Purpose or Learning Objective: We present our experience at a large tertiary teaching hospital of the imaging of common and uncommon coalitions within the foot and ankle. We demonstrate their imaging features and their secondary effects on adjacent structures due to the altered biomechanics of the ankle.

Background Despite numerous studies showing that diet and exercise influence mental health in children, there is limited data available from representative populations of children and adolescents on the relationship between regular healthy lifestyle behaviour and psychological health. Methods Data were obtained from the New South Wales Child Population Health Survey, 2013–2014. Parents were asked about diet, physical activity and screen time behaviours and completed the Strengths and Difficulties Questionnaire (SDQ) for one child aged 5-15. Higher scores on the SDQ indicate poorer psychological health and risk for mental health problems. Multivariable linear and logistic regression models examined the relationships between dietary consumption, physical activity, screen time and SDQ scores, adjusting for potential confounding. Results Proportionally more children than adolescents met the guidelines for appropriate diet, physical activity and screen time behaviours. Meeting screen time recommendations was most strongly associated with a lower SDQ total difficulties score (5-10yrs: -1.56 (-2.68, -0.44); 11-15yrs: -2.12 (-3.11, -1.12)). Children and adolescents who met screen time recommendations were also significantly less likely to have any score in the at-risk range. In addition, children and adolescents meeting vegetable intake guidelines had a significantly lower total difficulties score (5-10yrs: -1.54 (-3.03,-0.05); 11-15yrs: -1.19 (-3.60,-0.39)), as did adolescents meeting discretionary food guidelines (-1.16 (-2.14,-0.18)) and children consuming the recommended fruit intake (-1.26 (-2.42,-0.10)).Conclusions Since adopting regular healthy lifestyle behaviours is associated with better psychological health among children and adolescents, it is imperative that appropriate and effective interventions are implemented to increase these healthy lifestyle behaviours among young Australians.

Abstract Issue Obesity and its determinants are risk factors for most leading causes of chronic diseases. In New South Wales (NSW), Australia, 1 in 2 adults and more than 1 in 5 children are above a healthy weight. As a key symbolic part of a suite of health eating policies, the NSW Ministry of Health implemented a Healthy Food and Drink in NSW Health facilities for Staff and Visitors Framework (Framework) across 18 Local Health Districts (LHDs). Many countries are grappling to understand the effectiveness of obesity prevention policies. Description 2: This policy evaluation synthesised evaluation study findings and internal records to assess the effectiveness of the Framework in achieving implementation targets: a) the removal of sugar-sweetened drinks (SSDs) from sale (Dec 2017), b) implementation of 12 food-based practices (Dec 2018). Results The overall implementation package was appropriate for the large, geographically dispersed, decentralised health system (160 health facilities; 927 food outlets;76 retailers) and variable retail arrangements. The Ministry provided LHDs with overall direction, phasing, and monitoring; the LHDs had local leadership, governance, cross-functional support and autonomy to implement in a way to suit them. Accountability and pace of implementation was driven most notably by monitoring and reporting using an electronic tool (PHIMS-N), and a 'network of practice' that was pivotal to problem solving. SSDs were removed from 96% (n = 606) of applicable food outlets; overall average achievement of all practices was high at 82% (22.4 SD). Nine in 10 (92%) consumers support the Framework, and retailers are accepting of its targets. Lessons: This was the right policy at the right time, with well-orchestrated implementation. Annual monitoring and reporting enabled by PHIMS-N is unique in this type of policy implementation and essential for tracking progress, informing decision making, and ensuring accountability. Key messages Implementation of the Framework has resulted in the removal of SSDs from sale, increased availability of healthier foods and decreased unhealthy foods as measured by 12 food-based practices. The Framework is feasible and effective in influencing retail practices in health facilities, has high consumer support for its goals, and overall acceptability and adoption amongst retailers.

Introduction: People who are poor, who live in disadvantaged areas and who have low levels of formal education, have poorer health and earlier mortality that people who have material resources, live in affluent neighbourhoods and have high levels of formal education. Purposive mass media campaigns have been a popular means of conveying public health information over recent decades in many developed countries.

Integrated planning is a holistic approach to addressing the needs of local communities built on partnerships between those responsible for development, environmental quality and service provision. This study investigated the extent and key influences on the use of integrated planning to promote physical activity among six metropolitan councils in Melbourne Australia, which took part in the MetroACTIVE Project funded by the Victorian Health Promotion Foundation from 2005 to 2007. The evaluation entailed interviews conducted at the mid-term (N = 67) and completion (N = 50) of the project, and the review of relevant documents. Respondents included elected councillors, chief executive officers, officers from different council divisions and the project staff employed in each council. Three councils showed evidence of integrated planning for physical activity, whereas the remainder focused on the delivery of community participation programs. Leadership from senior management and an organizational culture that supported collaboration across council departments were prerequisites for integrated planning. Employment of a dedicated project officer with skills for engaging management and building partnerships within the organization was important. Barriers to integrated planning were a complex organization structure, high demands on the council due to a growing residential population and a poor climate among staff. Overall, integrated planning was found to be a viable approach for developing a coordinated approach to this issue involving the range of council services and functions. Ongoing strategies are needed to facilitate senior management commitment and organizational capacity for integrated planning, with leadership provided by departments responsible for infrastructure or corporate planning.

