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Introduction: There is a dire paucity of research into the burden, correlates and motives of substance use among trans young people in Australia. Method: Using data from a national survey of Australian trans young people (N = 859, Mage = 19.4), we estimated prevalence of past 6‐month substance use (tobacco, alcohol, cannabis, other drugs) and lifetime substance use disorder diagnoses. Covariate‐adjusted multivariate logistic regression models tested associations between substance use types with 18 interpersonal factors. Open‐ended responses regarding substance use motives (n = 489) were qualitatively analysed using thematic analysis with an interpretative phenomenological approach. Results: Prevalence of lifetime substance use disorder diagnosis was 13.5% (95% confidence interval [CI] 11.1, 16.1). Alcohol use was most reported (72.4%; 95% CI 68.9, 75.6) followed by tobacco (31.1%; 95% CI 27.7, 34.6) and cannabis (30.6%; 95% CI 27.2, 34.2). Trans women reported highest rates of alcohol and cannabis use; use of other drugs was highest among trans men. Highest risk of substance use was observed among trans youth who experienced discrimination, intimate partner abuse, peer rejection and lack of family support (adjusted odds ratios ranging 1.5 to 3.0). Four multi‐levelled themes of substance use motives were identified: circumstantial use, somatic use, feeling better about oneself and one's life, and harm reduction. Discussion and Conclusions: While substance use among trans young is largely circumstantial, hedonistic and altruistic, facilitating self‐exploration, friendship and community connectedness, substance use among trans young people is highly prevalent and may be used to cope with sleep difficulties, depression/anxiety and cisnormativity, including delays and waitlists for accessing gender‐affirming care. [ABSTRACT FROM AUTHOR]

Background: The prevalence of dementia is increasing worldwide and many people with the condition require some level of palliative care. However, the trajectories of function and symptom burden in palliative care services at the end of life remain unclear. This study aimed to describe and compare the longitudinal trajectories of function and symptom burden among patients with dementia between hospital versus palliative community care services in the last two weeks of life. Methods: A retrospective cohort study used data from the Australian Palliative Care Outcomes Collaboration. Patients with dementia who died between 1 January 2013 and 31 December 2020 from the Australian Palliative Care Outcomes Collaboration. Four validated clinical instruments were used to collect outcomes on each individual's function and symptom distress and severity. Multilevel models were used to estimate the differences in clinical trajectories between hospital and community-based palliative care in the last two weeks of life. Results: Patients with dementia tended to have low levels of distress for most symptoms but increasing levels of functional impairment. There were no or only marginally significant differences in the symptom trajectories between the community and hospital groups (OR ranged from 0.57 to 1.97). Although clinical trajectories of function were relatively similar between two groups, statistically higher functional indicators were observed for people when admitted to community palliative care services (OR = 0.42 and 2.27, respectively). Conclusions: Our findings suggest that community-based palliative care services can be as effective as hospital-based care for many patients with dementia nearing the end of life. With appropriate support for families, community-based care could serve as a viable alternative to hospital-based care for some patients in the final stages of dementia. [ABSTRACT FROM AUTHOR]

Young people who are lesbian, gay, bisexual, trans, queer or questioning, asexual and other diverse genders and sexualities (LGBTQA+) are at greater risk of adverse mental health outcomes and suicide, with additional barriers to accessing safe and affirming physical and mental health services in comparison to the general population. Parents of LGBTQA+ young people who are supportive and accepting can take on additional responsibilities and an active role in supporting young people, and more information is needed to understand how parents support LGBTQA+ young people in times of acute mental health difficulties (including suicide risk) and what parents experience while navigating support systems. It is imperative these experiences are better understood to inform other parents, clinicians and service providers alike. We aimed to develop a nuanced understanding of the experiences of Australian parents of LGBTQA+ young people in providing support during times of acute distress and suicidal crisis. We utilized an exploratory qualitative design using semi-structured one-on-one interviews with 11 parents. We provide clinically useful recommendations, with the aim of aiding enhanced parental support for LGBTQA+ young people, given this population's unique needs. [ABSTRACT FROM AUTHOR]

Background: Most people diagnosed with dementia live and die in community settings. This study aimed to: (i) describe the palliative care needs of patients with dementia at commencement of community palliative care; (ii) compare palliative care needs between patients with dementia and those with lung cancer and cardiovascular disease (CVD). Methods: This is a population-based descriptive study that involved 8,727, 7,539 and 25,279 patients who accessed community palliative care across Australia principally because of dementia, CVD and lung cancer. Patients' functional abilities, symptom burden and clinical condition were assessed at commencement of community alliative care using five validated instruments: Resource Utilisation Groups—Activities of Daily Living, Australia-modified Karnofsky Performance Status, Symptoms Assessment Scale, Palliative Care Problem Severity Score and Palliative Care Phase. We fitted ordinal logistic regression models to examine the differences in these assessments for dementia versus CVD and lung cancer, respectively. Results: Overall, patients with dementia generally had low levels of distress from symptoms but poor functional problems. Compared to the other two diagnostic groups, palliative care for dementia was often initiated later and with shorter contacts. Also, patients with dementia presented with poorer functional performance (adjusted OR (aOR) = 4.02, Confidence Interval (CI): 3.68 – 4.38 for dementia vs CVD; aOR = 17.59, CI: 15.92 – 19.44 for dementia vs lung cancer) and dependency (aOR = 5.68, CI: 5.28 – 6.12 for dementia vs CVD; aOR = 24.97, CI: 22.77 – 27.39 for dementia vs lung cancer), but experienced lower levels of distress and problem severity for the majority of symptoms. Conclusion: Community palliative care is often an ideal care option for many patients, particularly for those with dementia. We call for expansion of the palliative care workforce and options for home care support to optimize accessibility of community palliative care for dementia. [ABSTRACT FROM AUTHOR]

