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Objectives: Integrated respiratory and palliative care services for people with advanced lung disease provide disease-orientated care until the end of life, alongside symptom management and discussions about future care. This study aimed to explore patient, caregiver and general practitioner perspectives of an integrated respiratory and palliative care service, to understand which components of the service were considered valued and effective. Methods: We approached patients, caregivers and general practitioners, to participate in semi-structured phone interviews. A grounded theory approach guided data collection and qualitative analysis. Results: Between July and December 2019, 10 patients, eight caregivers and five general practitioners completed interviews. The overarching theme was that of valuing integrated care – the provision of disease-orientated care along with palliative care. Four other major themes emerged: Valuing communication and engagement between patient, caregiver and healthcare professionals – who spoke of 'growing this plan together'; the delivery of person-centred care – where physicians 'actually listen and you are not treated like a number'; the reality of action plan use in serious illness – while many found plans 'certainly' do help, others described when they were simply 'too ill to do the action plan'; and finally, divergent preferences for discussions about future care – while some patients felt this subject was 'better left alone', caregivers consistently reported their preference was to 'make a plan.' Conclusion: Consumer perspectives highlight the service was valued for delivering personalised care with high communication standards. Similar services should appreciate the usefulness and limitations of action plan use in advanced lung disease, and be sensitive to potential diverging preferences of the patient and caregiver when discussing future care. What is known about the topic? Integrated respiratory and palliative care services for people with advanced lung disease may improve quality of life and decrease acute healthcare utilisation and cost. What does this paper add? This paper adds to our understanding of patients', caregivers' and general practitioners' perspectives of this integrated care model. Participants highly valued this integrated service for providing person-centred care. Participants outlined both the effectiveness and limitations of action plan use in advanced lung disease, and of diverging preferences between patients and caregivers for discussions about future care. What are the implications for practitioners? The integration of disease-orientated care along with the provision of palliative care is highly valued from a consumer perspective. [ABSTRACT FROM AUTHOR]

Objective: To investigate the psychosocial effects of the COVID-19 pandemic on nurses and midwives working in acute care settings, specifically psychological distress, self-reported concerns, and perceived impact on their work and personal lives. Background: Little is known about the psychosocial impact of the pandemic on nurses and midwives in Australia, a country with a substantially lower number of COVID-19 cases and deaths than many others. Few studies investigating the prevalence of psychological distress among nurses during the pandemic have been conducted in more than one setting, especially in the Australian context. Study design and methods: Cross-sectional survey design (STROBE checklist). Nurses and midwives (n=1,611) at four metropolitan tertiary health services in Melbourne, Australia completed an anonymous online survey between 15 May and 31 August 2020, which assessed symptoms of depression, anxiety and stress (DASS-21); concerns related to COVID-19; and other effects of COVID-19. Space was provided for free-text comments. Results: Approximately one fifth of respondents reported moderate to extremely severe symptoms of depression, anxiety and stress. Fewer years of clinical experience were significantly associated with higher levels of psychological distress. More than half of the respondents were extremely/very concerned about passing COVID-19 on to family members and about their family's health, and almost half were concerned about caring for a patient who had confirmed or suspected COVID-19. Respondents reported that certain precautionary measures such as personal protective equipment (PPE) interfered with their ability to provide optimal patient care. Positive aspects of the pandemic were also reported including a sense of togetherness and cooperation among staff. Conclusion: The COVID-19 pandemic has had a considerable impact on the psychological wellbeing and work and personal lives of nurses and midwives working in acute care settings in Melbourne, Australia, particularly those with less clinical experience. Implications for nursing and health services research, policy and practice: Nurses and midwives, particularly those with less clinical experience, would benefit from additional, targeted wellbeing and support initiatives. For those with less experience, initiatives could include being partnered with more experienced colleagues and educators who can provide practical and emotional support and monitor their stress levels. What is already known about the topic? * Nurses and midwives have experienced more psychological distress than other healthcare workers during the COVID-19 pandemic. * Most studies about the psychosocial impact of the COVID-19 pandemic on nurses and midwives have been conducted in a single health service. * Few studies have concurrently investigated the experiences of nurses and midwives from different health services during the COVID-19 pandemic especially in the Australian context. What this paper adds * Despite the relatively low number of COVID-19 cases and deaths in Australia, the COVID-19 pandemic has had a considerable impact on the psychological wellbeing and work and personal lives of Australian nurses and midwives. * About one in five of the nurses and midwives surveyed reported moderate to extremely severe symptoms of depression, anxiety and stress during the first wave of the pandemic. * Nurses and midwives with fewer years of clinical experience experienced higher levels of psychological distress than those with more experience. [ABSTRACT FROM AUTHOR]

