Functioning and post-school transition outcomes for young people with Down syndrome.

AIM: To investigate the relationship between functioning and post-school day occupation for young adults with Down syndrome. METHODS: Families of young people with Down syndrome (n = 269) aged 15-30 years in 2009 were recruited from the population-based Down syndrome 'Needs Opinion Wishes' database in Western Australia. Questionnaires were mailed to participating families and involved two parts, young person characteristics and family functioning; 203 were returned (75%). Of those families who returned questionnaires, 164 (80.8%) of their young adults had left school. Participation in post-school day occupations was the main outcome and included; open employment, training, sheltered employment or alternatives to employment (ATE). RESULTS: Young adults were reported as participating in open employment (n = 42), training (n = 17), sheltered employment (n = 64) or ATE (n = 41) post-school. Those who reported better functioning in self-care, community and communication skills were more likely to be in open employment and/or attending Technical and Further Education compared with those attending sheltered employment and/or ATE after adjusting for age, gender and rural/metropolitan regions. Current health as measured by visits to a general practitioner (GP) and hospitalizations revealed a weak relationship with post-school day occupations, with increasing likelihood of participating in open employment or training with increasing hospitalizations and GP visits. CONCLUSIONS: Our analysis shows that functioning in activities of daily living was related to post-school day occupation. Current health status and behaviour were found to have a weak relationship with post-school day occupation adjusting for functioning in the final model.

Wet and wild: results from a pilot study assessing injuries among recreational water users in Western Australia.

To identify, describe and compare injuries among three water sport activities: kite surfing (KS), personal watercraft (PWC) and towed water sports (TWS). The study was a cross sectional, online survey. The setting was on Perth, Western Australia's popular beaches and riverbanks. Main outcome measures were number of injuries and level of severity; level of exposure and protection measures. Overall, 43% reported at least one injury in the past 12 months, a rate of 22.3 injuries per 100 h. Kite surfers were more likely to report an injury than PWC or TWS. One-half of injuries occurred while on the water. Most injuries were caused by landing awkwardly (56%) and/or trying new tricks (41%). Despite 90% of respondents having used at least one personal protective equipment (PPE) item, half (49%) reported always using a personal floatation device. This study provided information on KS, PWC and TWS injuries as well as a range of safety behaviours. It is recommended that these results form the basis of further research to reduce injury rates and encourage the use of PPE items.

Alcohol consumption among recreational boaters: factors for intervention.

Recreational boating is a popular leisure time activity in many countries. It is estimated that, in Australia, boating incidents cause more harm than rail and air crashes combined and, in terms of transport, are second only to motor vehicle crashes as a cause of serious injury. The consumption of alcohol among recreational boaters is considered an important risk factor for fatalities and injuries among both operators and passengers. Using a database of all recreational vessels registered in Western Australia (WA), a sample of 500 adult boaters was recruited to participate in a telephone survey. The effects of demographic variables and boating characteristics upon the use of alcohol among recreational boaters on their last trip were explored using logistic regression. The odds of not having a drink were associated, after adjusting for age, with having completed a boating education course and with carrying children less than 12 years on board. The use of alcohol was not found to be prevalent among WA recreational boat owners. Based on these findings, it is recommended that efforts to decrease boating-related incidents, such as through education and legislation measures, be monitored over time to determine the effects of these strategies upon safety behaviours.

An update of recent evidence of the relationship between objective and self-report measures of the physical environment and physical activity behaviours.

The physical environment has the potential to influence the physical behaviours of large numbers of people; hence creating supportive environments has the potential to increase physical activity (PA). During the last decade, there has been growing interest in how the physical environment shapes PA behaviour. This area of research is important given that levels of PA participation are declining globally. Literature was reviewed that examined the association between physical environmental attributes and PA behaviours. The environmental attributes were grouped into four categories based on a conceptual framework of environmental factors that might influence PA and included functionality, safety, aesthetics and destinations. Positive associations were found between both perceived and objectively measured environmental factors and PA behaviour. The availability, accessibility and convenience of destinations and facilities, as well as the general functionality of the neighbourhood (eg, the presence of sidewalks, traffic conditions) and aesthetics were positively associated with various levels of PA. The review highlights the need for future studies: to examine behaviour-specific environmental attributes, to collect objectively-measured environmental data and to include both objective and perceived environmental data in the same studies, and to adopt prospective study designs to allow causal relationships to be established.

Creating smoke-free environments in recreational settings.

To facilitate the banning of tobacco industry sponsorship, Australian health promotion foundations were established to provide health sponsorship to sport, arts, and racing organizations. Health sponsorship dollars procure health sponsorship benefits such as naming rights, signage, personal endorsement of a (health) product by a performer or player, and structural controls such as smoke-free policies. Data are presented from surveys and observations of spectators attending events sponsored by the West Australian Health Promotion Foundation (Healthway) and surveys of Healthway-sponsored organizations and the community. The results demonstrate that by using health sponsorship, Healthway increased the prevalence of smoke-free policies in recreational settings, and there was growing support for these policies. There was evidence of good compliance with smoke-free policies, thus reducing exposure to environmental tobacco smoke. The introduction of smoke-free policies in recreational settings has involved working collaboratively with sectors outside of health, taking an incremental approach to change, and gaining the support of stakeholders by communicating evaluation results.

Finding bile duct injuries using record linkage: a validated study of complications following cholecystectomy.

