Reply to the letter to the editor regarding 'Clinical assessment of subacromial shoulder impingement – which factors differ from the asymptomatic population?'

[Extract] Not surprisingly, impingement is a term which does not reflect the underlying cause of all shoulder pain. Hence there is healthy debateregarding alternate terminology (Braman et al., 2013; J. S. Lewis, 2011 ; McFarland et al., 2013). However, it continues to be a term used throughout the medical literature and in an attempt to embrace this wider audience, until there is agreement about terminology, it was chosen for use in this paper

The impact of excess alcohol consumption on health care utilisation in regional patients with chronic disease – a retrospective chart audit

Objective: To understand the impact of alcohol consumption on the health utilisation of people with chronic diseases. Methods: A retrospective chart audit was undertaken in two primary care settings in a regional Australian city. Three indicator conditions were selected: type 2 diabetes, chronic obstructive pulmonary disease and chronic kidney disease. The audits were analysed to examine the impact of alcohol consumption on primary care and hospital-based health utilisation. Results: A total of 457 records were audited. Alcohol consumption decreased engagement in the primary care setting, with fewer visits, prescriptions and lower primary care costs. There was a U-shaped association between alcohol consumption and hospital attendance rates and costs. Admission rates were unchanged but a decrease in length of stay was observed in nonsmokers in the highest alcohol consumption category. Conclusion: Excess alcohol consumption decreases engagement in primary care and results in increased emergency department attendance, but not admissions to hospital. In those who are admitted to hospital, alcohol is associated with a decreased length of stay. Implications for public health: Alcohol consumption should be considered as a potential cause of decreased engagement in primary care. Follow-up and recall of patients may reduce shifting of care to the hospital environment

Isokinetic clinical assessment of rotator cuff strength in subacromial shoulder impingement

Background: Current conservative management of subacromial shoulder impingement (SSI) includes generic strengthening exercises, especially for internal (IR) and external (ER) shoulder rotators. However, there is no evidence that the strength or the ratio of strength between these muscle groups is different between those with SSI (cases) and an asymptomatic population (controls). Objective: To identify if isokinetic rotator cuff strength or the ratio of strength is significantly different between cases and controls. Study Design: Case Control Study. Method: Fifty one cases with SSI and 51 asymptomatic controls matched for age, gender, hand dominance and physical activity level completed isokinetic peak torque glenohumeral IR and ER testing. Within the SSI group, 31 dominant limbs were symptomatic and 20 non-dominant limbs were symptomatic. IR and ER were measured separately using continuous reciprocal concentric (con) and eccentric (ecc) contraction cycles at a speed of 600 degrees per second and again at 1200 degrees per second. Values of peak torque (PT), relative peak torque (RPT) and ratios were compared using independent t-tests between the SSI and asymptomatic groups. Results: Significant strength differences between the two groups were present only when the symptomatic SSI shoulder was the dominant shoulder (con ER PT at 600 /second, ecc ER PT at 1200 /second, ecc ER RPT at 1200 /second and ecc IR PT at 600 /second and 1200 /second). Conclusions: Changes in rotator cuff strength in SSI may be related to limb dominance, which may have implications for strengthening regimes

The effect of excess alcohol consumption on clinical outcomes in regional patients with chronic disease: a retrospective chart audit

Objective To better understand the impact of alcohol consumption on the clinical management of chronic diseases in a regional general practice setting. Methods A retrospective chart audit was undertaken of individual patient records at two large group general practices in Townsville, a regional Australian city. Three common indicator chronic diseases were selected that have clear management guidelines for general practice: type 2 diabetes; chronic obstructive pulmonary disease; and chronic kidney disease. The audits were analysed using SPSS software to examine the association between alcohol consumption on acquisition of clinical management targets and primary disease intermediate outcomes (haemoglobin A1c fraction; per cent of normal forced expiratory volume at one second; and estimated glomerular filtration rate). Results A total of 457 records were audited. Higher‐risk alcohol consumption is associated with reduced ability of patients to reach management targets (F[3,453]=3.68; p=0.012) and decreased standardised primary disease outcome (F[3,403]=2.86; p=0.037). Conclusion Higher‐risk alcohol consumption is associated with reduced attainment of chronic disease management targets and worse chronic disease outcomes. Implications for public health Alcohol consumption should be assessed frequently in people with chronic disease, especially when there is difficulty acquiring management targets or worsening of disease outcomes without a clear explanation. Better education about the potential associations between alcohol use and chronic disease would benefit those managing these complex conditions, both clinicians and patients

Clinical assessment of subacromial shoulder impingement – Which factors differ from the asymptomatic population?