Objective: The aims of this paper were to report on the global psychosocial functioning of 5-year-old DHH children and examine the risk and protective factors that predict outcomes. Design: A cross-sectional analysis of data collected from a prospective, population-based longitudinal study. Study sample: Parents/caregivers of 356 children completed questionnaires on psychosocial development (CDI, SDQ), functional communication (PEACH) and demographic information. Children completed standardized assessments of non-verbal cognitive ability (WNV) and language (PLS-4). Results: On average, global psychosocial functioning was within the range of typically developing children; however, variability was high and 12% of children had scores that were more than 2 SDs below the norm. Non-verbal cognitive ability, presence of additional disabilities, language and functional communication significantly predicted outcomes. In contrast, type of hearing device, severity of hearing loss and age at intervention did not. Conclusion: The global psychosocial functioning of this cohort of 5-year-old DHH children fell within the range of typically developing children. The findings suggest that spoken language ability and functional communication skills are vital for healthy psychosocial development. [ABSTRACT FROM AUTHOR]

Background: Tendon pathology and tendinopathy have been reported in children and adolescents; however, the age at onset and prevalence of the conditions have not been examined systematically. Objective: To examine the prevalence of lower limb tendon pathology and tendinopathy in children and adolescents, and the factors associated with these conditions in this population. Methods: Six databases were searched (MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, Scopus, the Web of Science and the Allied and Complementary Medicine Database). Studies were included if the prevalence of lower limb tendon pathology and/or tendinopathy were reported in humans under the age of 18 years. Studies were divided according to the method of diagnosis (physical examination, ultrasound or a questionnaire) and further divided into studies that reported prevalence data by tendon [reported two data points (right and left) for each participant] and those that reported prevalence data for each participant [reporting one data point (right or left) per participant]. Results: Seventeen studies met the inclusion criteria. Lower limb tendinopathy prevalence (presence of pain and dysfunction) ranged between 8.2 and 33.3 %, and increased in prevalence as age increased up to 18 years. The odds ratio for studies reporting tendinopathy by tendon was 0.37 (95 % confidence interval 0.20-0.69) in favour of boys presenting with tendinopathy. Study aims and reporting methods were heterogeneous. Conclusions: The age at onset of lower limb tendinopathy in children and adolescents has not been widely studied. This systematic review found that tendinopathy is present in children and adolescents, and increases in prevalence with age up to 18 years. Male sex is significantly associated with tendinopathy in studies that report tendinopathy by tendon. [ABSTRACT FROM AUTHOR]

Background: As frontline healthcare workers, there is a growing expectation that nurses should be able to respond to disclosures of family violence. However, the profession and hospital systems have been slow to respond with clear skills, knowledge and confidence deficits identified in existing research. There is limited research which has robustly evaluated the effectiveness of in‐depth, multifaceted training on readiness to respond among nurses. Aim: To longitudinally evaluate the effectiveness of an in‐depth family violence training intervention on confidence, knowledge and clinical skills of nurses working in a large tertiary adult hospital. Design: Single‐centre, longitudinal intervention study. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross‐sectional guidelines were used. Methods: One hundred and ten nursing clinicians participated in this study to complete a comprehensive evidence‐based model of healthcare workers response for assisting patients experiencing family violence. A mixed methods survey was used to assess change in knowledge, confidence and clinical skills among participants. Outcome assessment was electronically undertaken at baseline, 6–9 months and 12–15 months following intervention. Results: Statistically significant improvement was seen in self‐reported knowledge, confidence and frequency of screening for family violence. Relative to baseline estimates, these improvements were identified 6–9 months and 12–15 months following intervention; albeit with consideration to the visually observed trend of skill reversion at follow‐up. Quantitative findings were paralleled by qualitatively identified improvements in the recognition of the intersectional nature of violence, need for patient collaboration in screening and depth in considerations around how family violence is screened for. Conclusions: Findings provide tentative support for the utility of a multidimensional training approach to improving nurses' readiness to respond to disclosures of family violence. Relevance to clinical practice: This study provides preliminary support for multidimensional, evidence‐based training to effectively improve nurses' confidence, knowledge and clinical skills required for responding to family violence. Reporting Method: The study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (SQUIRE) Statement: guidelines for reporting observational studies (see Table S1). Patient Contribution: Patients were involved in the initial design of the survey tool. This involvement came through the Allied Health Consumer panel and included input on the design and question wording of the survey items. [ABSTRACT FROM AUTHOR]

