Prevalence of atrial fibrillation in a regional Victoria setting, findings from the crossroads studies (2001–2003 and 2016–2018)

Objective: To estimate the prevalence of atrial fibrillation (AF) in regional Victoria at two time points (2001-2003 and 2016-2018), and to assess the use of electrocardiogram rhythm strips in a rural, community-based study for AF investigation. Design: Repeated cross-sectional design involving survey of residents of randomly selected households and a clinic. Predictors of AF were assessed using Firth penalised logistic regression, as appropriate for rare events. Setting: Goulburn Valley, Victoria. Participants: Household residents aged >= 16years. Non-pregnant participants aged 18+ were eligible for the clinic. Main outcome measures: Atrial fibrillation by 12 lead electrocardiogram (earlier study) or electrocardiogram rhythm strip (AliveCor (R) device) (recent study). Results: The age standardised prevalence of AF was similar between the two studies (1.6% in the 2001-2003 study and 1.8% in the 2016-2018 study, 95% confidence interval of difference -0.010, 0.014, p = 0.375). The prevalence in participants aged >= 65years was 3.4% (1.0% new cases) in the recent study. Predictors of AF in the earlier study were male sex, older age and previous stroke, while in the recent study they were previous stroke and self-reported diabetes. AliveCor (R) traces were successfully classified by the in-built algorithm (91%) vs physician (100%). Conclusion: The prevalence of AF among community-based participants in regional Victoria was similar to predominantly metropolitan-based studies, and was unchanged over time despite increased rates of risk factors. Electrocardiogram rhythm strip investigation was successfully utilised, and particularly benefited from physician overview

Hearing loss and access to audiology services in rural Victoria : findings from the crossroads study

Context: Rural residents can be exposed to high levels of agricultural machinery noise and are at risk of hearing loss. Aims: This study aimed to determine audiology service use and rates of hearing loss in a regional area of Australia, using both self-report and audiology testing. Setting and Design: A survey of randomly selected households was undertaken and 6432 participants were interviewed face to face about their health, hearing, and use of audiology services. A total of 1454 participants were randomly selected to undertake standard audiology testing. Material and Methods: Material Hearing was evaluated using conventional audiometry. Statistical Analysis Used: Independent t-tests, cChi-squared tests, and logistic regression were used to examine the association amongbetween hearing loss, use of audiology services, and demographic factors. Results: Hearing issues were present in 12.5% of the survey participants. The rate of hearing loss increased significantly with age. Males were significantly more likely to have hearing loss than females (9.5% vs. 5.2%, pP << 0.01). The majority of people who reported accessing audiology services in the past 12 months were satisfied with the care they received (85.2%), and experienced short waiting times for these services (68.2% waited ≤≤ 7 days). Conclusions: Males had higher rates of hearing issues than females in this rural area. Audiology services in the region were accessible within short waiting times, and clients were satisfied with the service

Changes in prevalence of diabetes over 15 years in a rural Australian population : the Crossroads studies

Aims: Secular trends in diabetes prevalence vary globally. We compared the prevalence of diabetes in two surveys 15 years apart in rural Australia. Method: Two cross-sectional household surveys and clinics (biomedical assessments including oral glucose tolerance tests (OGTTs)) in 2001–2003 (Crossroads) and 2016–2018 (Crossroads-II). Setting: Four rural Victorian towns. Participants: Residents of randomly selected households (Crossroads (n = 5258), Crossroads-II (n = 2649)) with nested clinic assessments for randomly selected participants (n = 1048 and 736 respectively). Response rate 61%. Main outcome measures: Self-reported diagnosed diabetes, screening history, and diabetes defined by OGTT. Results: The age standardised prevalence of diagnosed diabetes increased from 5.0(4.4–5.7)% to 7.7(6.7–8.6)%, with crude prevalence increasing overall (5.4 to 10.4% p < 0.001), in the smaller towns (5.4 to 11.1% p = 0.001) and, the regional centre (4.1 to 7.3% p < 0.001). Screening for diabetes over the previous two years increased (rural towns 49.8 to 63.8%; regional centre 44.9 to 63.6%; both p < 0.001). The proportion of undiagnosed diabetes was 23.2% in 2003 and 13.7% in 2018. The age and sex adjusted change in total diabetes was (1.15(0.84–1.59)). Central obesity (adjusted odd ratio 1.28(1.00–1.64)) but not overall obesity (adjusted odd ratio 1.17(0.95–1.46)) increased over time. Conclusions: Over 15 years, the crude prevalence of diagnosed diabetes increased while the age and sex adjusted total diabetes prevalence did not change significantly. The epidemic may be slowing in some settings

