,000 person-years. However, the heterogeneity of the methods and critical gaps in the reporting seriously limited the synthesis of the evidence on health and economic effects of shipping emissions. Sufficient spatial and temporal resolutions in both dispersion and exposure modeling, as well as presentation of uncertainties is needed. Health impact assessment should present the results with all the main risk functions and population attributable risks, and the magnitude of the effect should be expressed in excess number per a given person-time or per population size. Economic effects should also cover work productivity, mental well-being, and cognitive functions. CONCLUSIONS: We recommend that future studies should properly evaluate and report the uncertainty ranges and the confidence limits of the results. Rigorous studies are needed on multipollutant exposures, exposures from various source categories, and exposures attributed to various particulate matter measures. Studies should report the health impact measures in a format that facilitates straightforward inter-study comparisons. Further research should also specifically report the used grid spacings and resolutions and evaluate whether these are optimal for the task.

Incidence and risks of subarachnoid hemorrhage in China.

BACKGROUND AND PURPOSE: To determine incidence and risks of subarachnoid hemorrhage in China. METHODS: A prospective, population-based, 1:2 matched case-control study in Baotou, Inner Mongolia (≈2 million population) in 2009-2011. Multiple variable models used to determine relative risk and population-attributable risks for exposures. RESULTS: For a total of 226 patients (mean age, 59 years; 65% women; 434 controls), crude annual incidence (per 100 000) of subarachnoid hemorrhage was 6.2 (95% confidence intervals, 5.4-7.0); 4.3 (3.3-5.2) for men and 8.2 (6.9-9.6) for women. Compared with nonsmokers, adjusted relative risk of subarachnoid hemorrhage in current smokers was 2.31 (95% confidence interval, 1.31-4.09) but was 4.00 (1.62-9.89) in women. Population-attributable risk for smoking, hypertension, and low income were 18%, 36% and 59%, respectively. CONCLUSIONS: The incidence of subarachnoid hemorrhage in China is slightly lower than in Western countries and is related to smoking, hypertension, and poor socioeconomic status.

Patterns of subarachnoid hemorrhage admissions in England, 2008-2011.

BACKGROUND: To investigate hospital admissions for subarachnoid hemorrhage (SAH) across regions in England in recent years, with the hypothesis that deprived areas have higher admissions. METHODS: Hospital episode statistics between July 2008 and June 2011 were retrieved. Hospital admissions by geographic and seasonal variations were examined. Data on prevalence of deprivation were extracted from the English Indices of Deprivation. Comparisons were made by using linear regression models to test associations between deprivation and classical risk contributors and SAH admissions at the area level. RESULTS: SAH admissions were observed to be higher in warm months and lower in cold months. There was not much variation in SAH admissions across regions. Areas with higher prevalence of risk contributors had higher SAH admissions (all p < 0.05), but no relation with deprivation was found. Additionally, over the last 13 years, SAH admissions have decreased (beta: -0.011, 95% CI: -0.015 to -0.008, p < 0.001) annually, but the proportion of male patient admissions has increased (beta: 0.022, 95% CI: 0.008-0.036, p = 0.005). CONCLUSION: SAH admissions varied across seasons but not geographically. Additionally, they were correlated with known risk contributors. Policies attending to lifestyle change are suggested in reducing this disease.

Human biomonitoring reference values, exposure distribution, and characteristics of metals in the general population of Taiwan: Taiwan environmental survey for Toxicants (TESTs), 2013-2016.

