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Objective: This study aimed to describe and compare the proportion of patients classified as an emergency department (ED) mental health presentation under different definitions, including the Australian Institute of Health and Welfare (AIHW) definition. Methods: This retrospective cohort study enrolled all patients that presented to the EDs of a multi-centre Victorian health service between 1 January 2020 and 30 June 2023. Varying definitions of a mental health presentation were applied to each ED attendance, applying the current AIHW definition (using selected diagnosis codes), broader diagnosis-based coding, the presenting complaint recorded at triage and whether the patient was seen by or referred to the emergency psychiatric service (EPS). The proportion of all ED presentations meeting each definition and any overlap between definitions were calculated. The agreement between each definition and the AIHW definition was evaluated using Kappa's coefficient. Results: There were 813,078 presentations to ED of which 34,248 (4.2%) met the AIHW definition for a mental health presentation. Throughout the study, 45,376 (5.6%) patients were seen and/or referred to EPS, and 36,160 (4.4%) patients were allocated a mental health presenting complaint by triage staff. There was moderate interrater agreement between these definitions, with a kappa statistic (95% confidence interval) between the AIHW definition and a mental health presenting complaint recorded at triage of 0.58 (0.58–0.59) and between the AIHW definition and review by EPS of 0.58 (0.57–0.58). Conclusions: The AIHW definition is a conservative measure of ED mental health presentations and may underestimate emergency psychiatry workload in Australian EDs. What is known about this topic? It is unknown whether the Australian Institute of Health and Welfare (AIHW) definition of an emergency department (ED) mental health presentation definition accurately reflects ED mental health workload. What does this paper add? The AIHW definition appears to underestimate the clinical workload related to ED mental health presentations. There is moderate agreement between the AIHW definition and mental health presentations classified according to complaint recorded at triage, or whether the patient is reviewed by psychiatry services. What are the implications for practitioners? Accurate measurement of emergency psychiatry workload should not rely on the AIHW definition alone. [ABSTRACT FROM AUTHOR]

The introduction of long‐acting injectable buprenorphine preparations for opioid use disorder has been widely heralded as a breakthrough treatment, with several studies indicating positive results when using these medications. In many locations, nurse practitioners prescribe, administer, and monitor long‐acting injectable preparations. The objective of this paper is to explore whether a reduction in dispensed needles and syringes is attributable to increased nurse practitioner prescribing of LAIB. We used a retrospective audit of needles dispensed through the health service needle and syringe program vending machine, and individuals treated with long‐acting injectable buprenorphine by the nurse practitioner led model. In addition, we examined potential factors that may influence changes in the number of needles dispensed. Linear regression found that each individual with opioid dependence treated with long‐acting injectable buprenorphine was associated with 90 fewer needles dispensed each month (p < 0.001). The nurse practitioner led model of care for individuals with opioid dependence appears to have influenced the number of needles dispensed at the needle and syringe program. Although all confounding factors could not be discounted entirely, such as substance availability, affordability, and individuals obtaining injecting equipment elsewhere, our research indicates that a nurse practitioner led model of treating individuals with opioid use disorder influenced needle and syringe dispensing in the study setting. [ABSTRACT FROM AUTHOR]

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]

This paper examines whether involvement in an observational study may prompt participants to change their exercise behaviors. Data were collected from 394 older community dwellers in Victoria, Australia using a baseline survey, and 245 of these participated in a follow-up survey one year later. Survey domains were drawn from constructs of relevant health behavior models. Results showed that the proportion of respondents who were currently participating in exercises to prevent falls at follow-up was 12% higher than at baseline (Wilcoxon p value < .001). Twenty-nine percent reported they had changed their perceptions about falls and their risk of falls, with comments focused on threat appraisal. Forty-four percent reported having taken strategies to reduce their risk of falling, with comments based on implementation of different preventive strategies. Respondents who held favorable views toward exercises for the prevention of falls appear to change their behaviors that might address falls when participating in observational studies. [ABSTRACT FROM AUTHOR]

Context: Forested wetlands occurring on fluvial sediments are among the most threatened ecosystems in south-east Australia. The first quantitative diagnosis of forested wetland types in NSW was completed in 2005. Since then, there has been a three-fold increase in survey data on coastal floodplains, vegetation classification systems have been developed in New South Wales, Queensland and Victoria, and methods for the assessment of ecosystem conservation risks have been adopted by the International Union for the Conservation of Nature (IUCN). Aims: To ensure an evidence base that can support conservation decisions and national conservation assessments, there is a need to review and update the classification of forested wetlands and integrate classification schemes across jurisdictions. Methods: We evaluated the efficacy of a multi-stage clustering strategy, applied to data from different sources with largely unknown methodological idiosyncrasies, to retrieve ecologically meaningful clusters. We assessed the veracity and robustness of the 2005 classification of forest wetlands as a framework for national risk assessments over an expanded range. Key results: We derived a quantitative, cross-jurisdictional classification of forested wetlands based on a synthesis of 5173 plot samples drawn from three states and identified the status of our units in relation to IUCN's Global Ecosystem Typology. Conclusions: Our analyses support the retention of the five legacy types which are the basis for threatened ecosystem listings under the NSW Biodiversity Conservation Act 2016 and Commonwealth Environment Protection and Biodiversity Conservation Act 1999. Implications: Our results will support revised assessments of current listings and facilitate their integration at state, national and global scales. This paper presents a revised broad-scale classification of forested wetlands occurring on floodplains in temperate subtropical south-east Australia and identifies relationships with vegetation types of finer thematic scale described in sub-regional classifications in Queensland, Victoria and New South Wales. Patterns in the distribution of forested wetland types are described using statistical models. [ABSTRACT FROM AUTHOR]

