Medicare is Australia’s universal health scheme. It is a Commonwealth government program that guarantees all citizens (and some overseas visitors) access to a wide range of health services at little or no cost.

Medicare is funded through a mix of general revenue and the Medicare levy. The Medicare levy is currently set at 1.5% of taxable income with an additional surcharge of 1% for high-income earners without private health insurance cover.

Medicare funds access to health care in two main ways. The first, the Medical Benefits Scheme, provides benefits to people for:

• out-of-hospital medical services, including general practitioner (GP) and specialist services


• selected diagnostic imaging and pathology services


• dental care for children in limited circumstances


• eye checks by optometrists


• allied health services in limited circumstances, and


• medical services for private patients in public and private hospitals (excluding accommodation, theatre fees and medicines).

The benefits paid to patients under Medicare are generally 85% of the fee listed for the service in the Medicare Benefits Schedule (75% of the schedule fee for private patients in hospital). When providers are willing to accept the Medicare benefit as full payment for a service, they bill the government directly (bulk-billing) and the patient is not charged.

The Commonwealth’s Medicare scheme also guarantees public patients in public hospitals free treatment. Public hospitals, however, are funded jointly by the Commonwealth and state and territory governments (who own and operate public hospitals).

Medicare sits alongside the Pharmaceutical Benefits Scheme, which subsidised the cost of a wide range of pharmaceuticals.

For more and a discussion of future difficulties see the full article at The Conversation.

Booth JN, Leary SD, Joinson C, et al (2014) Associations between objectively measured physical activity and academic attainment in adolescents from a UK cohort.  British Journal of Sports Medicine 48:265–270

To test the associations between objectively measured free-living physical activity (PA) and academic attainment in adolescents. 4755 participants (45% male) had total Physical Activity measured at age 11. Data was related to school assessment results in English, Maths and Science at ages 11, 13 and 16. Findings suggest a long-term positive impact of Moderate to Vigorous Physical Activity on academic attainment in adolescence. 

Grøntved A, Pan A, Mekary RA, Stampfer M, Willett WC, et al. (2014) Muscle-Strengthening and Conditioning Activities and Risk of Type 2 Diabetes: A Prospective Study in Two Cohorts of US Women. PLoS Med 11(1): e1001587. 

The findings come from a study that tracked the health of nearly 100,000 US nurses over a period of eight years. Lifting weights, doing press-ups or similar resistance exercises to give the muscles a workout was linked with a lower risk of diabetes. The benefit seen in the study was on top of any gained from doing aerobic workouts that exercise the heart and lungs – something which adults are meant to do for at least 150 minutes a week.

Home exercise program to ge tyou started. Click here for handout

Franche et al (2005) Workplace-Based Return-to-Work Interventions: Optimizing the Role of Stakeholders in Implementation and Research. Journal of Occupational Rehabilitation 15(4): 525-542

The challenges of engaging and involving stakeholders in return-to-work (RTW) intervention and research have not been well documented. This article contrasts the diverse paradigms of workers, employers, insurers, labor representatives, and healthcare providers when implementing and studying workplace-based RTW interventions. Analysis of RTW stakeholder interests suggests that friction is inevitable; however, it is possible to encourage stakeholders to tolerate paradigm dissonance while engaging in collaborative problem solving to meet common goals. We review how specific aspects of RTW interventions can be instrumental in resolving conflicts arising from differing paradigms: calibration of stakeholders’ involvement, the role of supervisors and of insurance case managers, and procedural aspects of RTW interventions. Engaging stakeholders, and ethical aspects associated with that process are discussed. Developing methods for engaging stakeholders, determining the optimal level and timing of stakeholder involvement, expanding RTW research to more diverse work settings, and developing RTW interventions reflecting all stakeholders’ interests.

Out of shape individuals have more difficulty transferring from bed to a chair, using the toilet, dressing, bathing, preparing meals and walking normal distances. Muscle strength declines by approximately 15% per decade between the ages of 60 and 80 years. However this decline is not mandatory, those who participate in regular strength training activities can increase muscle mass and strength during the same period. These increases lead to improvements in gait efficiency and mobility tasks such as shopping, bend over, and climbing stairs.moderate level continuous aerobic fitness activity can significantly increase ones mobility status.

