Popmed Lo-Driven

Front 1

The epidemiology of acute respiratory infection in children and adults, and in the Indigenous population.

Back 1

• Epidemiology of ARI
o Average 2.2 respiratory episodes per person per year
o Mean duration 6 days
o Most don’t see a doctor
• ARI in children
o Most common cause of illness in childhood
o 95% are URTIs
o Peak incidence between 2-4 years (8-10 episodes annually)
• LRTI
o Peak incidence in first year of life, mostly bronchiolitis
o About 5% of children have been admitted to hospital with a respiratory illness by age 4
o Steep increase in incidence and severity of pneumonia after 75 years
• Indigenous
o ARIs over 3x more common

Front 2

The different pathogens causing acute respiratory infection

Back 2

• Pathogens by age
o Viral most common in young children, especially RSV
o Mycoplasma pneumoniae: mostly school age to young adults
o Legionella: mostly elderly
o Chlamydia trachomatis: acquired from birth canal, can cause pneumonia in young infants
o Chlamydia pneumoniae: mostly young adults
o Strep. pneumoniae: most important bacterial cause of otitis media and pneumonia, following by H. Influenzae
• Staph aureus & strep pyogenes also important, but less common

Front 3

The price policy, public education, pack warnings, advertising bans, harm reduction policy, passive smoking restrictions, reducing access and smoking cessation policy

Back 3

• National tobacco strategy:
o Strengthen community action (public education)
o Promote cessation of tobacco use (incentives to quit, education of benefits of cessation)
o ↓ availability of tobacco (taxes, restriction of sales to minors)
o ↓ tobacco promotion (regulation of tobacco advertising & sponsorship)
o Regulate tobacco (e.g., disclosure of ingredients on packets)
o ↓ environmental exposure (smoke-free public places)

Front 4

The criteria for establishing a causal relationship in epidemiology and their application to smoking related disease. The evidence for the relationship between smoking and lung cancer and the impact of tobacco smoke on human health

Back 4

• Benefits of smoking cessation
o Cardiovascular
• RR of dying from heart attack ↓ 50% in first year, returns almost to “never smoker” values by 5-10 years after quitting
• ↓ tendency to thrombosis
• ↑ exercise tolerance
o Cancer susceptibility
• Lung cancer risk ↓ slowly after cessation: falls by 50-70% after 10 years
• Halves the risk of mouth & throat cancers over 5 years
• Slower rate of risk reduction for bladder, cervix, pancreas cancers
o Respiratory
• Rapid improvement in cough, wheeze, sputum production
• Lung function ↑ by 5% within a few months
• In chronic lung disease, mortality ↓
o Other
• During pregnancy, partially protects foetus from adverse effects on intrauterine growth
• Smoking-related premature menopause may be reversible by cessation

Front 5

How cigarette smoking affects the various organs of the human body; appreciate clinical conditions that affected patients may present with

Back 5

• Effects of smoking:
o Cancer
• Lung
• Mouth & throat (oropharyngeal, laryngeal, oesophageal)
• Stomach
• Pancreatic
• Bladder
• Cervical
• Others (nasal, renal pelvic, urinary tract, myeoloid leukaemia)
o Other
• Cardiovascular disease (ischaemic heart disease, stroke, atherosclerosis, arrhythmias, heart failure)
• Pulmonary (COPD, pulmonary circulatory disease)
• Peptic ulcer
• Low birthweight
• Fire injuries
• Criteria for causation
o Exposure precedes outcome
o Association unlikely due to chance, bias, or confounding
o Non-absolute criteria:
• Association is strong, consistent, reversible, coherent with other epidemiological data, and biologically plausible
• There is a dose-response relationship

Front 6

The past and present uses of asbestos in Australia, the history of control strategies, the occupations and industries in which asbestos exposure was/is common

Back 6

• Asbestos exposure:
o Mining & milling
o Shipbuilding
o Building & construction
o Asbestos removal industries
o Motor vehicle industries
o Asbestos product manufacture
o Military
o Railways
• Hierarchy of control
o Eliminate
o Substitute
o Isolate
o Engineer
o Systems of work
o Administrative
o PPE
• Occupational asthma is probably the most important occupational lung disease in Australia now, associated with:
o Food & natural products processing
o Animal handling facilities
o Manufacturing
o Construction

Front 7

The prevalence of cardiac failure in Australia, including distribution, causes, prevention and management