This paper examines the ethical behaviour of new lawyers from two contrasting points of view. First, we review the prevalence and type of ethical misconduct by lawyers in the Australian state of Victoria during their first three years of practice. This examination is based upon data provided by the professional conduct oversight body, the Victorian Legal Services Board & Commissioner. An analysis of this data provides some understanding of how often and what kinds of misconduct occur, and how new lawyers differ from lawyers, however the data yields limited insight into how we might prevent ethical problems. Consequently, we turn to examine the findings from our empirical study into the ethical climate of legal workplaces. That study investigated the perceptions of new lawyers about the ethical climate of their workplaces and revealed that those perceptions influence new lawyers' understandings of professionalism and ethical conduct, as well as their job and career satisfaction and psychological wellbeing. By interrogating the developmental and situational context in which ordinary ethicality develops or is inhibited, a new opportunity becomes available to shape new lawyers' practice towards better ethical outcomes. [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]

Reflecting international patterns, Aboriginal people in Victoria are more likely to gamble and to experience gambling harm than non-Indigenous Victorians. This paper describes experiences of gambling reported by 50 Aboriginal people interviewed in regional Victoria in 2016 and 2017 as part of studies initiated by two Aboriginal community-controlled organisations. Data were analysed using social practice theory (SPT) and coded to the elements of 'meaning', 'material', 'competence', and 'temporality'. Across each element we identified highly contradictory experiences. Gambling held meaning as an opportunity for community gatherings but was also regarded as a cause of domestic violence, conflict, isolation and shame. Materially, the venues that offered gambling were experienced by many Aboriginal people as safe and welcoming, but at the same time gambling produced a damaging affective sense of addiction for some. Gambling was a competency that some people valued and taught to children, but it was also seen as undermining cultural practices. While Aboriginal people were historically denied access to licensed venues offering commercial gambling, many participants now found opportunities to gamble inescapable. The intermingling of benefits and harms described above supports the need for a multi-faceted response to gambling in Aboriginal communities, which includes harm reduction as well as supply restriction and treatment. Some experiences of gambling related by our participants reflected those reported also by non-Indigenous Australians, while others were differently nuanced. Because SPT is used to understand collectively-shared practices, it facilitates the identification of gambling interventions at the level of the community, as recommended by our research participants. [ABSTRACT FROM AUTHOR]

BACKGROUND: Accurate measurement of adherence to prescribed exercise programs is essential. Diaries and self-report rating scales are commonly used, yet little evidence exists to demonstrate their validity and reliability OBJECTIVES: To examine the concurrent validity of adherence to home strengthening exercises measured by (1) exercise diaries and (2) a self-report rating scale, compared to adherence measured using an accelerometer concealed in an ankle cuff weight. Test-retest reliability of the self-report rating scale was also assessed. METHODS: In this clinical measurement study 54 adults aged 45 years or older with self-reported chronic knee pain were prescribed a home quadriceps-strengthening program. Over 12 weeks, participants completed paper exercise diaries and, at appointments every 2 weeks, rated their adherence on an 11-point numeric rating scale. A triaxial accelerometer was concealed in the ankle cuff weight used for exercises. Self-reported adherence rating scale data over each 2-week period were analyzed using descriptive statistics, the Wilcoxon signed-rank test, and a Bland-Altman plot to assess agreement, Spearman correlations for validity and intraclass correlation coefficients for test-retest reliability RESULTS: Exercise adherence was significantly overestimated in diaries during the 12 weeks (diary median, 220 exercises; accelerometer, 176; P<.001) and was moderately correlated with accelerometer data (r = 0.52; 95% confidence interval: 0.25, 0.69). A Bland-Altman plot indicated large between-participant variability in agreement between these measures. Self-reported adherence showed poor to fair correlations with accelerometer data (mean r = 0.23-0.39), and less than acceptable reliability (intraclass correlation coefficient = 0.79; lower 1-sided 95% confidence limit, 0.68). CONCLUSION: Exercise diaries showed questionable validity and variable levels of agreement compared with accelerometer-measured exercise completion. A self-reported adherence rating scale had limited validity and less than acceptable test-retest reliability. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to determine whether the diagnosis of both carers’ mental health problems and substance misuse increase the likelihood of recurrent child maltreatment over and above the individual effects of these factors. Design/methodology/approach – Retrospective secondary data analysis of 29,455 children where child maltreatment was confirmed in the Victorian child protection system between 2001 and 2005. Recorded mental health, alcohol misuse and other drug misuse variables were entered into multivariate logistic regression models predicting repeated child maltreatment. Interactions and a range of other child, carer and socio-economic factors were included in these models. Findings – Carer alcohol misuse, other drug misuse and mental ill health all independently predicted recurrent child maltreatment. The presence of both other drug misuse and mental ill health increased the likelihood that recurrent child abuse was recorded over the likelihood that mental health alone predicted recurrent child maltreatment, and while alcohol misuse had an effect when there was no mental health condition recorded it did not have an additional effect when there was evidence of mental health problems. Research limitations/implications – Children in families where there is both mental health problems and other drug use problems are at greater risk of repeated maltreatment than where there is evidence of mental health problems or other drug use alone. Where there was evidence of carer mental health problems, alcohol misuse did not add to this likelihood. However, the effect of mental health and other drug use was similar in size to the effect of alcohol misuse alone. Originality/value – These findings add to understandings of the effects of co-occurring mental health problems and substance misuse on recurrent child maltreatment and differentiate between cases that involve alcohol and other drug misuse. [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]