Aim: This paper explored the relationship between maternal controlling feeding behaviours and child eating and weight in preschool-aged children. Methods: Ninety mothers of 2- to 5-year-old children (M = 3.48, SD = 0.84, 54.4% males) completed self-report measures assessing maternal controlling feeding behaviours, child eating patterns and weight. Results: Univariate analyses indicated that child food neophobia was associated with authoritarian feeding ( r= 0.29), pressure to eat ( r= 0.28) and restriction ( r= 0.34). Child food pickiness was associated with authoritarian feeding ( r= 0.35). No association was found between maternal feeding strategies and child weight. Multivariate regression analyses indicated that authoritarian feeding, restriction and pressure to eat were significantly associated with the variance in child food neophobia (adjusted R2= 12.6%) and pickiness (adjusted R2= 12.0%). Conclusions: The findings suggest that maternal control in feeding is associated with undesirable eating patterns in preschool-aged children. Interventions targeting reduction in maternal controlling feeding may promote desirable eating patterns in preschool-aged children. [ABSTRACT FROM AUTHOR]

Background: Preventable harms during hospitalization pose a major challenge for health systems globally. Nurse‐led strategies provide comprehensive harm prevention to keep the most vulnerable patients safe in hospital, but gaps in care are common. Nursing roles and activities to prevent harm to patients during acute hospitalization are poorly understood. Aim: The aim of this study was to identify nurses' perceived enablers and barriers to the implementation of comprehensive harm prevention for older people admitted to an acute hospital setting. Design: Anonymous, online, cross‐sectional survey. Methods: The adapted Influences on Patient Safety Behaviours Questionnaire (IPSBQ) was used to collect data from nurses working on five general medicine wards across three hospitals of a single tertiary health service in Australia in 2019. Participants also rated their perceptions of overall quality of care, missed care and awareness of strategies for an eight‐factor framework for comprehensive harm prevention. The STROBE reporting checklist was used. Results: Ward response rates between 35% and 58% resulted in 132 complete questionnaires for analyses. High mean scores for behavioural regulation (3.28), beliefs about capabilities (2.96) and environmental context and resources (2.73) indicated these domains were perceived by nurses as enablers. Low mean scores for the domains of intentions (1.65), beliefs about consequences (1.69), optimism (1.72) and professional role and identity (1.85) indicated these were barriers to comprehensive harm prevention by nurses. High perceived quality of care (scored 9–10/10) (p =.024), and awareness of strategies for the eight‐factor framework (p =.019) were significant enablers of comprehensive harm prevention. Conclusion: Targeted evidence‐based strategies that include education, persuasion, incentivization, coercion and modelling would be most useful for promoting comprehensive harm prevention by nurses. However, to be most effective the harm prevention strategy may need to be tailored for each ward. [ABSTRACT FROM AUTHOR]

Background: SEA Change Portland is a systems-based approach implemented in Portland, Victoria that utilises local community resources to sustainably prevent and reduce the prevalence of childhood obesity. Action is implemented by community-led task teams with differing priority areas, and supported by a steering committee representative of four collaborating organisations. This study examines the SEA Change Portland process to identify significant events, enablers and barriers of its development and implementation to date as reported by key stakeholders involved in implementation during the first 12 months.Methods: Semi-structured interviews were conducted with eight steering group members and three community task team members. Data was collected utilising open ended interview questions to gather in-depth information regarding program implementation, and the individual attitudes, beliefs and experiences of key stakeholders.Results: Data were analysed under three key themes: collective impact, systems thinking and asset based community development (ABCD). Participants gave perceptions of significant events; factors positively and negatively affecting the process; reasons for becoming involved in the process; perceived efficacy of task teams, principles of diversity and areas of concern. Themes emerged from participant responses allowing were categorisation of their responses into four key process stages: initial lead up; process development; establishing community ownership of the obesity system; and community action.Conclusion: Collective impact was a crucial element in applying the systems thinking. Strong and equitable relationships between steering organisations and topic experts provided the initiative with a sustainable foundation, and ABCD promotes community ownership and future sustainability. Understanding the process of implementing a new whole-of-community systems approach to childhood obesity prevention such as SEA Change Portland has provided vital knowledge for other communities regarding enablers and barriers of this promising approach. [ABSTRACT FROM AUTHOR]

