Breathlessness is not a normal part of aging: Development and testing of asthma awareness messages for older Australians

At least 420,000 Australian adults aged 55 years and over, or one in 10, currently have asthma (Australian Centre for Asthma Monitoring 2008). Asthma is under-diagnosed, often misdiagnosed, and undertreated in the older adult population in Australia (Gibson, McDonald and Marks 2010, Marks and Poulos 2005, Wilson et al 2001) as it is overseas. Contrary to the perception that asthma is a childhood disease, asthma can develop in older adults (Adams and Ruffin 2005). The risk of dying from asthma increases with age (AIHW 2010). While the overall mortality rate has decreased by almost 70% since 1989, much of this could be attributed to health promotion efforts directed largely at children and their parents and caregivers (Australian Centre for Asthma Monitoring 2008). In addition, the effects of asthma on quality of life lead to a significant asthma burden. Around 70% of the asthma burden in older adults is due to years lost on account of disability (Australian Institute for Health and Welfare 2010). Previous qualitative research has shown that older adults perceive that asthma is not serious and would not impact their lives (Andrews and Jones 2009)

Electronic discharge summary driving advice: current practice and future directions

BackgroundDriving is a complex task. Many older drivers are unaware of their obligation to inform authorities of conditions which may impact upon their driving safety.  AimsThis study sought to establish the adequacy of driving advice in electronic discharge summaries from an Australian stroke unit.MethodOne month of in-patient electronic discharge summaries were reviewed. A predetermined list of items was used to assess each electronic discharge summary: age; gender; diagnosis; relevant co-morbidities; deficit at time of discharge; driving advice; length of stay; and discharge destination.ResultsOf 41 participants, the mean age was 72 years. Twenty patients had a discharge diagnosis of stroke, nine of transient ischaemic attack, four of seizure and one of encephalitis. Of these, only eight discharge summaries included driving advice.ConclusionThe documentation of driving advice in electronic discharge summaries is poor. This has important public health, ethical and medico-legal implications. Avenues for future research are explore

“Body bags ready”: Print media coverage of avian influenza in Australia

In 2006 the avian influenza A (H5N1) virus received considerable media coverage in Australia, as it did in many other countries. It is often argued that the media sensationalizes health crises, and experts cautioned about the risk of panic as a result of fear of avian influenza. The purpose of the present study was to systematically analyze Australian print media coverage of avian influenza in 2006 and to examine whether this coverage served the purpose of informing, rather than alarming, the general public. For the period January 1, 2006 to December 31, 2006, 20 Australian newspaper titles were monitored for coverage of avian influenza. The identified articles were analyzed using aspects of protection motivation theory for theoretical direction to determine whether there were any consistent themes or perspectives in the coverage. A total of 850 articles were identified for analysis. Concerning vulnerability, 46% of articles reported the incidence of human cases, with 24% noting that avian influenza was a potential threat to Australia. The most common severity theme was “deadly” with over 50% of mentions, followed by “pandemic” with 35%. Only 11% of articles referred to any form of self-protection. We found that a considerable proportion of the articles reporting on avian influenza were framed in a way that had the potential to incite fear and panic amongst the public; the intensity of media coverage reduced over time; and, of particular concern, that there was little media coverage that focused on protective or preventative issues. Whether an influenza pandemic eventuates or not, it is prudent for governments and health authorities to continually develop appropriate resources and strategies to prepare the health system and the general public to respond to current, and future, infectious disease risks

The Telehealth Skills, Training, and Implementation Project: An evaluation protocol

External stabilization is reported to improve reliability of hand held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry. Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to four weeks. Within session reliability was assessed using intraclass correlations calculated for within session data grouped prior to surgery, immediately after surgery and in the sub-acute phase of injury. Minimum detectable differences were also calculated. In the same timeframe categories, construct validity was explored using regression analysis incorporating burn severity and demographic characteristics. Thirty-eight participants with total burn surface area 5 – 40% were recruited. Reliability was determined to be clinically applicable for the assessment method (intraclass correlation coefficient \u3e0.75) at all phases after injury. Muscle strength was associated with sex and burn location during injury and wound healing. Burn size in the immediate period after surgery and age in the sub-acute phase of injury were also associated with muscle strength assessment results. Hand held dynamometry is a reliable assessment tool for evaluating within session muscle strength in the acute and sub-acute phase of injury in burns up to 40% total burn surface area. External stabilization may assist to eliminate reliability issues related to patient and assessor strength

Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time

The impacts of increasing drought on forest dynamics, structure, and biodiversity in the United States

We synthesize insights from current understanding of drought impacts at stand‐to‐biogeographic scales, including management options, and we identify challenges to be addressed with new research. Large stand‐level shifts underway in western forests already are showing the importance of interactions involving drought, insects, and fire. Diebacks, changes in composition and structure, and shifting range limits are widely observed. In the eastern US, the effects of increasing drought are becoming better understood at the level of individual trees, but this knowledge cannot yet be confidently translated to predictions of changing structure and diversity of forest stands. While eastern forests have not experienced the types of changes seen in western forests in recent decades, they too are vulnerable to drought and could experience significant changes with increased severity, frequency, or duration in drought. Throughout the continental United States, the combination of projected large climate‐induced shifts in suitable habitat from modeling studies and limited potential for the rapid migration of tree populations suggests that changing tree and forest biogeography could substantially lag habitat shifts already underway. Forest management practices can partially ameliorate drought impacts through reductions in stand density, selection of drought‐tolerant species and genotypes, artificial regeneration, and the development of multistructured stands. However, silvicultural treatments also could exacerbate drought impacts unless implemented with careful attention to site and stand characteristics. Gaps in our understanding should motivate new research on the effects of interactions involving climate and other species at the stand scale and how interactions and multiple responses are represented in models. This assessment indicates that, without a stronger empirical basis for drought impacts at the stand scale, more complex models may provide limited guidance.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134257/1/gcb13160_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134257/2/gcb13160.pd

The Influence of Reproductive Experience on Milk Energy Output and Lactation Performance in the Grey Seal (Halichoerus grypus)

Although evidence from domestic and laboratory species suggests that reproductive experience plays a critical role in the development of aspects of lactation performance, whether reproductive experience may have a significant influence on milk energy transfer to neonates in wild populations has not been directly investigated. We compared maternal energy expenditures and pup growth and energy deposition over the course of lactation between primiparous and fully-grown, multiparous grey seal (Halichoerus grypus) females to test whether reproductive experience has a significant influence on lactation performance. Although there was no difference between primiparous females in milk composition and, thus, milk energy content at either early or peak lactation primiparous females had a significantly lower daily milk energy output than multiparous females indicating a reduced physiological capacity for milk secretion

Jellyfish Support High Energy Intake of Leatherback Sea Turtles (Dermochelys coriacea): Video Evidence from Animal-Borne Cameras

The endangered leatherback turtle is a large, highly migratory marine predator that inexplicably relies upon a diet of low-energy gelatinous zooplankton. The location of these prey may be predictable at large oceanographic scales, given that leatherback turtles perform long distance migrations (1000s of km) from nesting beaches to high latitude foraging grounds. However, little is known about the profitability of this migration and foraging strategy. We used GPS location data and video from animal-borne cameras to examine how prey characteristics (i.e., prey size, prey type, prey encounter rate) correlate with the daytime foraging behavior of leatherbacks (n = 19) in shelf waters off Cape Breton Island, NS, Canada, during August and September. Video was recorded continuously, averaged 1:53 h per turtle (range 0:08–3:38 h), and documented a total of 601 prey captures. Lion's mane jellyfish (Cyanea capillata) was the dominant prey (83–100%), but moon jellyfish (Aurelia aurita) were also consumed. Turtles approached and attacked most jellyfish within the camera's field of view and appeared to consume prey completely. There was no significant relationship between encounter rate and dive duration (p = 0.74, linear mixed-effects models). Handling time increased with prey size regardless of prey species (p = 0.0001). Estimates of energy intake averaged 66,018 kJ•d−1 but were as high as 167,797 kJ•d−1 corresponding to turtles consuming an average of 330 kg wet mass•d−1 (up to 840 kg•d−1) or approximately 261 (up to 664) jellyfish•d-1. Assuming our turtles averaged 455 kg body mass, they consumed an average of 73% of their body mass•d−1 equating to an average energy intake of 3–7 times their daily metabolic requirements, depending on estimates used. This study provides evidence that feeding tactics used by leatherbacks in Atlantic Canadian waters are highly profitable and our results are consistent with estimates of mass gain prior to southward migration