This paper provides evidence of environmental iodine deficiency in the Gippsland region. Quantitative study; water samples were collected from 18 water treatment plants and four rain water tanks across Gippsland and water iodine concentrations were measured. Gippsland region of Victoria, Australia. This paper reports on the iodine concentration of drinking water from sources across Gippsland and examines the contribution of iodine from water to the Gippsland diet. This study also briefly examines the relationship between the concentration of iodine in water and distance from the sea. The cut-off value for water iodine concentrations considered to be indicative of environmental iodine deficiency is <2 µg L. The mean iodine concentration of water from 18 Gippsland water treatment plants was 0.38 µg L and would therefore make negligible difference to the dietary intake of iodine. This finding also falls well below the suggested dietary intake of iodine from water estimated by the 22nd Australian Total Diet Study. Our study found no linear relationship between the water iodine concentration and distance from the sea. As Gippsland has environmental iodine deficiency there is a greater probability that people living in this region are at higher risk of dietary iodine deficiency than those living in environmentally iodine sufficient regions. Populations living in areas known to have environmental iodine deficiency should be monitored regularly to ensure that problems of iodine deficiency, especially amongst the most vulnerable, are addressed promptly. [ABSTRACT FROM AUTHOR]

McKenna L, McCall L, Wray N. International Journal of Nursing Practice 2010; 16: 176–182 Clinical placements and nursing students' career planning: A qualitative exploration Many nursing students enter undergraduate programmes with preconceived ideas about their future nursing careers, and intend to practice in particular areas such as midwifery or paediatrics. Through clinical placements, students are exposed to different clinical areas and professional socialization is facilitated. However, little is known about the influence of clinical placements on students' career intentions. This paper reports nursing findings drawn from a large qualitative study conducted in Victoria, Australia that sought to explore the influence of health professional students' clinical placements on their future career intentions. Participants were invited to be involved in either face-to-face or focus group interviews depending upon their own preference. Thematic data analysis revealed three main themes: ‘re-affirming career choice’, ‘working in a particular area’ and ‘work location’. Findings from the study add to our understanding of factors influencing nursing students' planning for their future careers including the impact of clinical placements. [ABSTRACT FROM AUTHOR]

The use of photography is an underreported method of research in the nursing literature. This paper explores its use in an ethnographic research project, the fieldwork of which was undertaken by the first author. The aim was to examine the governance of operating room nursing in the clinical setting and the theoretical orientation was the work of Michel Foucault. The focus of this paper is on how photography was used as a means of data generation. To establish some context we begin by drawing on writers from sociology and anthropology to provide an overview of the status of vision and visual research methods in contemporary social research. We then move to a brief discussion of the uses of photography in social research and the limitations imposed by ethical considerations of its use in clinical nursing settings. As well, the process and approach involved in this research project, and issues of analysis are discussed. Three 'snap-shots' of operating room nursing, taken by participants, are presented. Each is analysed in terms of its contributions to the research process as well as its substantive contribution to the theoretical framework and the research aims. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. Background Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. Design A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. Methods A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. Findings Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. Conclusions The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication management in an acute hospital setting. Language discourses shaped and were shaped by complex power relations between patients and clinicians and among clinicians themselves. Relevance to clinical practice Clinicians need to be encouraged to have regular conversations to talk about and challenge each other's practices. More emphasis should be placed on ensuring that patients are given opportunities to voice their concerns about how their medications are managed. [ABSTRACT FROM AUTHOR]

Objective To examine urban-rural differences and individual risk factors for a late stage of breast cancer at diagnosis in Australian women. Design Individual-level longitudinal data were linked with cancer registry data from New South Wales (New South Wales Cancer Registry linked by the Centre for Health Record Linkage (CHeReL)), Queensland (Queensland Cancer Registry) and Victoria (The Cancer Council Victoria). Setting Participants were drawn from the Australian Longitudinal Study on Women's Health 1946-1951 cohort (n = 13 715). Participants The sample included 195 women identified from the linked cancer registry data with a breast cancer diagnosis. Interventions Rural or urban residence was measured using Accessibility/Remoteness Index of Australia Plus (ARIA+). Individual characteristics and socio-demographic variables examined included survey year, menopausal status, country of birth, education and marital status. Main outcome measures A late stage of breast cancer at diagnosis was defined based on the TNM Classification of Malignant Tumours. Results A late stage of breast cancer diagnosis was observed in 36% of women residing in urban areas and 40% of women residing in rural areas. After adjusting for individual characteristics, we found that obesity was the strongest risk factor for a late stage of breast cancer at diagnosis. Conclusions Given that women are becoming increasingly obese, and that the rate of obesity is higher in the Australian rural population, this paper provides further evidence for targeting interventions for obesity, particularly in rural Australia, as a public health priority. [ABSTRACT FROM AUTHOR]

The University of Victoria, Canada, strives to enhance undergraduate students' labor market readiness through work-integrated learning (WIL) experiences. Students with disabilities have historically encountered low participation and success rates in WIL, potentially resulting in their under-representation in the post-graduation labor market. To address this issue, the CanWork program was created, aimed at eliminating participation barriers in co-operative education for students with disabilities. The program offered tailored support, including job development, one-on-one guidance at all stages, and the removal of grade point average (GPA) thresholds. As of its completion in September 2022, the CanWork program facilitated pre-employment training for 107 students with disabilities and 84 co-op work placements. Demographic-specific and personalized support mechanisms boosted participation and success rates for students with disabilities in work-integrated learning. Furthermore, an analysis of program data highlights that GPA requirements in well-resourced programs create unnecessary barriers for students with disabilities. [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]