Human biomonitoring (HBM) provides information to identify chemicals that need to be assessed regarding potential health risks to human populations. We established a population-representative sample in Taiwan, namely the Taiwan Environmental Survey for Toxicants (TESTs) in 2013-2016. In total, 1871 participants (aged 7-97 years) were recruited from throughout Taiwan. A questionnaire survey was applied to obtain individuals' demographic characteristics, and urine samples were obtained to assess metal concentrations. Inductively coupled plasma-mass spectrometry was used to determine concentrations of urinary As (total), Cd, Co, Cr, Cu, Fe, Ga, In, Mn, Ni, Pb, Se, Sr, Tl, and Zn. The purpose of this study was to establish the human urinary reference levels (RVs) for metals in the general population of Taiwan. We found that median concentrations of urinary Cu, Fe, Pb, and Zn in males were statistically significant (p < 0.05) higher than in females (Cu: 11.48 vs. 10.00 µg/L; Fe: 11.48 vs. 10.46 µg/L; Pb: 0.87 vs. 0.76 µg/L; and Zn: 448.93 vs. 348.35 µg/L). On the contrary, Cd and Co were significantly lower in males than in females (Cd: 0.61 vs. 0.64 µg/L; and Co: 0.27 vs. 0.40 µg/L). Urinary Cd levels in the ≥18-year-old group (0.69 µg/L) were significantly higher than those in the 7-17-year-old group (0.49 µg/L, p < 0.001). Among the investigated metals, most were significantly higher in the 7-17-year-old group than in the ≥18-year-old group, except for Cd, Ga, and Pb. Participants who lived in central Taiwan had higher median levels of urinary Cd, Cu, Ga, Ni, and Zn than those in other regions. Median levels of urinary As, Cd, Pb, and Se were significantly higher in participants who lived in harbor (94.12 µg/L), suburban (0.68 µg/L), industrial (0.92 µg/L), and rural (50.29 µg/L) areas, respectively, than the others who lived in other areas. RV95 percentiles of urinary metals (ng/mL) for 7-17/≥18-year-old groups were As (346.9/370.0), Cd (1.41/2.21), Co (2.30/1.73), Cr (0.88/0.88), Cu (28.02/22.78), Fe (42.27/42.36), Ga (0.13/0.12), In (0.05/0.04), Mn (3.83/2.91), Ni (8.09/6.17), Pb (8.09/5.75), Se (122.4/101.9), Sr (556.5/451.3), Tl (0.57/0.49), and Zn (1314.6/1058.8). In this study, we have highlighted the importance of As, Cd, Pb, and Mn exposure in the general population of Taiwan. The established RV95 of urinary metals in Taiwanese would be fundamental information to promote the reduction of metal exposure or policy intervention. We concluded that urinary levels of exposure to certain metals in the general Taiwanese population varied by sex, age, region, and urbanization level. References of metal exposure in Taiwan were established in the current study.

Neighbourhood satisfaction and happiness but not urbanization level affect self-rated health in adolescents.

BACKGROUND: It is hypothesized that neighbourhood satisfaction and subjective happiness are associated with self-rated health or mediate the effect from urbanization levels among youth. METHODS: Taiwan Youth Project was a cross-sectional study in two cities, Taipei and Yilan, Taiwan including 5,586 students. Information on neighbourhood satisfaction, happiness, urbanization levels, and self-rated health was obtained by interview. RESULTS: Neighbourhood satisfaction and happiness were both significantly associated with self-rated health (both p<0.001) while urbanization level was not (p>0.05). Neighbourhood satisfaction is also highly correlated with happiness (p<0.001). CONCLUSIONS: Future public health intervention should attend to neighbourhood satisfaction and happiness for youth.

Are Phthalate Exposure Related to Oxidative Stress in Children and Adolescents with Asthma? A Cumulative Risk Assessment Approach.

Childhood asthma has become one of the most common chronic diseases in children and adolescents. However, few case-control studies investigating the relationship between phthalate exposure and asthma in children and adolescents have been conducted, especially in Asia. Therefore, we assessed the potential associations between phthalate exposure and asthma among children and adolescents in Taiwan. Because various demographic and environmental variables may influence the incidence and prognosis of asthma, we performed a case-control study with propensity score matching. Out of 615 Childhood Environment and Allergic Diseases Study participants, we conditionally matched 41 children with clinically diagnosed asthma with 111 controls. We then analyzed 11 phthalate metabolites by using liquid chromatography with tandem mass spectrometry. Compared with the control group, the median urinary phthalate levels for most phthalate metabolites in the case group were slightly increased, including monomethyl phthalate, mono-n-butyl phthalate, monobenzyl phthalate, monoethylhexyl phthalate, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, mono-(2-ethyl-5-carboxypentyl) phthalate, and mono-(2-carboxymethylhexyl) phthalate. Hence, our results suggest that phthalate exposure may be associated with the development of asthma. In addition, prenatal environmental factors, such as active or passive smoking during pregnancy, may increase the risk of asthma.

Location and size of ruptured intracranial aneurysm and serious clinical outcomes early after subarachnoid hemorrhage: a population-based study in Australasia.

