To what extent is the elevated risk of psychological distress in people with diabetes accounted for by physical disability? Findings from a large population-based study

Objectives People with diabetes experience an elevated risk of psychological distress compared with people without diabetes. It is unclear how much of this elevated risk is attributable to the greater levels of physical disability in people with diabetes, and how this risk varies according to sociodemographic and health-behavioural characteristics. This study quantified levels of psychological distress in people with and without diabetes, considering these factors. Design Cross-sectional analysis of questionnaire data. Setting Men and women aged ≥45 years, in the 45 and Up Study, from New South Wales, Australia. Participants 236 441 people who completed the baseline postal questionnaire (distributed from 1 January 2006–31 December 2008), with valid data for diabetes status and psychological distress. Primary outcome measures High psychological distress (Kessler-10 >22). Modified Poisson regression with robust error variance was used to estimate prevalence ratios (PRs), comparing prevalence of high psychological distress among those with and without diabetes and across physical functional limitation (PFL) levels, adjusting for potential confounders. Results Overall, 8.4% (19 803/236 441) of participants reported diabetes. 11.8% (2339) of individuals with diabetes and 7.2% (15 664) without diabetes had high psychological distress: age-adjusted and sex-adjusted PR=1.89 (95% CI 1.81 to 1.97), becoming 1.58 (1.52 to 1.65) and 1.22 (1.17 to 1.27) following additional adjustment for sociodemographic factors, health behaviours and additionally for PFL, respectively. Compared with individuals with neither diabetes nor PFL, the adjusted PRs for high psychological distress were: 1.37 (1.17 to 1.60) with diabetes but no PFL, 7.33 (7.00 to 7.67) without diabetes but with severe PFL and 8.89 (8.36 to 9.46) with both diabetes and severe PFL. Conclusions People with diabetes have a 60% greater risk of high psychological distress than people without diabetes; a substantial proportion of this elevation is attributable to higher levels of disability with diabetes, especially factoring in measurement error. Psychological distress is strongly related to physical impairment.This specific project was supported by a Cardiovascular Disease Network Development Grant from the National Heart Foundation of Australia and a National Health and Medical Research Council of Australia Partnership Grant (GNT1092674). EB is supported by the National Health and Medical Research Council of Australia (1042717)

How do newly diagnosed patients with type 2 diabetes in the Waikato get their diabetes education?

Introduction: Education is accepted as the mainstay of management for people with diabetes. However, there are few population-based studies describing what education has been delivered from the patient's perspective. Aim: To ascertain the sources of education for patients with newly diagnosed type 2 diabetes; what education was received and what were the patients' views of group education. delivery of education to Maori was compared with non-Maori. Methods: A cross-sectional survey of patients identified from the Waikato Regional diabetes service database. Patients identified in one calendar year, having a diagnosis of type 2 diabetes and being aged between 20 and 89 years were included in the survey. Patients were sent a four-page questionnaire. non-responders were followed up by telephone. Results: 333/667 patients (50%) responded. The principal source of education for Waikato patients was general practice, from the general practitioner and/or the practice nurse. ninety-three percent of patients reported that they had received some education about diabetes at the time of diagnosis. There was no difference between Maori and non-Maori in the reported levels of diabetes education received, but the patient perceived knowledge score was significantly lower for Maori in all aspects studied. Discussion: The overall impression was that patients were receiving appropriate information about diabetes, but there does appear to be room for improvement in some areas, particularly the importance of blood pressure and lipid control. We believe that further research on the educational needs of Maori and ethnic minorities is needed

Post-caesarean section surgical site infection: rate and risk factors

Aim To identify the incidence of surgical site infection (SSI) post-caesarean section, and important contributory risk factors. Method A retrospective analysis was conducted to identify cases with SSI, using as a population all the caesarean sections fo

Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence

This study finds that up to two-thirds of deaths in current smokers  in Australia can be attributed to smoking. Abstract Background The smoking epidemic in Australia is characterised by historic levels of prolonged smoking, heavy smoking, very high levels of long-term cessation, and low current smoking prevalence, with 13% of adults reporting that they smoked daily in 2013. Large-scale quantitative evidence on the relationship of tobacco smoking to mortality in Australia is not available despite the potential to provide independent international evidence about the contemporary risks of smoking. Methods This is a prospective study of 204,953 individuals aged ≥45 years sampled from the general population of New South Wales, Australia, who joined the 45 and Up Study from 2006–2009, with linked questionnaire, hospitalisation, and mortality data to mid-2012 and with no history of cancer (other than melanoma and non-melanoma skin cancer), heart disease, stroke, or thrombosis. Hazard ratios (described here as relative risks, RRs) for all-cause mortality among current and past smokers compared to never-smokers were estimated, adjusting for age, education, income, region of residence, alcohol, and body mass index. Results Overall, 5,593 deaths accrued during follow-up (874,120 person-years; mean: 4.26 years); 7.7% of participants were current smokers and 34.1% past smokers at baseline. Compared to never-smokers, the adjusted RR (95% CI) of mortality was 2.96 (2.69–3.25) in current smokers and was similar in men (2.82 (2.49–3.19)) and women (3.08 (2.63–3.60)) and according to birth cohort. Mortality RRs increased with increasing smoking intensity, with around two- and four-fold increases in mortality in current smokers of ≤14 (mean 10/day) and ≥25 cigarettes/day, respectively, compared to never-smokers. Among past smokers, mortality diminished gradually with increasing time since cessation and did not differ significantly from never-smokers in those quitting prior to age 45. Current smokers are estimated to die an average of 10 years earlier than non-smokers. Conclusions In Australia, up to two-thirds of deaths in current smokers can be attributed to smoking. Cessation reduces mortality compared with continuing to smoke, with cessation earlier in life resulting in greater reductions

Physical functional limitations and psychological distress in people with and without colorectal cancer: findings from a large Australian study

Purpose To quantify physical disability and psychological distress in people with and without colorectal cancer (CRC). Methods Questionnaire data (2006–2009) from 267,153 Australian general population members aged ≥ 45 years participating in the 45 and Up Study (n = 213,231 following exclusions) were linked to cancer registry and hospital admission data, to ascertain CRC status. Modified Poisson regression estimated adjusted prevalence ratios (PRs) for physical disability and psychological distress in participants with CRC versus those without. Results Compared with participants without CRC (n = 210,836), CRC survivors (n = 2395) had significantly higher physical disability prevalence (11.9% versus 19.5%, respectively), PR = 1.11 (95% CI = 1.03-1.20); and a similar prevalence of distress (23.1% versus 20.2%), PR = 1.03 (0.94-1.20). Adverse outcomes were associated with certain clinical characteristics. Compared with participants without CRC, CRC survivors diagnosed 5–< 10 and ≥ 10 years, with regional spread, and without recent cancer treatment had broadly similar outcomes; survivors with metastatic CRC and recent treatment had 30–60% higher prevalence of disability and distress. Compared with participants with neither CRC nor disability, PRs for distress were 4.71 (4.22–5.26) for those with disability and CRC; and 4.22 (4.13–4.31) for those with disability without CRC. Conclusions Physical disability is elevated in CRC survivors. Psychological distress is elevated 4- to 5-fold with disability, regardless of CRC diagnosis, with lesser increases around diagnosis and treatment. Implications for cancer survivors CRC survivors with less advanced disease and who have not been recently diagnosed or treated have physical disability and psychological distress comparable to the general population. Survivors with disability are at particularly high risk of psychological distres

Erectile Dysfunction Severity as a Risk Marker for Cardiovascular Disease Hospitalisation and All-Cause Mortality: A Prospective Cohort Study