Accessible summary Clinical leadership is important for the strength of mental health nursing as a profession, particularly in utilizing clinical-based opportunities for the professional development of new graduates and nursing students., To date, there has been limited research examining the attributes of nurses considered by their colleagues to be clinical leaders. This study presents the views and experiences of mental health nurses who deliver care, about what they identify as important for effective clinical leadership., Clinical teaching and role modelling are two fundamental roles of effective clinical leaders; they are underpinned by the attributes of professionalism, honesty, willingness to share knowledge and approachability., Additional research is needed to consider the applicability of these roles and attributes across larger samples of nurses in mental health settings., Abstract Clinical leadership is acknowledged as important to the nursing profession. While studies continue to identify its significance in contributing to positive outcomes for consumers, the role that clinical leadership has in enabling and supporting professional development in mental health nursing is poorly understood. This study utilized a grounded theory methodology to explore the characteristics clinicians consider important for clinical leadership and its significance for mental health nursing in day-to-day clinical practice. Individual face-to-face, semi-structured interviews were conducted with nurses working in mental health settings. Participants described the important role that clinical leaders play in enabling professional development of others through role modelling and clinical teaching. They describe how nurses, whom they perceive as clinical leaders, use role modelling and clinical teaching to influence the professional development of nursing staff and undergraduate nursing students. Attributes such as professionalism and honesty were seen, by participants, as enablers for clinical leaders in effectively and positively supporting the professional development of junior staff and undergraduate nurses in mental health nursing. This paper examines clinical leadership from the perspective of mental health nurses delivering care, and highlights the important role of clinical leaders in supporting professional development in mental health nursing. [ABSTRACT FROM AUTHOR]

This paper reports on a study of Australian early childhood teachers' pedagogical practices with young children experiencing parental separation and divorce. Twenty-one semi-structured interviews and a focus group were conducted to explore the actions of teachers to support young children experiencing parental separation and divorce. A grounded theory approach was used to analyse data. Teachers reported actions that were focussed on constructing emotional, behavioural, and academic support for young children, as well as forming partnerships with parents, school personnel, and community members to assist. Results are discussed in terms of the implications for professional practice. [ABSTRACT FROM AUTHOR]

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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]

Purpose: The present study examines differences in the characteristics and recidivism risk of young people reported to police for family violence (FV) with a history of prior offending (generalists) and those only known to police for using FV (family-only). Method: A population-based cohort of youth aged 10–24 years (N = 5014) who were reported to police for using FV over a four-month period in 2019 was examined and FV-related risk and need data extracted, with a six-month follow-up period for further police-reported FV. All data was extracted from police databases. Logistic regression with odds ratios as a measure of effect size were used to compare generalist and family-only cohorts. Cox proportional hazards were used to assess time to FV recidivism among the two cohorts, and to assess whether diversity of prior offending was associated with risk of FV recidivism among generalist youth. Results: Generalists were more likely than family-only youth to be recorded as using FV in a high severity FV incident, be abusive across multiple relationships, and breach court orders. Generalists experienced a greater level of need and were more likely to engage in FV recidivism, and do so more quickly, than family-only youth. Diversity of prior offending among generalists was positively associated with risk of FV recidivism. Conclusion: Compared to family-only youth, generalists represent a higher risk cohort with a greater level of need. History of prior offending among young people may be a simple and efficacious means of prioritising higher risk youth who use FV. [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]

This paper describes the evaluation of the Transition Care Cognitive Assessment and Management Pilot (TC CAMP) at a residential care facility in Victoria, Australia. Transition care aims to provide a goal-oriented time-limited service to older people at the conclusion of an episode of hospital care. The TC CAMP was established to specifically meet the needs of people with cognitive impairment. The purpose of this study was to evaluate the implementation and effectiveness of the TC CAMP. The evaluation sought to explore the perceptions ofstaffandfamily carers, and outcomes for the person with dementia. Methods consisted of file audits, focus groups and individual interviews with nursing staff and carers. This evaluation found that it was possible to provide appropriate transition care to people with cognitive impair-ment who exhibited behavioural and psychological symptoms of dementia. The TC CAMP achieved length of stay and readmission rates that were comparable with transition care for cognitively intact people. The role of the Clinical Nurse Consultant was highly valued by staffand families involved in TC CAMP. The findings from TC CAMP suggest a suit-able environment, availability of trained and resourced nursing and clinical staff and clear roles and expectations for all stakeholders should be considered in implementation of this model of care. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This paper examined whether or not: (a) care-giver 'alcohol abuse' is associated with recurrent child maltreatment; (b) other 'risk factors' affect this relationship; and (c) which of alcohol abuse or other drug abuse plays a stronger role. It also examined (d) how children and families where alcohol-related child abuse was identified were managed by child protection services (CPS) in Victoria, Australia. Design, setting and participants Using anonymized data from Victorian CPS, repeat cases were examined involving 29 455 children identified between 2001 and 2005. Measurements Carer alcohol abuse, other drug abuse, mental ill-health, carer experience of abuse as a child, child age and gender, family type, socio-economic variables and level of child protection service intervention as recorded in the CPS electronic database were examined as risk factors for recurrence, using bivariate and multivariate techniques. Findings Almost one-quarter of children in CPS experienced a recurrent incident of child maltreatment in a 5-year period. Where carer alcohol abuse was identified children were significantly more likely to experience multiple incidents compared with children where this was not identified ( P < 0.001), as were children where other family risk factors (including markers of socio-economic disadvantage) were identified. The majority of children whose carers were identified with alcohol abuse experienced either repeat incidents or interventions (84%), although almost three-quarters of these children were managed without resort to the most serious outcome, involving court orders. Conclusions Alcohol and drug abuse in carers are important risk-factors for recurrent child maltreatment after accounting for other known risk factors; the increased risk appears to be similar between alcohol and drug abuse. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to investigate the change in the relationship between play, language and social skills of children aged 5-8 years pre and post participation in the "Learn to Play" program. The Learn to Play program is a child led play based intervention aimed at developing self-initiated pretend play skills in children. Methods: All 19 participants attended a specialist school, with 10 of the 19 children having a diagnosis of autism. The play, language and social skills of the children were assessed at baseline and at follow up. Children were assessed using the Child-Initiated Pretend Play Assessment, the Preschool Language Scale and the Penn Interactive Peer Play Scale. Follow up data collection occurred after the children had been participating in the Learn to Play program for 1 hour twice a week for 6 months. Results: After 6 months in the program, typical indicators of play accounted for an increase of 47.3% in shared variance with social interaction and an increase of 36% in shared variance for social connection. For language, object substitution ability accounted for 50% of the shared variance, which was an increase of 27% from baseline. Conclusion: The "Learn to Play" program was associated with increases in children's language and social skills over a 6-month period within a special school setting, indicating the Learn to Play program is an effective intervention for children with developmental disabilities. This paper presents an example of how the Learn to Play program can be adapted into a classroom setting. [ABSTRACT FROM AUTHOR]