BACKGROUND: It is uncertain whether the location and size of a ruptured intracranial aneurysm (IA) independently influences the outcome of subarachnoid hemorrhage (SAH). OBJECTIVE: To determine the independent relationship of location and size of a ruptured IA with serious clinical outcomes after SAH in an Australasian population-based study. METHODS: From 432 first-ever cases of primary SAH registered prospectively over 12 months in 4 Australasian cities between 1995 and 1998, the demographics, clinical features, risk factors and results of investigations were obtained, including the location and size of any ruptured IA as assessed by cerebral angiography, computed tomography and/or magnetic resonance imaging. Location was classified as either anterior (i.e. anterior communicating artery, internal carotid artery and middle cerebral artery) or posterior circulation (i.e. posterior communicating artery, posterior inferior cerebellar artery, basilar artery and vertebral artery), and size was classified as <5, 5-9 and ≥10 mm. Outcomes recorded during hospitalization were rebleeding, delayed ischemia, hydrocephalus, residual neurological impairment and in-hospital death. Logistic regression analysis was used to evaluate the effects of IA location and size on outcome, independent of other potential prognostic factors. Data are reported with odds ratios (OR) and 95% confidence intervals (CI). RESULTS: IA location and size were confirmed separately in 299 and 252 patients, respectively. Patients with a posterior circulation IA had a lower rate of rebleeding than those with an anterior circulation IA (adjusted OR: 0.11; 95% CI: 0.02-0.87), but otherwise there was no significant relationship between IA location and outcome. Patients with a larger ruptured IA had higher risks of rebleeding (p = 0.02 for trend) and in-hospital death (p = 0.001) after controlling for age, sex, ethnicity, location of the ruptured IA and neurosurgical intervention. CONCLUSION: IA location in the posterior circulation was associated with a lower risk of rebleeding than IA in the anterior circulation. A larger IA size was associated with higher risks of rebleeding and in-hospital death.

Dietary intake of key nutrients and subarachnoid hemorrhage: a population-based case-control study in Australasia.

BACKGROUND: A healthy, balanced diet can prevent stroke, but little is known about dietary risk factors for subarachnoid hemorrhage (SAH). We aimed to determine the relationship between common dietary habits and risk of SAH. METHODS: In a population-based, case-control study of SAH undertaken across 4 Australasian cities, a standardized questionnaire was used to obtain information on the frequency of consumption of 15 common food items and alcohol in incident cases (n = 383) and frequency-matched community controls (n = 473). Logistic regression models were used to estimate the independent effects of these dietary factors, after adjusting for conventional risk factors for SAH. Data are reported with odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The risk of SAH rose with increasing consumption of fat or skin on meat (p trend = 0.04), being highest in those with consumption >4 times weekly compared with no fat or skin on meat (adjusted OR 1.70, 95% CI 1.09-2.66), while use of skim or reduced-fat milk (p trend = 0.01) and fruit (p trend = 0.04) was associated with a reduced risk of SAH compared with rare use. Among people with a history of hypertension, frequently adding salt to food was associated with an increased risk of SAH, irrespective of whether they were (OR 2.58, 95% CI 1.29-5.13) or were not (OR 2.88, 95% CI 1.46-5.70) currently taking antihypertensive treatment. CONCLUSIONS: Frequent intake of fat appears to be associated with an increased risk of SAH, particularly in people with hypertension, while frequent use of skim or reduced-fat milk and fruit appears protective for SAH.

Estimation of the tourism climate in the Hunter Region, Australia, in the early twenty-first century.

Existing tourism-related climate information and evaluation are typically based on mean monthly conditions of air temperature and precipitation and do not include thermal perception and other climate parameters relevant for tourists. Here, we quantify climate based on the climate facets relevant to tourism (thermal, physical, aesthetical), and apply the results to the Climate-Tourism-Information-Scheme (CTIS). This paper presents bioclimatic and tourism climatological conditions in the Hunter Region-one of Australia's most popular tourist destinations. In the Hunter Region, generally, temperatures below 15°C occur from April through October, temperatures less than 25°C are expected throughout the whole year, while humidity sits around 50%. As expected, large differences between air temperature and physiologically equivalent temperature (PET) were clearly identified. The widest differences were seen in summer time rather than in the winter period. In addition, cold stress was observed less than 10% of the time in winter while around 40-60% of heat stress was observed in summer time. This correlates with the highest numbers of international visitors, who usually seek a warmer weather, at the beginning of summer time (November and December) and also to the number of domestic visitors, who tend to seek cooler places for recreation and leisure, in late summer (January-March). It was concluded that thermal bioclimate assessment such as PET and CTIS can be applied in the Hunter region, and that local governments and the tourism industry should take an integrated approach to providing more relevant weather and climate information for both domestic and international tourists in the near future.