BACKGROUND Erectile dysfunction is an emerging risk marker for future cardiovascular disease (CVD) events; however, evidence on dose response and specific CVD outcomes is limited. This study investigates the relationship between severity of erectile dysfunction and specific CVD outcomes. METHODS AND FINDINGS We conducted a prospective population-based Australian study (the 45 and Up Study) linking questionnaire data from 2006-2009 with hospitalisation and death data to 30 June and 31 Dec 2010 respectively for 95,038 men aged ≥45 y. Cox proportional hazards models were used to examine the relationship of reported severity of erectile dysfunction to all-cause mortality and first CVD-related hospitalisation since baseline in men with and without previous CVD, adjusting for age, smoking, alcohol consumption, marital status, income, education, physical activity, body mass index, diabetes, and hypertension and/or hypercholesterolaemia treatment. There were 7,855 incident admissions for CVD and 2,304 deaths during follow-up (mean time from recruitment, 2.2 y for CVD admission and 2.8 y for mortality). Risks of CVD and death increased steadily with severity of erectile dysfunction. Among men without previous CVD, those with severe versus no erectile dysfunction had significantly increased risks of ischaemic heart disease (adjusted relative risk [RR] = 1.60, 95% CI 1.31-1.95), heart failure (8.00, 2.64-24.2), peripheral vascular disease (1.92, 1.12-3.29), "other" CVD (1.26, 1.05-1.51), all CVD combined (1.35, 1.19-1.53), and all-cause mortality (1.93, 1.52-2.44). For men with previous CVD, corresponding RRs (95% CI) were 1.70 (1.46-1.98), 4.40 (2.64-7.33), 2.46 (1.63-3.70), 1.40 (1.21-1.63), 1.64 (1.48-1.81), and 2.37 (1.87-3.01), respectively. Among men without previous CVD, RRs of more specific CVDs increased significantly with severe versus no erectile dysfunction, including acute myocardial infarction (1.66, 1.22-2.26), atrioventricular and left bundle branch block (6.62, 1.86-23.56), and (peripheral) atherosclerosis (2.47, 1.18-5.15), with no significant difference in risk for conditions such as primary hypertension (0.61, 0.16-2.35) and intracerebral haemorrhage (0.78, 0.20-2.97). CONCLUSIONS These findings give support for CVD risk assessment in men with erectile dysfunction who have not already undergone assessment. The utility of erectile dysfunction as a clinical risk prediction tool requires specific testing.JC has received research grants from Servier, administered through the University of Sydney and The George Institute, as principal investigator for the ADVANCE trial and ADVANCE-ON post trial follow-up study, and have received honoraria from Servier for speaking about ADVANCE at Scientific meetings. PM has received payment from Pfizer for giving a lecture on the treatment of pulmonary hypertension. All other authors have declared that no competing interests exis

The overall health and risk factor profile of Australian Aboriginal and Torres Strait Islander participants from the 45 and up study

Background: Despite large disparities in health outcomes between Aboriginal and non-Aboriginal Australians, detailed evidence on the health and lifestyle characteristics of older Aboriginal Australians is lacking. The aim of this study is to quantify soc

Measuring psychological distress in older Aboriginal and Torres Strait Islanders Australians: A comparison of the K-10 and K-5

Objectives: To assess the cross-cultural validity of two Kessler psychological distress scales (K-10 and K-5) by examining their measurement properties among older Aboriginal and Torres Strait Islanders and comparing them to those in non-Aboriginal individuals from NSW Australia. Methods: Self-reported questionnaire data from the 45 and Up Study for 1,631 Aboriginal and 231,774 non-Aboriginal people were used to examine the factor structure, convergent validity, internal consistency and levels of missing data of K-10 and K-5. Results: We found excellent agreement in classification of distress of Aboriginal participants by K-10 and K-5 (weighted kappa=0.87), high internal consistency (Cronbach's alpha K-10: 0.93, K-5: 0.88), and factor structures consistent with those for the total Australian population. Convergent validity was evidenced by a strong graded relationship between the level of distress and the odds of: problems with daily activities due to emotional problems; current treatment for depression or anxiety; and poor quality of life. Conclusions and implications: K-10 and K-5 scales are promising tools for measuring psychological distress among Aboriginal and Torres Strait Islanders aged 45 and over in research and clinical settings

The overall health and risk factor profile of Australian Aboriginal and Torres Strait Islander participants from the 45 and up study