The existing literature exploring the experiences of parenting a trans child tends toward reporting the challenging aspects of the parental journey. Studies also reference positive experiences such as enhanced parent-child connectedness and affirmation of personal values. Limited dedicated research focused on the positive aspects of parenting a trans child exists. We aimed to better understand positive parental experiences accordingly. Using data from a large cross-sectional survey, we explored parental responses (N = 134) to a single open-text question asking what parents had experienced as positive about parenting their trans child. We used the general inductive approach (GIA) to analyze data and report on common themes. Almost all parents identified at least one positive aspect; most cited multiple benefits. Five major themes emerged from the data: 1) Personal growth; 2) experiencing the strengths of the child; 3) improved aspects of the parent-child relationship; 4) positive change in the child; 5) experiencing social connection and support. Findings provide a nuanced addition to the literature on parental experiences and have clinical implications for those working with parents of trans children. A better understanding of positive parental experiences can aid clinicians in increasing parental support and acceptance for young people within an affirmative framework. [ABSTRACT FROM AUTHOR]

Anthropogenic changes to forest cover have been linked to an increase in zoonotic diseases. In many areas, natural forests are being replaced with monoculture plantations, such as oil palm, which reduce biodiversity and create a mosaic of landscapes with increased forest edge habitat and an altered micro-climate. These altered conditions may be facilitating the spread of the zoonotic malaria parasite Plasmodium knowlesi in Sabah, on the island of Borneo, through changes to mosquito vector habitat. We conducted a study on mosquito abundance and diversity in four different land uses comprising restored native forest, degraded native forest, an oil palm estate and a eucalyptus plantation, these land uses varying in their vegetation types and structure. The main mosquito vector, Anopheles balabacensis, has adapted its habitat preference from closed canopy rainforest to more open logged forest and plantations. The eucalyptus plantations (Eucalyptus pellita) assessed in this study contained significantly higher abundance of many mosquito species compared with the other land uses, whereas the restored dipterocarp forest had a low abundance of all mosquitos, in particular, An. balabacensis. No P. knowlesi was detected by PCR assay in any of the vectors collected during the study; however, P. inui, P. fieldi and P. vivax were detected in An. balabacensis. These findings indicate that restoring degraded natural forests with native species to closed canopy conditions reduces abundance of this zoonotic malarial mosquito vector and therefore should be incorporated into future restoration research and potentially contribute to the control strategies against simian malaria. [ABSTRACT FROM AUTHOR]

Many trans young people seek mental health support and gender-affirming medical interventions including puberty suppression, gender-affirming hormones and/or surgeries. Trans young people and their parents face multiple barriers in accessing gender-affirming care and mental health support, however little is known about the parent perspective on accessing services for their trans child. This study aimed to understand the experiences of parents accessing medical and mental health services with and for their trans children within Australia. Using data from Trans Pathways, a large mixed-methods cross-sectional study, we examined the experiences of parents (N = 194) in Australia accessing primary care, psychiatry, therapy/counseling, mental health inpatient, and gender-affirming medical services with/for their trans children (aged 25 years or younger). Qualitative data on service experiences were thematically analyzed. Quantitative analyses included frequency of access to services, wait times, service satisfaction, and mental health diagnoses of the parents' trans child. Services were mostly first accessed when the young person was between 12 and 17 years of age, with primary care physicians being the most accessed service. Parents reported that some practitioners were respectful and knowledgeable about gender-affirming care, and others lacked experience in trans health. Across all services, common barriers included long wait times, complicated pathways to navigate to access support, as well as systemic barriers such as sparsity of gender speciality services. Across services, parents reported feeling as though they do not have the necessary tools to best support their child in their gender affirmation. This study highlights the crucial need for systemic changes in the processes of accessing gender-affirming care and mental health support to enable access to appropriate and timely care. These findings also indicate the importance of improving individual practitioner knowledge around trans health, to enhance the support provided to trans young people and their parents. [ABSTRACT FROM AUTHOR]

Musicians have been described as a 'high-risk' group for experiencing musculoskeletal symptoms (MSSs), yet few studies have tested this assumption. We aimed to determine whether the prevalence and profile of MSS outcomes differed between university music students and a reference group (science students). A survey was conducted of university music and science students. Reported MSS outcomes among the two groups were compared using regression analyses. The majority of participants in both groups reported experiencing MSSs in the last 12 months and 7 days. Music students reported a higher prevalence of wrist/hand MSSs compared with science students. Compared with symptomatic science students, music students reported a higher emotional impact of MSSs. We recommend prioritizing research into interventions for music students that address MSSs in the wrist/hand region, and the emotional impact of MSSs. Addressing these MSS outcomes could reduce the MSS burden for musicians during and beyond their studies. [ABSTRACT FROM AUTHOR]

Although the progressive clinical trajectory of motor neurone disease (MND) is widely understood, multiple challenges remain preventing optimal end-of-life care for this population with unique needs from the patient, carer and service provider perspectives. This paper reports on the experiences, gaps in service and unmet needs of MND patients and family carers and explores public health palliative care approaches that would facilitate coordinated and integrated care to respond to their changing needs. This is a qualitative study of responses to questions in an online consumer survey (353 respondents) in Western Australia (2020), focusing on a subset of 29 current and bereaved carers of people with MND who have used health services in the last five years. The analysis identified themes, highlighting the insufficient integration of services across health and social care; poor and unequal access to coordinated palliative care; significant gaps in the knowledge base of the workforce and a failure to meet the consumer expectations of person-centred care. For palliative care to be accessible to those living with MND and other under-served conditions, there needs to be a shift to more comprehensive, inclusive and sustainable options, such as the public health approach to palliative/end-of-life care that engages the assets of local communities in partnership with health services, one example being the "Compassionate Communities Connectors" model of care. Further considerations include advocacy for policy changes, fostering partnerships and developing indicators for evaluating the impact of the proposed models of care. The end result is not only better care but substantial savings for the health system. [ABSTRACT FROM AUTHOR]

