Workplace injuries in thoroughbred racing : an analysis of insurance payments and injuries amongst jockeys in Australia from 2002 to 2010

Background: There is no comprehensive study of the costs of horse-related workplace injuries to Australian Thoroughbred racing jockeys. Objectives: To analyse the characteristics of insurance payments and horse-related workplace injuries to Australian jockeys during Thoroughbred racing or training. Methods: Insurance payments to Australian jockeys and apprentice jockeys as a result of claims for injury were reviewed. The cause and nature of injuries, and the breakdown of payments associated with claims were described. Results: The incidence of claims was 2.1/1000 race rides, with an average cost of AUD 9 million/year. Race-day incidents were associated with 39% of claims, but 52% of the total cost. The mean cost of race-day incidents (AUD 33,756) was higher than non-race day incidents (AUD 20,338). Weekly benefits and medical expenses made up the majority of costs of claims. Fractures were the most common injury (29.5%), but head injuries resulting from a fall from a horse had the highest mean cost/claim (AUD 127,127). Conclusions: Costs of workplace injuries to the Australian Thoroughbred racing industry have been greatly underestimated because the focus has historically been on incidents that occur on race-days. These findings add to the evidence base for developing strategies to reduce injuries and their associated costs

Associations between the perceived environment and physical activity among adults aged 55-65 years : does urban-rural area of residence matter?

This study aimed to determine whether associations between the perceived environment and physical activity are moderated by urban-rural status among midolder aged adults. Environmental (safety, aesthetics, physical activity environment) and physical activity (total, leisure, transport) data from 3,888 adults (55 to 65 years) from urban and rural areas of Victoria, Australia, were analyzed. Multinomial logistic regression examined interactions between urban-rural status and environments in associations with physical activity. Significant (P < .05) interactions were evident and indicated positive associations only among older rural adults for both safety and aesthetics with total and transport physical activity (e.g., rural adults reporting higher safety were 91% to 118% more likely to have higher activity than rural adults reporting low safety). In contrast, the physical activity environment was positively associated with leisure activity among only urban adults. Findings suggest that some tailoring of physical activity promotion strategies targeting the environment may be required for urban and rural midolder aged adults

An Exploratory Study: A head-to-head comparison of the EQ5D-5L and AQoL-8D for long-term publicly waitlisted bariatric surgery patients before and 3 months after bariatric surgery

Background: Choice of a multi-attribute utility instrument (MAUI) that appropriately assesses an intervention's health-related quality-of-life (HRQoL) impacts is a vital part of healthcare resource allocation and clinical assessment.Objective: Our exploratory study compared the EuroQol (EQ)-5D-5L and Assessment of Quality of Life (AQoL)-8D MAUIs, which were used to assess the effect of bariatric surgery for a cohort of long-term publicly waitlisted, severely obese patients.Methods: The study was conducted at the Hobart Private Hospital (Tasmania, Australia). To compare the sensitivity and instrument content of the two MAUIs, we used dimensional comparisons by investigating the distribution of patient-reported responses (number/percentage) across the MAUIs' levels and dimensions; summary health-state utility valuations (utilities); and individual/super-dimension scores (AQoL-8D) to investigate discriminatory power and HRQoL improvements preoperatively and 3 months postoperatively.Results: Participants' (n = 23) overall MAUI completion rate was 74%. Postoperative total weight loss was 9.9%. EQ-5D-5L utilities were relatively higher pre- and postoperatively than AQoL-8D utilities [mean standard deviation (SD) EQ-5D-5L 0.70 (0.25) to 0.80 (0.25); AQoL-8D 0.51 (0.24) to 0.61 (0.24)]. AQoL-8D Psychosocial super dimension was relatively low postoperatively [0.37 (0.25)], driving the instrument's lower utility. These results were supported by the dimensional comparisons that revealed an overall greater dispersion for the AQoL-8D. Nevertheless, there were clinical improvements in utilities for both instruments. AQoL-8D utilities were lower than population norms; not so the EQ-5D-5L utilities. The AQoL-8D dimensions of Happiness, Coping, and Self-worth improved the most.Conclusions: AQoL-8D more fully captured the impact of obesity and bariatric surgery on HRQoL (particularly psychosocial impacts) for long-term waitlisted bariatric surgery patients, even 3 months postoperatively. AQoL-8D preoperative utility revealed our population's HRQoL was lower than people with cancer or heart disease

Associations between partnering and parenting transitions and dietary habits in young adults

Background Partnering and parenting are important life-stage transitions that often occur during young adulthood. Little is known about how these transitions affect two dietary behaviors linked to increased cardiometabolic disease risk: skipping breakfast and takeaway-food consumption. Objective Our aim was to examine whether partnering and parenting transitions during a 5-year period were associated with change in diet quality, skipping breakfast, and takeaway-food consumption. Design We conducted a cohort study. Questionnaires were completed at baseline (2004 to 2006) and follow-up (2009 to 2011). Marital status and number of children were self-reported. Participants/setting Australian participants (n=1,402 [39% men]) aged 26 to 36 years were included. Main outcomes measures Diet quality was assessed using a Dietary Guideline Index. Breakfast skipping (not eating before 9 am the previous day) and frequent takeaway-food consumption (≥2 times/week) were reported. Statistical analysis Linear regression (mean differences in Dietary Guideline Index) and log binomial regression (relative risks for skipping breakfast and frequent takeaway-food consumption) were adjusted for age, education, follow-up duration, day of the week (skipping breakfast only), the other transition, and baseline behavior. Results During the 5-year follow-up, 101 men and 93 women became married/living as married, and 149 men and 155 women had their first child. Diet quality improved among all groups and was similar at follow-up between those who experienced the transitions and those who did not. Compared to having no children, having a first child was associated with a lower risk of skipping breakfast for men (relative risk 0.65; 95% CI 0.42 to 1.01) and women (relative risk 0.47; 95% CI 0.31 to 0.72). Men who became partnered also had a lower risk of skipping breakfast than those who remained single (relative risk 0.64; 95% CI 0.42 to 0.98). The transitions were not significantly associated with takeaway-food consumption. Conclusions Life-stage transitions were not associated with better diet quality. Participants who became partnered or parents were more likely to eat breakfast at follow-up than those who remained single or had no children

