Betting on the House: The Impact of Gambling on Homeownership in Australia.

Gambling is commonly associated with social and economic disadvantage. In this paper we examine the impact of gambling on homeownership, using Australian panel data. We find that gambling is associated with a lower probability of homeownership. Specifically, our endogeneity corrected estimates show that an increase in problem gambling is associated with between 1.6 and 1.8 percentage point decrease in the probability of owning a home depending on the model. Our result show that financial stress and social capital are channels through which gambling influences the probability of homeownership.

Use of the knowledge to action model improved physical therapist adherence to a common clinical practice guideline across multiple settings: a multisite case series.

BACKGROUND: When a new guideline is published there is a need to understand how its recommendations can best be implemented in real-world practice. Yet, guidelines are often published with little to no roadmap for organizations to follow to promote adherence to their recommendations. The purpose of this study was to evaluate the impact of using a common process model to implement a single clinical practice guideline across multiple physical therapy clinical settings. METHODS: Five organizationally distinct sites with physical therapy services for patients with peripheral vestibular hypofunction participated. The Knowledge to Action model served as the foundation for implementation of a newly published guideline. Site leaders conducted preliminary gap surveys and face-to-face meetings to guide physical therapist stakeholders' identification of target-behaviors for improved guideline adherence. A 6-month multimodal implementation intervention included local opinion leaders, audit and feedback, fatigue-resistant reminders, and communities of practice. Therapist adherence to target-behaviors for the 6 months before and after the intervention was the primary outcome for behavior change. RESULTS: Therapist participants at all sites indicated readiness for change and commitment to the project. Four sites with more experienced therapists selected similar target behaviors while the fifth, with more inexperienced therapists, identified different goals. Adherence to target behaviors was mixed. Among four sites with similar target behaviors, three had multiple areas of statistically significantly improved adherence and one site had limited improvement. Success was most common with behaviors related to documentation and offering patients low technology resources to support home exercise. A fifth site showed a trend toward improved therapist self-efficacy and therapist behavior change in one provider location. CONCLUSIONS: The Knowledge to Action model provided a common process model for sites with diverse structures and needs to implement a guideline in practice. Multimodal, active interventions, with a focus on auditing adherence to therapist-selected target behaviors, feedback in collaborative monthly meetings, fatigue-resistant reminders, and developing communities of practice was associated with long-term improvement in adherence. Local rather than external opinion leaders, therapist availability for community building meetings, and rate of provider turnover likely impacted success in this model. TRIAL REGISTRATION: This study does not report the results of a health care intervention on human participants.

Efficacy and adherence of noninvasive ventilation treatment in children with Down syndrome.

OBJECTIVE: Children with Down syndrome (DS) have an increased prevalence of obstructive sleep apnea (OSA). Noninvasive ventilation (NIV) is a common modality of OSA treatment in this cohort. This study aimed to measure adherence and efficiency of NIV delivery in children with DS. STUDY DESIGN: This was a retrospective cohort study involving 106 children with confirmed OSA and home NIV with downloadable data capacity. Children were divided into DS (n = 44) and non-DS cohorts (n = 62). Adherence, clinical outcomes apnea-hypopnoea index (AHI), positive airway pressure delivery, and leakage were recorded and compared between DS and non-DS cohorts and within the DS cohort based on past surgical history. RESULTS: Significantly greater NIV usage was observed in the DS cohort, they showed more consistent use with an increased percentage of days used relative to their non-DS counterparts (78.95 ± 2.26 vs. 72.11 ± 2.14, p = .031). However, despite greater usage, poorer clinical outcomes in the form of increased AHI (p = .0493) was observed in the DS cohort, where significantly greater leakage was also shown 41.00 ± 1.61 L/min versus 36.52 ± 1.18 L/min (p = .022). Twenty children with DS had prior cardiac surgery; compliance across all parameters was significantly reduced relative to those without. CONCLUSION: These data confirm that satisfactory NIV adherence is achievable in children with DS. However, we have identified excessive system leak at the machine-patient interface as a factor, which could undermine NIV efficacy in children with DS.

Australia's Gambling Epidemic: The Role of Neighbourhood Ethnic Diversity.