Prevalence of Hepatitis C and treatment uptake in regional Victoria

Objective: The objective of this study was to assess the prevalence of hepatitis C virus (HCV) in regional Victoria and assess amenability to treatment. Methods: Households were randomly selected and one adult from each was invited to a ‘clinic’, which included HCV, liver function and liver stiffness/fibrosis tests. Participants reactive to HCV were asked about their amenability to treatment. Results: The study identified eight cases of HCV (antibody and PCR reactive, 1.1%) among 748 participants, half of which were new diagnoses. Most of the HCV-reactive participants were male (89%). Liver function and fibrosis were not significantly different between HCV-reactive and non-reactive participants. Most participants notified of their HCV were amenable to treatment. Conclusions: The prevalence of HCV in this regional Victorian study (1.1%) was similar to the Australian modelled prevalence estimates. Most participants were amenable to treatment. Implications for public health: The unique opportunity to eliminate HCV requires a reorientation of the public health response toward systematic implementation of treatment to address barriers and reduce stigma and discrimination for marginalised populations. This should include targeting regional areas where the HCV prevalence of undiagnosed cases may be higher than metropolitan areas

Self-reported skin cancer-related behaviours in rural Victoria : results from repeat cross-sectional studies in 2001-2003 and 2016-2018

Objective: To assess whether self-reported use of sun-protective measures and skin examination have changed between 2001 and 2018 in a rural setting. Methods: Repeat cross-sectional survey of randomly selected households in four rural Victorian towns. People aged 16 years and older were eligible to participate. Logistic regression was used to identify demographic factors associated with sun-protective measures and skin examination. Results: Overall, 5,328 participated in 2001–2003 and 2,680 in 2016–2018. Among participants who go out in the sun, the mean number of reported sun-protective measures (2.6±1.3 vs. 2.6±1.6, p=0.867) and the proportion of participants reporting usually/always using sun protection (65.1% vs. 63.9%, p=0.307) were unchanged between the two surveys. However, an increased proportion of participants reported avoiding the sun when outdoors in the more recent survey (from 18.8% to 34.3%, p<0.001). Avoiding the sun was associated with being older, female, of European origin and having post-secondary school education. Skin examination rates increased between the two surveys (32.7% to 40.8%, p<0.001). Skin examinations were associated with older age groups, European origin and post-secondary school education and being male. Conclusions: Given the small changes in sun protection over time, updated skin cancer campaigns are needed to encourage increased sun-protective behaviours and skin examinations among rural residents. Implications for public health: Results suggest that updated health promotion campaigns targeted to rural areas are warranted

Patterns of use of oral health care services in Australian rural adults : the Crossroads-II Dental sub-study

Background: As part of a larger study, the Crossroads-II Dental sub-study determined the patterns of, and barriers to, oral health care service utilization in a rural area of Victoria. Methods: In this cross-sectional sub-study predisposing, enabling, needs-related, and oral health variables were considered in association with patterns of oral health care utilization. A logistic regression was performed to explain the use of oral health care services. Results: Overall, 574 adults participated, with 50.9% reporting having visited an oral health care service in the previous 12 months. Age, number of chronic health conditions and holding a health card; were associated with increased visit to a dentist (OR = 1.01; 95% CI: 1.00–1.03; OR = 1.08; 95% CI: 1.01–1.16; OR = 2.06; 95% CI: 1.26–3.36, respectively). Perceived barriers to care and number of missing teeth decreased the odds of using services (OR = 0.46; 95% CI: 0.36–0.58; OR = 0.95; 95% CI: 0.92–0.98, respectively). Conclusions: Results suggest that use of oral health care services is associated with a range of financial, educational, health and structural barriers. Increasing the use of oral health care services in rural populations requires additional efforts beyond the reduction of financial barriers

