The influence of air pollution exposure on the short- and long-term health benefits associated with active mobility: A systematic review.

Active mobility (AM), defined as walking and cycling for transportation, can improve health through increasing regular physical activity. However, these health improvements could be outweighed by harm from inhaling traffic-related air pollutants during AM participation. The interaction of AM and air pollutants on health is complex physiologically, manifesting as acute changes in health indicators that may lead to poor long-term health consequences. The aim of this study was to systematically review the current evidence of effect modification by air pollution (AP) on associations between AM and health indicators. Studies were included if they examined associations between AM and health indicators being modified by AP or, conversely, associations between AP and health indicators being modified by AM. Thirty-three studies met eligibility criteria. The main AP indicators studied were particulate matter, ultrafine particles, and nitrogen oxides. Most health indicators studied were grouped into cardiovascular and respiratory indicators. There is evidence of a reduction by AP, mainly ultrafine particles and PM2.5, in the short-term health benefits of AM. Multiple studies suggest that long-term health benefits of AM are not negatively associated with levels of the single traffic-related pollutant NO2. However, other studies reveal reduced long-term health benefits of AM in areas affected by high levels of pollutant mixtures. We recommend that future studies adopt consistent and rigorous study designs and include reporting of interaction testing, to advance understanding of the complex relationships between AM, AP, and health indicators.

Individual socioeconomic position, neighbourhood disadvantage and mental well-being: a cross-sectional multilevel analysis of mid-age adults.

BACKGROUND: Socioeconomic disadvantage is associated with mental illness, yet its relationship with mental well-being is unclear. Mental well-being is defined as feeling good and functioning well. Benefits of mental well-being include reduced mortality, improved immune functioning and pain tolerance, and increased physical function, pro-social behaviour, and academic and job performance. This study aims to explore the relationship between individual socioeconomic position (SEP), neighbourhood disadvantage and mental well-being in mid-age adults. METHODS: Multilevel modelling was used to analyse data collected from 7866 participants from the second (2009) wave of HABITAT (How Areas in Brisbane Influence healTh and activiTy), a longitudinal study (2007-2018) of adults aged 40-65 years living in Brisbane, Australia. Mental well-being was measured using the Warwick Edinburgh Mental Well-Being Scale (WEMWBS). Exposure measures were education, occupation, household income, and neighbourhood socioeconomic disadvantage. RESULTS: The lowest MWB scores were observed for the least educated (ß = - 1.22, 95%CI = - 1.74, - 0.71), those permanently unable to work (ß = - 5.50, 95%CI = - 6.90, - 4.10), the unemployed (ß = - 2.62, 95%CI = - 4.12, - 1.13), and members of low-income households (ß = - 3.77, 95%CI = - 4.59, - 2.94). Residents of the most disadvantaged neighbourhoods had lower MWB scores than those living in the least disadvantaged neighbourhoods, after adjustment for individual-level SEP (ß = - 0.96, 95%CI = - 1.66, - 0.28). CONCLUSIONS: Both individual-level SEP and neighbourhood disadvantage are associated with mental well-being although the association is stronger for individual-level SEP. This research highlights the need to address individual and neighbourhood-level socioeconomic determinants of mental well-being.

Assessment of the validity and reliability of the Indonesian version of Short Form 12 (SF-12).