BACKGROUND: Despite large disparities in health outcomes between Aboriginal and non-Aboriginal Australians, detailed evidence on the health and lifestyle characteristics of older Aboriginal Australians is lacking. The aim of this study is to quantify socio-demographic and health risk factors and mental and physical health status among Aboriginal participants from the 45 and Up Study and to compare these with non-Aboriginal participants from the study. METHODS: The 45 and Up Study is a large-scale study of individuals aged 45 years and older from the general population of New South Wales, Australia responding to a baseline questionnaire distributed from 2006–2008. Odds ratios (OR) and 95% confidence intervals (CI) of self-reported responses from the baseline questionnaire for Aboriginal versus non-Aboriginal participants relating to socio-demographic factors, health risk factors, current and past medical and surgical history, physical disability, functional health limitations and levels of current psychological distress were calculated using unconditional logistic regression, with adjustments for age and sex. RESULTS: Overall, 1939 of 266,661 45 and Up Study participants examined in this study identified as Aboriginal and/or Torres Strait Islander (0.7%). Compared to non-Aboriginal participants, Aboriginal participants were significantly more likely to be: younger (mean age 58 versus 63 years); without formal educational qualifications (age- and sex- adjusted OR = 6.2, 95% CI 5.3-7.3); of unemployed (3.7, 2.9-4.6) or disabled (4.6, 3.9-5.3) work status; and with a household income < $20,000/year versus ≥$70,000/year (5.8, 5.0-6.9). Following additional adjustment for income and education, Aboriginal participants were significantly more likely than non-Aboriginal participants to: be current smokers (2.4, 2.0-2.8), be obese (2.1, 1.8-2.5), have ever been diagnosed with certain medical conditions (especially: diabetes [2.1, 1.8-2.4]; depression [1.6, 1.4-1.8] and stroke [1.8, 1.4-2.3]), have care-giving responsibilities (1.8, 1.5-2.2); have a major physical disability (2.6, 2.2-3.1); have severe physical functional limitation (2.9, 2.4-3.4) and have very high levels of psychological distress (2.4, 2.0-3.0). CONCLUSIONS: Aboriginal participants from the 45 and Up Study experience greater levels of disadvantage and have greater health needs (including physical disability and psychological distress) compared to non-Aboriginal participants. The study highlights the need to address the social determinants of health in Australia and to provide appropriate mental health services and disability support for older Aboriginal people

Factors related to receipt of non-cancer related transurethral prostatectomy: Findings from a large prospective study of 106,769 middle aged and older Australian men

Background: Transurethral prostatectomy (TURP) is a common surgical intervention for chronic lower urinary tract symptoms (LUTS). Little large-scale evidence exists on factors related to receipt of non-cancer-related TURP. Methods: A prospective study of men aged ≥45 years participating in the 45 and Up Study, a large Australian cohort study, without prior prostatectomy and/or bowel/genital/urinary-tract cancer; questionnaire data were linked to hospitalisations and deaths. HRs for TURP were estimated in relation to multiple factors, adjusting for confounders. Results: There were 3416 incident TURPs among 106 769 men (median follow-up 5.8 years), with rates of 1.8, 5.3, 9.1 and 11.4/1000 person-years for ages 45-54, 55-64, 65-74 and ≥75 years, respectively. Age-adjusted rates of TURP varied markedly according to baseline LUTS from 2.2/1000 person-years with no/mild symptoms to 30.7/1000 person-years with severe symptoms. Annual household income ≥$70 000 versus <$20 000, having private health insurance and living in major cities were associated with higher TURP rates; there were no significant differences according to baseline diabetes, stroke, high blood pressure or cardiovascular disease. Men reporting severe versus no physical functioning limitation, high versus low psychological distress or poor versus excellent self-rated health were 36-51% more likely to undergo procedures overall, but were 24-37% less likely to undergo procedures following additional adjustment for need (baseline LUTS). Conclusion: TURP rates were most strongly related to baseline LUTS and age, consistent with appropriate health services targeting. Lower TURP rates in men experiencing socioeconomic disadvantage and with poor health/disability, after accounting for baseline LUTS, suggest inequity and factors such as frailty and risks related to surgery.By the NHMRC Centre for Research Excellence in Medicines and Ageing. EB is supported by the NHMRC