Copyright © 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author manuscript is made available following 12 month embargo from date of publication (19 Dec 2016) in accordance with publisher’s copyright policyBackground To date, the significance of factors purported to be associated with subacromial shoulder impingement (SSI) and what differences, if any, are present in those with SSI compared to a matched asymptomatic population has not been identified. Gaining information about differences between people with SSI and asymptomatic people may direct clinicians towards treatments that impact upon these differences. Objective Compare the assessment findings of factors suggested to be associated with SSI; passive posterior shoulder range, passive internal rotation range, resting cervical and thoracic postures, active thoracic range in standing and scapula positioning between cases experiencing SSI and a matched asymptomatic group (controls). Method Fifty one SSI cases and 51 asymptomatic controls were matched for age, gender, hand dominance and physical activity level. The suggested associated factors were measured bilaterally. Independent t-tests were used to compare each of these measurements between the groups. Any variables for which a significant difference was identified, were then included in a conditional logistic regression analysis to identify independent predictors of SSI. Results The SSI group had significantly increased resting thoracic flexion and forward head posture, as well as significantly reduced upper thoracic active motion, passive internal rotation range and posterior shoulder range than the matched asymptomatic group. No independent predictors of SSI were identified in conditional logistic regression analysis. Conclusion Thoracic posture, passive internal rotation range and posterior shoulder range were significantly different between cases experiencing SSI and a matched asymptomatic group

Patient co-payments for women diagnosed with breast cancer in Australia

Purpose: Among Australian women, breast cancer is the most commonly diagnosed cancer. The out-of-pocket cost to the patient is substantial. This study estimates the total patient co-payments for Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) for women diagnosed with breast cancer and determined the distribution of these costs by Indigenous status, remoteness, and socioeconomic status. Methods: Data on women diagnosed with breast cancer in Queensland between 01 July 2011 and 30 June 2012 were obtained from the Queensland Cancer Registry and linked with hospital and Emergency Department Admissions, and MBS and PBS records for the 3 years post-diagnosis. The data were then weighted to be representative of the Australian population. The co-payment charged for MBS services and PBS prescriptions was summed. We modelled the mean co-payment per patient during each 6-month time period for MBS services and PBS prescriptions. Results: A total of 3079 women were diagnosed with breast cancer in Queensland during the 12-month study period, representing 15,335 Australian women after weighting. In the first 3 years post-diagnosis, the median co-payment for MBS services was AU$748 (IQR, AU$87–2121; maximum AU$32,249), and for PBS prescriptions was AU$ 835 (IQR, AU$480–1289; maximum AU$5390). There were significant differences in the co-payments for MBS services and PBS prescriptions by Indigenous status and socioeconomic disadvantage, but none for remoteness. Conclusions: Women incur high patient co-payments in the first 3 years post-diagnosis. These costs vary greatly by patient. Potential costs should be discussed with women throughout their treatment, to allow women greater choice in the most appropriate care for their situation

Travel-weary to travel-worry: the epidemiology of injury-related traveller deaths in Australia, 2006-2017

Objective: To explore injury deaths in international and domestic interstate travellers, together with those newly arrived to Australia. Methods: A population-based cohort study of all injury-related deaths between 1January 2006 and 31 December 2017 registered with Births Death and Marriages in Australia was conducted using Australian Bureau of Statistics’ (ABS) Cause of Death information. Population data on travellers were obtained from Tourism Research Australia. Results: There were 4,503 injury-related traveller deaths (domestic interstate:3,055; international:934; new arrivals:514). The average annual age-standardised mortality rates in domestic interstate travellers was 0.75 per 100,000, compared with 2.22 per 100,000 in international travellers. Leading causes of injury-related death were land transport incidents (n=1495, 33.2%), self-harm (n=786, 17.5%) and falls (n=513, 11.4%), with differences in mechanism by state/territory, traveller type and age group. Intentional self-harm was common amongst all visitor types, however, it was the primary cause of death in new arrivals Conclusion: Age-standardised mortality rates were almost three-fold higher in international than domestic travellers. New arrivals, international and domestic travellers have different injury profiles, and each require specific prevention strategies. Implications for public health: While COVID has restricted travel to and within Australia, this has provided an opportunity for exploration, reflection, and consideration of risk factors for travellers, and to develop targeted injury prevention strategies for visitor types, so travel experience can be optimised and the magnitude of harm can be reduced

Environmental health impacts of unconventional natural gas development: a review of the current strength of evidence

