The impact of socioeconomic status on arthritis and osteoporosis

Background: Low socioeconomic status has been shown to be associated with both osteoarthri s and rheumatoid arthri s, impac ng on outcomes and even the development of arthri s. However the associa on with osteoporosis has been less clear. The reasons for the associa on may be linked to socioeconomic status through educa onal aspects, income, employment type and even area of residence. Purpose: The purpose of this study was use a monthly surveillance and monitoring system to examine the prevalence of self-reported osteoarthri s, rheumatoid arthri  s and osteoporosis over  me and the associa  on with measures of socioeconomic status

A Population Study of 5 to 15 Year Olds: Full Time Maternal Employment not Associated with High BMI. The Importance of Screen-Based Activity, Reading for Pleasure and Sleep Duration in Children’s BMI

To describe the relationship between maternal full time employment and health-related and demographic variables associated with children aged 5–15 years, and the factors associated with child overweight/obesity. Data from a chronic disease and risk factor surveillance system were limited to children aged 5–15 years whose mothers responded on their behalf (n = 641). Univariate/multivariate analyses described the differences between mothers who did and did not work full time. The same data were analysed comparing children who are overweight/obese against those with a normal BMI. The children of mothers who worked full time are more likely to be older, live in a household with a higher household income, be an only child or have one sibling or other child in the household, have a sole mother family structure and not spend any time reading for pleasure. No relationship was found between maternal employment and BMI. Compared with children of normal weight, those who were overweight/obese were more likely to spend no time studying, spend more than 2 h per day in screen-based activity and sleep less than 10 h per night. Child BMI status was not related to maternal employment. Although this analysis included eight diet related variables none proved to be significant in the final models.This study has shown that mothers’ working status is not related to children’s BMI. The relationship between overweight/obesity of children and high levels of screen-based activity, low levels of studying, and short sleep duration suggests a need for better knowledge and understanding of sedentary behaviours of children

Influencing cancer screening participation rates - providing a combined cancer screening program (a 'One Stop' shop) could be a potential answer

Introduction: Participation in established cancer screening programs remains variable. Therefore, a renewed focus on how to increase screening uptake, including addressing structural barriers such as time, travel, and cost is needed. One approach could be the provision of combined cancer screening, where multiple screening tests are provided at the same time and location (essentially a 'One Stop' screening shop). This cohort study explored both cancer screening behavior and the acceptability of a combined screening approach. Methods: Participants of the North Western Adelaide Health Study (NWAHS), South Australia were invited to participate in a questionnaire about cancer screening behaviors and the acceptability of a proposed 'One Stop' cancer screening shop. Data were collected from 10th August 2015 to 18th January 2016, weighted for selection probability, age, and sex and analyzed using descriptive and multivariable logistic regression analysis. Results: 1,562 people, 52% female (mean age 54.1 years ± 15.2) participated. Reported screening participation was low, the highest being for Pap Smear (34.4%). Common reasons for screening participation were preventing sickness (56.1%, CI 53.2-59.0%), maintaining health (51%, CI 48-53.9%), and free program provision (30.9%, CI 28.2-33.6%). Females were less likely to state that screening is not beneficial [OR 0.37 (CI 0.21-0.66), p < 0.001] and to cite sickness prevention [OR 2.10 (CI 1.46-3.00), p < 0.001] and free program [OR 1.75 (CI 1.22-2.51), p < 0.003] as reasons for screening participation. Of those who did not participate, 34.6% (CI 30.3-39.1%) stated that there was nothing that discouraged them from participation, with 55- to 64-year olds [OR 0.24 (CI 0.07-0.74), p < 0.04] being less likely to cite this reason. 21% (CI 17.2-24.8%) thought they did not need screening, while a smaller proportion stated not having time (6.9%, CI 4.9-9.7%) and the costs associated with screening (5.2%, CI 3.5-7.7%). The majority of participants (85.3%, CI 81.9-88.2%) supported multiple screening being offered at the same time and location. Conclusion: Identified screening behaviors in this study are similar to those reported in the literature. The high support for the concept of combined cancer screening demonstrates that this type of approach is acceptable to potential end users and warrants further investigation.Amanda Bobridge, Kay Price, Tiffany K. Gill and Anne W. Taylo