Laparoscopic cholecystectomy was introduced to Western Australia in 1991 and has become the method of choice for this procedure, although there are concerns about complications, particularly bile duct injuries. Previous studies have investigated this problem but have not confirmed the accuracy of coded information. We used Record Linkage to link operative admissions to subsequent admissions for all people who underwent cholecystectomy between 1988 and 1994. Using ICD9-CM discharge codes, we identified patients with an associated complication. We validated these patients' medical notes to obtain the proportion of complications in the period encompassing the introduction of laparoscopic cholecystectomy. We found 48 bile duct injuries in 413 patients. Of these 43% were found using complication codes on the operative admission, 79% using linked records of subsequent admissions, and 90% by adding lists of complicated cases from the three teaching hospitals. Any epidemiological research that uses surgical complication codes from operative admissions, particularly in the absence of a specific ICD9-CM code, will lead to significantly underestimating the prevalence of complications. By using record linkage, and validating medical records, we captured a significant proportion of complications.

Are smoke-free policies implemented and adhered to at sporting venues?

OBJECTIVE: This study investigated the level of implementation of and adherence to smoke-free policies in two major sporting venues in Perth. METHOD: Smoking status and attitude toward the smoke-free policies in the venues were determined in a random sample of spectators as they entered each venue. An observational study of randomly selected non-smoking seated areas in each venue was conducted on the same day to determine compliance with smoke-free policies. A butt-count was conducted to validate these observations. RESULTS: There was a high level of both awareness and agreement with the smoke-free policies, however, this level of agreement was higher in non-smokers than smokers. The results of the observational study and the butt-count indicated that the policies were implemented and there was a high level of adherence with the smoke-free policy at both venues. CONCLUSION: The results provide further evidence that smoke-free policies in sporting venues are both supported and adhered to by spectators. IMPLICATIONS: The implementation of the smoke-free policies at venues is highly effective in protecting non-smokers from the effects of environmental tobacco smoke.

Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study.

BACKGROUND: Previous studies suggest that laparoscopic cholecystectomy (LC) is associated with an increased risk of intraoperative injury involving the bile ducts, bowel, and vascular structures compared with open cholecystectomy (OC). Population-based studies are required to estimate the magnitude of the increased risk, to determine whether this is changing over time, and to identify ways by which this might be reduced. METHODS: Suspected cases of intraoperative injury associated with cholecystectomy in Western Australia in the period 1988 to 1994 were identified from routinely collected hospital statistical records and lists of persons undergoing postoperative endoscopic retrograde cholangiopancreatography. The case records of suspect cases were reviewed to confirm the nature and site of injury. Ordinal logistic regression was used to estimate the risk of injury associated with LC compared with OC after adjusting for confounding factors. RESULTS: After the introduction of LC in 1991, the proportion of all cholecystectomy cases with intraoperative injury increased from 0.67% in 1988-90 to 1.33% in 1993-94. Similar relative increases were observed in bile duct injuries, major bile leaks, and other injuries to bowel or vascular structures. Increases in intraoperative injury were observed in both LC and OC. After adjustment for age, gender, hospital type, severity of disease, intraoperative cholangiography, and calendar period, the odds ratio for intraoperative injury in LC compared with OC was 1.79. Operative cholangiography significantly reduced the risk of injury. CONCLUSION: Operative cholangiography has a protective effect for complications of cholecystectomy. Compared with OC, LC carries a nearly twofold higher risk of major bile, vascular, and bowel complications. Further study is required to determine the extent to which potentially preventable factors contribute to this risk.

Environmental factors and asthma and allergy in schoolchildren from Western Australia.

The association of environmental factors with atopic disease in children remains poorly understood. The aim of this study was to investigate the relationship between socio-environmental factors and symptoms of asthma and atopy in 6-7-yr-old children assessed as an adjunct to Phase I of the International Study of Asthma and Allergy in Childhood in Perth, Western Australia. Parental questionnaire responses were obtained for 2,193 children (73.6%) in 34 randomly selected primary schools in the Perth metropolitan area. Children born in Australia had a significantly increased risk of current asthma (odds ratio (OR) 237, p = 0.001). Having a mother born in Australia was the only factor independently associated with an increased risk of current hay fever (OR 1.56, p = 0.005). Increasing numbers of people living in the home were significantly associated with a multiplicative decrease in risk of current asthma (OR 0.88, p = 0.03) and eczema (OR 0.82, p = 0.01). Houses made of fibrocement (OR 2.40, p = 0.02) and the presence of mats on less than half of the floor area in the "main bedroom" (relative to wall-to-wall carpet) (OR 3.50, p = 0.003) were associated with an increased risk of current eczema. All reported associations were independent of socioeconomic status (categorized by school), age and sex. This study suggests that household and country-specific environmental factors are associated with asthma, hay fever and eczema risk in 6-7-yr-old schoolchildren, and may have substantially contributed to the increased prevalence of these diseases in Australia.

[The present status of tuberculosis in the Slovak Republic]. / Súcasná situácia tuberkulózy v Slovenskej republike.

In 1988 the incidence of newly detected cases of TB in the Slovak Republic was 31.6/100,000 population. As compared with 1987, a decline of the disease by 9.8% was recorded. Its incidence in the SR shifts to higher age groups. The prevalence of active tuberculosis reached in 1988 34.4 and the mortality 0.4/100,000 population. Despite these relatively favourable indicators, TB remains in the SR a public health issue which will require also in future systematic attention and care.