Summer of sorrow: measuring exposure to and impacts of trauma after Queensland's natural disasters of 2010-2011.

OBJECTIVES: To assess the population prevalence of property, income and emotional impacts of the 2010-2011 Queensland floods and cyclones. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional telephone-based survey using a brief trauma exposure and impact screening instrument, conducted between 11 March and 6 June 2011, of 6104 adults who answered natural disaster and mental health questions. MAIN OUTCOME MEASURES: Natural disaster property damage exposure and emotional wellbeing impacts. RESULTS: Two-thirds of respondents (62%) reported being affected by the disasters, with property damage exposure ranging from 37.2% (suburb or local area) to 9.2% (own home, with 2.1% living elsewhere at least temporarily). Income was reduced for 17.0% of respondents and 11.7% of income-producing property owners reported damage to those properties. Trauma impacts ranged from 14.3% of respondents feeling "terrified, helpless or hopeless" to 3.9% thinking they might be "badly injured or die". Up to 5 months after the disasters, 7.1% of respondents were "still distressed" and 8.6% were "worried about how they would manage". Adults of working age and residents of regional and remote areas and of socioeconomically disadvantaged areas were disproportionately likely to report exposure to damage and emotional impacts. CONCLUSIONS: Weather-related disasters exact a large toll on the population through property damage and resultant emotional effects. Vulnerable subpopulations are more severely affected. There is a need for realistic, cost-effective and rapid-deployment mass interventions in the event of weather disasters.

Frequency of sunburn in Queensland adults: still a burning issue.

OBJECTIVE: To assess the current frequency of sunburn, a preventable risk factor for skin cancer, among Queensland adults. DESIGN AND SETTING: Cross-sectional population-based surveys of 16 473 residents aged ≥ 18 2013s across Queensland in 2009 and 2010. MAIN OUTCOME MEASURES: Proportion of the adult population reporting sunburn (skin reddening lasting 12 hours or more) during the previous weekend, by age, sex and other risk factors. RESULTS: One in eight men and one in 12 women in Queensland reported being sunburnt on the previous weekend. Age up to 65 2013s was the strongest predictor of sunburn: eg, people aged 18-24 2013s were seven times more likely (adjusted odds ratio [OR], 7.35; 95% CI, 5.09-10.62) and those aged 35-44 2013s were five times more likely (adjusted OR, 5.22) to report sunburn compared with those aged ≥ 65 2013s. Not having a tertiary education and being in the workforce were also significantly associated with sunburn. Those who had undertaken any physical activity the previous week were more likely to be sunburnt than those who were physically inactive. Sunburn was significantly less likely among people who generally took sun-protective measures in summer. Sunburn was not related to location of residence, socioeconomic disadvantage, skin colour, body weight or current smoking status. CONCLUSIONS: Sunburn remains a public health problem among Queensland residents, especially those under 45 2013s of age. Sun-safe habits reduce sunburn risk, but advice must be integrated with health promotion messages regarding physical activity to reduce the skin cancer burden while maintaining active wellbeing.

Guideline-discordant care in acute myocardial infarction: predictors and outcomes.

OBJECTIVES: To determine (i) factors which predict whether patients hospitalised with acute myocardial infarction (AMI) receive care discordant with recommendations of clinical practice guidelines; and (ii) whether such discordant care results in worse outcomes compared with receiving guideline-concordant care. DESIGN: Retrospective cohort study. SETTING: Two community general hospitals. PARTICIPANTS: 607 consecutive patients admitted with AMI between July 1997 and December 2000. MAIN OUTCOME MEASURES: Clinical predictors of discordant care; crude and risk-adjusted rates of inhospital mortality and reinfarction, and mean length of hospital stay. RESULTS: At least one treatment recommendation for AMI was applicable for 602 of the 607 patients. Of these patients, 411(68%) received concordant care, and 191 (32%) discordant care. Positive predictors at presentation of discordant care were age > 65 years (odds ratio [OR], 2.5; 95% CI, 1.7-3.6), silent infarction (OR, 2.7; 95% CI, 1.6-4.6), anterior infarction (OR, 2.5; 95% CI, 1.7-3.8), a history of heart failure (OR, 6.3; 95% CI, 3.7-10.7), chronic atrial fibrillation (OR, 3.2; 95% CI, 1.5-6.4); and heart rate >/= 100 beats/min (OR, 2.1; 95% CI, 1.4-3.1). Death occurred in 12.0% (23/191) of discordant-care patients versus 4.6% (19/411) of concordant-care patients (adjusted OR, 2.42; 95% CI, 1.22-4.82). Mortality was inversely related to the level of guideline concordance (P = 0.03). Reinfarction rates also tended to be higher in the discordant-care group (4.2% v 1.7%; adjusted OR, 2.5; 95% CI, 0.90-7.1). CONCLUSIONS: Certain clinical features at presentation predict a higher likelihood of guideline-discordant care in patients presenting with AMI. Such care appears to increase the risk of inhospital death.