Back 7

• Prevalence of cardiac failure
o 1% of people aged 50-59
o 10% of people aged over 65
o 50% of people aged over 85
o Lifetime risk = 20%
o 2-3x more common in indigenous
• Causes of cardiac failure
o Hypertension & MI account for ¾ of attributable risk
o Other risk factors:
• Age
• Alcohol
• Diabetes (2-8x increase)
• Obesity
• OSA
• Cardiomyopathy
• Valvular disease
• Prognosis
o 5-year survival only ~50%
• Treatment
o Hospitalization is common
o Expensive (10% of total cost of cardiovascular care)

Front 8

The concept of medical ethics and professionalism

Back 8

• non-maleficence
• beneficence
• autonomy
• distributive justice

Front 9

The foetal diagnosis and screening for chromosomal anomalies, with particular reference to Down Syndrome

Back 9

• Foetal screening = combination of:
o Maternal serum parameters of foetal well-being (e.g., α-fetoprotein)
o Foetal measurement (e.g., nuchal fold translucency)

Front 10

The factors that contribute to the surgical management of valvular heart disease, in particular when to intervene, the interventional options and the choices of the options

Back 10

• Natural history of valvular heart disease is quite poor; in most patients surgery will dramatically improve prognosis
• Intervene before permanent damage to heart, lungs, or other organs & before operative risk is too high

Front 11

The distribution in the community, causes, prevention and screening methods for hypertension

Back 11

• Hypertension (defined by WHO):
o Systolic > 140 and/or
o Diastolic > 90 and/or
o Taking hypertension meds
• ~14% of deaths worldwide attributable to hypertension
• Prevalence in Australia
o ~30% of people > 25 years
o But decreased by ~1/2 since 1980 (possibly due to ↓ salt intake, but unsure)
o Up to 3x more common in indigenous
o The most commonly managed problem by GPs
• Causes of HT
o Family history
o Overweight / physically inactive
o Excessive EtOH
o High dietary salt intake
o Low fruit/vegetable intake & high saturated fat
• Primary prevention includes:
o Healthy body weight
o ↓ salt intake
o Regular exercise
• Secondary prevention
o Current guidelines are for screening of all Australians > 15 yrs every 2 years

Front 12

The main issues concerning "labelling" and stigmatisation in epilepsy

Back 12

• 3 types of stigmatisation:
o Legal discrimination (e.g., epileptics not allowed to be airline pilots)
o Enacted stigma (e.g., person refused a job in a bank just because he has epilepsy)
o Perceived stigma (epileptic avoids disclosure because fearful of enacted stigma)

Front 13

Be able to describe and discuss the financial and social costs of dementia on the individual, carers and the community

Back 13

• 4th highest course of death in Australia (after heart disease, stroke, and lung cancer) and will be #1 by 2030
• Accounts for ~10% of entire spending on health & residential aged care, and will be #1 cost in the future
• 2nd largest cause of disability burden in Australia (after depression)
• Very high carer burden (1 in 4 carers provide > 40 hrs per week of care), and huge shortage (150,000) of paid & unpaid carers predicted for the future

Front 14

Be able to describe and discuss the social and financial effects of, and the societal response to, mental illness in the community

Back 14

• 12-month prevalence of mental disorders in Australia: ~18%
• “Low-prevalence” disorders are more likely to be treated in the public sector (acute or community services) and incur high costs of treatment ($20k per person p.a. for schizophrenia)
• Social / financial costs of mental illness:
o Unipolar depression is the #4 cause of DALYs in Australia, projected to increase
o Life expectancy 25-30 years less on average
o Disability is often greater than would be predicted by symptoms
o 70% of people with psychological disorders are not in the labor force (higher % than for any other type of illness)
o But spend on mental health has been low relative to DALYs
• Better treatment (e.g., antidepressants) have resulted in ↓ suicide rates in recent years
• Commonwealth government has stepped in with funding for non-hospital care for mental illness

Front 15

Be able to describe the pathogenesis of Alzheimer disease, including risk factors, diagnosis, genetic changes and the role of apolipoproteins

Back 15

• Epidemiology & risk factors:
o Old age is by far the strongest risk factor
o Family history of AD or dementia --> 2 – 6x odds ratio of AD
• Stronger for early-onset disease
o Causative mutations include amyloid protein precursor (APP) on chromosome 21, presenilin-1, and presenilin-2, but account for < 5% of AD cases
o Apolipoprotein E (involved in synaptic repair) allele E4 is associated with AD
o Other suggested risk factors:
• Heavy metals (esp. Al) – weak link
• Low level of education (↓ reserve capacity of brain)
• Physical inactivity
• Vascular risk factors
• NSAIDs & statins (protective)
o Age-specific prevalence similar for men and women, but AD more common in women due to longer lifespan
o No proposed risk factors have yet translated into effective disease-modifying therapy