Those over 65 years of age, who participate in regular exercise consisting of appropriate strength training, moderate intensity fitness training and flexibility training show higher levels of mobility and less functional disability than there inactive counter parts. Your exercise goals should focus on maintaining a functional level, preventing soft tissue and joint injury and maintaining or reducing your risk of cardiovascular problems.

To get you going I have put together six of my favourite home exercise activities.

1. Walking. Weight-bearing exercise is one of the best all around activities for those over 65. It is evident that between 3 to 4 hours of walking a week (30+ minutes per day) is associated with a reduction in your risk of coronary event.


2. Squats. Good exercise to maintain strength in the leg muscles, stand erect behind a chair or table and place your hands on the object for balance.  Bend your knees then rise to the upright starting position.


3. Step-ups. Good exercise to promote leg strength and endurance, as well as challenging your balance. Find a single step or a number of steps and step up and down repeatedly.


4. Calf raises. Good exercise to strengthen the muscles in your lower leg. These muscles are important in controlling normal postural sway. With your heels of the edge of a step slowly raise up onto your toes while not allowing your knees to bend, hold for a brief period and return to the starting position.


5. Shoulder blade squeezes. Some believe strength of the muscles in the upper back promotes good postural alignment. Allow your hands to hang down by your side, while standing or perched on the edge of a chair. Relax the muscles in your neck and turn your arms out at the shoulders so that your thumbs turn away from your belly button. Gently squeeze your shoulder blades together, and hold for between three-10 relaxed breathes. You should feel a small area of muscles between your shoulder blades working, but not the muscles up into your neck.


6. Wall push-ups. Chest and upper limb strength is important for moving from sitting to standing, moving from the ground to standing or lifting objects. Stand leaning against a wall in a normal push-up position. Allow your elbows to bend so your nose moves towards the wall. Use your chest and arm muscles to push your self away from the wall and back to the starting position

 The following clip adds a few extras. Click for handout

Sinclair and Cunningham (2014) Safety activities in small businesses. Safety Science 64:32–38

This study uses data from a national random survey of firms (n = 722) with less than 250 employees conducted in 2002. It was found that, regardless of firm size or industry, safety activities were more common in 2002 than they were in a similar 1983 study. Having had an OSHA inspection in the last five years and firm size were stronger predictors of safety activities than industry hazardousness and manager’s perceptions of hazardousness. All four variables were significant predictors. Further progress in the prevention of injuries in small firms will require attention to factors likely subsumed within the firm size variable, especially the relative lack of slack resources that might be devoted to safety activities.

Funny little Clip

Ng et al (2014) Neck and shoulder muscle activity during standardized work-related postural tasks. Applied Ergonomics 45:556-563

The aim of the present study was to assess the activity levels of the neck muscles during static postures under controlled and standardized conditions, and to determine whether the muscle activity differed between sexes. Muscle activity was recorded unilaterally from the sternocleidomastoid and upper trapezius muscle in 17 participants whilst they were performing various postural tasks. The intensity of muscle activity was ranked as light (<3%MVC), moderate (3%MVC
EMG
8%MVC), and substantial (>8%MVC). During most tasks the two muscles contracted light to moderately. Head leaning and shoulder shrugging postures yielded substantial muscle activity in both muscles. Muscle activity did not differ significantly between male and female participants. Our findings provided normative values, which will enhance future studies of muscle activity during work in a natural, unrestrained environment.

Wing et al (2011) Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals With Type 2 Diabetes. Diabetes Care 34:1481–1486

Modest weight losses of 5 to 10% of initital weight were associated with significant improvements in heart disease risk at 1 year, but larger weight losses had greater benefits. 