Prevalence of non‐alcoholic fatty liver disease in regional Victoria : a prospective population‐based study

Objectives: To investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) and its risk factors in regional Victoria. Design: Prospective cross-sectional observational study (sub study to CrossRoads II health study in Shepparton and Mooroopna). Setting: Four towns (populations, 6300‒49 800) in the Goulburn Valley of Victoria. Participants: Randomly selected from households selected from residential address lists provided by local government organisations for participation in the CrossRoads II study. Main outcome measures: Age- and sex-adjusted estimates of NAFLD prevalence, defined by a fatty liver index score of 60 or more in people without excessive alcohol intake or viral hepatitis. Results: A total of 705 invited adults completed all required clinical, laboratory and questionnaire evaluations of alcohol use (participation rate, 37%); 392 were women (56%), and their mean age was 59.1 years (SD, 16.1 years). Of the 705 participants, 274 met the fatty liver index criterion for NAFLD (crude prevalence, 38.9%; age- and sex-standardised prevalence, 35.7%). The mean age of participants with NAFLD (61 years; SD, 15 years) was higher than for those without NAFLD (58 years; SD, 16 years); a larger proportion of people with NAFLD were men (50% v 41%). Metabolic risk factors more frequent among participants with NAFLD included obesity (69% v 15%), hypertension (66% v 48%), diabetes (19% v 8%), and dyslipidaemia (63% v 33%). Mean serum alanine aminotransferase levels were higher (29 U/L; SD, 17 U/L v 24 U/L; SD, 14 U/L) and mean median liver stiffness greater (6.5 kPa; SD, 5.6 kPa v 5.3kPa; SD, 2.0 kPa) in participants with NAFLD. Conclusion: The prevalence of NAFLD among adults in regional Victoria is high. Metabolic risk factors are more common among people with NAFLD, as are elevated markers of liver injury

Non-alcoholic fatty liver disease prevalence in Australia has risen over 15 years in conjunction with increased prevalence of obesity and reduction in healthy lifestyle

Background and Aim Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver condition globally. The aim of this study was to evaluate the change in age- and sex-standardized prevalence of NAFLD in regional Victoria over a 15-year period and explore the underlying factors associated with differences over time. Methods Repeated comparative cross-sectional studies in four towns in regional Victoria, Australia. Individuals randomly selected from households from residential address lists from local government organizations in 2001-2003 (CrossRoads I [CR1]) and 2016-2018 (CrossRoads II [CR2]) with 1040 (99%) and 704 (94%) participants from CR1 and CR2 having complete data for analysis. Primary outcome was change in prevalence estimates of NAFLD (defined by a fatty liver index & GE; 60 in the absence of excess alcohol and viral hepatitis) between 2003 and 2018. Results Crude prevalence of NAFLD increased from 32.7% to 38.8% (P < 0.01), while age-standardized/sex-standardized prevalence increased from 32.4% to 35.4% (P < 0.01). Concurrently, prevalence of obesity defined by BMI and elevated waist circumference increased 28% and 25%, respectively. Women had a greater increase in the prevalence of NAFLD than men, in parallel with increasing prevalence of obesity. Proportion of participants consuming takeaway food greater than once weekly increased significantly over time. Up to 60% of NAFLD patients require additional tests for assessment of significant fibrosis. Conclusions Crude and age-standardized/sex-standardized prevalence of NAFLD have both increased significantly over the last 15 years, particularly among women, in association with a parallel rise in the prevalence of obesity

Impact of renaming NAFLD to MAFLD in an Australian regional cohort : results from a prospective population-based study