Front 16

Be able to summarise factors required for a valid population health survey

Back 16

• Random sampling (e.g., electoral rolls, telephone numbers, area probability sampling) OR census
• At least 80% response rate

Front 17

Be able to outline the current model of mental health services provision and the challenges to be faced in the organisation and delivery of mental health services

Back 17

• Developments in recent decades:
o From institutional care to community-based care
• Most patients now receive treatment as outpatients
• Most outpatient mental health services operate on a “case management” system, where each new patient is allocated a case manager to coordinate care
o From stand-alone psychiatric facilities to psychiatric units in general hospitals
• Providers of mental health care:
o Public mental health services: mostly severe mental disorders
o Private psychiatrists: mostly chronic conditions
o GPs: mostly mild or transient conditions
o Addictive services
• Current challenges:
o Rural and remote areas
• ↑ youth suicide compared to cities
• Very few psychiatric services
• Under-utilization by Aborigines
o Decision on which treatments to fund
o The future: ↑ in depression

Front 18

Be able to describe the specialist contributions of health professionals other than doctors in the management of patients with spinal cord injury, e.g. specialist nurses, psychologists, physiotherapists, occupational therapists and social workers

Back 18

• Short term:
o Spinal immobilization
o Neurological examination → determine level & extent of spinal cord damage
o Radiological assessment
o Catheterization for bladder paralysis
o Naso-gastric aspiration for paralytic ileus
o Proton pump inhibitors for stress ulceration
o Medications & pressure stockings for thromboembolism risk
o Prevention of pressure sores
o Position paralysed limbs to prevent muscle shortening (↓ spasticity)
o Other complications: spinal shock, respiratory insufficiency
• Long term:
o Education: bladder & bowel management, autonomic dysreflexia, skin care, sexuality
o Bowel training & optimization of stool consistency
o Interventions for pain & spasticity
o Physical strengthening
o Specialized equipment for mobility & function
o Home modifications
o Pyschosocial intervention

Front 19

Be able to summarise the epidemiological features of stroke and its risk factors. Be able to outline the prognosis following stroke. Be able to describe methods of stroke prevention at different levels (primary, secondary and tertiary) and outline the evidence for these methods, including relevant clinical protocols and guidelines

Back 19

• Stroke is 2nd most common cause of death and most common cause of disability
• ~350,000 Australians have a stroke each year, ~9000 deaths
• Treatment can prevent up to 80% of strokes
• Signs of stroke:
o Acute onset
o Neurologic deficit
o Localizing signs
o Well in last week
• Treat brain infarct with tPA as fast as possible (“Time is brain”)

Front 20

Be able to summarise data on the occurrence of and risk factors for multiple sclerosis, i.e. identify and interpret measures of frequency and information about disease patterns for MS; identify risk factors for MS; and interpret measures of association of these risk factors with MS

Back 20

• Latitudinal effect: higher prevalence in Scandinavia, Tasmania, etc. may be due to lack of sun exposure in childhood
o Also, individuals who migrate after puberty take risk with them
• But also a racial effect: very rare or nonexistent in non-white races
• Some genetic component: 25% concordance in monozygotic twins
• 2x risk for a certain HLA class II allele
• No other risk factors have been established
• Prevalence: 10 – 75 per 100,000 in Australia (highest in Tas, lowest in Qld)
EXTRA BITS: SUBDURAL HAEMORRHAGES 70% Mortality, 10% good recovery
DIFFUSE AXONAL INJURY 10% Mortality, 70% good recovery.
SPINAL CORD INJURIES: 60% in cervical region, 60% incomplete. 20% develop post traumatic syringomyelgia.