Maher (2000) A systematic review of workplace interventions to prevent low back pain. Australian Journal of Physiotherapy 46: 259-269

A systematic review of randomised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain. Potential trials were located by a computerised search supplemented with citation tracking. The methodological quality of the trials was assessed on 11 criteria and the level of evidence for each intervention was determined, based upon the amount, consistency and quality of evidence from the trials. The review located 13 trials that were generally of moderate quality. The trials suggest that workplace exercise is effective, braces and education are ineffective, and workplace modification plus education is of unknown value in preventing low back pain.

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The cost of workers’ compensation premiums are driven by three primary factors:

1. The industry you work in (and therefore the gazette rate for your industry);


2. Your wage roll; and


3. Your claims costs.

The first two factors are largely set in stone. WorkCover WA estimates the total cost of the scheme for the next year and determines the overall amount of premium that must be collected to cover these costs. The gazette rate for each industry is calculated based on the total amount of premium required and the historical performance of individual industries within the scheme.

Therefore, your understanding of claims costs and how to control them is your only opportunity to impact on the cost of your workers’ compensation premium. Claims costs are the actual dollars spent by the insurer when an injury occurs, plus the insurer’s estimate of what the total cost will be by the time the injury has resolved and the claim is closed.

As the employer, you can make decisions about and have legislative control over the following areas:

1. Medical treatment – refer injured workers to consultant doctors with excellent communication skills;


2. Wages – you may choose not to recoup wages;


3. Rehabilitation – in many cases, you are capable of overseeing this with internal resources.

Your understanding of these factors, your approach to injury management and your relationship with your insurer to communicate this will impact on outstanding reserves and can ultimately reduce the cost of the claim. However, the establishment of preventative strategies and a consistent, proactive support system for your injured workers is critical to achieving the above outcome.

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We know sitting too much is bad, and most of us intuitively feel a little guilty after a long TV binge. But what exactly goes wrong in our bodies when we park ourselves for nearly eight hours per day, the average for a U.S. adult apparently. This handout was published in the Washington Post and has been forwarded around by the Australian Physiotherpay Association.

Click to download

Eungpinichpong W et al, (2013) Effects of restrictive clothing on lumbar range of motion and trunk muscle activity in young adult worker manual material handling. Applied Ergonomics. 44:1024-1032

Epidemiologic studies have reported that tasks involving lifting with repetitive trunk bending and heavy loads pose risk factors for low back pain (LBP). Recent research has found LBP in adolescents to be more frequent than previously suspected. Trunk bending requires multi-joint coordination for lumbopelvic and hip movements as well as trunk muscle activation. However, if there is restriction of one of the multiple joints in the lumbo-pelvic and hip regions, this can result in altered movement and biomechanics of the remaining unrestricted joints. Tight pants, specifically sizes smaller than fit to a wearer’s anthropometry, may restrict hip movement and alter trunk muscle activity during work tasks and leisure. Such clothing has become a popular clothing choice for adolescents. Previous research observed reduced hip mobility in association with increased spinal flexion and extension. This mobility limitation and spinal motion may be factors contributing to development of LBP. In this study twenty-eight young adultsperformed box lifting, liquid container handling while squatting, and forward reaching while sitting on a task chair when wearing tight pants (sizes too small for the wearer) vs. fit pants (correct size according to anthropometry). Each task was repeated three times and video recordings were used as a basis for measuring lumbar range of motion (LRoM). 

Results revealed significant effects of both pants and task types on the normalized LRoM, trunk muscle activity and subjective ratings of LBD. The LRoM was higher and trunk muscle (ES) activity was lower for participants when wearing tight pants, as compared to fit pants. Discomfort ratings were significantly higher for tight pants than fit. These results provide guidance for recommendations on work clothing fit in specific types of manual material handlingactivities in order to reduce the potential of low-back pain among younger workers in industrial companies.

Dwyer et al (2010) Association of change in daily step count over five years with insulin sensitivity and adiposity: population based cohort study. BMJ 2010;341:c7249

Recent increases in type 2 diabetes and obesity in many countries, including the United States and Australia, have been partly attributed to declines in physical activity. The aim of this study was to examine the relation between change in physical activity (measured objectively by pedometer) over a five year period and each of body mass index, waist to hip ratio, and insulin sensitivity. The study concluded that an increase in physical activity over time, measured objectively by pedometer, is associated with better insulin sensitivity probably due to lower body fat.