INTRODUCTION: Psychometric evaluation of the 12-item Short-Form Health Survey (SF-12), a well-used scale for measuring health-related quality of life (HrQoL), has not been done in general populations in Indonesia. This study assessed the validity and reliability of the SF-12 in middle-aged and older adults. METHODS: Participants self-completed the SF-12 and SF-36. Scaling assumptions, internal consistency reliability, and 1-week test-retest reliability were assessed for the SF-12. Confirmatory factor analysis was conducted to assess its construct validity. Correlations between SF-12 and SF-36 component scores were computed to assess convergent and divergent validity. Effect size differences were calculated between SF-12 and SF-36 component scores for assessing criterion validity. RESULTS: In total, 161 adults aged 46-81 years (70% female) participated in this study. Scaling assumptions were satisfactory. Internal consistency for the SF-12 Physical Component Summary (PCS-12) and the Mental Component Summary (MCS-12) were acceptable (a = 0.72 and 0.73, respectively) and test-retest reliability was excellent (ICC = 0.88 and 0.75, respectively). A moderate fit of the original two-latent structure to the data was found (root mean square error of approximation [RMSEA] = 0.08). Allowing a correlation between physical and emotional role limitation subscales improved fit (RMSEA = 0.04). Correlations between SF-12 and SF-36 component summary scores support convergent and divergent validity although a medium effect size difference between PCS-12 and PCS-36 (Cohen's d = 0.61) was found. CONCLUSIONS: This study provides the first evidence that SF-12 is a reliable and valid measure of HrQoL in Indonesian middle-aged and older adults. The algorithm for computing SF-12 and its association with SF-36 in the Indonesian population warrant further investigation.

Longitudinal associations between bicycling and having dependent children, in middle-aged men and women.

Bicycling has multiple health benefits. Child-rearing may influence bicycling, but little is known about the impact of this between men's and women's bicycling, or of number and ages of children on bicycling. This study examined the longitudinal associations between having dependent children and bicycling for transportation and recreation over 4 years among mid-aged men and women. Data were from the HABITAT study (Australia). We analysed data from three survey waves (2007, 2009, 2011) using multilevel logistic regression stratified by gender (n = 7758). Findings indicate that having dependent children was associated with bicycling for transportation and recreation in contrasting ways for men and women. The odds of bicycling were higher in men with ≥2 children aged under 18y than men without children (transportation: OR = 1.93, 95% CI: 1.26, 2.98; recreation: OR = 2.37, 95% CI: 1.67, 3.37). Over time, the odds of recreational bicycling were lower in women with ≥2 children than women without children (OR = 0.83, 95% CI: 0.73, 0.93). However, for both men and women, the odds of recreational bicycling were higher in those with children aged 6-12y than those with younger or older children (men: OR = 1.86, 95% CI: 1.39, 2.49; women: OR = 1.79, 95% CI: 1.31, 2.46). Interventions to promote bicycling must therefore consider gendered differences in bicycling for travel and active leisure, and family circumstances. An opportunity to promote bicycling might be to target parents with children aged 6-12y.

Individual and contextual factors associated with bicyclist injury severity in traffic incidents between bicyclists and motorists in Chile.

Bicyclists are vulnerable road users who risk incurring severe injuries from traffic incidents involving motorists. However, the prevalence of severe bicycle injuries varies across countries and is not well-documented in Latin American countries. Studies from developed countries outside of Latin America have shown that individual and contextual factors are associated with severe injuries incurred by bicyclists in road traffic incidents with motorists, but it is not clear whether these factors are the same as those incurred by Latin American bicyclists. Moreover, most studies on bicyclist-motorist traffic incidents have treated injury severity as a binary variable for analysis although injuries range widely in severity. The aims of this study were to determine the prevalence of bicycle injuries from incidents between motorists and bicyclists in Chile and examine the associations between individual and contextual factors and bicyclist injury severity, treated as an ordinal outcome variable, in these incidents. Data on road traffic incidents between bicyclists and motorists from the 2016 Traffic Accident of Bicycle Riders and Consequences database of the Chilean Transport Ministry were analysed. Multilevel mixed-effects ordinal regression models were used to examine associations. In total, 81.2 % of 4093 traffic incidents between bicyclists and motorists resulted in nonfatal injuries to bicyclists and another 2.3 % resulted in fatalities. Most incidents involved collisions (84.3 %), and most were due to a motorist being distracted while driving (50.4 %). Severe bicyclist injuries were more likely when the incident involved a stationary cyclist who was struck, a collision between a moving bicycle and a moving motor vehicle, or an overturning motor vehicle striking a bicyclist (p < 0.001). Other factors included the motorist driving under the influence of alcohol (p = 0.05), the incident taking place in a mid-size community (p = 0.04), the incident occurring between 7:00 pm and 4:59 am (p < 0.01), and the injured bicyclist being under 18 years or 45+ years of age (p < 0.05). These findings suggest the need for educational programs that promote safe driving behaviour in the presence of bicyclists, better enforcement of laws and higher penalties for distracted or drunk driving, and provision of high-quality exclusive bicyclist infrastructure to address the vulnerability of the youngest and oldest bicyclists on shared roads, particularly in mid-size communities, and to provide better lighting on bikeways for evening bicycling, to reduce the high incidence of severe bicyclist injuries in motorist-bicyclist incidents.