Gambling is a popular leisure activity but also a significant public health issue in Australia. The severity of gambling in Australia is characterised by unprecedented gambling expenditures and losses representing the highest gambling rates in the world, which has led to renewed interests in understanding the factors influencing gambling behaviours. We contribute to the debate on the determinants of gambling by providing the first study that examines the impact of ethnic diversity on gambling. Using data from the Household, Income and Labour Dynamics in Australia survey, we find that ethnic diversity is positively associated with gambling. This result is robust to alternative estimation approaches, alternative ways of measuring ethnic diversity and irrespective of whether gambling is measured using the Problem Gambling Severity Index, gambling expenditures or number of gambling activities. Our results also suggest stronger effects of ethnic diversity for problem gamblers compared to gamblers in other risk categories. These results support the need for policies that promote social capital in diverse communities to reduce the risks of social isolation, which is an important motivator of gambling behaviour.

Social Capital and Gambling: Evidence from Australia.

The prevalence of problem gambling in many countries necessitates research that examines factors influencing excessive and addictive consumption. We consider how social capital impacts gambling participation for a large representative sample of the Australian population. Specifically, we examine the association between social capital and gambling addiction using data from the Household, Income and Labour Dynamics in Australia survey. We address the endogeneity of social capital by instrumenting for social capital using an urban/rural reversed measure of ethnic diversity. Our main findings suggest that higher levels of social capital are associated with lower gambling risks measured by the Problem Gambling Severity Index. This general finding is robust to alternative ways of measuring social capital and gambling, and alternative estimation approaches. We also find that the effect of social capital is stronger in the case of problem gamblers compared to gamblers in other risk categories.

Neighbourhood ethnic diversity and mental health in Australia.

We present the first study that empirically examines the effects of neighbourhood ethnic diversity on mental health. Using 16 waves of longitudinal data from the Household, Income and Labour Dynamics in Australia survey, we find that ethnic diversity is negatively associated with mental health. Our preferred estimates, using lagged ethnic diversity at the state level to instrument for neighbourhood ethnic diversity, suggest that a standard deviation increase in ethnic diversity is associated with a decline of 0.092-0.129 standard deviations in mental health. This result is robust to alternative estimation approaches to addressing endogeneity of ethnic diversity and alternative ways of measuring ethnic diversity and irrespective of whether mental health is measured with the Mental Health Inventory scale or the Kessler Psychological Distress Scale (K10). We further find that ethnic diversity influences mental health through the level of neighbourhood trust. Our findings point to the need to develop policies that promote social inclusion in multicultural societies and build trust between heterogeneous ethnic groups as a vehicle to improve mental health.

Understanding the Relationship Between Subjective Wellbeing and Gambling Behavior.

This paper examines the relationship between gambling behavior and subjective wellbeing. It is often asserted that populations consist of different types of gamblers: those for whom gambling is a harmless leisure activity and those (pathological/problem gamblers) for whom the activity has harmful effects. One might, therefore, assume that subjective wellbeing will be negativity associated with an individual's level of gambling addiction. Alternatively, gamblers may choose to gamble because they derive utility from participating in this activity and so the relationship between happiness and gambling might be positively correlated. In this paper we test this association, empirically, using data from the 2010 British Gambling Prevalence Survey. The statistically significant findings from this analysis support the hypothesis that individual wellbeing falls as gambling disorder increases.

The RunSmart training program: effect on oxygen consumption and lower extremity biomechanics during running.

As recreational running continues to gain popularity, more individuals are seeking ways to improve running performance. RunSmart is a running intervention program designed to enhance a runner's form. In addition to correcting flaws in a runner's form, RunSmart offers the opportunity for runners to continue a regular regimen while slowly integrating changes in form. The purpose of this case series was twofold: to determine if the RunSmart program coincides with improvements in oxygen consumption (VO2), a variable often associated with better running performance times, and to evaluate the RunSmart program in regard to enhancing gait biomechanics. Five recreational runners volunteered to participate in this program. Subjects initially reported to the clinic for an initial submaximal VO2 treadmill test and lower extremity biomechanical analysis. After the initial testing session, each subject attended one session of one-on-one individualized RunSmart instruction per week for 6 weeks. At the first RunSmart session, subjects received a biomechanical analysis to determine their foot strike pattern and areas of muscular weakness and range of motion limitations. Throughout the 6-week run-ning program, participants ran 5 days every week for predetermined times each day; 2 runs every week were designated as interval training runs. Subjects then underwent a follow-up submaximal VO2 treadmill test and lower extremity biomechanical analysis at the end of 6 weeks. Descriptive statistics were used to assess data pertaining to VO2 and biomechanical analysis and compare initial and follow-up testing sessions. Following completion of the RunSmart program, subjects demonstrated improvements in VO2 and also improved several biomechanical factors related to the lower extremity running gait. Based on the results from this case series, the RunSmart training program may have the potential to change a runner's form and improve VO2, thus resulting in improved distance running times. However, this is speculation given the nonexperimental nature of this case series. Future research on this topic should include a greater number of participants in randomized controlled trials on injury prevention and running efficiency.