Making life a little more physically demanding can reduce your risk of chronic disease

The University of New South Wales Rural Clinical School, Port Macquarie has developed guidelines for the clinical management of rotator cuff syndrome in the workplace. Shoulder pain is a common musculoskeletal presentation in primary care practice – both degenerative and acute. As such, it provides a challenge to all involved in prevention and treatment, from patients to clinicians to employers.

 Click to read

Funny little clip on a funny little topic.

Arial M, Benoît D and Wild P (2014) Exploring implicit preventive strategies in prehospital emergency workers: A novel approach for preventing back problems. Applied Ergonomics. inpress: 1-7

Back problems are a major occupational health issue for most labour intensive Jobs. THe following study of Paramedics used a questionnaire survey of 334 paramedics and emergency medical technicians and an ergonomic work practice analysis involving shadowing ambulance crews in 12 medical emergency services (over 400 hours). A majority of ambulance professionals had experienced back pain in the twelve-month period before the survey. Work practice analysis revealed strategies and 'tricks of the trade' used by ambulance professionals to reduce the chances of back strain while working. Multiple regression analyses showed that self-reported use of such strategies was associated with fewer back symptoms. Preventive strategies should be integrated into specialised training programs the work settings.

Table 3 shows strategies used by the Paramedic staff, many of which can be utilised in other labour intensive roles

To understand your own habits, you need to identify the components of your loops. Once you have diagnosed the habit loop of a particular behaviour, you can look for ways to supplant old vices with new routines. This little clip explains it nicely.

GIBBS BB, REIS JP, SCHELBERT EB, CRAFT LL, SIDNEY S, LIMA J, and LEWIS CE (2014) Sedentary Screen Time and Left Ventricular Structure and Function: The CARDIA Study. Medicine and Science in Sports and Exercise, Vol. 46, No. 2, pp. 276–283

Sedentary screen time (watching TV or using a computer) predicts heart disease outcomes independently from moderate and vigorous physical activity. Screen time and left ventricule structure and function was measured in 2854 participants, age 43–55 yr. Sedentary screen time is associated with greater LVM in white adults, and this relationship was largely explained by higher overall adiposity. It is suggested that sedentary screen time potentially contributes to adverse cardiac remodeling through its association with comorbidities (hypertension and diabetes) and, to a greater extent, overall adiposity. The most plausible interpretation was that sedentary screen time contributes to obesity and obesity-related comorbidities, which in turnmay lead to increased LVM, LVM indexed to height and volume, and relative wall thickness. 

Use these tips to help your sedentary workers avoid long-term health issues caused by insufficient movement throughout their working day:

• Encourage workers to alternate between computer work and a variety of other tasks where possible.


• Take regular breaks from typing and other repetitive activities, e.g. a pause break every half hour to stand up and stretch.


• Commit to making life a little more difficult! Take advantage of situations throughout the day when standing and moving is possible, e.g. take the stairs rather than the lift, stand up when you are commuting on public transport. 


• Incorporate methods to reduce sedentary work practices into your company policies and procedures, e.g. your working from home policy should promote regular standing breaks throughout the day.


• If possible, change the working environment and task design to promote workers to stand and move around more often.


• Train your managers and supervisors in the risks of sitting for prolonged periods of time and the importance of physical activity throughout the working day.


• Encourage a working environment where there is open discussion about the best ways to promote less sitting and more movement.


• Teach your workers to remind each other to stand and move throughout the day.

Exercising outside the workplace as a risk control for sedentary work?

