Building multidisciplinary health workforce capacity to support the implementation of integrated, people-centred Models of Care for musculoskeletal health.

To address the burden of musculoskeletal (MSK) conditions, a competent health workforce is required to support the implementation of MSK models of care. Funding is required to create employment positions with resources for service delivery and training a fit-for-purpose workforce. Training should be aligned to define "entrustable professional activities", and include collaborative skills appropriate to integrated and people-centred care and supported by shared education resources. Greater emphasis on educating MSK healthcare workers as effective trainers of peers, students and patients is required. For quality, efficiency and sustainability of service delivery, education and research capabilities must be integrated across disciplines and within the workforce, with funding models developed based on measured performance indicators from all three domains. Greater awareness of the societal and economic burden of MSK conditions is required to ensure that solutions are prioritised and integrated within healthcare policies from local to regional to international levels. These healthcare policies require consumer engagement and alignment to social, economic, educational and infrastructure policies to optimise effectiveness and efficiency of implementation.

Prevalence and associations of gout and hyperuricaemia: results from an Australian population-based study.

BACKGROUND: Despite gout and hyperuricaemia being major comorbid health issues worldwide, there is a knowledge gap regarding their impact in the Australian community. AIMS: To determine the prevalence and associations of self-reported medically diagnosed gout and hyperuricaemia in an Australian population-based cohort. METHODS: The North West Adelaide Health Study is a longitudinal cohort study consisting of three stages of data collection. Each stage comprised a self-complete questionnaire, clinic assessment and computer-assisted telephone interview. In Stage 3 (2008-2010), participants were asked if a doctor had ever diagnosed them with gout. Additional data included demographics, comorbidities, laboratory data and Short Form 36 (SF-36). Participants were defined as having gout if they had self-reported medically diagnosed gout or were taking any gout-specific medication (allopurinol, colchicine, probenecid). Hyperuricaemia was defined as a serum uric acid (SUA) level >0.42 mmol/L in men and >0.34 mmol/L in women. RESULTS: The overall prevalence of gout was 5.2%. Males were significantly more likely to have gout than females (8.5 vs 2.1%, P < 0.001). The overall prevalence of hyperuricaemia was 16.6%, with being male again identified as a significant risk factor (17.8 vs 15.4%, P < 0.01). Both gout and hyperuricaemia were associated with male sex, body mass index and renal disease after multivariable adjustment. There was no significant difference reported in quality of life (mean SF-36) scores in participants with gout compared to unaffected individuals. CONCLUSION: The prevalence of gout and hyperuricaemia is high in the South Australian population. This study emphasises the need for optimal diagnosis and management of gout in Australia.

Shoulder pain in the community: an examination of associative factors using a longitudinal cohort study.

OBJECTIVE: To determine factors that are predictive of incident, recurrent, or resolved shoulder pain in a community-based sample from the general population. METHODS: This study used data from the North West Adelaide Health Study, a cohort study located in the northwestern suburbs of Adelaide, South Australia. Data were obtained between 2004 and 2006 and between 2008 and 2010, with time between measurements ranging from 2-6 years (median 4 years), using a computer-assisted telephone interview, a clinical assessment, and a self-completed questionnaire. Multivariate logistic regression was used to examine the factors associated with shoulder pain. RESULTS: Overall, 14.6% (95% confidence interval [95% CI] 12.7-16.7) of 2,337 eligible participants reported that they had developed (or had incident) shoulder pain between 2 time points of the cohort study, 8.8% (95% CI 7.5-10.3) reported recurrent shoulder pain, and 8.7% (95% CI 7.0-10.6) had resolved shoulder pain. Incident shoulder pain was significantly associated with physically heavier occupational activities and pain in other joints after adjustment for age, sex, and body mass index. Recurrent shoulder pain was also associated with pain in other joints, but also with depressive symptoms, smoking, and decreased shoulder range of movement. Resolved shoulder pain was associated with being female, other areas of pain, and decreased shoulder range of movement, but higher grip strength. CONCLUSION: Different factors were associated with incident, recurrent, or resolved shoulder pain in a longitudinal cohort study. Consideration of all of these factors may assist in the prevention and management of shoulder pain and the possible identification of those at risk of long-term shoulder problems.

Impact of the new national health standard for rail safety workers on ischaemic heart disease risk factors in train drivers.