Purpose: Prevention of the female athlete triad is essential to protect female athletes' health. The aim of this study was to investigate the knowledge, attitudes, and behaviors of regularly exercising adult women in Australia toward eating patterns, menstrual cycles, and bone health. Methods: A total of 191 female exercisers, age 18.40 yr, engaging in ≥2 hr/wk of strenuous activity, completed a survey. After 11 surveys were excluded (due to incomplete answers), the 180 participants were categorized into lean-build sports (n = 82; running/ athletics, triathlon, swimming, cycling, dancing, rowing), non-lean-build sports (n = 94; basketball, netball, soccer, hockey, volleyball, tennis, trampoline, squash, Australian football), or gym/fitness activities (n = 4). Results: Mean (± SD) training volume was 9.0 ± 5.5 hr/wk, with participants competing from local up to international level. Only 10% of respondents could name the 3 components of the female athlete triad. Regardless of reported history of stress fracture, 45% of the respondents did not think that amenorrhea (absence of menses for ≥3 months) could affect bone health, and 22% of those involved in lean-build sports would do nothing if experiencing amenorrhea (vs. 3.2% in non-lean-build sports, p = .005). Lean-build sports, history of amenorrhea, and history of stress fracture were all significantly associated with not taking action in the presence of amenorrhea (all p < .005). Conclusions: Few active Australian women are aware of the detrimental effects of menstrual dysfunction on bone health. Education programs are needed to prevent the female athlete triad and ensure that appropriate actions are taken by athletes when experiencing amenorrhea. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the factors emergency nurses use to inform their decisions regarding frequency and nature of vital sign assessment. Background Research related to clinical deterioration and vital sign assessment in the emergency department is in its infancy. Studies to date have explored the frequency of vital sign assessment in the emergency department; however, there are no published studies that have examined factors that emergency nurses use to inform their decisions regarding frequency and nature of ongoing vital sign assessment. Design A prospective exploratory design was used. Data were collected using a survey consisting of eight patient vignettes. Methods The study was conducted in one emergency department in metropolitan Melbourne. Participants were emergency nurses permanently employed at the study site. Results A 96% response rate was achieved ( n = 47/49). The most common frequency of patient reassessment nominated by participants was 15 or 30 minutely, with an equal number of participants choosing these frequency intervals. Abnormality in initial vital sign parameters was the most common factor identified for choosing either a 15- or 30-minute assessment interval. Frequency of assessment decisions was influenced by years of emergency nursing experience in one vignette and level of postgraduate qualification in three vignettes. Heart rate, respiratory rate and blood pressure were all nominated by over 80% of participants as vital signs that participants considered important for reassessment. The frequency and nature of vital signs selected varied according to vignette content. There were significant negative correlations between assessment of conscious state and years of nursing experience and assessment of respiratory rate and years of emergency nursing experience. Level of postgraduate qualification did not influence selection of parameters for reassessment. Conclusion Emergency nurses are tailoring vital sign assessment to patients' clinical status, and nurses are integrating known vital sign data into vital sign decision-making. Relevance to clinical practice Accurate assessment and interpretation of vital sign data is fundamental to patient safety. Emergency nurses are responsible for the initial and ongoing assessment of undiagnosed or undifferentiated patients. Prior to medical assessment, emergency nurses are solely responsible for patient assessment, escalation of care and implementation of interventions within nursing scope of practice. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the reliability, validity and responsiveness of the High-level Mobility Assessment Tool (HiMAT) in children and adolescents with traumatic brain injury (TBI) and to compare the mobility skills of children with TBI to those of healthy peers. Method: The mobility skills of 52 children with moderate and severe TBI (36 males; mean age = 12 years, range = 6–17) were assessed using the HiMAT and the Pediatric Evaluation of Disability Inventory (PEDI). Inter-rater reliability, re-test reliability and responsiveness of the HiMAT were evaluated in sub-groups by comparing results scored at several time-points. The HiMAT scores of children with TBI were compared with those of a healthy comparative cohort. Results: The HiMAT demonstrated excellent inter-rater reliability (ICC = 0.93), re-test reliability (ICC = 0.98) and responsiveness to change (p = 0.002). The PEDI demonstrated a ceiling effect in mobility assessment of ambulant children with TBI. The HiMAT scores of children with TBI were lower than those of their healthy peers (p < 0.001). Interpretation: The HiMAT is a reliable, valid and sensitive measure of high-level mobility skills following childhood TBI. The high-level mobility skills of children with TBI are less proficient than their peers. [ABSTRACT FROM PUBLISHER]

Previous research has shown an association between children's development of psychosocial and motor skills. This study evaluated the development of these skills in 301 three-year-old deaf and hard of hearing children (M: 37.8 months) and considered a range of possible predictors including gender, birth weight, age at first fitting with hearing devices, hearing device used, presence of additional disabilities, severity of hearing loss, maternal education, socio-economic status (SES), language ability, and communication mode. Caregivers reported on children's development using the Child Development Inventory (CDI). On average, both psychosocial and motor development quotients were within the typical range for hearing children, with large individual differences. There was a positive correlation between language ability and both social and motor development, and also between social and motor development. Age at first fitting of hearing aids (as an indicator of age at identification of hearing loss), SES, degree of hearing loss, and maternal education were not significant predictors of social skill or motor development, whereas presence of additional disabilities and birth weight were. Girls performed better than boys on all but the Gross Motor subscale of the CDI. Children with hearing aids tended to perform better than those with cochlear implants on the Gross Motor subscale. [ABSTRACT FROM AUTHOR]