OBJECTIVE:This study examined adherence to home modification recommendations made by an occupational therapist and attempted to identify predictors of adherence. METHOD:An experienced occupational therapist visited the homes of 178 people (mean age = 764 years) to evaluate for and recommend appropriate home modifications for falls prevention. One year later, a research assistant visited these persons' homes to assess adherence. RESULTS:At least one home modification was recommended in 150 of the 178 homes visited. The most common recommendations were to remove mats and throw rugs (48%), to change footwear (24%), and to use a nonslip bathmat (21%). In the 121 homes revisited after 12 months, 419 home modifications had been recommended, and 216 (52%) were met with partial or complete adherence. The only significant predictors of adherence were a belief that home modifications can prevent falls and having help at home from relatives. CONCLUSION:A major barrier to adherence to home modification recommendations is that many older people do not believe that home modifications can reduce their risk of falling.

BACKGROUND The aim of this study was to assess the impact of fear of falling on the health of older people. METHODS A total of 528 subjects (mean age 77 years) were recruited from two hospitals in Sydney, Australia, and followed for approximately 12 months. Eighty-five subjects died during follow-up, and 31 were admitted to an aged care institution. Tinetti's Falls Efficacy Scale (FES) was successfully administered to 418 subjects as part of the baseline assessment. Among those with baseline FES scores, ability to perform 10 activities of daily living (ADLs) was assessed at baseline and follow-up in 307 subjects, and SF-36 scores were assessed at baseline and follow-up in 90 subjects recruited during the latter part of the study. Falls during follow-up were identified using a monthly falls calendar. RESULTS Compared with those with a high fall-related self-efficacy (FES score = 100), those with a low fall-related self-efficacy (FES score < or = 75) had an increased risk of falling (adjusted relative risk 2.09, 95% confidence interval [CI] 1.31-3.33). Those with poorer fall-related self-efficacy had greater declines in ability to perform ADLs (p < .001): the total ADL score decreased by 0.69 activities among persons with low FES scores (< or =75) but decreased by only 0.04 activities among persons with FES scores of 100. Decline in ADLs was not explained by the higher frequency of falls among persons with low FES scores. SF-36 scores (particularly scores on the Physical Function and Bodily Pain subscales) tended to decline more among persons with poor fall-related self-efficacy. Nonfallers who said they were afraid of falling had an increased risk of admission to an aged care institution. CONCLUSIONS Fear of falling has serious consequences for older people. Interventions that successfully reduce fear of falling and improve fall-related self-efficacy are likely to have major health benefits.

OBJECTIVE: To determine whether occupational therapist home visits targeted at environmental hazards reduce the risk of falls.DESIGN: A randomized controlled trial.SETTING: Private dwellings in the community in Sydney, Australia.PARTICIPANTS: A total of 530 subjects (mean age 77 years), recruited primarily before discharge from selected hospital wards.INTERVENTION: A home visit by an experienced occupational therapist, who assessed the home for environmental hazards and facilitated any necessary home modifications.MEASUREMENTS: The primary study outcome was falls, ascertained over a 12-month follow-up period using a monthly falls calendar.RESULTS: Thirty six percent of subjects in the intervention group had at least one fall during follow-up, compared with 45% of controls (P = .050). The intervention was effective only among subjects (n = 206) who reported having had one or more falls during the year before recruitment into the study; in this group, the relative risk of at least one fall during follow-up was 0.64 (95% confidence interval, 0.50-0.83). Similar results were obtained when falls data were analyzed using survival analysis techniques (proportional and multiplicative hazards models) and fall rates (mean number of falls per person per year). About 50% of the recommended home modifications were in place at a 12-month follow-up visit.CONCLUSIONS: Home visits by occupational therapists can prevent falls among older people who are at increased risk of falling. However, the effect may not be caused by home modifications alone. Home visits by occupational therapists may also lead to changes in behavior that enable older people to live more safely in both the home and the external environment.

Objective: To determine the prevalence of tuberculosis (TB) infection in Year 8 schoolchildren (aged 12-14 years) in Sydney.Design: Cross-sectional survey.Setting: 22 inner city Sydney secondary schools.Participants: 2290 Year 8 school children enrolled in 1992.Outcome measures: Distribution of Mantoux test reaction size and proportion of children who were Mantoux positive (i.e., having Mantoux reaction greater than or equal to 15 mm with previous Bacille Calmette-Guerin vaccination; greater than or equal to 10 mm without).Results: Of the 2290 children, 1836 (81%) were screened and 1801 Mantoux reactions were read. Ten per cent of children were Mantoux positive -27% of foreign-born children and 2% of Australian-born children (relative risk 16.7, 95% confidence interval 10.6-26.4). Two children were found to have active TB disease.Conclusion: There is a high prevalence of primary (non-contagious) TB infection in children aged 12-14 years in inner Sydney, mostly confined to children born overseas. Thus there is a large pool of infected children at risk of developing active (contagious) adult-type TB disease in the future. This public health problem should be addressed by identification and treatment of those infected.

Surveillance of tuberculosis in New South Wales depends on notification of cases by medical practitioners and careful follow-up by public health nurses dedicated to the control of tuberculosis. Evaluation of tuberculosis surveillance data enables identification of patterns of infection, highlighting areas requiring specific interventions. In 1986, 290 cases of tuberculosis were notified to the Department of Health, New South Wales. The majority of patients (72.8%) were diagnosed as having pulmonary disease. The highest rates of infection were in people from Southeast Asian countries. Whereas 5.2% of cases were identified when the patients entered Australia, a substantial proportion of diagnoses (23.1%) were made in people who had been resident in Australia for 10 or more years. This article highlights the need to continue efforts to improve tuberculosis surveillance and control programmes in New South Wales.