BACKGROUND: In 2004, a compulsory National Standard for the Australian rail industry was introduced outlining health standards that drivers must meet to be deemed fit to drive. AIM: To examine the trend in ischaemic heart disease (IHD) risk factors in train drivers between 2004 and 2009, following the introduction of a National Standard. METHODS: A retrospective analysis of IHD risk factors of drivers (n = 386) of an Australian train company, who underwent health assessments between February 2004 and November 2009, was performed. The Framingham Score for 10-year risk of coronary artery disease, body mass index (BMI), cigarette smoking, diabetes, systolic and diastolic blood pressure, high-density lipoprotein (HDL), low-density lipoprotein and total cholesterol were compared with that of controls at these two time periods. RESULTS: There were significant reductions in the rates of 10-year coronary heart disease risk/year (OR = 0.47; 95% CI 0.19, 0.75) in the train drivers compared with the control population. This was driven by a reduction in the rate of cigarette smoking (OR = 0.87; 95% CI 0.79, 0.96) and total cholesterol (OR = -0.05; 95% CI -0.09, 0.003) and an increase in HDL cholesterol levels (OR = 0.02; 95% CI 0.006, 0.03) between groups over time. This was despite an increase in BMI (OR = 0.10; 95% CI 0.01, 0.19). CONCLUSION: Following the introduction of a National Standard for drivers in Australia, there has been a significant improvement in the health of drivers. Such a programme may have a significant impact in this group of safety critical workers.

Osteoporosis in the community: Sensitivity of self-reported estimates and medication use of those diagnosed with the condition.

OBJECTIVES: To assess the sensitivity and specificity of self-reported osteoporosis compared with dual energy X-ray absorptiometry (DXA) defined osteoporosis, and to describe medication use among participants with the condition. METHODS: Data were obtained from a population-based longitudinal study and assessed for the prevalence of osteoporosis, falls, fractures and medication use. DXA scans were also undertaken. RESULTS: Overall 3.8% (95% confidence interval (CI) 3.2 to 4.5) of respondents and 8.8% (95% CI 7.5 to 10.3) of those aged ≥ 50 years reported that they had been diagnosed with osteoporosis by a doctor. The sensitivity (those self-reporting osteoporosis and having low bone mineral density (BMD) on DXA) was low (22.7%), although the specificity was high (94.4%). Only 16.1% of those aged ≥ 50 years and with DXA-defined osteoporosis were taking bisphosphonates. CONCLUSIONS: The sensitivity of self-reporting to identify osteoporosis is low. Anti-osteoporotic medications are an important part of osteoporosis treatment but opportunities to use appropriate medications were missed and inappropriate medications were used.

Prevalence and associations of hand pain in the community: results from a population-based study.

OBJECTIVES: To assess the prevalence and associations of hand symptoms in a community setting. METHODS: The North West Adelaide Health Study (NWAHS) is a longitudinal cohort study of people aged ≥ 18 years. Analysis was performed in participants who completed a telephone interview, a quality of life questionnaire [the 36-item short-form health survey, (SF-36)], and the Australian/Canadian (AUSCAN) Osteoarthritis (OA) Hand Index, and underwent grip strength measurement. RESULTS: Overall, 477 (13.7%) reported hand pain, aching, or stiffness. Of these, 169 (35.8%) had been diagnosed with hand arthritis. Women were more likely to have hand symptoms than men, as were those aged ≥ 50 years (p < 0.001). Hand symptoms were associated with lower quality of life scores (p < 0.05). Participants with hand arthritis had more severe pain, stiffness, and poorer physical functioning as reflected by higher AUSCAN scores. Grip strength was reduced in those with hand symptoms and hand arthritis (p < 0.05) and inversely associated with mean AUSCAN subscores and SF-36 physical functioning scores (p < 0.001). CONCLUSIONS: Hand symptoms were present in 14% of the population and were more common in women and those aged ≥ 50 years. Hand symptoms were associated with reduced grip strength and reduced quality of life. Hand arthritis was associated with higher AUSCAN scores. Hand symptoms and hand arthritis have a significant impact on physical functioning and quality of life.

Continuing decline in hormone therapy use: population trends over 17 years.

