Association between socioeconomic deprivation and bone health status in the UK biobank cohort participants.

The effect of deprivation on total bone health status has not been well defined. We examined the relationship between socioeconomic deprivation and poor bone health and falls and we found a significant association. The finding could be beneficial for current public health strategies to minimise disparities in bone health. PURPOSE: Socioeconomic deprivation is associated with many illnesses including increased fracture incidence in older people. However, the effect of deprivation on total bone health status has not been well defined. To examine the relationship between socioeconomic deprivation and poor bone health and falls, we conducted a cross-sectional study using baseline measures from the United Kingdom (UK) Biobank cohort comprising 502,682 participants aged 40-69 years at recruitment during 2006-2010. METHOD: We examined four outcomes: 1) low bone mineral density/osteopenia, 2) fall in last year, 3) fracture in the last five years, and 4) fracture from a simple fall in the last five years. To measure socioeconomic deprivation, we used the Townsend index of the participant's residential postcode. RESULTS: At baseline, 29% of participants had low bone density (T-score of heel < -1 standard deviation), 20% reported a fall in the previous year, and 10% reported a fracture in the previous five years. Among participants experiencing a fracture, 60% reported the cause as a simple fall. In the multivariable logistic regression model after controlling for other covariates, the odds of a fall, fracture in the last five years, fractures from simple fall, and osteopenia were respectively 1.46 times (95% confidence interval [CI] 1.42-1.49), 1.26 times (95% CI 1.22-1.30), 1.31 times (95% CI 1.26-1.36) and 1.16 times (95% CI 1.13-1.19) higher for the most deprived compared with the least deprived quantile. CONCLUSION: Socioeconomic deprivation was significantly associated with poor bone health and falls. This research could be beneficial to minimise social disparities in bone health.

Cognitive impairment following sedative overdose.

INTRODUCTION: Patients with sedative overdose may have residual cognitive impairment at the time they are deemed medically cleared for discharge. Impairment could affect the performance of high-risk activities, including driving. The Trail Making Test is an alpha-numeric assessment that can be performed at the bedside to assess cognitive function. We examined whether there were differences in cognitive function when medically cleared between patients that overdosed on sedative and non-sedative drugs. METHODS: A prospective, observational study assessed cognitive function using the Trail Making Test between 2018 and 2021. Patients (16 years and greater) completed testing upon medical clearance if they spoke English and had no previous neurological injury. Continuous covariates were compared using t-tests or Mann-Whitney U tests and multiple linear regression; binary variables were modelled using logistic regression. RESULTS: Of 171 patients enrolled, 111 (65 per cent) had sedative overdose; they were older (median 32.1 versus 22.2 years) and more likely to be male (58.6 per cent versus 36.7 per cent). Benzodiazepines and paracetamol were the commonest drug overdoses. Patients with sedative overdose performed worse on Trail Making Test part A (37.0 versus 33.1 seconds, P = 0.017) and Trail Making Test part B (112.4 versus 81.5 seconds, P = 0.004). Multiple linear regression analysis indicated that patient age (P < 0.001, 1.7 seconds slower per year, 95 per cent confidence interval: 0.9-2.6 seconds) and perception of recovery (P = 0.006, 36.4 seconds slower if perceived not recovered, 95 per cent confidence interval: 10.8-62.0 seconds) were also associated with Trail Making Test part B times. Patients with sedative overdose were more likely to be admitted to the intensive care unit (Odds Ratio: 4.9, 95 percent confidence interval: 1.1-22.0; P = 0.04). DISCUSSION: Our results are broadly in keeping with previously published work, but include a wider range of drug overdose scenarios (polypharmacy and recreational drugs). While patients demonstrated some perception of their cognitive impairment, our model could not reliably be used to provide individual discharge advice. The study design did not allow us to prove causation of cognitive impairment, or to make comparison between the strength of an overdose to the trail making test time. CONCLUSIONS: Trail Making Test results suggested that patients who had sedative drug overdoses may have significant cognitive deficits even when medically cleared. Risk of harm may be minimised with advice to avoid high-risk activities such as driving. More profound impacts seen on the Trail Making Test part B than A may mean higher-order thinking is more affected than simple cognitive function.

Overnight joint replacement surgery: a pilot Australian study.