This study used Rasch analysis to examine the psychometric validity of the Illness Perception Questionnaire-Revised to assess beliefs about diabetes in 470 participants with Type 2 diabetes and 71 participants with Type I diabetes. All Illness Perception Questionnaire-Revised scales had psychometric issues, which included poorly utilised response categories, poor scale precision and multidimensionality. Following reengineering, only four of the eight scales (Consequences, Illness coherence, Timeline cyclical and Emotional representations) were psychometrically adequate according to the Rasch model. The diabetes-specific version of the Illness Perception Questionnaire-Revised provides suboptimal assessment of beliefs held by patients with diabetes. [ABSTRACT FROM AUTHOR]

Background: There is little empirical evidence of the impact of transition from primary to secondary school on obesity-related risk behaviour. The purpose of this study was to examine the effect of a change of school system on physical activity (PA) and sedentary behaviour in pre-early adolescents. Methods: Fifteen schools in Victoria, Australia were recruited at random from the bottom two strata of a five level socio-economic scale. In nine schools, students in year 6 primary school transitioned to a different school for year 7 secondary school, while in six schools (combined primary-secondary), students remained in the same school environment from year 6 to year 7. Time 1 (T1) measures were collected from students (N=245) in year 6 (age 11-13). Time 2 (T2) data were collected from 243 (99%) of the original student cohort when in year 7. PA and sedentary behaviour data were collected objectively (via ActiGraph accelerometer) and subjectively (via child self-report recall questionnaire). School environment data were collected via school staff survey. Change of behaviour analyses were conducted longitudinally i) for all students and ii) by change/no change of school. Mixed model regression analysis tested for behavioural interaction effects of changing/not changing school. Results: Sixty-three percent (N=152) changed schools from T1 to T2. Across all students we observed declines in average daily moderate to vigorous physical activity (MVPA) (-4 min) and light PA (-23 min), and increases in average daily sedentary behaviour (16 min), weekday leisure screen time (17 min) and weekday homework screen time (25 min), all P<0.05. Compared to students who remained in the same school environment, students who changed school reported a greater reduction in PA intensity at recess and lunch, less likelihood to cycle to/from school, greater increase in weekday (41 mins) and weekend (45 mins) leisure screen time (P<0.05) and greater encouragement to participate in sport. School staff surveys identified that sport participation encouragement was greater in primary and combined primary-secondary than secondary schools (P<0.05). Conclusion: Transitioning from primary to secondary school negatively impacts on children's PA and sedentary behaviour, and has further compounding effects on behaviour type by changing school environments. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to develop the evidence-based Healthy Ageing Quiz (HAQ). Methods: Phase 1 activities (focus groups with 33 older adults, literature review and discussion with an advisory panel) informed the development of a draft HAQ. Phase 2 involved assessing the quiz's psychometric properties and collecting respondent feedback. Results: Phase 1 provided broad topics for formulating quiz questions. In Phase 2, 297 and 122 respondents returned a quiz for validity and reliability testing respectively (over 70% response rate). The HAQ was found to be both valid (r =−0.7 to 0.6) and reliable (r = 0.8). Conclusions: The development of the HAQ was guided by the literature and input from older people and experts in healthy ageing. The quiz showed good psychometric properties and was acceptable to respondents. It allows older adults and people approaching old age to evaluate their current lifestyle in order to maximise their chances of ageing well. [ABSTRACT FROM AUTHOR]

Objective To examine health literacy in a rural community by measuring the understanding of the preventable nature of six major health conditions. Design Cross-sectional population survey. Setting New housing areas of Strathfieldsaye, Victoria. Participants A total of 197 adults aged 18 years or older. Main outcome measures Perceived preventability of skin cancer, lung cancer, cervical cancer, high blood pressure, heart attack and diabetes. Results Skin cancer was the only condition which most people perceived as being all or mostly preventable (50.3%). Lung cancer was perceived to be all or mostly preventable by 35.5% of respondents, high blood pressure by 34.0%, cervical cancer by 27.4%, diabetes by 25.4% and heart attack by only 14.7%. Conclusions This study shows that there is a lack of understanding of the preventability of these health conditions. Efforts need to be directed towards improving the public's knowledge of disease prevention and to ensure that health promotion programs reach populations with the most need. [ABSTRACT FROM AUTHOR]