We aimed to evaluate and compare the prevalence and profile of musculoskeletal symptom (MSS) outcomes across cohorts of university music students with different 'majors': (i) performance and nonperformance students, and (ii) classical and non-classical performance students. Data were collected using a cross-sectional questionnaire survey, and regression analyses were used to compare the groups. Of the 166 participating students, 92.5% reported experiencing MSSs in the last 12 months, and 72.6% in the last 7 days. Few significant differences were identified between groups. Musculoskeletal symptoms are a problem for all types of university music students, and all should have access to support to prevent and manage their MSSs, regardless of their majors. [ABSTRACT FROM AUTHOR]

Previous research on general practitioners' (GPs') involvement in end‐of‐life care has largely focused on a specific aspect of care or has provided broad overviews that failed to capture individual variations in patient management. This qualitative study aimed to explore Australian GPs' feedback and reflections on the individual‐level care provided for patients in their last year of life. The findings of the study were drawn from a nation‐wide survey of GPs' experiences in end‐of‐life care. We analysed responses from 63 GPs for 267 of the 272 reported deaths. Factors influencing delivery of optimal end‐of‐life care reported by GPs were categorised into four groups: patient‐related factors, carer‐related factors, interactions between GPs and patients/carer‐related factors and broader health system issues. Each group included both barriers and facilitators. Our study highlighted importance of the emotional dimensions of therapeutic relationships with patients and their family, availability and capacity of family support and smooth communication and continuity of care between GPs and hospitals in delivery of optimal end‐of‐life care. Lack of these facilitators, misconceptions of palliative care and conflicts on implementing care plans among patients and their family tended to impede delivery of such care. On the basis of our findings in the present study and previous literature, we conclude that improved end‐of‐life care in general practice requires comprehensive approaches to supporting both the GP and family to provide care in patients' preferred place, such as enhanced palliative care training and improved availability of external support for GPs, higher levels of hospital‐based services reaching into community settings and broader community‐based resources for families beyond simply the healthcare system. [ABSTRACT FROM AUTHOR]

Concerns have been raised for the health and wellbeing of self-employed workers. Musicians are the 'original' gig workers, and musicians have a high prevalence of musculoskeletal symptoms (MSSs). Studies of musicians' MSSs have typically focused on classical, employer-employed musicians; leaving self-employed musicians under-investigated. We investigated the prevalence of MSS outcomes in all types of professional musicians, and compared the MSS outcomes between self-employed and employer-employed musicians. We conducted a cross-sectional study of professional musicians. Given the large proportion of musicians who were both self-employed and employer-employed, three groups were compared: self-employed only (self-employed group), employer-employed only (employer-employed group), and both self-employed and employer-employed (both group) musicians. Multivariable regression analyses were conducted. A total of 225 professional musicians were included in the study, 87.9% of whom reported MSSs in the last 12 months. For MSSs that impaired musical activity, the 12-month prevalence was 43.2%. Musicians in the self-employed group reported a significantly higher 7-day prevalence of MSSs compared with those in the employer-employed group. Compared with musicians in the employer-employed group, musicians in the both group reported a higher 12-month prevalence of MSSs that impaired musical activity. A higher proportion of symptomatic musicians in the both group reported seeing a health professional for their MSSs, compared with the employer-employed group. Similarly, symptomatic musicians in the both group reported higher ratings of emotional impact from MSSs, compared with symptomatic musicians in the employer-employed group. The majority of musicians have experienced MSSs. Several significant differences were reported between the three groups of musicians, with musicians in the both group generally reporting poorer MSS outcomes, compared with musicians in the employer-employed group. There are several potential reasons for why musicians who are both self-employed and employer-employed appear to have poorer MSS outcomes, including the stress of balancing multiple demands. Further research is required into the risk factors for MSS outcomes in self-employed musicians, including those who are both self-employed and employer-employed, and interventions should be directed towards self-employed musicians to minimise the MSS burden. [ABSTRACT FROM AUTHOR]

Trans youth are at high risk of mental health difficulties and negative life events. Strong parental support is highly protective however there is little understanding of what factors facilitate the process of parental understanding and acceptance of a child's gender identity. We aimed to better understand a) preexisting factors influencing levels of parental acceptance of their child's gender identity; b) the factors parents find helpful in facilitating acceptance of their child's gender identity once they become aware; and c) how parents experience extended family, cultural and religious reactions. Using cross-sectional survey data, we explored the experiences of parents and guardians (N = 194). Quantitative data were primarily analyzed using Bayesian regression models and qualitative data were thematically analyzed. Several factors were salient in influencing parental acceptance, including the nature of their child's gender identity, and levels of awareness and acceptance of the child's gender identity at time of initial parental awareness. Multiple factors aided acceptance, including information, peer support, and the quality of the dyadic relationship. Findings provide a better understanding of how parental acceptance of a child's gender identity develops. We provide recommendations on what may help parents to optimally support their child, such as accessible, good-quality information. [ABSTRACT FROM AUTHOR]