While we all know that to maintain a healthy lifestyle, at least 3 sessions of exercise each week is recommended — long periods of sedentary work during the day can still have adverse effects on your health even if you exercise 5 days a week outside of work! So encourage your workers to exercise and participate in activities that involve movement on their days off (this could be done through a health promotion program), but do not assume that this means you don't need to implement control measures for your sedentary workers.

van der Ploeg HP, Chey T, Korda RJ, Banks E, and Bauman A (2012) Sitting Time and All-Cause Mortality Risk in 222 497 Australian Adults. Archives and  Internal Mrdicine 172(6):494-500

Prolonged sitting is considered detrimental to health. This study aimed to determine the independent relationship of sitting time with all-cause mortality. Sitting less than 8 h/d and meeting the physical activity recommendation (2.5 hours per week) protected against death. The adverse effects of prolonged sitting are thought to be mainly owing to reduced metabolic and vascular health. Prolonged sitting has been shown to disrupt metabolic function, resulting in increased plasma triglyceride levels, decreased levels of high-density lipoprotein cholesterol, and decreased insulin sensitivity, which appear to be at least partially mediated by changes in lipoprotein lipase activity. It has also been suggested that sedentary behaviour affects carbohydrate metabolism through changes in muscle glucose transporter protein content. 

Manual material handling (MMH) tasks typically consist of activities such as lifting/lowering, pushing/pulling, and holding/carrying loads. The primary jobs of the workers at these distribution centers involve order picking and delivery, which typically are performed using manual handling aids such as carts, trolleys, and hand-pallet trucks on level and ramped surfaces. The use of such assist devices eliminates manual carrying and in some cases lifting and lowering, changing the nature of MMH tasks predominantly to pushing and pulling. It has been estimated that nearly half of MMHtasks common at workplaces consist of pushing and pulling exertions performed on level surfaces and variable inclined ramps.

Nimbarte AD, Sun Y, Jaridi M and Hsiao H (2013) Biomechanical loading of the shoulder complex and lumbosacral joints during dynamic cart pushing task. Applied Ergonomics 44:841-849

The primary objective of this study was to quantify the effect of dynamic cart pushing exertions on the biomechanical loading of shoulder and low back. Ten participants performed cart pushing tasks on flat (0
), 5
, and 10
ramped walkways at 20 kg, 30 kg, and 40 kg weight conditions. At the lumbosacral joint, negligible loading in the mediolateral direction was observed compared to the anterioposterior and compression directions. Among the shoulder complex joints, the peak reaction forces at the acromioclavicular and glenohumeral joints were comparable and much higher than the sternoclavicular joint. Increased shear loading of the lumbosacral joint, distraction loading of glenohumeral joint and inferosuperior loading of the acromioclavicular joint may contribute to the risk of work-related low back and shoulder musculoskeletal disorder with prolonged and repetitive use of carts.

Understanding the role of your prefered GP, and the difficulties they face in dealing with return to work following injury can help improve workers compensation outcomes.  

Fenner P (2013) Returning to work after an injury. Australian Family Physician 42(4):182-185

Workplace injuries are common, cause significant morbidity for workers and have considerable economic impact. General practitioners can play an important role in facilitating early return to work, improving outcomes for all parties. This article provides guiding principles for the initial assessment and early treatment phase of injury with a primary focus on the rehabilitation and return to work process. A case management approach to assist injured workers return to work that involves collaboration between the injured worker, medical and rehabilitation providers, the employer and work insurers, achieves better outcomes. Efficient rehabilitation involves good initial assessment, effective early treatment, early mobilisation and good communication between all parties. General practitioners have an important role to play in facilitating this process.

Temika Lee's next Dietitian Talk is on Friday 31st January 2014, 11.30am at Central West Health & Rehabilitation in Geraldton. This talk is free for gym members and people who are completing Central West Health & Rehab's Diabetes Management and Chronic Disease Prevention programs.

This talk covers:

• Healthy Eating Habits


• Glycemic Index


• Fat Types and Cholesterol


• Recipe Modification Label Reading

Qin J, Chen H and Dennerlein JT (2013)Wrist posture affects hand and forearm muscle stress during tapping. Applied Ergonomics 44:969-976

Non-neutral wrist posture is a risk factor of the musculoskeletal disorders among computer users. This study aimed to assess internal loads on hand and forearm musculature while tapping in different wrist postures. The sustained high motor unit recruitment of extensors suggests a greater risk than other muscles especially in flexed wrist posture. This study demonstrated from the perspective of internal tissue loading the importance of maintaining neutral wrist posture during keying activities.