there is an increased risk of multiple falls, but not single falls, in older people with poorer gait. Specific measures of gait and gait variability seem to confer this risk and may be amenable to interventions designed to reduce the risk of multiple falls in older people.

In community-dwelling older people, executive function/attention and processing speed were associated with many aspects of gait, whereas visuospatial ability may only play a role in double support phase variability.

Background and Purpose-The association between cerebral white matter lesions (WMLs) and the risk of falls in older people is uncertain, with no supporting prospective evidence. We aimed to determine the risk of incident falls associated with WML volume, and the interactions between WML volume, gait, and other sensorimotor factors leading to falls. Methods-We conducted a prospective, population-based study (nϭ294, mean age 72.3 years, independently mobile).Volumetric MRI, computerized gait measures, and sensorimotor measures of falls risk were obtained at baseline. Incident falls were recorded prospectively over a 12-month period. Using regression modeling, we estimated the risk of incident falls associated with baseline WML volume. Results-Increasing baseline WML volume was independently associated with any incident fall (Pϭ0.01) and multiple incident falls (Pϭ0.02). The risk of incident falls was doubled in people with lesion volumes in the highest quintile of its distribution compared with the lowest (adjusted relative risk, 2.32; 95% CI, 1.28 -4.14).Greater lesion volume was also associated with poorer gait and greater gait variability (both PϽ0.001).

BackgroundSevere air pollution generated by forest fires is becoming an increasingly frequent public health management problem. We measured the association between forest fire smoke events and hospital emergency department (ED) attendances in Sydney from 1996–2007.MethodsA smoke event occurred when forest fires caused the daily citywide average concentration of particulate matter (PM10 or PM2.5) to exceed the 99th percentile of the entire study period. We used a time-stratified case-crossover design and conditional logistic regression models adjusted for meteorology, influenza epidemics, and holidays to estimate odds ratios (OR) and 95% confidence intervals (CI) for ED attendances on event days compared with non-event days for all non-trauma ED attendances and selected cardiorespiratory conditions.ResultsThe 46 validated fire smoke event days during the study period were associated with same day increases in ED attendances for all non-trauma conditions (1.03, 95% CI 1.02, 1.04), respiratory conditions (OR 1.07, 95% CI 1.04, 1.10), asthma (OR 1.23, 95% CI 1.15, 1.30), and chronic obstructive pulmonary disease (OR 1.12, 95% CI 1.02, 1.24). Positive associations persisted for one to three days after the event. Ischaemic heart disease ED attendances were increased at a lag of two days (OR 1.07, 95% CI 1.01, 1.15) while arrhythmias had an inverse association at a lag of two days (OR 0.91, 95% CI 0.83, 0.99). In age-specific analyses, no associations present in children less than 15 years of age for any outcome, although a non-significant trend towards a positive association was seen with childhood asthma. A further association between smoke event and heart failure attendances was present for the 15–65 year age group, but not older adults at a lag of two days (OR 1.37 95% CI 1.05, 1.78).ConclusionSmoke events were associated with an immediate increase in presentations for respiratory conditions and a lagged increase in attendances for ischaemic heart disease and heart failure. Respiratory impacts were either absent or considerably attenuated in those <15 years. Similar to previous studies we found inconsistent associations between fire smoke and cardiovascular diseases. Better characterisation of the spectrum of population health risks is needed to guide public heath responses to severe smoke events as this exposure becomes increasingly common with global climate changeElectronic supplementary materialThe online version of this article (doi:10.1186/1476-069X-13-105) contains supplementary material, which is available to authorized users.

Objective: We examined the association between validated bushfire smoke pollution events and hospital admissions in three eastern Australian cities from 1994 to 2007. Methods: Smoke events were defined as days on which bushfire smoke caused the 24-hour citywide average concentration of airborne particles to exceed the 99 th percentile of the daily distribution for the study period. We used a time-stratified case-crossover design to assess the association between smoke events and hospital admissions. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for cardiovascular and respiratory conditions on event days compared with non-event days. Models were adjusted for daily meteorology, influenza epidemics and holidays. Results: Smoke events occurred on 58 days in Sydney (population: 3,862,000), 33 days in Wollongong (population: 406,000) and 50 days in Newcastle (population: 278,000). In Sydney, events were associated with a 6% (OR=1.06, 95%CI=1.02-1.09) same day increase in respiratory hospital admissions. Same day chronic obstructive pulmonary disease admissions increased 13% (OR=1.13, 95%CI=1.05-1.22) and asthma admissions by 12% (OR=1.12, 95%CI=1.05-1.19). Events were also associated with increased admissions for respiratory conditions in Newcastle and Wollongong. Conclusions: Smoke events were associated with increased hospital admissions for respiratory but not cardiovascular conditions. Large populations are needed to assess the impacts of brief exposures. Implications: Public health impacts from bushfire pollution events are likely to increase in association with a warming climate and more frequent severe fire weather.

The research investigated the association between school engagement and adult education and occupation outcomes, within the context of a 1985 Australian longitudinal national cohort study of the factors affecting children's long‐term health and well‐being. School engagement may be more modifiable than other factors related to academic success, such as academic attainment, which is influenced by family background. A School Engagement Index was constructed using questionnaire items on school enjoyment and boredom. Related school engagement items included learner self‐concept, motivation to learn, sense of belonging, participation in school or extra‐mural activities, and enjoyment of physical activity. In 2004–2006, participants (aged 26 to 30 years) reported their highest level of education achieved and current occupation. Potential covariates included age, sex, markers of socio‐economic status in childhood, personality and school‐level variables (i.e., number of students, single sex versus co‐education; government, private or independent). Logistic regression was used to estimate the odds of achieving post‐compulsory school education and achieving higher status occupations. Findings revealed that each unit of school engagement was independently associated with a 10% higher odds (OR 1.10 95% CI 1.01,1.21) of achieving a post‐compulsory school education. Maternal education, self‐concept as a learner, motivation to learn, all also significantly predicted achieving post‐compulsory school education. School engagement was found to mediate the association between the personality characteristic of agreeableness and education outcomes. Higher school engagement was also independently associated with achieving higher status occupations 20 years later (OR 1.11 95% CI 1.03, 1.20). Importantly, this was independent of a host of background factors.

Preventing falls due to physiological impairments in community-dwelling older people may need to be tailored based on cognitive impairment, a key factor in their inability to compensate for physical decline.

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