BACKGROUND: With a stretched healthcare system and elective surgery backlog, measures to improve efficiency and decrease costs associated with surgical procedures need to be prioritized. This study compares the benefits of multi-disciplinary involvement in an enhanced recovery after surgery (ERAS) protocol-led overnight model following total hip replacement (THR) and total knee replacement (TKR). METHODS: Patients in each of two private hospitals undergoing THR or TKR were prospectively enrolled. One hospital (Overnight) was fully committed to the ERAS protocol implementation on all levels and formed the treatment group while in the other hospital (control), patients only had the anaesthetic and operative procedure as part of the ERAS protocol but did not follow the perioperative measures of the protocol. Outcomes on hospital length of stay (LOS), inpatient rehabilitation, functional outcomes, satisfaction, adverse events and readmission rates were investigated. RESULTS: Median LOS in the Overnight group was significantly smaller than in the control group (1 vs. 3 days, P < 0.0001). The Overnight group had lower rates of inpatient rehabilitation utilization (4% vs. 41.2%, P < 0.0001), similar improvements in functional hip and knee scores and no increased rate of adverse events or readmission. All patients in both groups were satisfied with their treatment. CONCLUSION: Overnight THR and TKR can safely be performed in the majority of patients, with a multi-disciplinary approach protocol and involvement of all perioperative stakeholders.

Trace elements in rice grain and agricultural soils: assessment of health risk of inhabitants near a former secondary lead smelter in Khulna, Bangladesh.

Ingestion of food grain grown in metal-contaminated soils may cause serious effects on human health. This study assessed the concentrations of Pb, As, Cd and Zn in agricultural soils and in rice grains near a former secondary lead smelter in Khulna, Bangladesh. It analyzed 29 samples of surface soil and rice grain collected around 500 m of the smelter. Contamination factor (Cf), pollution load index and total hazard quotient (THQ) were calculated to determine ecological and human health risks. Cd was not detected in any of the samples. For the soil samples, medians of the concentrations of Pb, As and Zn were 109, 6.2 and 514 mg/kg, respectively. For the rice grain samples, medians of the concentrations of Pb, As and Zn were 4, 1.4 and 25 mg/kg fw, respectively. Medians of the concentrations of Pb and As in rice grain were higher compared to their maximum allowable limit (0.2 mg/kg), which indicate potential health risks to inhabitants near the Pb smelter. The mean values of Cf for Pb, As, and Zn were, respectively, 11.6, 2.1 and 7.4. For Pb, around 41% of the samples had Cf > 6 indicating very strong contamination. THQ values for Pb and As were greater than 1.0, which evinces the health hazards of these trace elements. Measures should be taken to prevent trace elements exposure from Pb smelter in the study area.

Knowledge of low-risk drinking and its relationship with a reduction in alcohol consumption: Results from six waves of an Australian national survey.

This study examined changes in public knowledge of low-risk drinking, explored factors associated with knowledge level and its relationship with a reduction in alcohol consumption. Data (n = 153,820) of six waves of the National Drug Strategy Household Survey, conducted during the period 2001-2016, were analysed. Australian Guidelines to Reduce Health Risks from Drinking Alcohol was applied to compute participants' knowledge of low-risk drinking. This guideline was introduced in 2001 and later revised in 2009. Multivariable log-binomial regression model was used to analyse the pooled dataset. Subgroup analysis examined the relationship between knowledge score and a reduction in alcohol consumption across drinker categories. Public knowledge was better for long-term than short-term low-risk drinking, and women had better knowledge than men. Since 2010 there has been a small increase in knowledge of low-risk drinking. Although level of knowledge improved over time, it appears to align more towards the 2001-guideline, particularly for the recommended limits for men. Those who were relatively old; were women; received at least year-10 or more education; were not residing in the most disadvantaged areas; identified themselves as either light-, social-, heavy- or binge-drinkers; were currently/previously married; or perceived their health 'excellent' were significantly more likely than others to have an accurate knowledge of low-risk drinking. There was a positive association between knowledge score and the reduction in alcohol consumption among the self-reported social drinkers, heavy drinkers and binge drinkers. Tailored interventions are recommended for those who lack adequate knowledge and drink at a risky level.

Climate change and health in Bangladesh: a baseline cross-sectional survey.