The reporting of suspected child abuse and neglect is a mandated role of medical doctors, nurses, police and teachers in Victoria, Australia. This paper reports on a research study that sought to explicate how mandated professionals working in rural Victorian contexts identify a child/ren at risk and the decisions they make subsequently. [ABSTRACT FROM AUTHOR]

Background and Purpose The purpose of this paper was to determine if the Six-minute Walk Test (6MWT) was a reliable exercise test for patients referred to cardiac rehabilitation when up to three tests were performed and to determine if test scores differed according to between-test time interval. Methods Thirty adults aged 63 ± 7.9 years referred to cardiac rehabilitation participated in a repeated measures reliability trial. Participants completed three 6MWTs within a one-week period. Participants were randomly allocated to one of three groups: on the first day, Group A completed three walks, Group B completed two walks and Group C completed one walk. Relative reliability was expressed in a ratio (ICC2,1), and absolute reliability was expressed in metres (95% confidence intervals) for group and individuals. Results The 6MWT demonstrated a high level of relative reliability (intraclass correlation coefficients [ICC] = 0.94) across the three walks. There was no statistically significant difference between the test scores of the three groups. However, there was an increase in distance walked from the first to the second to the third 6MWT. Absolute reliability indicated that a change of at least 44 m would be required to be interpreted as true change in a group, and at least 95 m to be interpreted as true change in an individual with 95% confidence. Conclusion Three 6MWTs completed in relatively short timeframes were not sufficient for reliable results as there was an increase in the distance walked, and relatively large increases in distances would be required to be interpreted as change. It did not make any difference whether the tests were all completed on one day or over one week. This study highlighted problems that may arise when relying on reliability coefficients alone to interpret reliability. These results suggest that the 6MWT may not have sufficient reliability to be a suitable test to evaluate exercise tolerance in patients referred to cardiac rehabilitation. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Rate is an important, but difficult, mathematical concept. Despite more than 20 years of research, especially with calculus students, difficulties are reported with this concept. This paper reports the results from analysis of data from 20 Australian Grade 10 students. Interviews targeted students' conceptions of rate, focussing on the influence of representation and context on their expression of their understanding of rate. This analysis shows that different representations of functions provide varying levels of rate-related information for individual students. Understandings of rate in one representation or context are not necessarily transferred to another representation or context. Rate is an important, but commonly misunderstood, mathematical concept with many everyday applications (Swedosh, Dowsey, Caruso, Flynn, & Tynan, ). It is a complicated concept comprising many interwoven ideas such as the ratio of two numeric, measurable quantities but in a context where both quantities are changing. In mathematics classes, this is commonly expressed as change in the dependent variable resulting from a unit change in the independent variable, and variously described as constant or variable rate; average or instantaneous rate. In addition, rate may be seen as a purely abstract mathematical notion or embedded in the understanding of real-world applications. This paper explores the research question: Are students' expressions of their conceptions of rate affected by either context or mathematical representation? This question was part of a larger study (Herbert, ) conducted with Grade 10 students from the Australian state of Victoria. [ABSTRACT FROM AUTHOR]

The aim of this paper is to study the effects of factors broadly captured under the rubric of parental social and cultural capital on child health. The setting was 11 disadvantaged communities in Victoria, Australia during the conduct and evaluation of Best Start, an early childhood initiative of the Victorian State Government. Questionnaires were sent to parents of 3-year-old children in 2004 and 2006. The principal dependent variable was parental global rating of their child's health. Social capital variables focussed, for example, on community support for parent's child rearing practices. Cultural capital variables focussed, for example, on parent's reading to their child. Socio-economic status and other potential confounding variables were also measured. Stepwise multivariable logistic regression was used. There were consistent independent effects for the cultural capital variables—‘Age started reading to the child’ and ‘Confident being a good parent’, and only one of a number of social capital variables—‘Community support for childrearing’ as well as for some other variables particularly that ‘Child had a chronic health/medical condition’. Dichotomizing parent's global ratings of their child's health differently had some effects on results. Cultural capital and, to a lesser extent, social capital variables were associated with parent's rating of the child's health. It is now timely to conduct and evaluate programs aimed at improving parents’ cultural capital. Better measures or inventories of parent's cultural capital will be essential for this. [ABSTRACT FROM AUTHOR]

Abstract: For young people with refugee backgrounds, establishing a sense of belonging to their family and community, and to their country of resettlement is essential for wellbeing. This paper describes the psychosocial factors associated with subjective health and wellbeing outcomes among a cohort of 97 refugee youth (aged 11–19) during their first three years in Melbourne, Australia. The findings reported here are drawn from the Good Starts Study, a longitudinal investigation of settlement and wellbeing among refugee youth conducted between 2004 and 2008. The overall aim of Good Starts was to identify the psychosocial factors that assist youth with refugee backgrounds in making a good start in their new country. A particular focus was on key transitions: from pre-arrival to Australia, from the language school to mainstream school, and from mainstream school to higher education or to the workforce. Good Starts used a mix of both method and theory from anthropology and social epidemiology. Using standardized measures of wellbeing and generalised estimating equations to model the predictors of wellbeing over time, this paper reports that key factors strongly associated with wellbeing outcomes are those that can be described as indicators of belonging – the most important being subjective social status in the broader Australian community, perceived discrimination and bullying. We argue that settlement specific policies and programs can ultimately be effective if embedded within a broader socially inclusive society – one that offers real opportunities for youth with refugee backgrounds to flourish. [ABSTRACT FROM AUTHOR]