Background and Aims: Clinical and public health implications of the recent redefining of non-alcoholic fatty liver disease (NAFLD) to metabolic-associated fatty liver disease (MAFLD) remain unclear. We sought to determine the prevalence and compare MAFLD with NAFLD in a well-defined cohort. Methods: A cross-sectional study was conducted in regional Victoria with participants from randomly selected households. Demographic and health-related clinical and laboratory data were obtained. Fatty liver was defined as a fatty liver index ≥ 60 with MAFLD defined according to recent international expert consensus. Results: A total of 722 participants were included. Mean age was 59.3 ± 16 years, and 55.3% were women with a median body mass index of 27.8 kg/m2 . Most (75.2%) participants were overweight or obese. MAFLD was present in 341 participants giving an unadjusted prevalence of 47.2% compared with a NAFLD prevalence of 38.7%. Fifty-nine (17.5%) participants met the criteria of MAFLD but not NAFLD. The increased prevalence of MAFLD in this cohort was primarily driven by dual etiology of fatty liver. All participants classified as NAFLD met the new definition of MAFLD. Compared with NAFLD subjects, participants with MAFLD had higher ALT (26.0 [14.0] U/L vs 30.0 [23] U/L, P = 0.024), but there were no differences in non-invasive markers for steatosis or fibrosis. Conclusion: Metabolic-associated fatty liver disease is a highly prevalent condition within this large community cohort. Application of the MAFLD definition increased prevalence of fatty liver disease by including people with dual etiologies of liver disease

Dissimilar respiratory and hemodynamic responses in TRALI induced by stored red cells and whole blood platelets

Background &Aims: Transfusion-related acute lung injury (TRALI) is a predominant cause of transfusion-related morbidity and mortality, however the mechanism underlying its development remains undefined. We have previously demonstrated that heat-treated supernatant from stored (day 5) human whole blood platelet components (d5-PLT-S/N) cause TRALI in lipopolysaccharide (LPS) treated sheep (Tung et al. Vox Sang 2010). This two-event in-vivo model was used to further investigate TRALI due to heat-treated supernatant from stored (day 42) human red cells (d42-PRBC-S/N), and a comparison of the two models is reported here. Methods: Sheep were infused with LPS (15µg/kg; to model a first event of clinical infection), and then transfused with either d5-WB-PLT-S/N or d42-PRBC-S/N (10% of estimated blood volume; second event), with saline and supernatant from fresh blood components as controls. Microarray techniques were used to analyze cytokine and chemokine expression levels in both the supernatants. A range of hemodynamic and respiratory parameters were recorded with continuous in-line monitoring. This data was then analyzed using non-linear mixed effects modelling. TRALI was defined by both hypoxemia during or within 2 hours of transfusion and histological evidence of pulmonary edema. Results & Discussion: TRALI developed in 80% of LPS-treated sheep following transfusion with either d5-WB-PLT-S/N (n=5) or d42-PRBC-S/N (n=5), with significantly lower (P less than 0.05) incidence of TRALI in control sheep (9%; n=23). These results demonstrated: (i) that LPS-infusion made sheep susceptible to development of TRALI; (ii) that heat-treated supernatant from either stored human whole blood platelets or red cell components were able to cause TRALI in LPS-treated sheep; and (iii) that TRALI pathogenesis followed a two-event mechanism. Importantly, several differences in respiratory and hemodynamic responses were observed between the two models. To further characterize these differences, data from only sheep that developed TRALI were re-analyzed using non-linear mixed effects modelling. Changes in pulmonary artery pressure, cardiac output and central venous pressure proved to be more severe in the d42-PRBC-S/N model (P less than 0.05). These re-analyses also demonstrated that rather than being the result of independent responses to LPS and transfusion, the measured changes were due to interactions between these first and second events. To investigate the cause of these pathophysiological differences we analyzed the cytokine and chemokine expression in the d5-PLT-S/N and d42-PRBC-S/N. Both stored supernatants displayed high levels of EGF, ENA-78, and GRO relative to supernatant from equivalent fresh blood components, however d42-PRBC-S/N also displayed high levels of IGFBP-1, IGF-1, IL-8, IL-16, MCP-1 and MIF. These results therefore indicated that while the clinical incidence of TRALI was identical in the two models, the mechanisms of TRALI pathogenesis in each model may have been different. Conclusions: Together, these in-vivo ovine TRALI models provide further evidence that factors in stored cellular blood components as well as the patients' underlying clinical condition are important determinants in the pathogenesis of TRALI. The differing pathophysiological responses in the two models in conjunction with the divergent cytokine and chemokine profiles of the two supernatants, provide novel evidence that each type of stored blood component may cause TRALI by different mechanisms. TRALI pathogenesis is therefore more likely to be multifacted than a single mechanism