The socioeconomic gradient in physical inactivity: evidence from one million adults in England.

Understanding the socioeconomic gradient in physical inactivity is essential for effective health promotion. This paper exploits data on over one million individuals (1,002,216 people aged 16 and over) in England drawn from the Active People Survey (2004-11). We identify the separate associations between a variety of measures of physical inactivity with education and household income. We find high levels of physical inactivity. Further, both education and household income are strongly associated with inactivity even when controlling for local area deprivation, the availability of physical recreation and sporting facilities, the local weather and regional geography. Moreover, the gap in inactivity between those living in high and low income households is already evident in early adult life and increases up until about age 85. Overall, these results suggest that England is building up a large future health problem and one that is heavily socially graded.

Medical education needs to teach health technology assessment.

Health technology assessment evaluates the effects of drugs, devices, procedures and policies on patients and the healthcare system. Because of its potential to optimize healthcare resources and patient care, health technology assessment is becoming increasingly important in healthcare systems at national and local levels. This article provides an explanation of health technology assessment and an example of its application in residency education.

Smokers of illicit tobacco report significantly worse health than other smokers.

INTRODUCTION: The aim of this study was to ascertain whether the health of past and current smokers of illicit tobacco (chop-chop) differs from that of smokers of licit tobacco. METHODS: The design was a telephone survey, stratified by state, using computer aided telephone interviewing, with households selected by random digit dialing from the telephone white pages. Setting was all Australian states and territories, 1,621 regular tobacco smokers aged 18+ years. Measures were social and personal characteristics of tobacco smokers, smoking histories and patterns, and health status (SF-8 and disability weights). Binary logistic regression was used to identify variables associated with current and lifetime chop-chop use. RESULTS: Compared with licit-only tobacco smokers, current users of chop-chop had significantly greater odds of beginning smoking aged <16 years (odds ratio [OR] 1.65, 95% CI = 1.09-2.50), of reporting below-average social functioning (OR 1.61, 95% CI = 1.06-2.44), and of a measurable disability (OR 1.95, 95% CI = 1.08-3.51). Lifetime chop-chop users were relatively likely to be less than 45 years of age (OR 1.82, 95% CI = 1.38-2.39), report below-average mental health (OR 1.61, 95% CI = 1.22-2.13) and above-average bodily pain (OR 1.40, 95% CI = 1.06-1.85), smoke more than 120 cigarettes/week (OR 1.39, 95% CI = 1.06-1.83), and to have begun smoking aged <16 years (OR 1.33, 95% CI = 1.01-1.75). DISCUSSION: Current and lifetime users of chop-chop report significantly worse health than smokers of licit tobacco. Investigation of how to communicate this finding to current and potential chop-chop smokers is warranted.

Dedicated CT scanner in an emergency department: quantification of factors that contribute to lack of use.

OBJECTIVE: The purpose of our study was to quantify the factors that contribute to the lack of use of a dedicated CT scanner in the emergency department of our institution and to identify possible changes to reduce scanner idle time. MATERIALS AND METHODS: We designed a data collection form to record consecutive periods of patient scanning and periods between patients when the CT scanner was not in use. The contributing factors for each idle period were identified and logged according to an entry system previously decided in consensus. Data were collected continuously for 11 days. The factors we identified for measurement were no request for scanning, preventive maintenance, equipment failure, technologist unavailable, room cleaning and preparation, patient preparation for abdominal CT, patient undergoing other tests, transportation delays, pending laboratory workup, and miscellaneous factors. The time attributed to the most prevalent factors was also grouped into four 6-hr periods corresponding to our department's shifts. RESULTS: The scanner was idle 73% of the total study time. The chief contributing factors to lack of use were having no patients to scan, patient undergoing preparation, and transportation delays, which accounted for 38.5%, 31%, and 11.7% of the aggregate idle time, respectively. The 6-hr periods of least use were the 7:00 A.M.-1:00 P.M. and the 1:00 A.M.-7:00 A.M. shifts, which accounted for 17% and 19% of idle time, respectively. CONCLUSION: Dedicated emergency department CT scanners can have significant daily periods of consistent lack of use. The idle time can be reduced by identifying patterns of referral time and correcting specific operational delays.