Women cycling in Queensland: Results from an observational study.

Women are less likely to ride than men in low cycling countries such as Australia. In Australia, self-reported cycling participation appears to be declining, particularly for women. This paper examines the rider and road environment correlates of women's cycling. While most earlier studies relied on self-report data to understand gender differences in cycling, this study video-recorded 24,868 riders (22 % female) at 17 sites across Queensland, Australia. The probabilities of an observed rider being female under different circumstances (e.g., speed limit, riding location, time of riding, group riding) at these sites were modelled in a binomial logistic regression framework. The likelihood of a rider being a woman was greater during the day (9am-8pm) than the early morning (5-9 a.m.); on weekends than on weekdays; in groups of two or more riders than among single riders; in lower speed zones than speed zones of 60 km/h or over; on roads with bike lanes or multiple traffic lanes or raised medians than on roads without these, and in urban areas than suburban areas. The likelihood of the rider being a woman was lower among those riding road bikes than other types of bicycles. The use of a naturalistic study design marks the key strength of this paper. Findings of this study should help better understand women's cycling patterns and preferred cycling locations, which cycling communities and organisations can use to advocate for better roads and paths that make female riders feel safe.

Verification of the Reliability and Validity of the Short Form 36 Scale in Indonesian Middle-aged and Older Adults.

OBJECTIVES: The Short Form 36 (SF-36) questionnaire is increasingly being used to measure health-related quality of life (HRQoL) in Indonesia. However, evidence that it is valid for use in Indonesian adults is lacking. This study assessed the validity and reliability of the SF-36 in Indonesian middle-aged and older adults. METHODS: Adults aged 46-81 years (n=206) in Yogyakarta, Indonesia completed the SF-36, another measure of HRQoL (the EuroQoL visual analogue scale [EQ-VAS]), and measures assessing their demographic characteristics. Fifty-four percent (n=121) completed the SF-36 measure again 1 week later. Confirmatory factor analysis was conducted to confirm the factor structure of the SF-36. Internal consistency reliability was estimated using Cronbach's alpha, and test-retest reliability was assessed using intraclass correlations. Convergent and discriminant validity were assessed by computing correlations among SF-36 subscales, between subscales and the 2 component scores, and between component scores and EQ-VAS scores. RESULTS: Most scaling assumptions were met. The hypothetical factor structure fit the data poorly (root mean square error of approximation [RMSEA]=0.108) and modification was required for a good fit (RMSEA=0.060). Scores on all subscales demonstrated acceptable internal consistency (α>0.70) and test-retest reliability (r>0.70). Divergent validity was supported by weak to moderate interscale correlations (r=0.19 to 0.64). As expected, the 2 summary scores were moderately to strongly correlated with the EQ-VAS (r>0.60). CONCLUSIONS: The findings adequately support the use of SF-36 in Indonesian middle-aged and older adults, although the optimal algorithm for computing component scores in Indonesia warrants further investigation.

Establishing and implementing a health promoting school in rural Cambodia.