There are potential benefits associated with advance care planning (ACP), and general practitioners (GPs) are well placed to coordinate ACP initiatives with their patients. Few studies have reported on the uptake of different forms of advance care plan conducted by GPs and how this affects patients' place of death. The primary aims of the study were to examine uptake of verbal (conversations regarding care preferences) and written (documented care preferences) advance care plans and their associated factors from the perspective of Australian GPs. The secondary aim was to determine the impact of different types of advance care plans on place of death. Sixty‐one GPs from three Australian states used a validated clinic‐based data collection process to report on care provided for decedents in the last year of life, including provision of services, place of death, and uptake of ACP. We found that 58 (27.9%), 91 (43.7%) and 59 (28.4%) reported decedents had no advance care plans, verbal plans or written plans, respectively. There were increased uptake of both verbal plans (relative risk ratio [RRR] = 13.10, 95% confidence interval [CI]: 2.18–77.34) and written plans (RRR = 10.61, 95% CI: 1.72–65.57) if GPs foresaw the death for >90 days versus <7 days. Palliative care training history for GPs predicted uptake of verbal plans (RRR = 5.83, 95% CI: 1.46–31.93). Patients with verbal plans versus no plans were more likely to die at a private residence (odds ratio = 4.97, 95% CI: 1.32–18.63). Our findings suggest that expectation of death for at least three months prior to the event (where clinically possible) and palliative care training for GPs improve the uptake of ACP in general practice. Larger pragmatic trials are required to determine the impact of ACP on patients' place of death. [ABSTRACT FROM AUTHOR]

We investigated the association of allergic diseases and epilepsy with risk of brain tumours, in Interphone, a 13-country case–control study. Data were obtained from 2693 glioma cases, 2396 meningioma cases, and 1102 acoustic neuroma cases and their 6321 controls. Conditional logistic regression models were used to estimate pooled odds ratios (ORs) and their respective 95% confidence intervals (CIs), adjusted for education and time at interview. Reduced ORs were observed for glioma in relation to physician-diagnosed asthma (OR = 0.73; CI 0.58–0.92), hay fever (OR 0.72; CI 0.61–0.86), and eczema (OR 0.78, CI 0.64–0.94), but not for meningioma or acoustic neuroma. Previous diagnosis of epilepsy was associated with an increased OR for glioma (2.94; CI 1.87–4.63) and for meningioma (2.12; CI 1.27–3.56), but not for acoustic neuroma. This large-scale case–control study adds to the growing evidence that people with allergies have a lower risk of developing glioma, but not meningioma or acoustic neuroma. It also supports clinical observations of epilepsy prior to the diagnosis of glioma and meningioma. [ABSTRACT FROM AUTHOR]

Background: Exposure to high doses of ionizing radiation is among the few well-established brain tumour risk factors. We used data from the Interphone study to evaluate the effects of exposure to low-dose radiation from diagnostic radiological examinations on glioma, meningioma and acoustic neuroma risk.Methods: Brain tumour cases (2644 gliomas, 2236 meningiomas, 1083 neuromas) diagnosed in 2000-02 were identified through hospitals in 13 countries, and 6068 controls (population-based controls in most centres) were included in the analysis. Participation across all centres was 64% for glioma cases, 78% for meningioma cases, 82% for acoustic neuroma cases and 53% for controls. Information on previous diagnostic radiological examinations was obtained by interviews, including the frequency, timing and indication for the examinations. Typical brain doses per type of examination were estimated based on the literature. Examinations within the 5 years before the index date were excluded from the dose estimation. Adjusted odds ratios were estimated using conditional logistic regression.Results: No materially or consistently increased odds ratios for glioma, meningioma or acoustic neuroma were found for any specific type of examination, including computed tomography of the head and cerebral angiography. The only indication of an elevated risk was an increasing trend in risk of meningioma with the number of isotope scans, but no such trends for other examinations were observed. No gradient was found in risk with estimated brain dose. Age at exposure did not substantially modify the findings. Sensitivity analyses gave results consistent with the main analysis.Conclusions: There was no consistent evidence for increased risks of brain tumours with X-ray examinations, although error from selection and recall bias cannot be completely excluded. A cautious interpretation is warranted for the observed association between isotope scans and meningioma. [ABSTRACT FROM AUTHOR]

Aims: Hyperactive delirium (HD) is a common and distressing symptom among palliative care patients. This study aimed to describe the characteristics of HD and associated symptoms among palliative care inpatients and evaluate relationships between HD development and symptom trajectories in this population. Design: A retrospective study was conducted. Methods: A retrospective review of medical records was conducted for all patients who died in a large Australian specialist palliative care unit between 1 January and 31 December 2019. Patients were assessed daily using the Symptoms Assessment Scale (SAS) and Palliative Care Problem Severity Scale (PCPSS). Multilevel models were used to estimate the differences in symptoms trajectories in the last 7 days of life between the two groups. Results: Of the 501 included patients, 64.5% (323) had an episode of HD. For 30% (95) of patients, HD occurred prior to admission. Compared with patients without HD, those with HD had significantly higher odds ratios (ORs) for four of the seven SAS symptoms (sleep problems, appetite, fatigue and pain; OR range: 1.94–4.48, p <.05), and all four PCPSS items (OR range: 2.00–3.00, p <.05) in the last week of life. Conclusions: Palliative care inpatients commonly experience HD in their last week of life. There are higher levels of symptom distress, complexity, psychological concerns and family/carer concerns among patients with HD compared with those without HD. Impact: The high prevalence of HD, and its association with higher levels of symptom distress, highlights the importance of routine screening and optimal management for HD among palliative care patients. Given the widely recognized challenges facing palliative care professionals in assessment and management of delirium, provision of relevant training among these professionals is recommended. [ABSTRACT FROM AUTHOR]

We have little knowledge of differences in end‐of‐life care between home settings and residential aged care facilities (RACFs) where people spend most of their last year of life. This study aimed to compare end‐of‐life care between home settings and RACFs from the perspective of Australian general practitioners (GPs). A descriptive study was conducted with 62 GPs from Western Australia, Queensland and Victoria. Participants were asked to provide reports on end‐of‐life care of decedents in their practice using a validated clinic‐based data collection process developed by our team between September 2018 and August 2019. Of the 213 reported expected deaths, 66.2% mainly lived at home in the last year of life. People living at home were more likely to die at a younger age (median 77 vs. 88, p < 0.001), to be male (51.1% vs. 33.3%, p = 0.01) and to die of cancer (53.9% vs. 4.2%, p < 0.001) compared to those in RACFs. There were no significant differences between the two patient groups for seven out of the eight assessed symptoms, except nausea. GPs' perceived roles in caring for patients and levels of their involvement in provision of common palliative care services were comparable between the two groups. The usual accommodation setting was most frequently considered the preferred place of death in both groups. However, more home residents ended up dying in hospital compared to RACF residents. There were significantly higher frequencies of end‐of‐life discussions (ORs ranged 5.46–9.82 for all topic comparisons) with GPs associated with people living at home versus RACFs. One opportunity for improved care is through promoting greater involvement of GPs in end‐of‐life discussions with RACF residents and staff. In general, more Australians could potentially remain at home until death if provided with greater access to essential specialist palliative care services and supportive services in home settings. [ABSTRACT FROM AUTHOR]