BACKGROUND: Bangladesh is facing the unavoidable challenge of adaptation to climate change. However, very little is known in relation to climate change and health. This article provides information on potential climate change impact on health, magnitude of climate-sensitive diseases, and baseline scenarios of health systems to climate variability and change. DESIGN: A cross-sectional study using multistage cluster sampling framework was conducted in 2012 among 6,720 households of 224 rural villages in seven vulnerable districts of Bangladesh. Information was obtained from head of the households using a pretested, interviewer-administered, structured questionnaire. A total of 6,720 individuals participated in the study with written, informed consent. RESULTS: The majority of the respondents were from the low-income vulnerable group (60% farmers or day labourers) with an average of 30 years' stay in their locality. Most of them (96%) had faced extreme weather events, 45% of people had become homeless and displaced for a mean duration of 38 days in the past 10 years. Almost all of the respondents (97.8%) believe that health care expenditure increased after the extreme weather events. Mean annual total health care expenditure was 6,555 Bangladeshi Taka (BDT) (1 USD=77 BDT in 2015) and exclusively out of pocket of the respondents. Incidence of dengue was 1.29 (95% CI 0.65-2.56) and malaria 13.86 (95% CI 6.00-32.01) per 1,000 adult population for 12 months preceding the data collection. Incidence of diarrhoea and pneumonia among under-five children of the households for the preceding month was 10.3% (95% CI 9.16-11.66) and 7.3% (95% CI 6.35-8.46), respectively. CONCLUSIONS: The findings of this survey indicate that climate change has a potential adverse impact on human health in Bangladesh. The magnitude of malaria, dengue, childhood diarrhoea, and pneumonia was high among the vulnerable communities. Community-based adaptation strategy for health could be beneficial to minimise climate change attributed health burden of Bangladesh.

Knowledge and perception about climate change and human health: findings from a baseline survey among vulnerable communities in Bangladesh.

BACKGROUND: Bangladesh is one of the countries most vulnerable to climate change (CC). A basic understanding of public perception on vulnerability, attitude and the risk in relation to CC and health will provide strategic directions for government policy, adaptation strategies and development of community-based guidelines. The objective of this study was to collect community-based data on peoples' knowledge and perception about CC and its impact on health. METHODS: In 2012, a cross-sectional survey was undertaken among 6720 households of 224 enumeration areas of rural villages geographically distributed in seven vulnerable districts of Bangladesh, with total population of 19,228,598. Thirty households were selected randomly from each enumeration area using the household listing provided by the Bangladesh Bureau of Statistics (BBS). Information was collected from all the 6720 research participants using a structured questionnaire. An observation checklist was used by the interviewers to collect household- and community-related information. In addition, we selected the head of each household as the eligible participant for an interview. Evidence of association between sociodemographic variables and knowledge of CC was explored by cross-tabulation and measured using chi-square tests. Logistic regression models were used to further explore the predictors of knowledge. RESULTS: The study revealed that the residents of the rural communities selected for this study largely come from a low socioeconomic background: only 9.6% had postsecondary education or higher, the majority worked as day labourer or farmer (60%), and only 10% earned a monthly income above BDT 12000 (equivalent to US $150 approx.). The majority of the participants (54.2%) had some knowledge about CC but 45.8% did not (p < 0.001). The majority of knowledgeable participants (n = 3645) felt excessive temperature as the change of climate (83.2%). Among all the respondents (n = 6720), 94.5% perceived change in climate and extreme weather events. Most of them (91.9%) observed change in rainfall patterns in the last 10 years, and 97.8% people think their health care expenditure increased after the extreme weather events. Age, educational qualification, monthly income, and occupation were significantly associated with the knowledge about climate change (p < 0.001). People with higher educational level or who live near a school were more knowledgeable about CC and its impact on health. CONCLUSIONS: The knowledge level about CC in our study group was average but the perception and awareness of CC related events and its impact on health was high. The most influential factor leading to understanding of CC and its impact on health was education. School-based intervention could be explored to increase peoples' knowledge about CC and necessary health adaptation at community level.

Child Centred Approach to Climate Change and Health Adaptation through Schools in Bangladesh: A Cluster Randomised Intervention Trial.