Few studies have used a whole-of-school approach in implementing a health promoting schools (HPS) framework. Descriptions of how HPS is being implemented, particularly in low-resourced, developing countries, are limited. This study used an exploratory case study design to examine the planning and implementation of a HPS in a rural Cambodian village. Data were collected via observations of the school, school documentation, and interviews with stakeholders (n = 9). The data were analysed inductively as an iterative process, from initial coding, through to categorizing, leading to concept mapping and then identifying the emergent themes within the stages of school development and implementation of educational and health programming. The case study demonstrated how all six components of the HPS framework can be used to plan and implement a school in a rural village in a developing country. The key elements of implementation were building local and international partnerships, local leadership, and a culture of change and participation. These elements were used to establish a non-profit school that aimed to address the stated health and educational needs of local villagers. This case study adds to the limited evidence on the HPS components and implementation methods that are being applied in low-resourced, developing countries.

Drivers who don't comply with a minimum passing distance rule when passing bicycle riders.

INTRODUCTION: Drivers' passing cyclists closely can contribute to crashes, falls, and intimidation, which may discourage cycling. In response, minimum passing distance (MPD) rules have been introduced in many jurisdictions. This study examined the factors associated with non-compliance with a MPD rule. METHOD: An online survey of 3,769 drivers in Queensland, Australia was administered 1 year after a MPD rule began. It assessed compliance with and attitudes toward the rule. Linear regression modeling was used to examine which attitudinal and demographic factors were associated with non-compliance. RESULTS: The percentage of drivers who reported that they did not comply with the road rule "most of the time" or "almost always" was 35.5% in speed zones of ≤60 km/h and 31.8% in speed zones of >60 km/h. Associated with a greater likelihood of being non-compliant were: only infrequently observing motorists giving bicycle riders more distance when overtaking; greater awareness of bicycle riders when driving on the road; disagreeing that the rule had changed the person's driving; agreeing that the rule was making overtaking bicycle riders difficult; disagreeing that the rule had made it safer for bicycle riders; agreeing that it was difficult to judge 1 or 1.5 m when overtaking a bicycle rider; and agreeing that giving 1.5 m clearance in >60 km/h zones to bicycle riders was annoying (p < .05). In high speed zones, drivers aged 18-39 years were more likely than those aged 50+ years to be non-compliant (p < .05). Compliance was not associated with driver sex, amount of driving, or perceived level of enforcement. CONCLUSIONS: Reported non-compliance with the MPD rule is widespread and is related more to attitudinal than demographic factors. Practical applications: Strategies for helping drivers to judge passing distance and improve their understanding of the importance for cyclist safety of leaving an adequate distance are needed.

Validity of objective methods for measuring sedentary behaviour in older adults: a systematic review.

BACKGROUND: The evidence showing the ill health effects of prolonged sedentary behaviour (SB) is growing. Most studies of SB in older adults have relied on self-report measures of SB. However, SB is difficult for older adults to recall and objective measures that combine accelerometry with inclinometry are now available for more accurately assessing SB. The aim of this systematic review was to assess the validity and reliability of these accelerometers for the assessment of SB in older adults. METHODS: EMBASE, PubMed and EBSCOhost databases were searched for articles published up to December 13, 2017. Articles were eligible if they: a) described reliability, calibration or validation studies of SB measurement in healthy, community-dwelling individuals, b) were published in English, Portuguese or Spanish, and c) were published or in press as journal articles in peer-reviewed journals. RESULTS: The review identified 15 studies in 17 papers. Of the included studies, 11 assessed the ActiGraph accelerometer. Of these, three examined reliability only, seven (in eight papers) examined validity only and one (in two papers) examined both. The strongest evidence from the studies reviewed is from studies that assessed the validity of the ActiGraph. These studies indicate that analysis of the data using 60-s epochs and a vertical magnitude cut-point < 200 cpm or using 30- or 60-s epochs with a machine learning algorithm provides the most valid estimates of SB. Non-wear algorithms of 90+ consecutive zeros is also suggested for the ActiGraph. CONCLUSIONS: Few studies have examined the reliability and validity of accelerometers for measuring SB in older adults. Studies to date suggest that the criteria researchers use for classifying an epoch as sedentary instead of as non-wear time (e.g., the non-wear algorithm used) may need to be different for older adults than for younger adults. The required number of hours and days of wear for valid estimates of SB in older adults was not clear from studies to date. More older-adult-specific validation studies of accelerometers are needed, to inform future guidelines on the appropriate criteria to use for analysis of data from different accelerometer brands. TRIAL REGISTRATION: PROSPERO ID# CRD42017080754 registered December 12, 2017.