Rapid global expansion of unconventional natural gas development (UNGD) raises environmental health concerns. Many studies present information on these concerns, yet the strength of epidemiological evidence remains tenuous. This paper is a review of the strength of evidence in scientific reporting of environmental hazards from UNGD activities associated with adverse human health outcomes. Studies were drawn from peer-reviewed and grey literature following a systematic search. Five databases were searched for studies published from January 1995 through March 2014 using key search terms relevant to environmental health. Studies were screened, ranked and then reviewed according to the strength of the evidence presented on adverse environmental health outcomes associated with UNGD. The initial searches yielded >1000 studies, but this was reduced to 109 relevant studies after the ranking process. Only seven studies were considered highly relevant based on strength of evidence. Articles spanned several relevant topics, but most focussed on impacts on typical environmental media, such as water and air, with much of the health impacts inferred rather than evidenced. Additionally, the majority of studies focussed on short-term, rather than long-term, health impacts, which is expected considering the timeframe of UNGD; therefore, very few studies examined health outcomes with longer latencies such as cancer or developmental outcomes. Current scientific evidence for UNGD that demonstrates associations between adverse health outcomes directly with environmental health hazards resulting from UNGD activities generally lacks methodological rigour. Importantly, however, there is also no evidence to rule out such health impacts. While the current evidence in the scientific research reporting leaves questions unanswered about the actual environmental health impacts, public health concerns remain intense. This is a clear gap in the scientific knowledge that requires urgent attention

Incidence and characteristics of low-speed vehicle run over events in rural and remote children aged 0–14 years in Queensland: an eleven year (1999–2009) retrospective analysis

Introduction: The main objective of this study is to describe incidence rates of low-speed vehicle run-over (LSVRO) events among children aged 0–14 years residing in Queensland from 1999 to 2009. A second objective was to describe the associated patterns of injury, with respect to gender, age group, severity, characteristics (host, vehicle and environment), and trends over time in relation to geographical remoteness. Final results are hoped to inform prevention policies. Methods: In this statewide, retrospective, population-based study, data were collected on LSVRO events that occurred among children aged 0–14 years in Queensland from 1999 to 2009 from all relevant data sources across the continuum of care, and manually linked to obtain the most comprehensive estimate possible of the magnitude and nature of LSVRO events to date. Crude incidence rates were calculated separately for males and females, for fatal events, non-fatal events (hospital admissions and non-admissions, respectively), and for all LSVRO events, for each area of geographical remoteness (major cities, inner regional, outer regional, remote/very remote). Relative risks and 95% confidence interval were calculated, and trends over time were examined. Data on host, injury and event characteristics were also obtained to investigate whether these characteristics varied between areas of remoteness. Results: Incidence rates were lowest among children (0–14 years) living in major cities (13.8/100000/annum, with the highest recorded incidence in outer regional areas (incidence rate =42.5/100000/annum). Incidence rates were higher for children residing outside major cities for both males and females, for every age group, for each of the 11 years of the study, and consequences of LSVRO events were worse. Young children aged 0–4 years were identified as those most at risk for these events, regardless of geographical location. Differences were observed as a function of remoteness category in relation to injury characteristics (eg injury type), and host characteristics (eg sociodemographic status), but there were no observed differences in environmental characteristics (eg time of day, day of week). Heavy vehicles such as four-wheel drives, utilities, trucks and tractors were more frequently involved in LSVRO events that occurred outside major cities. Conclusion: The results confirmed that children of all ages and genders residing outside of major cities in Queensland are more at risk of being involved in an LSVRO incident, and experience more severe consequences compared to children in major cities. Future research should address the specific risk factors and focus on engaging rural communities to assist in the prevention of LSVRO incidents

Supporting placement supervision in clinical exercise physiology

The continued engagement of the professional workforce as supervisors is critical for the sustainability and growth of work-integrated learning activities in university degrees. This study investigated factors that influence the willingness and ability of clinicians to continue to supervise clinical exercise physiology work-integrated learning opportunities and makes recommendations for future supervision engagement. Themes identified from a supervisor survey were: staffing and time availability; administrative processes and support; student quality, knowledge and attitudes; student learning experiences; supporting the profession; service benefit; clinical personal benefit; funding; workplace support; staff qualifications and experience; prior positive experiences; future recruitment; facilities and infrastructure; and supporting the university. The responses resulted in five key recommendations for future enhanced and sustainable placement supervision. These were: adoption of efficient supervision structures; development and use of a competency checklist; enhanced recognition of supervision; standardized placement paperwork and assessment tools; and broadening of placement scheduling