Front 21

The epidemiology of obesity and the public health approaches for preventing obesity

Back 21

• Epidemiology of obesity
o Average weight gain of population: 0.46 kg / year
o BMI has increased from 25.7 in 1996 to (projected) 29.7 in 2014
o ~25% of children currently overweight (only 10-15% in 1985)
• Current and proposed population interventions
o Point-of-purchase (food promotion, pricing)
o Improving access to PA (physical activity) facilities
o Worksite PA facilities and support
o Stair use prompts
o Active transport infrastructure
o Mixed land use
o Mass media education campaigns
o GP dietary & physical activity advice

Front 22

The key elements required for diabetes screening

Back 22

• Height, weight, BMI, waist-hip ratio
• Blood pressure, peripheral pulses, bruits
• Sensation, reflexes
• Foot inspection
• Eye examination
• Blood glucose
• Urine protein

Front 23

The common causes of infertility, the associated psychological stresses of infertility and the modern management of this condition

Back 23

• Monthly probability of pregnancy in normal couples = 20% (but big drop-off around age 35)
• Causes of infertility
o Tubal disease (or other anatomical factors)
• Pelvic inflammatory disease (e.g., from STD, previous surgery)
• Congenital anomalies
o Endometriosis (--> can cause phagocytosis of sperm, autoimmune response to endometrial lining, PG production affecting oocytes & sperm transport)
o Ovulation disorder
• Polycystic ovary syndrome
• Hypothalamic disturbance
• Hyperprolactinaemia
• Primary ovarian failure
o Uterine factors
• Submucous fibroids
• Endometrial polyps
• Intrauterine adhesions / scarring
• Infections (e.g., TB)
o Male factors
• Obstructive azoospermia (congenital = BCAVD, infection, vasectomy)
• Non-obstructive azoospermia (genetic, maldescent, chemotherapy, mumps)
• ↓ sperm parameters
o Immunological factors
• Antisperm ab in female or male

Front 24

The causal risk factors for uterine cancer

Back 24

• Risk factors for uterine cancer:
o Hypertension
o Diabetes mellitus , obesity, POS
o Late menopause
o Nulliparity
o Prolonged unopposed oestrogen exposure
o Other cancers
o Familial Cancer Syndromes
• Protective:
o OCP
o Alcohol
o Progestogens

Front 25

Compliance with treatment

Back 25

• It’s effectively impossible to achieve perfect blood glucose control with diabetes
• Therefore it’s counterproductive for a clinician to berate the patient every time he has a hyper or hypo episode
• Clinician needs to play the role of a supportive partner to the patient
• Clinician should also be cognizant of depression, which is common in diabetes (and any chronic disease) and has a detrimental effect on compliance

Front 26

The causes of chronic renal failure leading to the patient requiring dialysis support and a transplant. The prevention strategies of this disorder.

Back 26

• Renal failure significantly more common in aborigines
• Common causes of chronic renal failure:
o Glomerulonephritis
o Diabetic renal diseases
o Polycystic renal disease
o Reflux renal disease
o Hypertension
o Analgesic Renal disease
o Obstructive Nephropathy
• Preventable causal factors include:
o Diabetes
o Chronic infection
o Urinary & general sepsis
o Hypertension & vascular disease
o Drug toxicity (e.g., cyclosporin, penicillamine)
• Strategies to prevent the development of renal failure:
o Diabetes & hypertension: education, detection, & control
o Urinary screening for infection or protein
o Early detection of clinical RPGN (rapidly progressive glomerulonephritis)
o Early intervention with renal-protective therapies (e.g., ACEi)

Front 27

The incidence, prevalence and causes of kidney disease in Indigenous Australians

Back 27

• Incidence
o Incidence of end stage kidney disease in indigenous population ranges from less than 100 / million / yr in capital cities to almost 1300 / million / yr in some remote locations
o Correlates with socioeconomic disadvantage
• Chronic kidney disease in indigenous vs. other Australians:
o Indigenous have 8x higher mortality, average ~25 yrs life lost vs. 10 yrs for non-indigenous
o Indigenous have lower access to renal transplant

Front 28

The current issues in prostate gland screening, particularly in relation to prostate specific antigen

Back 28

• Considerable uncertainty about clinical significance of smaller prostate cancers
o Estimate: 40% of men have undiagnosed prostate cancer, of which 1/5 have volume > 0.5 cm^3
• Current recommendations: screen for ages 50-75 (but start earlier if family history)
o But men should make an informed but personal choice about PSA testing
• (Definitive data from two large studies not available till 2008-2010)