Factors influencing noncompliance with bicycle passing distance laws.

Many jurisdictions around the world have implemented laws to require a minimum distance when motor vehicles pass cyclists, but research into the factors influencing passing distances has produced inconsistent results, indicating the need for future research. This study examined the factors influencing motorists' compliance with a legislated bicycle passing distance rule in Queensland, Australia. Unlike the earlier studies, which used volunteer riders to record passing events, this study used a naturalistic study design to record passing events where none of the motorists or the cyclists were aware of being studied. As a result, this study captured the 'true' driving and riding behaviours during passing events. The likelihood of non-compliance was greater on higher (70-80 km/h speed limits) and lower (40 km/h) speed roads than 60 km/h roads, at curved road sections, and on roads with narrower traffic lanes. Rider characteristics (age, gender, helmet status, type of clothing, type of bicycle, and individual or group riding) had no statistically significant association with compliance status. The findings indicate that efforts to improve cyclist safety during overtaking events should focus on non-rider related factors, such as roadway infrastructure characteristics.

Ethnicity, length of residence, and prospective trends in body mass index in a national sample of Australian adults (2006-2014).

PURPOSE: Increasing global migration, high obesity in developed countries, and ethnic health inequalities are compelling reasons to monitor immigrant obesity trends. Longitudinal studies of ethnicity, length of residence, and adiposity in contexts outside of the United States are lacking. METHODS: Nine waves (2006-2014) of the Household Income and Labour Dynamics in Australia survey were analyzed (n = 20,934; 52% women; 101,717 person-year observations) using random effects modeling to assess average annual change in body mass index (BMI) by ethnic group. A second analysis used an immigrant only cohort (n = 4583; 52% women; 22,301 person-year observations) to examine BMI change by length of residence. RESULTS: Over 9 years, mean BMI increased significantly in all ethnic and Australian-born groups, and by the final wave, mean BMI exceeded 25 kg m-2 for all groups. Trajectories of change did not vary between groups, with the exception of slower BMI increases for North-West European men compared with Australian born. Immigrants residing in Australia for 10-19 years had significantly faster annual increases in BMI compared with long-term immigrants (≥30 years). CONCLUSIONS: Immigrants to Australia, regardless of ethnicity, are at risk of obesity over time. Obesity prevention policy should prioritize immigrants in the early-mid settlement period.

Neighbourhood disadvantage, geographic remoteness and body mass index among immigrants to Australia: A national cohort study 2006-2014.