Respiratory distress is a common presentation attended by paramedics. Chest auscultation has been shown to have low accuracy for diagnosing respiratory complaints, and this can lead to inaccurate patient assessment and potentially poor patient outcomes. Conversely, lung ultrasound is a relatively simple exam allowing for rapid differentiation of respiratory complaints with comparable accuracy to more advanced imaging modalities. Evidence suggests that lung ultrasound is easy to learn and apply and could be ideal for assessment of respiratory illness by paramedics. This study aimed to explore the utility of out-of-hospital lung ultrasound performed by intensive care paramedics (ICP) for patients with medical causes of respiratory distress, and explore whether the use of lung ultrasound affects the ICP's clinical impression or management. This was a prospective observational pilot study. After a training program, a sample of ICPs working in metropolitan and regional Victoria, Australia used ultrasound to assess adult patients with respiratory distress and/or dyspnea. ICPs used a handheld point-of-care ultrasound device to scan respiratory patients using a modified protocol, and completed a worksheet with their scan findings. The scans were then reviewed by a subject matter expert for quality and agreement. Ninety-five patients were enrolled over the study period. The average image quality score was 2.68/5, and 56% of scans were of interpretable quality. Interrater agreement (between the ICPs and the subject matter expert) was reported using Cohen's kappa. Moderate overall agreement (0.44) was shown, with the highest reliability reported in A-profile and B-profile (0.49 and 0.57). In 42% of cases performance of the scan affected paramedic clinical impression and/or management. ICPs can perform lung ultrasound with moderate accuracy for some respiratory conditions, and the scans may affect clinical impression and management. Future research should focus on enhanced education, expert feedback, and clinical outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationship between structural characteristics of Australian residential aged care facilities (RACFs) and breaches of the aged care quality standards. Methods: Facility‐level analysis of audits, sanctions and non‐compliance notices of all accredited Australian RACFs between 2015/16 and 2018/19. Structural factors of interest included RACF size, remoteness, ownership type and jurisdiction. Two government data sources were joined. Each outcome was analysed to calculate time trends, unadjusted rates and relative risks. Results: Non‐compliance notices were imposed on 369 RACFs (13%) and 83 sanctions on 75 RACFs (3%). Compared with New South Wales (NSW), non‐compliance notices were less likely in Victoria, Queensland and the Northern Territory (NT), more likely in South Australia (SA), and comparable in Western Australia (WA), Tasmania and the Australian Capital Territory (ACT). RACFs with more than 100 beds and RACFs located in remote and outer regional areas (vs. major cities) also increased the likelihood of non‐compliance notices. Compared with NSW, sanctions were less likely in Victoria, Queensland, NT and WA and comparable in SA, Tasmania and ACT. Additionally, the likelihood of sanctions was higher for RACFs with more than 40 beds. For both non‐compliance notices and sanctions, no significant relationship was found with RACF ownership type. Conclusions: We partially confirmed other Australian findings about the relationship between RACF structural characteristics and regulatory sanctions and reported new findings about non‐compliance notices. Routine and standardised public reporting of RACF performance is needed to build trust that Australia's latest aged care reforms have led to sustained quality improvements. [ABSTRACT FROM AUTHOR]

The technical progress in the last decades makes photo and video recording devices omnipresent. This change has a significant impact, among others, on police work. It is no longer unusual that a myriad of digital data accumulates after a criminal act, which must be reviewed by criminal investigators to collect evidence or solve the crime. This paper presents the VICTORIA Interactive 4D Scene Reconstruction and Analysis Framework ("ISRA-4D" 1.0), an approach for the visual consolidation of heterogeneous video and image data in a 3D reconstruction of the corresponding environment. First, by reconstructing the environment in which the materials were created, a shared spatial context of all available materials is established. Second, all footage is spatially and temporally registered within this 3D reconstruction. Third, a visualization of the hereby created 4D reconstruction (3D scene + time) is provided, which can be analyzed interactively. Additional information on video and image content is also extracted and displayed and can be analyzed with supporting visualizations. The presented approach facilitates the process of filtering, annotating, analyzing, and getting an overview of large amounts of multimedia material. The framework is evaluated using four case studies which demonstrate its broad applicability. Furthermore, the framework allows the user to immerse themselves in the analysis by entering the scenario in virtual reality. This feature is qualitatively evaluated by means of interviews of criminal investigators and outlines potential benefits such as improved spatial understanding and the initiation of new fields of application. [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]

This study sought to better understand the views and practices of disability employment specialists working with clients with mental illness. Specifically, it explored what helps and hinders employment specialists in their work. A constructivist grounded theory methodology was used. Semi-structured interviews with 16 disability employment specialists from four employment service providers in Victoria, Australia, were transcribed and analysed through initial coding, focused coding, and constant comparative methods. Analysis led to the substantive grounded theory of "moving clients forward." The key themes included "taking a firm but fair approach," "meeting clients where they are at," "getting clients ready for work," "managing the interface between clients and employers," and as a consequence, "working under pressure." These findings contribute the first grounded theory of how Australian disability employment specialists work with clients with mental illness and enhance understanding of employment specialists' notions of job readiness and their use of discretion in implementing seemingly contradictory employment-related policies. Practice tensions for these employment specialists could be reduced by modifying disability employment policies, and through training to deliver evidence-based practices that offer varied vocational services, pathways, and adjunct interventions tailored to clients' interests, needs and readiness for change. Australian disability employment specialists experience tensions between meeting the needs of clients with mental illness and feeling pressured to adhere to performance-based funding and disability employment policies. Greater emphasis on evidence-based, individualised vocational interventions would better align with a recovery orientation and offer vocational options tailored to the needs and goals of job seekers with mental illness Further training and systemic support is needed for disability employment specialists to adopt evidence-based practices in their work with jobseekers with mental illness. Since Australian disability employment specialists describe considering the "job readiness" of clients in practice, the usefulness of this concept merits further investigation. [ABSTRACT FROM AUTHOR]

