For people with MS, the decision to engage in physical activity (or not) is complex, fluid and individual; made more complex by the unpredictable nature of MS. Rehabilitation professionals attempting to engage people with MS in a physical activity programme should consider adopting an individualised approach to barrier management which takes into account personal beliefs and perceptions regarding physical activity engagement.

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multicenter, prospective case-control study involving 1,714 participants >5 years of age was conducted in Australia to identify risk factors for Campylobacter infection. Adjusted population-attributable risks (PARs) were derived for each independent risk factor contained within the fi nal multivariable logistic regression model. Estimated PARs were combined with adjusted (for the >5 years of age eligibility criterion) notifi able disease surveillance data to estimate annual Australian Campylobacter case numbers attributable to each risk factor. Simulated distributions of "credible values" were then generated to model the uncertainty associated with each case number estimate. Among foodborne risk factors, an estimated 50,500 (95% credible interval 10,000-105,500) cases of Campylobacter infection in persons >5 years of age could be directly attributed each year to consumption of chicken in Australia. Our statistical technique could be applied more widely to other communicable diseases that are subject to routine surveillance. F oodborne gastroenteritis is a major public health concern in many countries, including Australia. A recent study estimated that 5.4 million cases (95% credible interval [CrI] 4.0-6.9 million), 15,000 hospitalizations (95% CrI 11,000-18,000), and 80 deaths (95% CrI 40-120) annually are caused by foodborne gastroenteritis in Australia (1). Norovirus, enteropathogenic Escherichia coli, Salmonella spp., and Campylobacter spp. accounted for 88% of the estimated 1.5 million (95% CrI 1.0-1.9 million) cases of foodborne disease caused by known pathogens.Among known foodborne pathogens, Campylobacter spp. are the most frequently reported enteric pathogens in Australia (2). The incidence of Campylobacter infection steadily increased from 1991 through 2001 but has been relatively stable since. In 2005, >15,000 cases were reported in Australia, a crude rate of 113.0/100,000 population. However, because of underreporting, ≈223,000 Campylobacter infections are estimated to occur annually; ≈75% of these are foodborne (3). Most of these infections are sporadic.Case-control studies have identifi ed a range of different risk factors for infection; consumption of chicken is the most frequently reported (4-9). Some of these studies report population-attributable fractions associated with independent risk factors, but no estimates of the total magnitude of infection caused by chicken or other risk factors have yet been reported. Using a multicentered, prospective casecontrol study, we aimed to develop a multivariable logistic regression model that identifi ed independent foodborne and nonfoodborne risk factors for Campylobacter infection for this sample (7) and calculate population-attributable risk (PAR) proportions. These PARs were then combined with annual Campylobacter infection surveillance data to estimate the total number of infections (with associated CrIs) among persons >5 years of age attributable to specifi c risk factors that occur in the community each year in Australia.

Components contributing to work-ability go beyond the ability to perform particular work tasks. Measures intended to be used to inform vocational rehabilitation arguably need to consider all these factors to maximise likelihood of a sustainable return to work.

The fetal fraction in maternal plasma cfDNA increased with gestational age, serum pregnancy-associated plasma protein A (PAPP-A), β-hCG, and PlGF and decreased with increasing maternal BMI. There was no significant correlation between low FF and test accuracy, when FF was above 4%.

Identi®cation, ranking and selecting hazardous traf®c accident locations from a group under consideration is a fundamental goal for traf®c safety researchers. Few methods exist that can quantitatively, accurately and easily discriminate between sites that commonly have small and variable observation count periods. One method that embodies all these advantages is the hierarchical Bayesian model, the method proposed in this paper. The particular hierarchical Bayesian approach that we use incorporates expert knowledge about accident sites as a group believed a priori to be exchangeable, the Poisson assumption and a conjugate gamma prior. We then propose three natural strategies for ranking and selecting the most hazardous subgroup of accident locations. Also presented is an especially useful procedure that gives the probability that each particular site is worst and by how much it is worst. All proposed strategies are illustrated using previously published fatality accident data from 35 sites in Auckland, New Zealand.

Objective: To describe changing patterns of skin cancer surgery by Australian general practitioners and make comparisons with specialists. Design and setting: Analysis of Medicare Australia item number reports for skin cancer excisions and for flap and graft repairs between 2001 and 2005. Main outcome measures: GPs’ and specialists’ rates of non‐melanoma skin cancer (NMSC) excisions, melanoma excisions, flap repairs and graft repairs; excision to flap ratios. Results: NMSC excisions in Australia increased from 338 712 (2001) to 451 628 (2005), a mean annual increase of 1.11/1000 population (P = 0.04); GPs did 51.1% of excisions in 2001, increasing to 54.4% in 2005, representing a higher mean annual rate increase than in specialists (P = 0.003). Nationally, melanoma excisions increased from 20 414 (2001) to 25 580 (2005); GPs did 34.3% of excisions in 2001, increasing to 35.8% in 2005 — a similar mean annual rate increase to that in specialists (P = 0.25). Total flap repairs increased from 58 550 (2001) to 80 742 (2005); GPs did 21.3% of flap repairs in 2001, increasing to 26.9% in 2005 — a similar mean annual rate increase to that in specialists (P = 0.83). Nationally, the excision to flap ratio for GPs fell from 14 : 1 (2001) to 12 : 1 (2005); in Queensland the ratio fell from 14 : 1 to 9 : 1 over the same period. Conclusion: GPs excise the majority of skin cancers, and the proportion excised by GPs is increasing. GPs are increasingly using skin flaps for repair, suggesting substantial changes to patterns of treatment, especially in Queensland.

BackgroundThe disparities in health and life expectancy of Aboriginal and Torres Strait Islander peoples compared to non-Indigenous Australians are well documented. Chronic diseases are a leading contributor to these disparities. We aimed to determine the feasibility, acceptability and appropriateness of a case management approach to chronic disease care integrated within an urban Aboriginal and Torres Strait Islander primary health care service.MethodsThe Home-based, Outreach case Management of chronic disease Exploratory (HOME) Study provided holistic, patient centred multidisciplinary care for Aboriginal and Torres Strait Islander people with chronic disease. A developmental evaluation approach supported the implementation and ongoing adaptations in the delivery of the model of care, and ensured its alignment with Aboriginal and Torres Strait Islander peoples’ understandings of, and approaches to, health and wellbeing. In-depth, semi-structured interviews were conducted with nine patient participants (one interview also included a participant’s spouse) and 15 health service staff and key themes were identified through an iterative reflective process. Quantitative data were collected directly from patient participants and from their medical records at baseline, 3 and 6 months. Patient participants’ baseline characteristics were described using frequencies and percentages. Attrition and patterns of missing values over time were evaluated using binomial generalized estimating equation (GEE) models and mean differences in key clinical outcomes were determined using normal GEE models.ResultsForty-one patients were recruited and nine withdrew over the 6 month period. There was no evidence of differential attrition. All participants (patients and health service staff) were very positive about the model of care. Patient participants became more involved in their health care, depression rates significantly decreased (p = 0.03), and significant improvements in systolic blood pressure (p < 0.001) and diabetes control (p = 0.05) were achieved.ConclusionsThe exploratory nature of our study preclude any definitive statements about the effectiveness of our model of care. However, staff and patients' high levels of satisfaction and improvements in the health and wellbeing of patients are promising and suggest its feasibility, acceptability and appropriateness. Further research is required to determine its efficacy, effectiveness and cost-effectiveness in improving the quality of life and quality of care for Aboriginal and Torres Strait Islander peoples living with chronic disease.