Obesity is socioeconomically, geographically and ethnically patterned. Understanding these elements of disadvantage is vital in understanding population obesity trends and the development of effective and equitable interventions. This study examined the relationship between neighbourhood socioeconomic disadvantage and geographic remoteness with prospective trends in mean body mass index (BMI) among immigrants to Australia. Longitudinal data (2006-2014) from a national panel survey of Australian adults was divided into an immigrant-only sample (n = 4,293, 52.6% women and 19,404 person-year observations). The data were analysed using multi-level random effects linear regression modelling that controlled for individual socioeconomic and demographic factors. Male immigrants living in the most disadvantaged neighbourhoods had significantly higher mean BMI compared with those living in the least disadvantaged. Over time, mean BMI increased for all groups except for men living in the least disadvantaged neighbourhoods, for whom mean BMI remained almost static (0.1 kg/m2 increase from 2006 to 2014), effectively widening neighbourhood inequalities. Among women, mean BMI was also significantly higher in the most compared with the least, disadvantaged neighbourhoods (ß = 2.08 kg/m2; 95%CI: 1.48, 2.68). Neighbourhood inequalities were maintained over time as mean BMI increased for all groups at a similar rate. Male and female immigrants residing in outer regional areas had significantly higher mean BMI compared with those living in major cities; however, differences were attenuated and no longer significant following adjustment for ethnicity, individual socioeconomic position and neighbourhood disadvantage. Over time, mean BMI increased in all male and female groups with no differences based on geographic remoteness. Obesity prevention policy targeted at immigrant cohorts needs to include area-level interventions that address inequalities in BMI arising from neighbourhood disadvantage, and be inclusive of immigrants living outside Australia's major cities.

Walking with Diabetes (WW-DIAB) programme a walking programme for Indonesian type 2 diabetes mellitus patients: A pilot randomised controlled trial.

OBJECTIVES: This pilot study aimed to examine the feasibility and effectiveness of a pedometer-based walking programme in Indonesian type 2 diabetes mellitus patients. METHODS: Feasibility was assessed by monitoring participant recruitment, retention, and adherence to the step-monitoring and recording instructions. Effectiveness was assessed in a pilot randomised controlled trial. Participants were type 2 diabetes mellitus patients randomly assigned to a pedometer-only (PED-only) group (n = 22) and a pedometer with text message support (PED+) group (n = 21). Outcomes were step counts, self-reported physical activity, social cognitive constructs, glycaemic parameters, and health-related quality of life. These were assessed at baseline, 12-week intervention, and 12 weeks later. Longitudinal analyses using generalised estimating equations were carried out to assess treatment and time effects on study outcomes. RESULTS: All but one participant (98%) attended 12- and 24-week data collection follow-ups. Throughout the study period, 82% of PED+ participants submitted their daily steps log. Daily steps increased in both groups (p < 0.001) but more in the PED+ group (2064 more steps at week 24, 95% confidence interval: 200-3925, p = 0.03). Self-reported physical activity levels and glycaemic parameters increased similarly in the two groups over time (p < 0.05). Improvements in social cognitive processes were seen only in the PED+ group (p < 0.05). There were no significant improvements in health-related quality of life. CONCLUSION: This study provides preliminary evidence that a pedometer-based walking programme, with or without additional support, is feasible and improves physical activity and glucose levels in Indonesian type 2 diabetes mellitus patients. Greater increases in step counts can result from the provision of text message support and education materials than from the provision of a pedometer only.

A shift from motorised travel to active transport: What are the potential health gains for an Australian city?

INTRODUCTION: An alarmingly high proportion of the Australian adult population does not meet national physical activity guidelines (57%). This is concerning because physical inactivity is a risk factor for several chronic diseases. In recent years, an increasing emphasis has been placed on the potential for transport and urban planning to contribute to increased physical activity via greater uptake of active transport (walking, cycling and public transport). In this study, we aimed to estimate the potential health gains and savings in health care costs of an Australian city achieving its stated travel targets for the use of active transport. METHODS: Additional active transport time was estimated for the hypothetical scenario of Brisbane (1.1 million population 2013) in Australia achieving specified travel targets. A multi-state life table model was used to estimate the number of health-adjusted life years, life-years, changes in the burden of diseases and injuries, and the health care costs associated with changes in physical activity, fine particle (<2.5 µm; PM2.5) exposure, and road trauma attributable to a shift from motorised travel to active transport. Sensitivity analyses were conducted to test alternative modelling assumptions. RESULTS: Over the life course of the Brisbane adult population in 2013 (860,000 persons), 33,000 health-adjusted life years could be gained if the travel targets were achieved by 2026. This was mainly due to lower risks of physical inactivity-related diseases, with life course reductions in prevalence and mortality risk in the range of 1.5%-6.0%. Prevalence and mortality of respiratory diseases increased slightly (≥0.27%) due to increased exposure of larger numbers of cyclists and pedestrians to fine particles. The burden of road trauma increased by 30% for mortality and 7% for years lived with disability. We calculated substantial net savings ($AU183 million, 2013 values) in health care costs. CONCLUSION: In cities, such as Brisbane, where over 80% of trips are made by private cars, shifts towards walking, cycling and public transport would cause substantial net health benefits and savings in health care costs. However, for such shifts to occur, investments are needed to ensure safe and convenient travel.