Identify the perceived benefit of mental health service use for two adolescent populations: (i) those who had considered getting help from a mental health service but had not yet done so, and (ii) those who had previously contacted or accessed a mental health service but not continued with care. Cross-sectional online survey of adolescents aged 14–18 years currently residing in Perth, Western Australia. Those who had previously accessed a mental health service but not continued with care often had less favourable perceptions of service benefit. Participants in both populations considered that mental health service use was least likely to be beneficial for conduct-related behaviours. Participants in both population groups from single-carer households or identifying as LGBTIQ reported a higher perceived benefit of mental health services. Our study highlights potential gaps in adolescent knowledge regarding mental health help-seeking. Perceptions of service benefit were often no different or less favourable amongst those who had previously accessed a mental health service but not continued with care. The range of sociodemographic factors significantly associated with perceived benefit across both populations in the sample indicates subpopulations of young people may require extra support within the system. [ABSTRACT FROM AUTHOR]

Issues Addressed: To explore adolescents' experiences of access to and continued use of mental health services, and identify factors influencing their perceived satisfaction with their care. This paper focusses on the role of organisational and policy-level factors in the mental health system.Method: Qualitative semi-structured face-to-face interviews with 22 adolescents aged 14-18 years living in Perth, Western Australia.Results: Adolescents identified key policy, systemic and service-based factors which influenced their access to and continued use of mental health services. These were strongly related to the processes of service intake, level of orientation towards person-centred care and adequacy of service resourcing and funding. Areas of concern for adolescents included, complex service intake procedures, suboptimal mental health service environments, lack of client-centred care and the quality of mental health support provided in school settings.Conclusions: Our research has identified a wide spectrum of factors influencing mental health service access and use amongst adolescents. The findings further support the growing national consensus for major reform to address the mental health needs of this age group. The current strengths within mental health services and the system identified by adolescents need to be supported and extended. SO WHAT?: Although there have been numerous recommendations on ways to improve mental health service access and ongoing engagement for Australian adolescents, a number of the major challenges faced by this high-risk population have shown little improvement. The findings of this research indicate the importance of now moving towards implementing meaningful plans for action. [ABSTRACT FROM AUTHOR]

Objective: Trans and gender diverse young people experience mental health difficulties self-harm and suicidality at markedly higher rates than the general population, yet they often feel isolated from mental health services. There is little qualitative research on the experiences of trans and gender diverse young people accessing mental health support in Australia. The objective of this study was to comprehensively explore the experiences of trans and gender diverse young people in Australia who have sought mental health support from therapists, counsellors, psychiatrists and/or inpatient care providers. Methods: We report on findings from the Trans Pathways study, which was a mixed-methods study to evaluate the experiences of trans and gender diverse young people accessing mental health services: specifically, therapy and counselling services, psychiatric services and mental health inpatient services. Results: A total of 859 trans and gender diverse young people aged 14–25 years across Australia completed an anonymous online questionnaire. Therapy and/or counselling services (64.4%) were most frequently sought by trans and gender diverse young people in this study, followed by psychiatric services (43.0%) and mental health inpatient services (12.3%). The findings demonstrated that many mental health professionals lacked expertise in gender diversity, and that trans and gender diverse young people found it difficult to locate mental health professionals who were able to meet their needs in a timely manner. Conclusion: These findings indicate that training is necessary for all mental health professionals to improve their knowledge of gender diversity, enhance the support provided to trans and gender diverse young people and help to address the high rates of poor mental health. The findings outlined here provide insight into the areas in which clinicians could optimise their care of trans and gender diverse young people. [ABSTRACT FROM AUTHOR]

The materials corrosion test (MaCoTe) is a long‐term, multinational in situ corrosion experiment setup at the Grimsel Test Site, Switzerland. The experiment has been operating since 2014 with a focus on the corrosion behaviour of container materials for the disposal of high‐level waste and spent nuclear fuel under conditions representing a granitic deep geological repository. The experiment consists of eight modules containing metal coupons and bentonite. Two of the modules, each with a different bentonite density, have been retrieved after 394 days of exposure and have been analysed using a range of techniques aimed at studying the corrosion behaviour of the metals and the mineralogical evolution of the bentonite. Weight loss measurements show that carbon steel had a relatively low average corrosion rate (~2 µm year−1). Much lower average corrosion rates were measured for the various types of copper (0.13–0.32 µm year−1). No detectable corrosion was measured on stainless steel coupons. To date, no significant differences were observed in the corrosion behaviour and rate of the test metals in bentonite with different dry densities. [ABSTRACT FROM AUTHOR]