Aims and objectives. To gain understandings into service providers' perceptions of organisational communication and identify areas for improvement across the perioperative pathway. Background. Effective communication among healthcare service providers is vital to the delivery of safe and quality patient care. Locally and internationally, research into sentinel and adverse events consistently demonstrate the perioperative environment and communication breakdown as recurring constituents in the generation of sentinel and adverse patient events. Design. Prospective cross-sectional survey design. Methods. Using a whole population sampling method all service providers from across the perioperative pathway including surgeons, nurses, anaesthetists, theatre technicians, patient service assistants and receptionists were surveyed using the International Communication Association survey. Responses were analysed using descriptive statistics, univariate analysis of variance and independent samples t-tests. Results. In total, 281 service providers from the perioperative pathway of three Australian public hospitals completed the survey. Respondents were dissatisfied with communication from top management and service providers employed in an operating room or postanaesthetic care unit perceived the communication of information to be inadequate. Further, analysis by service providers' occupation revealed nurses were less satisfied with channels of information than surgeons and anaesthetists were less satisfied with the timeliness of information than nurses. Conclusions. Restricted communication flow was evident as many areas of organisational communication were reported to be insufficient for the transmission of information. This research highlights the need for improved communication flow between service providers, and between management and service providers, working across the perioperative pathway. Relevance to clinical practice. Areas identified for communication improvement can be used to prevent communication failures and promote effective communication strategies such as meetings, education, providing time for open communication and developing organisational policy and procedures. [ABSTRACT FROM AUTHOR]

Background: Women living in socio-economically disadvantaged neighbourhoods are at increased risk for physical inactivity and associated health outcomes and are difficult to reach through personally tailored interventions. Targeting the built environment may be an effective strategy in this population subgroup. The aim of this study was to examine the mediating role of environmental perceptions in the relationship between the objective environment and walking for transportation/recreation among women from socio-economically disadvantaged neighbourhoods. Methods: Baseline data of the Resilience for Eating and Activity Despite Inequality (READI) study were used. In total, 4139 women (18-46 years) completed a postal survey assessing physical environmental perceptions (aesthetics, neighbourhood physical activity environment, personal safety, neighbourhood social cohesion), physical activity, and socio-demographics. Objectively-assessed data on street connectivity and density of destinations were collected using a Geographic Information System database and based on the objective z-scores, an objective destinations/connectivity score was calculated. This index was positively scored, with higher scores representing a more favourable environment. Two-level mixed models regression analyses were conducted and the MacKinnon product-of-coefficients test was used to examine the mediating effects. Results: The destinations/connectivity score was positively associated with transport-related walking. The perceived physical activity environment mediated 6.1% of this positive association. The destinations/connectivity score was negatively associated with leisure-time walking. Negative perceptions of aesthetics, personal safety and social cohesion of the neighbourhood jointly mediated 24.1% of this negative association. Conclusion: For women living in socio-economically disadvantaged neighbourhoods, environmental perceptions were important mediators of the relationship between the objective built environment and walking. To increase both transport-related and leisure-time walking, it is necessary to improve both objective walkability-related characteristics (street connectivity and proximity of destinations), and perceptions of personal safety, favourable aesthetics and neighbourhood social cohesion. [ABSTRACT FROM AUTHOR]

newton j.m., jolly b.c., ockerby c.m. & cross w.m. (2012) Student centredness in clinical learning: the influence of the clinical teacher. Journal of Advanced Nursing 68(10), 2331-2340. Abstract Aim. This article reports a longitudinal study examining how nursing students learn on clinical placements in three cohorts of undergraduates at a large Australian university. Background. Preceptorship models of clinical learning are increasing in popularity as a strategy to maximize collaboration between university and healthcare organizations. A clinical education model, underpinned by preceptorship, was offered by an Australian university in partnership with a tertiary healthcare organization to some students. Design. The study utilized a mixed method approach of surveys and interviews. Method. It was hypothesized that students participating in the preceptorship partnership model would have more positive perceptions of the clinical learning environment than students participating in other models of clinical education. Data were collected over 3 years, from 2006-2008, using a modified Clinical Learning Environment Inventory from second ( n = 396) and third ( n = 263) year nursing students. Students were classified into three groups based on which educational model they received. Results. On the inventory factor, 'Student centredness', a Welch test indicated an important difference between the responses of students in the three groups. Games-Howell post hoc test indicated that students in the clinical preceptorship partnership model responded more positively than students who had both a clinical teacher and a preceptor in a non-preceptorship partnership model. Conclusion. Developing sustainable approaches to enhance the clinical learning environment experience for student nurses is an international concern. The significance of continuity of clinical teachers to the contribution of student centredness is an important aspect to be considered. [ABSTRACT FROM AUTHOR]