Gait outcomes of older adults receiving subacute hospital rehabilitation following orthopaedic trauma: a longitudinal cohort study.

OBJECTIVES: This study aimed to describe gait speed at admission and discharge from inpatient hospital rehabilitation among older adults recovering from orthopaedic trauma and factors associated with gait speed performance and discharge destination. DESIGN: A longitudinal cohort study was conducted. SETTING: Australian tertiary hospital subacute rehabilitation wards. PARTICIPANTS: Patients aged ≥60 years recovering from orthopaedic trauma (n=746, 71% female) were eligible for inclusion. INTERVENTIONS: Usual care (multidisciplinary inpatient hospital rehabilitation). PRIMARY AND SECONDARY OUTCOME MEASURES: Gait speed was assessed using the timed 10 m walk test. The proportion of patients exceeding a minimum gait speed threshold indicator (a priori 0.8 m/s) of community ambulation ability was calculated. Generalised linear models were used to examine associations between patient and clinical factors with gait speed performance and being discharged to a residential aged care facility. RESULTS: At discharge, 18% of patients (n=135) exceeded the 0.8 m/s threshold indicator for community ambulation ability. Faster gait speed at discharge was found to be associated with being male (B=0.43, 95% CI -0.01 to 0.87), admitted with pelvic (B=0.76, 95% CI 0.14 to 1.37) or multiple fractures (B=1.13, 95% CI 0.25 to 2.01) (vs hip fracture), using no mobility aids (B=-0.93, 95% CI -1.89 to 0.01) and walking at a faster gait speed at admission (B=5.77, 95% CI 5.03 to 6.50). Factors associated with being discharged to residential aged care included older age (OR 1.06, 95% CI 1.03 to 1.10), longer length of stay (OR 1.01, 95% CI 1.01 to 1.02), having an upper limb fracture (vs hip fracture) (OR 2.81, 95% CI 1.32 to 5.97) and lower Functional Independence Measure cognitive score (OR 0.89, 95% CI 0.86 to 0.92). CONCLUSIONS: Patients with a range of injury types, not only those presenting to hospital with hip fractures, are being discharged with slow gait speeds that are indicative of limited functional mobility and a high risk of further adverse health events.

Cyclists' perceptions of motorist harassment pre- to post-trial of the minimum passing distance road rule amendment in Queensland, Australia.

Issues addressed Cyclists' perceptions of harassment from motorists discourages cycling. This study examined changes in cyclists' reporting of harassment pre- to post-introduction of the Queensland trial of the minimum passing distance road rule amendment (MPD-RRA). Methods Cross-sectional online surveys of cyclists in Queensland, Australia were conducted in 2009 (pre-trial; n=1758) and 2015 (post-trial commencement; n=1997). Cyclists were asked about their experiences of harassment from motorists while cycling. Logistic regression modelling was used to examine differences in the reporting of harassment between these time periods, after adjustments for demographic characteristics and cycling behaviour. Results At both time periods, the most reported types of harassment were deliberately driving too close (causing fear or anxiety), shouting abuse and making obscene gestures or engaging in sexual harassment. The percentage of cyclists who reported tailgating by motorists increased between 2009 and 2015 (15.1% to 19.5%; P<0.001). The percentage of cyclists reporting other types of harassment did not change significantly. Conclusions Cyclists in Queensland continue to perceive harassment while cycling on the road. The amendment to the minimum passing distance rule in Queensland appears to be having a negative effect on one type of harassment but no significant effects on others. So what? Minimum passing distance rules may not be improving cyclists' perceptions of motorists' behaviours. Additional strategies are required to create a supportive environment for cycling.