Since 2012, a long‐term in situ corrosion experiment (IC‐A) is being conducted in the Mont Terri Underground Research Laboratory in Switzerland to investigate the corrosion behaviour of candidate canister materials in conditions representative of the Swiss concept for the disposal of high‐level waste and spent nuclear fuel. To date, carbon steel and various types of copper coatings have been retrieved after different exposure periods of up to 3 years, and characterised to establish the composition of the corrosion product, the morphology of the corroded surface, the nature of the interaction between the metal and the surrounding bentonite, and the microbial populations in the bentonite and surrounding porewater. For carbon steel specimens, a complex corrosion product was identified, consisting predominantly of magnetite. Much less alteration on either the metal or the bentonite was observed in the case of copper samples. Low average anaerobic corrosion rates were measured for carbon steel and a very modest amount of alteration was identified on copper. The density and the initial form of the bentonite had a small influence on the rate of corrosion, across all materials. This paper summarises the results of the experimental programme obtained to date and discusses the relationship observed between exposure time and the evolution of the metal–bentonite interface for both carbon steel and copper. [ABSTRACT FROM AUTHOR]

Objectives: To (a) compare palliative care needs of lung cancer patients on their final admission to community‐based and inpatient palliative care services; and (b) explore whether and how these care needs affect their utilisation of different palliative care services in the last days of life. Methods: Descriptive study involving 17,816 lung cancer patients who received the last episode of palliative care from specialist services and died between 1 January 2013 and 31 December 2018. Results: Both groups of patients admitted to community‐based and inpatient palliative care services generally experienced relatively low levels of symptom distress, but high levels of functional impairment and dependency. "Unstable" versus "stable" palliative care phase (Odds ratio = 11.66; 95% Confidence Interval: 9.55–14.24), poorer functional outcomes and severe levels of distress from many symptoms predicted greater likelihood of use of inpatient versus community‐based palliative care. Conclusions: Most inpatient palliative care admissions are not associated with high levels of symptom severity. To extend the period of home care and rate of home death for people with lung cancer, additional investment is required to improve their access to sufficiently skilled palliative care staff, multi‐disciplinary teams and 24‐hour home support in community settings. [ABSTRACT FROM AUTHOR]

The aim of this study is to identify factors that stopped, discouraged or delayed mental health help-seeking in adolescents. An Online survey of 113 adolescents aged 14–18 years old, living in Perth, Western Australia, was conducted. For participants who had not yet accessed a mental health service, the top barrier was 'Having no-one who could help me get professional care' (62%). For participants who had previously accessed a mental health service, the top barrier was 'Previous experiences with a mental health service were not helpful' (63%). Major reported barriers in this population included financial costs, negative past experiences and having no one to help access professional care. [ABSTRACT FROM AUTHOR]

OBJECTIVES Our aim was to (1) describe the clinical characteristics and symptoms of people diagnosed with dementia at the time of admission to inpatient palliative care; and (2) compare the nature and severity of these palliative care–related problems to patients with other chronic diseases. DESIGN Descriptive study using assessment data on point of care outcomes (January 1, 2013, to December 31, 2018). SETTING A total of 129 inpatient palliative care services participating in the Australian Palliative Care Outcomes Collaboration. PARTICIPANTS A total of 29,971 patients with a primary diagnosis of dementia (n = 1,872), lung cancer (n = 19,499), cardiovascular disease (CVD, n = 5,079), stroke (n = 2,659), or motor neuron disease (MND, n = 862). MEASUREMENTS This study reported the data collected at the time of admission to inpatient palliative care services including patients' self‐rated levels of distress from seven common physical symptoms, clinician‐rated symptom severity, functional dependency, and performance status. Other data analyzed included number of admissions, length of inpatient stay, and palliative care phases. RESULTS: At the time of admission to inpatient palliative care services, relative to patients with lung cancer, CVD, and MND, people with dementia presented with lower levels of distress from most symptoms (odds ratios [ORs] range from.15 to.80; P <.05 for all) but higher levels of functional impairment (ORs range from 3.02 to 8.62; P <.001 for all), and they needed more assistance with basic activities of daily living (ORs range from 3.83 to 12.24; P <.001 for all). The trends were mostly the opposite direction when compared with stroke patients. Patients with dementia tended to receive inpatient palliative care later than those with lung cancer and MND. CONCLUSION: The unique pattern of palliative care problems experienced by people with dementia, as well as the skills of the relevant health services, need to be considered when deciding on the best location of care for each individual. Access to appropriately trained palliative care clinicians is important for people with high levels of physical or psychological concerns, irrespective of the care setting or diagnosis. J Am Geriatr Soc 68:1825‐1833, 2020. [ABSTRACT FROM AUTHOR]

(i) identify principles underpinning optimal mental health service provision for adolescents as identified by mental health service professionals; (ii) identify mental health service practice- and policy-level factors which act as facilitators and barriers to providing optimal care for adolescents. qualitative approach utilising semi-structured, face-to-face interviews with 23 purposively recruited government and non-government mental health professionals. The data were thematically analysed. The mental health professionals identified three main service feature principles underpinning optimal mental health service provision for adolescents: (1) flexibility, (2) consistency; and (3) trust. Participants identified practices within mental health services that were facilitators and barriers to these three principles. The main characteristics mental health professionals believe are required to provide optimal mental health care for adolescents, differentially contrast with the reported current service provision process. Many service practices, such as triage processes and entry criteria, were perceived to be strategies that services implement to protect themselves from the high stress and demand they face rather than for adolescent benefit. These results highlight that mental health services for adolescents remain fragmented, with little system-wide planning to stream-line processes and thus negatively impacting adolescent mental health care. Ongoing demands of the system have created an environment where constant client turnover and rigidity are a must to cope. [ABSTRACT FROM AUTHOR]

Background General practitioners (GPs) do not typically receive education regarding gender diversity despite the increasing number of trans, gender diverse and non-binary (TGDNB) patients presenting to general practice. It is important for GPs, as the first point of entry into the healthcare system, to provide a safe and affirming environment for TGDNB patients to reduce ill-health later in life. Objective The aim of this article is to clarify how GPs can improve their care of TGDNB patients to be more inclusive and thereby promote a positive relationship with the health system, assist in gender-affirming care and reduce illness within this population. The authors provide simple suggestions for clinical practice and encourage clinicians to seek professional development in this rapidly developing field. Discussion Care of TGDNB patients extends beyond gender-affirming care to include mental health and community supports to ensure the overall wellbeing of the patient. Central to this care is respect of the patient's gender identity and expression. [ABSTRACT FROM AUTHOR]