OBJECTIVE: To describe the prevalence of menopausal hormone therapy (HT) in 2008 and trends over the last 17 years in an Australian population. METHODS: Data were obtained from nine representative population face-to-face interview surveys of the South Australian population from 1991 to 2008. The surveys used consistent method and quality control procedures. In 2008, demographic data, HT use and eight dimensions of health, using the SF-36 health survey questionnaire, were measured. Participants Over 3000 South Australian adults were interviewed in their own home by trained health interviewers in each of the surveys; in the 2008 survey, 1555 women participated, of whom 953 were over age 40. RESULTS: After a peak in use in the 2000 survey, HT use fell from 2003 and has continued to decline in 2008. In 2008, current use over age 50 of registered conventional HT products is now 11.8%, with a further 4.0% using non-registered alternative 'hormonal' products. Current HT use is highest between the ages of 50 and 59 years, where 13.4% use conventional HT and 7.7% use unconventional alternative hormones. Use of these unregistered hormonal products was rare in previous surveys. Median and mean length of conventional HT use were 10.0 and 10.5 years, respectively. HT users continued to have a demographic profile similar to those in previous surveys, i.e. they were better educated, employed, partnered, had a higher income and were less inclined to use complementary and alternative medicines. CONCLUSIONS: There has been a continuing decline in both the overall prevalence and length of use of conventional HT from 2003, probably in association with negative media about HT. Of medical concern is that about one-quarter of women using HT around menopause now chooses unregistered hormonal mixtures that are untested for long-term safety and efficacy.

Discharge planning quality from the carer perspective.

Discharge planning endeavours to assist the transition of patients from the acute hospital setting into the community. We examined the quality of discharge planning from the perspective of the carer. Spouses were the most common carers for the elderly patients in our study. Many carers were also elderly, with their own health problems. Using a new instrument (entitled PREPARED) (K. Grimmer and J. Moss, Int J Qual Health Care (in press)), carers rated the quality of planning for discharge much lower than did the patient, indicating that their needs were often not met when discharge was being planned. In free text responses, carers expressed their dissatisfaction over communication about how the family would cope once the patient went home. Carers generally had lower summary mental quality of life scores than the Australian norms (as measured by the SF-36 health survey (J. Ware and R. Sherbourne, Med Care 1992; 30: 473-483)), suggesting that the caring role may have impacted upon their emotional wellbeing. The rate of use of community services in the first week post-discharge was low, suggesting that carers and patients carried the majority of the burden immediately after discharge. We suggest that planning for hospital discharge requires more consideration of the carer.

The associations between adolescent head-on-neck posture, backpack weight, and anthropometric features.

STUDY DESIGN: A Cross-sectional, observational study, examining the effects of backpack weight on adolescent posture. OBJECTIVES: To investigate the response of the craniovertebral angle to backpack load. SUMMARY OF BACKGROUND DATA: There is a widely held belief that repeated carrying of heavy loads, such as school backpacks, places additional stress on rapidly growing adolescent spinal structures, making them prone to postural change. METHODS: Ten volunteer state high schools in metropolitan Adelaide, South Australia, provided 985 students, aged 12 to 18 years and from five different high school years, for this study. Students' posture was measured with and without their school backpack. All data analyses were undertaken per school year level to account for specific load-carrying requirements and spinal development associated with the age group. RESULTS: A significant change in craniovertebral angle was found at every year level, when comparing standing posture with no backpack with posture when carrying a backpack. The change was greatest for the youngest students. Incremental change in craniovertebral angle was not strongly associated with backpack loads. The association became stronger for the oldest girls when controlled for body mass index and for weight. CONCLUSION: The results support a differential postural response per gender and per level of spinal development but also suggest that the craniovertebral angle may not be the most sensitive measure of head-on-neck postural change for adolescents.

Metacentric sex-chromosomes in a rodent species, Rattus (Millardia) meltada pallidior (Ryley).

The diploid chromosome number in Rattus (Millardia) meltada pallidior (Ryley) is 52 where all the autosomes are acrocentric, and the sex-chromosomes X and y are metacentric. The X chromosome is the largest in the complement being 13.25 microns and the y chromosome is 6.00 microns in length. The autosomes range in size from 9 microns to 2.57 microns.

Chromosomal polymorphism in Lepidospyris demissus (Coleoptera, Curculionidae).

The diploid number of chromosomes in Lepidospyris demissus is 22 including a pair of sex-chromosomes (Xy). However, in its polymorphic forms the diploid number is 23 with three sex-chromosomes (X,yy).