Differences in risk factors and chronic conditions between informal (family) carers and non-carers using a population-based cross-sectional survey in South Australia

Background: There is growing discussion on the impact of informal caregiving on the health status and morbidity of family carers. Evidence suggests a proportion of carers may be at risk of poor health outcomes. However, there are limited population-based studies that provide representative data on specific risk factors among carers (eg, blood pressure, cholesterol, smoking status, activity and body mass index) and major chronic conditions (eg, asthma, diabetes and arthritis). This study aimed to redress that imbalance. Method: Self-reported data were from the South Australian Monitoring and Surveillance System (SAMSS), a representative cross-sectional state-wide population-based survey of 600 randomly selected persons per month. SAMSS uses computer-assisted telephone interviewing (CATI) to monitor chronic health-related problems and risk factors and to assess health outcomes. In total, 2247 family carers were identified from 35 195 participants aged 16 years and older for the 5-year period from 2010 to 2015. Logistic regression analyses examined associations of being a carer with self-reported chronic diseases and health risk factors. In addition, the population attributable risk (PAR) of being a carer was examined for selected chronic conditions. Results: The prevalence of carers was 6.4%, and peak age group for carers was 50-59 years. Adjusted ORs for chronic conditions in carers were significant for all chronic conditions examined. Although there is a high prevalence of self-reported risk factors and chronic conditions among carers compared with non-carers at the population level, PAR findings suggest that caregiving is associated with a small to moderate increased risk of having these chronic conditions. Conclusions: Monitoring of carer health and morbidity particularly 'at risk' individuals such as female carers with asthma or diabetes remains important and provides an ongoing baseline for future surveys. To achieve this, caregiver-based studies need to become part of mainstream biomedical research at both epidemiological and clinical levels.Anne F Stacey, Tiffany K Gill, Kay Price, Anne W Taylo

Access to interpreting services in England: secondary analysis of national data

Background: Overcoming language barriers to health care is a global challenge. There is great linguistic diversity in the major cities in the UK with more than 300 languages, excluding dialects, spoken by children in London alone. However, there is dearth of data on the number of non-English speakers for planning effective interpreting services. The aim was to estimate the number of people requiring language support amongst the minority ethnic communities in England. Methods: Secondary analysis of national representative sample of subjects recruited to the Health Surveys for England 1999 and 2004. Results: 298,432 individuals from the four main minority ethnic communities (Indian, Pakistani, Bangladeshi and Chinese) who may be unable to communicate effectively with a health professional. This represents 2,520,885 general practice consultations per year where interpreting services might be required. Conclusion: Effective interpreting services are required to improve access and health outcomes of non-English speakers and thereby facilitate a reduction in health inequalities

Oral complementary medicine and alternative practitioner use varies across chronic conditions and attitudes to risk

