Professor Kichu Nair

© The Author(s) 2019. Objective: To assess which older Australian women had Medicare subsidized health assessments between 1999 and 2013. Methods: This study used prospective, longitudinal survey data from the 1921 to 1926 birth cohort of Australian Longitudinal Study on Women¿s Health (ALSWH) linked with Medicare Australia data on health services use. Over 11,000 Australian women were included in the study. Latent class analysis was used to identify assessment patterns over time, accounting for death, and based on three categories (¿no assessment¿; ¿assessment; ¿deceased¿) for each year between 1999 and 2013. Further analysis explored the impact of health and sociodemographic characteristics on class membership. Results: Of the women included in the latent class analysis, 37% never had any assessment and the remainder had had at least one assessment. After a steady uptake from 1999 to 2003, there was decline in uptake from 2003 onwards. A six-class model with sufficient homogeneity and reliable estimation was selected to represent assessment patterns and mortality risk, labelled as: ¿high mortality¿ rate with little chance for assessment (12.4%), ¿intermediate mortality, low assessment¿ (14.1%), ¿later mortality/low assessment¿ (13.1%), ¿later mortality, high assessment¿ (7.0%), ¿low mortality, low assessment¿ (31.8%), ¿low mortality, high assessment¿ (21.6%). Older women with certain conditions (such as diabetes, depression, heart disease) were more likely to be in the low assessment groups, and women with difficulty managing on income were more likely to be in low assessment groups. Conclusion: Distinct assessment and mortality patterns were seen, with many women not having assessment, in particular those who had certain health conditions, were taking 3+ medications, had difficulty in managing on income, needed help or were in respite care, and had caring responsibilities. The findings point to a need to promote these assessments among older women, and to reduce financial barriers, even within the context of a heavily subsidized health care system.

Objective: To estimate the cost of resources required to deliver a program to assess international medical graduates (IMGs) in Newcastle, Australia, known as the Workplace Based Assessment (WBA) Program. Design and setting: A costing study to identify and evaluate the resources required and the overheads of delivering the program for a cohort of 15 IMGs, based on costs in 2012. Main outcome measures: Labour-related costs. Results: The total cost in 2012 for delivering the program to a typical cohort of 15 candidates was $243 384. This equated to an average of $16226 per IMG. After allowing for the fees paid by IMGs, the WBA Program had a deficit of $153384, or $10226 per candidate, which represents the contribution made by the health system. Conclusion: The cost per candidate to the health system of this intensive WBA program for IMGs is small.

In this series, we present authoritative advice on the investigation of a common clinical problem, especially commissioned for family doctors and written by members of the Royal Australasian College of Physicians.

Background: The purpose of this study was to compare apolipoprotein E e4 (Apo E e4) and apolipoprotein E e2 (Apo E e2) as predictors of cognitive and functional trajectories over 30 months. Methods: This prospective cohort study included 287 community-dwelling memory clinic patients with dementia, mild cognitive impairment, or no cognitive impairment. The Addenbrooke Cognitive Assessment, Mini-Mental State Examination, Montreal Cognitive Assessment, Delirium Index, and Nottingham Instrumental Activities of Daily Living tests were administered to each subject. Results: One hundred and nine subjects (40%) carried Apo E e4 and 48 (16.7%) carried Apo E e2. One hundred and nine e4-positive subjects differed significantly from 178 e4-negative subjects in 19/52 comparisons (36.5%), whereas 46 Apo E e2-positive subjects had 0/52 significant differences from 239 e2-negative subjects (P < 0.0001). The variables most affected by e4 were the Delirium Index and Mini-Mental State Examination. Instrumental Activities of Daily Living score and residence were unrelated to Apo E e4 or e2. Conclusion: Apo E e4 positivity predicted four cognitive scores measured every 6 months over 30 months. Apo E e2 scores predicted none of 52 comparisons. © 2013 Regal et al.

We report on an elderly lady with a large hiatus hernia presenting with presyncope and syncope associated with large meals. Though left atrial filling and mitral inflow was unimpaired, this case is interesting since the symptoms resolved with adjustment to meal size. Copyright 2013 BMJ Publishing Group. All rights reserved.