Background and Aims: Data from sports injury surveillance systems are a prerequisite to the development and evaluation of injury prevention strategies. This review aimed to identify ongoing sports injury surveillance systems and determine whether there are gaps in our understanding of injuries in certain sport settings. A secondary aim was to determine which of the included surveillance systems have evaluated the quality of their data, a key factor in determining their usefulness. Methods: A systematic search was carried out to identify (1) publications presenting methodological details of sports injury surveillance systems within clubs and organisations; and (2) publications describing quality evaluations and the quality of data from these systems. Data extracted included methodological details of the surveillance systems, methods used to evaluate data quality, and results of these evaluations. Results: Following literature search and review, a total of 15 sports injury surveillance systems were identified. Data relevant to each aim were summarised descriptively. Most systems were found to exist within professional and elite sports. Publications concerning data quality were identified for seven (47 %) systems. Validation of system data through comparison with alternate sources has been undertaken for only four systems (27 %). Conclusions: This review identified a shortage of ongoing injury surveillance data from amateur and community sport settings and limited information about the quality of data in professional and elite settings. More surveillance systems are needed across a range of sport settings, as are standards for data quality reporting. These efforts will enable better monitoring of sports injury trends and the development of sports safety strategies. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to explore how workers' compensation policies related to healthcare provision for workers with musculoskeletal injuries can affect the delivery and trajectories of care for injured workers. The principal research question was: What are the different ways in which workers' compensation (WC) policies inform and transform the practices of healthcare providers (HCPs) caring for injured workers? Methods: We conducted a cross-jurisdictional policy analysis. We conducted qualitative interviews with 42 key informants from a variety of perspectives in the provinces of Ontario and Quebec in Canada, the state of Victoria in Australia and the state of Washington in the United States. The main methodological approach was Framework Analysis. Results: We identified two main themes: (1) Shaping HCPs' clinical practices and behaviors with injured workers. In this theme, we illustrate how clinical practice guidelines and non-economic and economic incentives were used by WCs to drive HCP's behaviours with workers; (2) Controlling workers' trajectories of care. This theme presents how WC policies achieve control of the workers' trajectory of care via different policy mechanisms, namely the standardization of care pathways and the power and autonomy vested in HCPs. Conclusions: This policy analysis shed light on the different ways in which WC policies shape HCP's day-to-day practices and workers' trajectories. A better understanding and a nuanced portrait of these policies' impacts can help support reflections on future policy changes and inform policy development in other jurisdictions. [ABSTRACT FROM AUTHOR]

Aim: To explore patient, surgical and clinical factors associated with readinessfor- discharge and total length of stay in the Post Anaesthesia Care Unit (PACU). Background: Longer stay in the PACU decreases the flow of patients and is associated with increased risk of adverse events. The time to readiness-fordischarge reflects clinical parameters associated with patient flow in the PACU independent of system delays. Methods: This retrospective cohort study included a randomly selected sample of 244 post-surgical patients admitted to a large private, Australian health service. Results: The median and average times to readiness-for-discharge were 48 minutes and 56 minutes respectively with a range from 9 to 175 minutes. The total length of stay in the PACU had median and average times of 66 minutes and 73 minutes respectively. Five independent factors associated with longer time to readiness-for-discharge identified in multivariable modelling were: age, surgery duration, post-operative nausea and vomiting, administration of opioids and medical consultation. Additional factors that were determined from univariate analyses to be associated with longer time to readiness-for-discharge from the PACU were hypothermia, moderate or severe pain, major surgery and neurological surgery. Conclusion: This study found that modifiable and non-modifiable factors are associated with time to readiness-for-discharge. The findings provide a focus for the clinical care of patients in the PACU to optimise the time to readinessfor- discharge and increase patient flow. Understanding factors associated with longer stay helps efficient management of staffing levels and patient flow within the PACU, to improve the quality of care provided. [ABSTRACT FROM AUTHOR]

The effect of early adolescent alcohol use on antisocial behavior was examined at 1- and 2-year follow-up in Washington State, United States, and Victoria, Australia. Each state used the same methods to survey statewide representative samples of students (N = 1,858, 52% female) in 2002 (Grade 7 [G7]), 2003 (Grade 8 [G8]), and 2004 (Grade 9 [G9]). Rates of lifetime, current, frequent, and heavy episodic alcohol use were higher in Victoria than Washington State, whereas rates of five antisocial behaviors were generally comparable across states. After controlling for established risk factors, few associations between alcohol use and antisocial behavior remained, except that G7 current use predicted G8 police arrests and stealing and G9 carrying a weapon and stealing; G7 heavy episodic use predicted G8 and G9 police arrests; and G7 lifetime use predicted G9 carrying a weapon. Hence, risk factors other than alcohol were stronger predictors of antisocial behaviors. [ABSTRACT FROM AUTHOR]

Objective To describe and evaluate a six-session program provided to parents of children with Autism in rural Australia. The program was designed to improve parent's knowledge and understanding of Autism, improve their confidence in managing their child and decrease parental anxiety. Design A self-constructed questionnaire administered pre- and post-intervention. Setting An early intervention centre in a large town in rural Victoria. Participants Ninety-eight parents (or family members) of young children primarily aged 2-6 years of age, diagnosed with Autism. Interventions A 'multi-stranded content' program was offered over six evenings. Ten programs were conducted over six years. Results The pre- versus post-session analysis using a paired t-test on matched person-to-person parental responses ( n = 92) showed significant increases in parental understanding of Autism and understanding of their own child ( P < 0.001), and in understanding the communication, sensory, social, learning and behavioural features of Autism ( P < 0.001). Significant increases in parental confidence and a significant reduction in parental anxiety were also shown ( P < 0.001). Qualitative data indicated that parents valued learning about the general nature of Autism and sensory processing, and reported feeling less alone. Conclusions The six-week program was successful in terms of its aims. Parent feedback indicated that ongoing parent education sessions at regular intervals would enhance the impact of the program. [ABSTRACT FROM AUTHOR]