Front 29

The virology, clinical features and epidemiology of Hepatitis B

Back 29

• Epidemiology / clinical features
o Exclusively a human virus
o High rates of chronic HBV infection (> 8%) in China, SE Asia, & Africa
o In Australia: immigrants account for 80-90% of cases
o Most transmission of HBV worldwide is perinatal, and 95% of infected babies become chronic carriers
o Most adults, however, will clear the infection
o If untreated, 25-40% of chronically infected will die prematurely of liver disease
o 9th leading cause of death worldwide
o Incubation period average 2-3 months
o Acute illness < 10% in young children, 30-50% in older children & adults
• Transmission of HBV infection
o Perinatal
o Percutaneous / parenteral
o Sexual (commonest in AU)
o Saliva contains much less virus, and urine & faeces contain none unless contaminated with blood
• Concentration of HBV in body fluids
o High in blood, serum, wound exudates
o Moderate in semen, vaginal fluid, saliva
o Low in urine, faeces, sweat, tears, breast milk

Front 30

The high level of drug use in older people and how the associated risks can be minimised

Back 30

• Drugs that are inappropriate or high risk for elderly:
o Benzodiazepines
o NSAIDs
o Tricyclic antidepressants
o Digoxin
o Antihistamines
• Beware – many drugs have anticholinergic effects:
o SSRIs
o Anti-histamines
o Antipsychotics
• Particularly watch out for:
o Triple whammy: ACE inhibitor + diuretic + NSAID
o Serotonin-increasing medications
o Phenothiazines (conventional antipsychotics) & EPS
o Use of alternative medications

Front 31

The determinants and distribution of child poverty

Back 31

• Determinants of poverty in Australia:
o Social inequality
o Unemployment
o Ethnicity
o “Cultures" of poverty
• Obstacles to medical care and support services for poor families
o Cost barriers to fee-for-services resources
o Overcoming unfamiliarity and distrust of available resources
o Availability of specially targeted services for Non English Speaking Background groups and Aboriginal people

Front 32

Prevention and control of foodborne disease in Australia

Back 32

• Burden of foodborne disease in Australia
o 5.4 million cases of gastro-enteritis & 6000 cases of non-gastrointestinal illnesses per year
o Susceptible groups: infants, elderly, immunosuppressed, pregnant women
• Notifiable conditions in NSW
o Salmonellosis
o Listeriosis
o Shigellosis
o Hep A
o Typhoid, paratyphoid
o Haemolytic uraemia syndrome
o Shigatoxigenic E. Coli
• Also to be notified by doctors:
o Foodborne illness in two or more related cases
o Gastroenteritis in an institution (e.g., educational or aged care institution)
• Foodborne diseases can be spread by:
o Food (faecal contamination, poor storage, cross contamination, under cooking)
o Person to person
o Animal to person
o Water (faecal contamination)

Front 33

Overall goals of PopMed and its role in the SMP curriculum

Back 33

1. How common is the problem?
2. What causes the problem?
3. How can the problem be prevented?
4. What is the appropriate management?
5. How strong is the evidence?
6. What are the personal effects?
7. What are the effects of problem on society?
8. How does society respond?

Front 34

To introduce some key concepts related to burden of disease

Back 34

• Top 6 causes of DALYs in Australia:
o Cardiovascular
o Cancer
o Mental
o Nervous system
o Injury

Front 35

To outline the patterns and causes of health inequalities in Australia, and ways of reducing them

Back 35

• Consistent relationship between socioeconomic status and health

Front 36

History, structure, current functions, cost and future of Australian health care system

Back 36

• 68% of total health expenditure from public sources (2/3 federal, 1/3 states), remainder private

Front 37

The rationale, purposes and data sources for disease surveillance and apply them to the investigation of outbreaks

Back 37

• Use case control studies to confirm the cause of an outbreak (e.g., oysters --> hep A)

Front 38

Determinants that lead to high prevalence of TB in certain areas; how the three levels of prevention are applied to tuberculosis and the barriers to accessing healthcare and some strategies for overcoming these. Some particular barriers to healthcare access for immigrants

Back 38

• Cases of TB in NSW:
o Overseas-born (85%)
o Close contact with infectious TB case
o Healthcare workers
• Management
o Surveillance & control programs, isolation of TB cases as appropriate
o Directly observed therapy
o Preventive therapy for infected contacts

Front 39

Health issues for indigenous people

Back 39

• Total indigenous population in Australia: ~500,000
• Indigenous life expectancy: 60-65 years
• Dialysis is the biggest cause of hospitalization

Front 40

The organisation of the health service and workforce in rural Australia

Back 40

• Large rural centres generally have more acute hospital beds per capita (+ more nurses) than capital cities and smaller rural centres
• Inaccessibility of general practitioners remains the greatest source of disadvantage for most rural residents
• The number of medical specialists per capita is similar between large rural centres and metropolitan but very much smaller in the remainder
• The supply of pharmacists per capita is similar across metropolitan, larger and smaller rural centres but is lower in other rural areas and remote zones