Physical activity and quality of life in older women with a history of depressive symptoms.

Physical activity (PA) is positively associated with health-related quality of life (HRQL) in older adults. It is not evident whether this association applies to older adults with poor mental health. This study examined associations between PA and HRQL in older women with a history of depressive symptoms. Participants were 555 Australian women born in 1921-1926 who reported depressive symptoms in 1999 on a postal survey for the Australian Longitudinal Study on Women's Health. They completed additional surveys in 2002, 2005 and 2008 that assessed HRQL and weekly minutes walking, in moderate PA, and in vigorous PA. Random effects mixed models were used to examine concurrent and prospective associations between PA and each of 10 HRQL measures (eight SF-36 subscales; two composite scales). In concurrent models, higher levels of PA were associated with better HRQL (p<0.001). The strongest associations were found for the bodily pain, physical functioning, general health perceptions, social functioning and vitality measures. Associations were attenuated in prospective models, more so for mental HRQL-related scales than for physical HRQL-related scales. However, strong associations (>3 point differences) were evident for physical functioning, general health, vitality and social functioning. For women in their 70s-80s with a history of depressive symptoms, PA is positively associated with HRQL concurrently, and to a lesser extent prospectively. This study extends previous work by showing significant associations in older women with a history of depressive symptoms. Incorporating PA into depression management of older women may improve their HRQL.

Risk factors for hospital re-presentation among older adults following fragility fractures: a systematic review and meta-analysis.

BACKGROUND: Older adults hospitalized with fragility fractures are at high risk of negative events that can culminate in re-presentations to hospital emergency departments or readmissions to hospital. This systematic review aimed to identify patient, clinical, or hospital-related factors that are identifiable at the index admission and that may be associated with re-presentations to hospital emergency departments or hospital readmissions in older adults following fragility fractures. METHODS: Four electronic databases (PubMed, CINAHL, Embase, and Scopus) were searched. A suite of search terms identified peer-reviewed English-language articles that examined potential correlates of hospital re-presentation in older adults (mean age ≥ 65 years) who were discharged from hospital following treatment for fragility fractures. A three-stage screening process (titles, abstracts, full text) was conducted by two researchers independently. Participant characteristics, study design, potential correlates examined, analyses, and findings were extracted for studies included in the review. Quality and risk of bias were assessed with the Effective Public Health Practice Project Quality Assessment Tool. The strength of evidence was incorporated into a best evidence synthesis, and meta-analysis was conducted where effect pooling was possible. RESULTS: Eleven of 35 eligible studies were categorized as high quality studies. These studies reported that age, higher Cumulative Illness Rating scores, American Society of Anesthesiologists scores > 3, longer length of stay, male sex, cardiovascular disease, low post-operative hemoglobin, kidney disease, dementia and cancer were factors identified at the index admission that were predictive of subsequent re-presentation to hospital. Age was the only predictor for which pooling of effects across studies was possible: pooling was conducted for re-presentation ≤ 30 days (pooled OR, 1.27; 95 % CI, 1.14-1.43) and > 30 days (pooled OR, 1.23; 95 % CI, 1.01-1.50). CONCLUSIONS: The best-evidence synthesis, in addition to the meta-analysis, identified a range of factors that may have utility in guiding clinical practice and policy guidelines for targeted interventions to reduce the need for re-presentation to hospital among this frail clinical population. The paucity of studies investigating re-presentations to hospital emergency departments without admission was an important gap in the literature identified in this review. Key limitations were exclusion of non-English language studies and grey literature. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015019379 .