Abstract: This paper examines how household size and composition influences whether a household runs fewer cars than adults of driving age or at least one car per adult (‘household car saturation’). Data from the Victorian Integrated Survey of Travel and Activity in Melbourne, Australia was used to compare the household characteristics, neighbourhood characteristics and household income of saturated and non-saturated households. These predictors were then entered into two binary logit models. The largest influence on car saturation was the number of adults in the household where households with three adults were 45% less likely to be car-saturated than one-adult households, ceteris paribus. The presence of a young adult was particularly influential, likely because young adults are less likely to be licensed and less likely to be able to afford their own vehicle. The impact of household size is a concern in Australia where the average household size has been slowly decreasing; however this trend may be countered by an increase in young adults living at home for longer. Implications for policy are discussed. [Copyright &y& Elsevier]

The objective is to identify and test regulatory options for creating supportive environments for physical activity and healthy eating among local governments in Victoria, Australia. A literature review identified nine potential areas for policy intervention at local government level, including the walking environment and food policy. Discussion documents were drafted which summarized the public health evidence and legal framework for change in each area. Levels of support for particular interventions were identified through semi-structured interviews conducted with key informants from local government. We conducted 11 key informant interviews and found support for policy intervention to create environments supportive of physical activity but little support for policy changes to promote healthy eating. Participants reported lack of relevance and competing priorities as reasons for not supporting particular interventions. Promoting healthy eating environments was not considered a priority for local government above food safety. There is a real opportunity for action to prevent obesity at local government level (e.g. mandate the promotion of healthy eating environments). For local government to have a role in the promotion of healthy food environments, regulatory change and suitable funding are required. [ABSTRACT FROM AUTHOR]

Background: There have been few evaluations of national area-based interventions. This study evaluated the early effects of Communities for Children (CfC) on children and their families and whether the effectiveness differed for more disadvantaged families. Methods: A quasi-experimental cohort study in socioeconomically disadvantaged communities in Australia. Mothers of children aged 2--3 years participated at wave 1; 1488 children in CfC communities and 714 children in comparison communities. Outcome measures included child health and development, family functioning and parenting, and services and community. Results: After controlling for background factors, there were beneficial effects associated with CfC. At wave 3, in CfC areas children had higher receptive vocabulary (mean difference (MD) 0.25, 95% CI --0.02 to 0.51; p=0.07), parents showed less harsh parenting (MD --0.14, 95% CI --0.30 to 0.02; p=0.08) and higher parenting self-efficacy (MD 0.11, 95% CI 0.00 to 0.21; p=0.04). Fewer children living in CfC sites were living in a jobless household (OR 0.56, 95% CI 0.32 to 0.95; p=0.03) but children's physical functioning (MD --0.26, 95% CI --0.53 to 0.00; p=0.05) was worse in CfC sites. For children living in households with mothers with low education there were reduced child injuries requiring medical treatment (MD --0.61, 95% CI --0.07 to --1.13; p=0.03) and increased receptive vocabulary (MD 0.57, 95% CI 0.06 to 1.08; p=0.03). Conclusions: CfC showed some benefits for child receptive vocabulary, parenting and reducing jobless households and two adverse effects. Children living in the most disadvantaged households also benefited. [ABSTRACT FROM AUTHOR]

HOEY L.M., SUTHERLAND G., WILLIAMS P.A. & WHITE V. (2011) European Journal of Cancer Care, 87-92 This study explored the perceived needs of health professional and peer facilitators of cancer support groups. Participants were facilitators of support groups affiliated with The Cancer Council Victoria (Australia). Facilitators completed questionnaires assessing their experience of support group facilitation, including training and support needs. Data from health professional and peer facilitators ( n= 74) were analysed in this paper. The majority of facilitators (88%) were female; 57% had run their group for more than 3 years, and 47% reported between 11 and 20 people attended each group. Although results showed the characteristics of support groups are broadly similar for peers and professionals, there were some distinct differences in perceived needs. Health professional facilitators were more likely than peers to regard training as valuable and beneficial to their role. In addition, health professionals more frequently reported needing debriefing as well as more difficulty accessing debriefing than cancer peers. This study builds on the small body of literature exploring the experiences of cancer support group facilitators. Given the experiences and needs of health professional and peer facilitators may differ, it may be relevant to tailor training and support so that it meets the needs of both health professionals and cancer peers. [ABSTRACT FROM AUTHOR]

Objective. To examine what new health information is identified at a patient's most recent 75þHA compared with their standard GP consultations in the prior 24 months. Methods. Parameters measured included newly identified chronic conditions, new management for previously diagnosed chronic conditions, medication management, referrals, vaccinations, and positive test results for the monitoring of previously diagnosed chronic conditions. A retrospective patient record study collecting data from two GP clinics in metropolitan and regional Victoria was undertaken. A total of 195 75þHA recipients were included. Results. No significant difference was found in the number of new chronic conditions recorded at patients' most recent 75þHA compared with standard GP consultations in the prior 24 months. However, significant differences in the types of conditions were noted, with 75þHAs significantly more likely to record elevated lipids (P, 0.001), vitamin D deficiencies (P = 0.004), eye/vision-related (P = 0.011), diabetes (P = 0.019), and hearing conditions (P = 0.045) compared with standard GP consultations. Significantly more referrals (P, 0.001) and new management for previously diagnosed conditions (P=0.009) occurred at 75þHAthan at standard GP consultations. Patients who were receiving their first 75þHAwere significantly more likely to receive vaccinations than those receiving a subsequent 75þHA(P=0.022). Conclusion. 75þHAs fulfil a role in addressing chronic health problems otherwise overlooked during standard GP consultations. [ABSTRACT FROM AUTHOR]