Musculoskeletal symptoms (MSSs) are a common problem for musicians, but the MSS burden of amateur musicians specifically is under-investigated. For the first time we sought to compare the MSS prevalence and profile (e.g. MSS location, impact) of adult amateur musicians with those of non-musicians. Amateur and non-musicians were asked to complete a questionnaire that collected data on their demographics, musical activities and MSS outcomes. A total of 456 participants were included, 30.9% of whom were amateur musicians. MSSs were common for both amateurs and non-musicians (96.4% and 96.1%, respectively, for the last twelve months). The only significant difference between the two groups was for the twelve-month prevalence of head MSSs with amateur musicians having a higher prevalence than non-musicians (49.6% and 39.8%, respectively, p<0.05). We conclude that amateur musicians do not have a substantially different MSS prevalence and profile compared with non-musicians for this university-based population. [ABSTRACT FROM AUTHOR]

Defining the linkages between landscape change, disease ecology and human health is essential to explain and predict the emergence of Plasmodium knowlesi malaria, a zoonotic parasite residing in Southeast Asian macaques, and transmitted by species of Anopheles mosquitos. Changing patterns of land use throughout Southeast Asia, particularly deforestation, are suggested to be the primary drivers behind the recent spread of this zoonotic parasite in humans. Local ecological changes at the landscape scale appear to be increasing the risk of disease in humans by altering the dynamics of transmission between the parasite and its primary hosts. This paper will focus on the emergence of P. knowlesi in humans in Malaysian Borneo and the ecological linkage mechanisms suggested to be playing an important role. [ABSTRACT FROM AUTHOR]

Background: The majority of end-of-life (EOL) care occurs in general practice. However, we still have little knowledge about how this care is delivered or how it can be assessed and supported. Aim: (i) To review the existing evaluation tools used for assessment of the delivery of EOL care from the perspective of general practice; (ii) To describe how EOL care is provided in general practice; (iii) To identify major areas of concern in providing EOL care in this context. Design: A systematic review. Data Sources: Systematic searches of major electronic databases (Medline, EMBASE, PsycINFO, and CINAHL) from inception to 2017 were used to identify evaluation tools focusing on organizational structures/systems and process of end-of-life care from a general practice perspective. Results: A total of 43 studies representing nine evaluation tools were included. A relatively restricted focus and lack of validation were common limitations. Key general practitioner (GP) activities assessed by the evaluation tools were summarized and the main issues in current GP EOL care practice were identified. Conclusions: The review of evaluation tools revealed that GPs are highly involved in management of patients at the EOL, but there are a range of issues relating to the delivery of care. An EOL care registration system integrated with electronic health records could provide an optimal approach to address the concerns about recall bias and time demands in retrospective analyses. Such a system should ideally capture the core GP activities and any major issues in care provision on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Therapeutic use of spring waters has a recorded history dating back to at least 1550 BC and includes both bathing in and drinking such waters for their healing properties. In Australia and New Zealand the use of therapeutic spring waters is a much more recent phenomenon, becoming a source of health tourism from the late 1800s. We conducted a systematic review aimed at determining the potential health outcomes relating to exposure to Australian or New Zealand natural spring water. We found only low-level evidence of adverse health outcomes relating to this spring water exposure, including fatalities from hydrogen sulphide poisoning, drowning and primary amoebic meningoencephalitis. We found no studies that investigated the therapeutic use of these waters, compared with similar treatment with other types of water. From the broader literature, recommendations have been made, including fencing potentially harmful spring water, and having signage and media messages to highlight the potential harms from spring water exposure and how to mitigate the risks (e.g. not putting your head under water from geothermal springs). Sound research into the potential health benefits of Australian and New Zealand spring waters could provide an evidence base for the growing wellness tourism industry. [ABSTRACT FROM AUTHOR]

Objective: To identify barriers and enablers to professional mental health service utilisation for disadvantaged adolescents from the perspective of mental health service providers. Method: This study incorporated qualitative research methods with eight semi-structured, face-to-face interviews completed with purposively recruited government, non-government and school mental health service providers. The data were collected from May to September 2015 in Perth, Western Australia. Data analysis was undertaken using content analysis. Results: Service providers identified multiple barriers and facilitators for disadvantaged adolescents accessing and using mental health services including: (1) pathways to mental health services; (2) how services listen to and interact with adolescents; (3) service environment, including youth-friendly locations and atmosphere; and (4) government and organisational policies. Discussion: These results highlight the need to simplify pathways and provide support for adolescents in negotiating the mental health system. Schools can be utilised as an important gatekeeper to mental health services. Legislation associated with adolescent mental health appears to be a barrier for adolescents in seeking or continuing with care. Service should place more emphasis on building trusted relationships with clients and developing capacity to perform outreach. Strategies to enable services to work collaboratively may reduce the risk that adolescents experience multiple referrals within the system. To reduce the impact on individuals and long-term costs, the State Government needs to make early intervention a priority and modifying the current service delivery system to be more inclusive of adolescents’ perspectives. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether the Koorliny Moort program could reduce emergency department presentations, hospital admissions and length of stay, and improve attendance at out-of-hospital appointments for Aboriginal and Torres Strait Islander children in Western Australia.Design: Children were enrolled in the program from 1 August 2012. Each child acted as their own control. Evaluation data were collected from 1 August 2010 to 31 July 2014. Occasions of service and person-time in days were compared for each child before and after referral to the program.Setting and Participants: Aboriginal children aged 0-16 years residing in three WA regions (Kimberley, Pilbara, Perth metropolitan) who were referred to the Koorliny Moort program.Interventions: Partnerships with primary care providers; nurse-led care coordination; and outreach care by paediatricians, nurses and social workers closer to the home of the child.Main Outcome Measures: Emergency department presentations; hospital admissions; length of hospital stay; non-attended appointments.Results: A total of 942 children were referred to the program. There were significant decreases after referral to the program in the incidence of emergency department presentations (incident rate ratio [IRR], 0.47; 95% CI, 0.43-0.53; P < 0.001), of hospitalisation (IRR, 0.70; 95% CI, 0.62-0.79; P < 0.001), and of non-attended appointments (IRR, 0.83; 95% CI, 0.74-0.94; P < 0.001), as well as in the mean length of hospital stay (IRR, 0.23; 95% CI, 0.21-0.25; P < 0.001).Conclusions: Health-seeking behaviour and health outcomes for Aboriginal children can be improved by engaging Aboriginal families in their health care, providing effective communication between health service providers, and delivering a coordinated program of Aboriginal service provider-led care. [ABSTRACT FROM AUTHOR]