Front 41

The patterns of alcohol consumption and its burden on Australian society, the problems associated with binge drinking, intoxication as a major factor in road accidents and the effect of alcohol on judgment and disinhibition

Back 41

• 1/3 of people aged 14 years binge drink at least once per year (taking 7 or more standard drinks for males and 5 or more standard drinks for females on one occasion)
o Males 20-29 years are the most likely to binge drink regularly
• BAC > 0.05g/100mL in at least 1/3 of motor accidents
• Alcohol a contributing factor in ¾ of assaults

Front 42

The epidemiological, legal and social data relevant to the current medical and sociopolitical status of injecting drug use in Australian

Back 42

• 38 % ever used illicit drugs
• 1.8% injected drug at some time
• In last year:
o 13 % cannabis
o 3 % amphetamine use
o < 1 % heroin use
o 0.6% injected

Front 43

The prevalence and distribution of risk factors and the prevention strategies for osteoarthritis

Back 43

• ~8% of population suffers from OA
• Risk factors – underlying susceptibility
o Age
o Female
o Genetics
o Obesity
o Hormones (predilection for peri-menopausal onset)
• Risk factors – biomechanical
o Trauma
o Joint shape / malalignment
o Occupational overuse
o Infection
• Prevention
o Weight reduction
o Exercise / muscle strengthening

Front 44

The major forms of skin cancer including squamous cell carcinomas, basal cell carcinomas and malignant melanomas

Back 44

• Incidence
o BCC > SCC > melanoma, but low mortality rate for BCC & SCC
o Melanoma = 4th most common cancer in Australia (not including non-melanoma skin cancers)
• Risk factors
o UV light (esp. for BCC & SCC)
o Moles (for melanoma)
o Solar keratoses (for SCC)
• Prevention
o Protective clothing, sunscreen

Front 45

Some approaches to public health problems including measurement of health related quality of life and economic appraisal of interventions• Prevention of hip fractures:

Back 45

o Vitamin D & calcium
o Hip protectors
o Bisphosphonates
o HRT

Front 46

Non-pharmacological treatment of osteoarthritis including patient education, exercise, psychosocial strategies, physical therapies and mechanical devices; the surgical management of degenerative joint disease

Back 46

• Non-pharmacological treatments for OA (with evidence):
o Exercise
o Patient education
o Self-management programs
o Weight reduction
o Occupational therapy (splints, orthotics)
o Patella taping
o Leeches
o Topical therapies (capsaicin, anti-inflammatories)
o Glucosamine & chondroitin
o Avocado / soybean
o Acupuncture
o Hydrotherapy
o TENS

Front 47

The worker's compensation laws in Australia and the responsibilities of employers, workers and doctors under the Workers' Compensation legislation

Back 47

• All employers must have:
o A current workers compensation policy with a registered insurer (unless self-insured)
o A return-to-work program for injured workers
• Injured employees must obtain a WorkCover certificate from a doctor if they want compensation, and must participate in an Injury Management Plan (from the insurer) and return-to-work plan (from the employer)

Front 48

The different types of injury prevention (primary, secondary and tertiary); the prevention strategies for health problems and the incidence of falls in Australian society

Back 48

• Prevention concepts:
o 1° prevention: ↓ incidence of disease
o 2° prevention: ↓ prevalence of disease by shortening duration (e.g., screening programs for early detection)
o 3° prevention: ↓ complications of disease
• 4% of Australian population have a fall with injury every 4 weeks
• Falls in children
o 23% of all falls
o Not a common cause of death, but a significant cause of morbidity
o Younger children tend to fall in the home, older children from play equipment
• Falls in adults > 65 years old
o Only 2% of all falls, but more likely to cause serious morbidity or death
o Risk of hospitalization & death ↑ with age
o F> M 3:1
• Prevention for children:
o Engineer visits to playgrounds
o ↑ depth of bark on playground surfaces
• Prevention for elderly
o Multidisciplinary / multifactorial risk factor screening & intervention in the community
o Muscle strengthening & balance retraining
o Home hazard assessment & modification
o Withdrawal of psychotropic medication
o Cardiac pacing for fallers with carotid sinus hypersensitivity
o Tai Chi

Front 49

The evidence and opinion concerning AA and SMART

Back 49

• AA affiliation is associated with good outcome
• SMART = self management & recovery training (based on CBT)
o Evidence ?