BACKGROUND: Bangladesh is one of the most vulnerable countries to climate change. People are getting educated at different levels on how to deal with potential impacts. One such educational mode was the preparation of a school manual, for high school students on climate change and health protection endorsed by the National Curriculum and Textbook Board, which is based on a 2008 World Health Organization manual. The objective of this study was to test the effectiveness of the manual in increasing the knowledge level of the school children about climate change and health adaptation. METHODS: This cluster randomized intervention trial involved 60 schools throughout Bangladesh, with 3293 secondary school students participating. School upazilas (sub-districts) were randomised into intervention and control groups, and two schools from each upazila were randomly selected. All year seven students from both groups of schools sat for a pre-test of 30 short questions of binary response. A total of 1515 students from 30 intervention schools received the intervention through classroom training based on the school manual and 1778 students of the 30 control schools did not get the manual but a leaflet on climate change and health issues. Six months later, a post-intervention test of the same questionnaire used in the pre-test was performed at both intervention and control schools. The pre and post test scores were analysed along with the demographic data by using random effects model. RESULTS: None of the various school level and student level variables were significantly different between the control and intervention group. However, the intervention group had a 17.42% (95% CI: 14.45 to 20.38, P = <0.001) higher score in the post-test after adjusting for pre-test score and other covariates in a multi-level linear regression model. CONCLUSIONS: These results suggest that school-based intervention for climate change and health adaptation is effective for increasing the knowledge level of school children on this topic.

Colon and rectal cancer incidence and water trihalomethane concentrations in New South Wales, Australia.

BACKGROUND: There is evidence, although inconsistent, that long term exposure to disinfection by products (DBPs) increases the risk of bowel cancer. No study has been conducted in Australia to examine this association and due to difference in the methods of disinfection the risk can vary across geographical regions and. This study was conducted to analyse the association of trihalomethanes (THMs) in water with colon and rectal cancer in NSW Australia. METHODS: Average yearly concentrations of total and individual species of THMs were obtained for 50 local government areas (LGAs). Indirectly-standardized incidence rates of colon and rectal cancers in LGAs for the period 1995 to 2001 were regressed against mean THM concentrations lagged five years, adjusting for socioeconomic status, high risk drinking, smoking status, usual source of water and year of diagnosis, including local and global random effects within a Bayesian framework. The incidence rate ratios (IRRs) for an interquartile range (IQR) increase in THMs were estimated. RESULTS: Using five year lag of exposure there was a positive association between bromoform concentration and CRC in men (IRR = 1.025, 95% CI 1.010, 1.040) but not in women (IRR = 1.003, 95% CI 0.987, 1.018). The association in men was mainly found in colon cancer with bromoform (IRR = 1.035, 95% CI 1.017, 1.053). There was no appreciable association of colorectal cancer with other species of THMs. Sensitivity analyses did not materially change the associations observed. CONCLUSION: A positive association was observed between colon cancer and water bromoform concentrations in men. Given the potential population impact of such an association, further research into the relationship between THMs, particularly brominated species, and colorectal cancer is warranted.

The association of ultraviolet radiation-B (305 nm), season of diagnosis, and latitude on the survival outcome of prostate cancer in the high UV environment of Australia.

BACKGROUND: Positive associations between sun exposure and cancer survival have been observed in regions of high latitudes, where ambient solar ultraviolet (SUV) radiation is generally low. PURPOSE: We examined the effects of ambient ultraviolet-B radiation (UVB) at time of diagnosis, season of diagnosis and latitude of residence on survival outcome from prostate cancer. METHOD: Regression models for relative survival were used to estimate relative excess risks (RER) of death after diagnosis of prostate cancer from cancer registries in Eastern Australia (Queensland, New South Wales, Victoria and Tasmania). RESULTS: Relative excess risks was increased with diagnosis in summer (RER = 1.20; 95 % CI 1.14-1.26) relative to winter, high ambient UVB at the time of diagnosis (>60 mW/m(2); RER = 1.10; 95 % CI 1.05-1.15) relative to low SUV (<30 mW/m(2)), and with residence in high latitudes (35°S-43°S; RER = 1.20; 95 % CI 1.14-1.26) relative to low latitudes (9°S-29.9°S). RER was highest for summer diagnosis in all three latitude bands, after adjusting for age, follow-up period, and socioeconomic status. CONCLUSION: The contradictory outcome from season and latitude suggests that their use as surrogates for UV warrants validation. Our data suggest that high ambient solar ultraviolet radiation at the time of diagnosis of prostate cancer increases the risk of dying from this cancer.