Background: Murray Valley encephalitis virus (MVEV) is a clinically important virus in Australia responsible for a number of epidemics over the past century. Since there is no vaccine for MVEV, other preventive health measures to curtail its spread must be considered, including the development of predictive risk models and maps to help direct public health interventions. This article aims to support these approaches by presenting a model for assessing MVEV risk in Western Australia (WA). Methods: A Bayesian Belief Network (BBN) for assessing MVEV risk was developed and used to quantify and map disease risks in WA. The model combined various abiotic, biotic, and anthropogenic factors that might affect the risk of MVEV into a predictive framework, based on the ecology of the major mosquito vector and waterbird hosts of MVEV. It was further refined and tested using retrospective climate data from 4 years (2000, 2003, 2009, and 2011). Results: Implementing the model across WA demonstrated that it could predict locations of human MVEV infection and sentinel animal seroconversion in the 4 years tested with some degree of accuracy. In general, risks are highest in the State's north and lower in the south. The model predicted that short-term climate change, based on the Intergovernmental Panel on Climate Change's A1B emissions scenario, would decrease MVEV risks in summer and autumn, largely due to higher temperatures decreasing vector survival. Conclusions: To our knowledge, this is the first model to use a BBN to quantify MVEV risks in WA. The models and maps developed here may assist public health agencies in preparing for and managing Murray Valley encephalitis in the future. In its current form, the model is knowledge-driven and based on the analysis of potential risk factors that affect the dynamics of MVEV using retrospective data. Further work and additional testing should be carried out to test its validity in future years. [ABSTRACT FROM AUTHOR]

The article focuses on topics related to corrosion control. Topics include use of density functional theory (DFT) for hydrocarbons, polymer coatings for substrates in the presence of an oxide film, and presence of graphene on the diamond surface. Also discussed are topics like control of hydrogen ion (pH) concentration during polymeric coating process.

The article focuses on topics related to corrosion. Topics include formation of passive films, effect of humidity on corrosion, and effect of radiation on corrosion of uranium dioxide. Also discussed are topics like production of hydrogen peroxide by radiolysis, corrosion of magnesium, and effect on the corrosion rate due to presence of aluminium in alloys.

The article focuses on various topics related to corrosion. Topics include the use of zinc oxide as a semiconducting oxide, formation of oxide films, and the effect of oxygen on copper. Also discussed are topics like sensitivity of metal ions, corrosion due to carbon dioxide in oil industry, and ultra high vacuum treatment.

The morphology of atmospheric pitting corrosion in 304L stainless steel plate was analysed using MgCl2 droplets in relation to changes in relative humidity (RH) and chloride deposition density (CDD). It was found that highly reproducible morphologies occur that are distinct at different RH. Pitting at higher concentrations, i.e. lower RH, resulted in satellite pits forming around the perimeter of wide shallow dish regions. At higher RH, these satellite pits did not form and instead spiral attack into the shallow region was observed. Increasing CDD at saturation resulted in a very broad-mouthed pitting attack within the shallow dish region. Large data sets were used to find trends in pit size and morphology in what is essentially a heterogeneous alloy. Electrochemical experiments on 304 stainless steel wires in highly saturated solutions showed that the passive current density increased significantly above 3 M MgCl2 and the breakdown pitting potential dropped as the concentration increased. It is proposed that the shallow dish regions grow via enhanced dissolution of the passive film, whereas satellite pits and a spiral attack take place with active dissolution of bare metal surfaces. [ABSTRACT FROM AUTHOR]

Background: There are many communities around the world that are exposed to high levels of particulate matter <10 µm (PM10) of geogenic (earth derived) origin. Mineral dusts in the occupational setting are associated with poor lung health, however very little is known about the impact of heterogeneous community derived particles. We have preliminary evidence to suggest that the concentration of iron (Fe) may be associated with the lung inflammatory response to geogenic PM10. We aimed to determine which physico-chemical characteristics of community sampled geogenic PM10 are associated with adverse lung responses. Methods: We collected geogenic PM10 from four towns in the arid regions of Western Australia. Adult female BALB/c mice were exposed to 100 µg of particles and assessed for inflammatory and lung function responses 6 hours, 24 hours and 7 days post-exposure. We assessed the physico-chemical characteristics of the particles and correlated these with lung outcomes in the mice using principal components analysis and multivariate linear regression. Results: Geogenic particles induced an acute inflammatory response that peaked 6 hours post-exposure and a deficit in lung mechanics 7 days post-exposure. This deficit in lung mechanics was positively associated with the concentration of Fe and particle size variability and inversely associated with the concentration of Si. Conclusions: The lung response to geogenic PM10 is complex and highly dependent on the physico-chemical characteristics of the particles. In particular, the concentration of Fe in the particles may be a key indicator of the potential population health consequences for inhaling geogenic PM10. [ABSTRACT FROM AUTHOR]