Objectives: To determine whether chronic conditions and patient factors, such as risk perception and decision-making preferences, are associated with complementary medicine and alternative practitioner use in a representative longitudinal population cohort. Participants and setting: Analysis of data from Stage 2 of the North West Adelaide Health Study of 3161 adults who attended a study clinic visit in 2004–2006. The main outcome measures were the medications brought by participants to the study clinic visit, chronic health conditions, attitudes to risk, levels of satisfaction with conventional medicine, and preferred decision-making style. Results: At least one oral complementary medicine was used by 27.9% of participants, and 7.3% were visiting alternative practitioners (naturopath, osteopath). Oral complementary medicine use was significantly associated with arthritis, osteoporosis, and mental health conditions, but not with other chronic conditions. Any pattern of complementary medicine use was generally significantly associated with female gender, age at least 45 years, patient-driven decision-making preferences(odds ratio [OR] 1.38, 95% confidence interval [CI]: 1.08–1.77), and frequent general practitioner visits (.five per year; OR 3.62, 95% CI: 2.13–6.17). Alternative practitioner visitors were younger, with higher levels of education (diploma/trade [OR 1.88, 95% CI: 1.28–2.76], bachelor’s degree [OR 1.77, 95% CI: 1.11–2.82], income . $80,000 (OR 2.28, 95% CI: 1.26–4.11), female gender (OR 3.15, 95% CI: 2.19–4.52), joint pain not diagnosed as arthritis (OR 1.68, 95% CI: 1.17–2.41), moderate to severe depressive symptoms (OR 2.15, 95% CI: 1.04–4.46), and risk-taking behaviour (3.26, 1.80–5.92), or low-to-moderate risk aversion (OR 2.08, 95% CI: 1.26–4.11). Conclusion: Although there is widespread use of complementary medicines in the Australian community, there are differing patterns of use between those using oral complementary medicines and those using alternative practitioners.Robert J Adams, Sarah L Appleton, Antonia Cole, Tiffany K Gill, Anne W Taylor and Catherine L Hil

Multimorbidity - not just an older person's issue. Results from an Australian biomedical study

Background Multimorbidity, the simultaneous occurrence of two or more chronic conditions, is usually associated with older persons. This research assessed multimorbidity across a range of ages so that planners are informed and appropriate prevention programs, management strategies and health service/health care planning can be implemented. Methods Multimorbidity was assessed across three age groups from data collected in a major biomedical cohort study (North West Adelaide Health Study). Using randomly selected adults, diabetes, asthma, and chronic obstructive pulmonary disease were determined clinically and cardio-vascular disease, osteoporosis, arthritis and mental health by self-report (ever been told by a doctor). A range of demographic, social, risk and protective factors including high blood pressure and high cholesterol (assessed bio-medically), health service use, quality of life and medication use (linked to government records) were included in the multivariate modelling. Results Overall 4.4% of the 20-39 year age group, 15.0% of the 40-59 age group and 39.2% of those aged 60 years of age or older had multimorbidity (17.1% of the total). Of those with multimorbidity, 42.1% were aged less than 60 years of age. A variety of variables were included in the final logistic regression models for the three age groups including family structure, marital status, education attainment, country of birth, smoking status, obesity measurements, medication use, health service utilisation and overall health status. Conclusions Multimorbidity is not just associated with older persons and flexible care management support systems, appropriate guidelines and care-coordination programs are required across a broader age range. Issues such as health literacy and polypharamacy are also important considerations. Future research is required into assessing multimorbidity across the life course, prevention of complications and assessment of appropriate self-care strategies.Anne W Taylor, Kay Price, Tiffany K Gill, Robert Adams, Rhiannon Pilkington, Natalie Carrangis, Zumin Shil and David Wilso

Relationship of social factors including trust, control over life decisions, problems with transport and safety, to psychological distress in the community

PURPOSE: Psychological distress encompasses anxiety and depression with the previous studies showing that psychological distress is unequally distributed across population groups. This paper explores the mechanisms and processes which may affect the distribution of psychological distress, including a range of individual and community level socioeconomic determinants. METHODS: Representative cross-sectional data was collected for respondents aged 16+ from July 2008 to June 2009, as a part of the South Australian Monitoring and Surveillance System (SAMSS) using Computer Assisted Telephone Interviews (CATI). Univariate and multivariate analyses (n = 5,763) were conducted to investigate the variables that were associated with psychological distress. RESULTS: The overall prevalence of psychological distress was 8.9%. In the multivariate model, females, those aged 16–49, respondents single with children, unable to work or unemployed, with a poorer family financial situation, earning $20,000 or less, feeling safe in their home some or none of the time, feeling as though they have less then total control over life decisions and sometimes experiencing problems with transport, were significantly more likely to experience psychological distress. CONCLUSIONS: This paper has demonstrated the relationship between low-income, financial pressure, less than optimal safety and control, and high-psychological distress. It is important that the groups highlighted as vulnerable be targeted in policy, planning, and health promotion and prevention campaigns