Spatio-temporal variation in trihalomethanes in New South Wales.

AIM: This paper describes the spatio-temporal variation of trihalomethanes in drinking water in New South Wales, Australia from 1997 to 2007 METHOD: We obtained data on trihalomethanes (THMs) from two metropolitan and 13 rural water utilities and conducted a descriptive analysis of the spatial and temporal trends in THMs and the influence of season and drought. RESULTS: Concetrations of monthly THMs in the two metropolitan water utilities of Sydney/Illawarra (mean 66.8 µg/L) and Hunter (mean 62.7 µg/L) were similar compared to the considerable variation between rural water utilities (range in mean THMs: 14.5-330.7 µg/L). Chloroform was the predominate THM in two-thirds of the rural water utilities. Higher concentrations of THMs were found in chlorinated water distribution systems compared to chloraminated systems, and in distribution systems sourced from surface water compared to ground water or mixed surface and ground water. Ground water sourced supplies had a greater proportion of brominated THMs than surface water sourced supplies. There was substantial variation in concentration of THMs between seasons and between periods of drought or no drought. There was a moderate correlation between heavy rainfall and elevated concentrations of THMs. CONCLUSION: There is considerable spatial and temporal variation in THMs amongst New South Wales water utilities and these variations are likely related to water source, treatment processes, catchments, drought and seasonal factors.

Disinfection by-products in drinking water and colorectal cancer: a meta-analysis.

BACKGROUND: There is inconclusive evidence from observational studies that disinfection by-products (DBPs) in drinking water are associated with colorectal cancer. METHODS: A literature search, without language or time limits, was performed to identify relevant case-control and cohort studies. Separate risk estimates for colon and rectal cancer were extracted from studies meeting the inclusion criteria. Relative risks (RRs) or odds ratios (ORs) comparing the highest exposure category with the lowest were pooled using random effects methods. RESULTS: A total of 13 studies (3 cohort and 10 case-control) were analysed. For colon cancer, the pooled RR estimates were 1.11 [95% confidence interval (CI): 0.73-1.70] for cohort studies, 1.33 (95% CI: 1.12-1.57) for case-control studies and 1.27 (95% CI: 1.08-1.50) combining both study types. For rectal cancer, the corresponding RR estimates were 0.88 (0.57-1.35), 1.40 (1.15-1.70) and 1.30 (1.06-1.59). Sensitivity analysis showed these results were not importantly influenced by any single study. Publication bias was not evident for the colon cancer analysis but may have been a minor issue for the rectal cancer analysis. The results for rectal cancer may have been influenced by the quality of the studies. CONCLUSIONS: The study findings provide limited evidence of a positive association between colorectal cancer and exposure to DBPs in drinking water. The small number of studies and limitations in study quality prevent causal inference.

Robot-assisted laparoscopic prostatectomy: analysis of an experienced open surgeon's learning curve after 300 procedures.

To critically analyse the learning curve for a single experienced open surgeon converting to robotic surgery. From February 2006 to July 2009, 300 patients underwent a robot-assisted laparoscopic prostatectomy (RALP) by a single urologist. This study is a prospective analysis of the baseline patient and tumour characteristics, intraoperative and postoperative data, and histopathologic features. To analyse the RALP learning curve, the joinpoint regression method was used. Mean age of the patient was 61.3 years (range 46-76). Mean pre-operative PSA level was 7 ng/ml (range 0.7-41), and follow-up was 14 months (0.7-41). The mean operating time was 185 min (range 119-525). One hundred and ten cases were required to achieve 3-h proficiency. There were no conversions. The mean hospital stay was 2.8 days (range 2-7). Major complications rate was 1.3%. The blood transfusion rate was 0.6%. The overall positive surgical margin (PSM) rate was 21.3%. pT2 and pT3 PSM rate was 10 and 44%, respectively. The joinpoint regression method showed that the learning curve started to plateau for the overall PSM rate after 205 cases (95% CI 200-249). For pT2 and pT3, PSM rate, the learning curve tended to flatten after 130 and 170 cases, respectively. The analysis of an experienced open surgeon learning curve in transferring his skills to the robotic platform has shown that 3-h proficiency requires 110 cases. The overall, pT2, and pT3 PSM rate take approximately 200, 130, and 170 cases, respectively, to flatten.