Depression and Insulin Resistance: Cross-sectional associations in young adults

OBJECTIVE - To examine the association between depressive disorder and insulin resistance in a sample of young adults using the Composite International Diagnostic Interview to ascertain depression status. RESEARCH DESIGN AND METHODS - Cross-sectional data were collected on 1,732 participants aged between 26 and 36 years. Insulin resistance was derived from blood chemistry measures of fasting insulin and glucose using the homeostatis model assessment method. Those identified with mild, moderate or severe depression were classified as having depressive disorder. RESULTS - The 12 month prevalence of depressive disorder was 5.4% among men and 11.7% among women. In unadjusted models mean insulin resistance was 17.2% (95% CI 0.7-36.0%, P = 0.04) higher in men and 11.4%(1.5-22.0%, P=0.02) higher in women with depressive disorder. After adjustment for behavioral and dietary factors, the increased level of insulin resistance associated with depressive disorder was 13.2% (-3.1 to 32.3%, P = 0.12) in men and 6.1% (-4.1 to 17.4%, P - 0.25) in women. Waist circumference was identified as a mediator in the relationship between depression and insulin resistance, reducing the β coefficient in the fully adjusted models in men by 38% and in women by 42%. CONCLUSIONS - A positive association was found between depressive disorder and insulin resistance in this population-based sample of young adult men and women. The association seemed to be mediated partially by waist circumference

Principal Findings of the Invasive Blood Pressure Meta-Analysis Consortium (Inspect) on the Accuracy of Brachial Cuff Blood Pressure Devices

OBJECTIVE: Accurate measurement of blood pressure (BP) is crucial for hypertension management. Accuracy of brachial cuff (B_CUFF) devices to measure invasive (intra-arterial) BP at the brachial artery (B_INV) and aorta (A_INV) has never been systematically assessed. This study aimed to determine the: 1) relationship between B_INV and A_INV; 2) accuracy of B_CUFF devices to estimate invasive BP and; 3) accuracy of B_CUFF devices to classify BP thresholds. DESIGN AND METHOD: Three individual patient meta-analyses (by search of online databases and systematic review supplemented by measurements in a tertiary hospital cardiac catheterization laboratory) were performed to determine: 1) B_INV versus A_INV BP; 2) B_CUFF versus B_INV BP and A_INV BP and; 3) B_CUFF for BP classification versus invasive BP. RESULTS: Most subjects (90%) were patients undergoing cardiac catheterization (total N = 3004; mean age 58.7 years, 95%CI [54.0, 63.4], 68% male). As shown in the table: 1) B_INV systolic BP (SBP) was significantly higher than A_INV SBP whilst A_INV diastolic BP (DBP) was slightly higher than B_INV DBP. 2) B_CUFF underestimated B_INV SBP and overestimated B_INV DBP. The mean difference between B_CUFF SBP and A_INV SBP was small, whilst B_CUFF DBP overestimated A_INV DBP. However, according to mean absolute difference, B_CUFF and A_INV showed poor agreement. 3) B_CUFF correctly classified 31.1/28.4% of high-normal (SBP 130–139 mmHg), 54.2/52.6% of grade I (SBP 140–159 mmHg) and 45.2/50.3% of grade II (SBP 160–179 mmHg) hypertension cases, using B_INV/A_INV, respectively, as the reference. Correct classification was more frequent for SBP B_CUFF values 75%). CONCLUSIONS: While recognising the clinical importance of B_CUFF devices, there is wide variability in device accuracy for measuring intra-arterial BP. Although B_CUFF devices are reasonable for correctly classifying BP at low and very high BP thresholds, more accurate B_CUFF devices in the high-normal BP to grade II hypertension range should improve hypertension management

Workplace Health Promotion and Mental Health: Three-Year Findings from Partnering Healthy@Work

This study aimed to investigate the association between mental health and comprehensive workplace health promotion (WHP) delivered to an entire state public service workforce (~28,000 employees) over a three-year period. Government departments in a state public service were supported to design and deliver a comprehensive, multi-component health promotion program, Healthy@Work, which targeted modifiable health risks including unhealthy lifestyles and stress. Repeated cross-sectional surveys compared self-reported psychological distress (Kessler-10; K10) at commencement (N = 3406) and after 3 years (N = 3228). WHP availability and participation over time was assessed, and associations between the K10 and exposure to programs estimated. Analyses were repeated for a cohort subgroup (N = 580). Data were weighted for non-response. Participation in any mental health and lifestyle programs approximately doubled after 3 years. Both male and female employees with poorer mental health participated more often over time. Women's psychological distress decreased over time but this change was only partially attributable to participation in WHP, and only to lifestyle interventions. Average psychological distress did not change over time for men. Unexpectedly, program components directly targeting mental health were not associated with distress for either men or women. Cohort results corroborated findings. Healthy@Work was successful in increasing participation across a range of program types, including for men and women with poorer mental health. A small positive association of participation in lifestyle programs with mental health was observed for women but not men. The lack of association of mental health programs may have reflected program quality, its universality of application or other contextual factors