Background Research examining long-term health outcomes for women after childbirth has been limited. The objective of this study was to investigate the natural history of common morbidities in the 18 months after the birth of a first child, and to explore the hypothesis that women who have a cesarean section for a first birth experience less overall morbidity in the postnatal period. Methods A prospective nulliparous pregnancy cohort study was conducted of 1,507 women recruited in early pregnancy from six public hospitals in Melbourne, Australia (mean gestation 15 weeks). Follow-up questionnaires at 3, 6, 12, and 18 months postpartum included standardized measures of urinary and fecal incontinence, and a symptom checklist asking about common physical health problems. Results At 6, 12, and 18 months postpartum, no statistically significant differences were found in the proportion of women reporting three or more health problems by method of birth. Compared with women who had a spontaneous vaginal birth, women who had a cesarean section were more likely to report extreme tiredness at 6 months postpartum (adjusted OR: 1.39; 95% CI: 1.07-1.82) and at 12 months postpartum (adjusted OR: 1.40; 95% CI: 1.05-1.85), and were more likely to report back pain at 6 months postpartum (adjusted OR: 1.37; 95% CI: 1.06-1.77) and at 12 months postpartum (adjusted OR: 1.41; 95% CI: 1.06-1.87). Women who had a cesarean section were less likely to report urinary incontinence at 3, 6, and 12 months postpartum, respectively (adjusted OR: 0.26; 95% CI: 0.19-0.36; adjusted OR: 0.36; 95% CI: 0.25-0.52; adjusted OR: 0.48; 95% CI: 0.33-0.68). For all other physical health problems the pattern of morbidity did not differ between cesarean section and spontaneous vaginal birth. Conclusions Physical health problems commonly persist or recur throughout the first 18 months postpartum, with potential long-term consequences for women's health. Cesarean section does not result in women experiencing less overall morbidity in the postpartum period compared with women who have a spontaneous vaginal birth. ( BIRTH 39:3 September 2012). [ABSTRACT FROM AUTHOR]

Background Discrimination in women's health care, particularly perinatal care, has received minimal attention. The aim of this study is to describe women's experience of discrimination in different models of maternity care and to examine the relationship between maternal social characteristics and perceived discrimination in perinatal care. Methods A population-based postal survey was mailed 6 months postpartum to all women who gave birth in two Australian states in September and October 2007. Perceived discrimination was assessed using a five-item measure designed to elicit information about experiences of unequal treatment by health professionals. Results A total of 4,366 eligible women completed the survey. Women attending public models of maternity care were significantly more likely to report perceived discrimination compared with women attending a private obstetrician (30.7% vs 19.7%, OR 1.79, 95% CI 1.5-2.1). Compared with women reporting no stressful life events or social health issues in pregnancy, those reporting three or more stressful life events or social health issues had a twofold increase in adjusted odds of perceived discrimination (41.1% vs 20.4%, adj OR 2.27, 95% CI 1.8-2.8). Young women (< 25 yr) and women who were smoking in pregnancy were also at increased risk of experiencing perceived discrimination. Conclusions Discrimination is an unexplored factor in how women experience perinatal care. Developing approaches to perinatal care that incorporate the capacity to respond to the needs of vulnerable women and families requires far-reaching changes to the organization and provision of care. ( BIRTH 39:3 September 2012) [ABSTRACT FROM AUTHOR]

Background Adolescent cannabis use predicts the onset of later illicit drug use. In contrast, little is known about whether cannabis in young adulthood also predicts subsequent progression or cessation of licit or illicit drug use. Methods 13-year longitudinal cohort study with recruitment in secondary school students in Victoria, Australia. There were six waves of adolescent data collection (mean age 14.9-17.4 years) followed by three in young adulthood (mean age 20.7, 24.1 and 29.0 years). Discrete-time proportional hazards models were used to assess predictive associations between cannabis use frequency (occasional (

Client-centered practice requires therapists to actively seek the perspectives of children and families. Several assessment tools are available to facilitate this process. However, when evaluating motor skill performance, therapists typically concentrate on performance-based assessment. To improve understanding of the information provided by the different approaches, the study investigated correlations between performance-based, child-report, and parent-report measures of children's motor skill performance. A sample of convenience of 38 children 8-12 years of age with no history of motor or intellectual impairments and their parents was recruited from Victoria, Australia. Scores for the Bruininks-Oseretsky Test of Motor Proficiency (performance-based, administered by a therapist), Physical Self-Description Questionnaire (child report), and Movement Assessment Battery for Children Checklist (parent report) were analyzed using Spearman's rho correlation. Several significant moderate-to-large correlations were found between scores for parent-report and scores for performance-based assessments, while few significant correlations were found between scores for child report and scores for the other two measures. The results suggest that children offer a unique perspective which should be integrated with other sources of information to gain a more holistic perspective of their motor skill performance. [ABSTRACT FROM AUTHOR]

To compare the timing of first hospital antenatal care visit by mothers of Aboriginal and non-Aboriginal infants, and to identify the risk and protective factors associated with timeliness of accessing care, mothers who delivered at Campbelltown hospital between October 2005 and November 2006 were surveyed on the maternity ward. This survey was linked to hospital administrative data. Gestational age at first visit to a hospital-based antenatal clinic was compared for mothers of Aboriginal and non-Aboriginal infants. Risks and protective factors associated with timing of antenatal care were also examined using Cox regression and Kaplan-Meier survival curves. Data on 1520 deliveries were included in this study. Mothers of Aboriginal infants presented slightly later to hospital-based antenatal clinics than mothers of non-Aboriginal infants (median 15.6 weeks versus 14.0 weeks). This difference did not remain after adjustment for all risk and protective factors. The three significant factors remaining were: maternal smoking; not in paid employment; and residence in a disadvantaged suburb. The results may reflect the complex associations that exist between the clustering of disadvantage among families of Aboriginal infants. A multifaceted approach is required to improve the timeliness of hospital-based antenatal care for the mothers of Aboriginal infants. [ABSTRACT FROM AUTHOR]

hutchinson a.f., thompson m.a., brand c.a., black j., anderson g.p. & irving l.b. (2010) Community care assessment of exacerbations of chronic obstructive pulmonary disease. Journal of Advanced Nursing 66(11), 2490-2499. Aim. The aim of this study was to develop a clinical algorithm to assess chronic obstructive pulmonary disease exacerbation severity in a community setting. Background. An important aspect of community management of exacerbations is assessing patient safety. Although researchers have investigated risk factors for rapid deterioration, there is a lack of evidence validating clinical measures of exacerbation severity. Methods. This was a prospective, community-based cohort study of patients enrolled in the Melbourne Longitudinal Chronic Obstructive Pulmonary Disease Cohort. The outreach team collected data on symptom severity at baseline and exacerbation onset using the Medical Research Council Dyspnoea Scale, St George Quality-of-Life Questionnaire and Symptom Severity Index. Results. Ninety-two patients were monitored from 2003 to 2005. There were 148 exacerbations: 121 (82%) were treated at home and 27 (17·5%) required hospitalization. An ordinal logistic regression model demonstrated that a combination of chronic obstructive pulmonary disease severity with dyspnoea and wheeze severity at exacerbation onset could differentiate severe from milder episodes [(OR 7·69, 95%CI: 3·9-11·5, P < 0·01), area under the receiver operating characteristics curve 0·75 (95%CI: 0·65-0·86)]. Conclusion. The majority of chronic obstructive pulmonary disease exacerbations can be safely managed in a community setting, but clinical assessment alone may not be sufficient to identify all patients who will develop complications such as respiratory failure. Further research is needed to validate clinical assessment and decision-making algorithms for community-management of chronic obstructive pulmonary disease exacerbations. [ABSTRACT FROM AUTHOR]

Empathy is an important attribute for occupational therapists in establishing rapport and in better understanding their clients. However, empathy can be compromised by high workloads, personal stressors and pressures to demonstrate efficacy. Occupational therapists also work with patients from a variety of diagnostic groups. The objective of this study was to determine the extent of empathy and attitudes towards clients amongst undergraduate occupational therapy students at one Australian University. A cross-sectional study was undertaken using a written survey of the Jefferson Scale of Physician Empathy (JSPE) and the Medical Condition Regard Scale. Overall, a strong level of empathy was reported amongst students. Four medical conditions that occupational therapists work with (stroke, cerebral palsy, traumatic brain injury and depression) were held in high regard. Substance abuse, however, was held in comparatively low regard. Overall, the year of study appeared to have no significant impact on the students' empathy. Despite having a lower reported empathy level than found in health professions from other studies using the JSPE, occupational therapy students were found to have a good level of empathy. Of concern, however, was the bias reported against the medical condition of substance abuse, highlighting that the there may be a need to reinforce that patients from this diagnostic group are equally deserving of quality care irrespective of their clinical condition. Recommendations for future research include completing a longitudinal study of occupational therapy students' empathy levels and investigating the empathy levels of occupational therapists working with different client groups. Limitations of the study include the convenience sampling of occupational therapy students enrolled at one university which limits the generalizability of the results to groups of participants with similar characteristics. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective. Despite the expansion of postnatal domiciliary services, we know little about the women receiving visits and how they regard their care. The aim of this study is to examine the provision of postnatal domiciliary care from a consumer perspective. Methods. All women who gave birth in September--October 2007 in South Australia and Victoria were mailed questionnaires 6 months after the birth. Women were asked if they had received a midwifery home visit, and to rate the care they received. Results. More women in South Australia reported receiving a domiciliary visit than in Victoria (88.0% v. 76.0%) and they were more likely to rate their care as 'very good' (69.1% v. 63.4%). Younger women, women on a lower income, who were holding a healthcare concession card or who had not completed secondary education were less likely to receive a visit. Conclusion. Although the majority of women in public maternity care in Victoria and South Australia receive domiciliary care and rate it positively, there are significant state-based differences. Those more likely to benefit from domiciliary care are less likely to receive a visit. There is a need to further explore the purpose, aims and content of domiciliary care at individual and state-wide levels. [ABSTRACT FROM AUTHOR]