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Background In 2014, a composite pack containing mifepristone-buccal misoprostol, indicated for use to 63 days gestation replaced the existing regimen for early medical abortion ( EMA) in Australia. Aims To provide updated efficacy and safety information for the use of mifepristone-buccal misoprostol for EMA in Australia, and assess the effect of patient age and gestational age on efficacy. Materials and methods Observational cohort study of 15 008 women attending one of 16 Marie Stopes International clinics in Australia for an EMA (gestational age ≤ 63 days) between 1 March 2013 and 30 September 2015. Administration of 200 mg oral mifepristone in-clinic was followed 24-48 h later by 800 μg buccal misoprostol self-administered at home. Method success was defined as complete abortion not requiring surgical intervention. Results Follow-up information was available for 87.14% (13 078/15 008) of women. Likelihood of follow-up was significantly lower for women from rural or remote locations (adjusted odds ratio, 0.47; P < 0.001). Medical abortion was successful in 95.16% (12 445/13 078) of women with follow-up. Higher patient and gestational ages were associated ( P < 0.001) with a slight increase in method failure. There were 674 serious adverse events (5.15%), mainly due to method failure. Infection (15; 0.11%) and haemorrhage (17; 0.13%) were rare. One death was recorded (<0.01%); however, an association between EMA and cause of death, necrotising pneumonia, was not established. Conclusion Mifepristone-buccal misoprostol is an effective and safe alternative to surgical termination of pregnancy up to 63 days gestation. [ABSTRACT FROM AUTHOR]

Background: Specialised early intervention (SEI) programs have offered individuals with psychotic disorders and their families new hope for improving illness trajectories and outcomes. The Early Psychosis Prevention and Intervention Centre (EPPIC) was one of the first SEI programs developed in the world, providing services for young people experiencing their first episode of psychosis.Methods: We conducted a narrative synthesis of controlled and uncontrolled studies that have been conducted at EPPIC.Discussion: The history of the EPPIC model is first described. This is followed by a discussion of clinical research emerging from EPPIC, including psychopharmacological, psychotherapeutic trials and outcome studies. Neurobiological studies are also described. Issues pertaining to the conduct of clinical research and future research directions are then described. Finally, the impact of the EPPIC model on the Australian environment is discussed. [ABSTRACT FROM AUTHOR]

The requirement that mifepristone be dispensed only by physicians in offices, clinics or hospitals — and not by prescription in pharmacies — has likely limited uptake by providers in the United States. However, in several other countries, provision by prescription in pharmacies is allowed, including in Australia. Mifepristone was first registered in Australia in 2012, and in 2015, a composite package including 200 mg mifepristone and four tablets of misoprostol 200 mcg was registered. Both were approved as Schedule 4 medications, which require prescribing by a physician and may be dispensed at pharmacies. As part of the registration for both products, a risk management plan was instituted that has several components. First, physicians must be certified to prescribe mifepristone. General practitioners wishing to become certified must complete online training that includes prescribing requirements and managing the medical abortion process; obstetrician-gynecologists are exempt from the online learning module. Pharmacists must also be certified in order to dispense the medication, although this does not require additional training. When a pharmacist receives a prescription for mifepristone, she or he must confirm through a secure website that the prescriber is certified. In every region of the country, there are more certified prescribers and dispensers of mifepristone than the number of facilities providing abortion care. The experience in Australia demonstrates the feasibility of mifepristone by prescription and should be a model for expanding access to early medical abortion in the United States. [ABSTRACT FROM AUTHOR]

The article discusses the research which examines the uptake of long-acting reversible contraceptive (LARC) methods after abortion among women presenting abortions through a major abortion provider in Australia. It states that a quarter of women chose LARC method after abortion. It notes that women aged 16-19 were less likely to have LARC insertion. It mentions that immediate LARC provision occurred often after surgical abortion.

Objectives This study explored specific and differential effects of metacognitive beliefs on proneness to both hallucinations and delusions in a general population sample, including a control for the alternate symptom. The study then examined whether similar findings were reproduced in a sample of people with psychotic disorders. Design Linear and hierarchical regressions were used to determine the role of metacognitive beliefs in the proneness to symptoms, whilst ANCOVAs analysed group differences. Methods Participants were recruited to a non-clinical sample ( N = 133) and a psychosis sample ( N = 100). Both groups completed the Launay-Slade Hallucinations Scale-Revised (Laroi et al., ; Eur. Psychiatry, 19, 15), the Peters Delusions Inventory (Peters et al., ; Schizophr. Bull., 25, 553), and the Metacognitions Questionnaire-30 (Wells & Cartwright-Hatton, ; Behav. Res. Ther., 42, 385). Results Metacognitions were predictive of both hallucination- and delusion-proneness in the non-clinical sample. Controlled analyses in the non-clinical sample revealed specific effects: low cognitive confidence ( CC) predicted hallucination-proneness, whilst negative beliefs about the uncontrollability and danger of thoughts ( NBUD) predicted delusion-proneness. Mean ratings on NBUD , low CC, and need to control thoughts were elevated in the psychosis sample; however, after controlling for comorbid symptoms, no metacognitive belief predicted symptom-specific vulnerability in the clinical sample. Conclusions The pattern of findings provided little support for Morrison's theoretical model of symptom-proneness. Metacognitive beliefs may be related to sub-acute vulnerability to psychosis symptoms; however, the specificity of the relationship between individual metacognitive beliefs and positive psychosis symptoms appeared no longer significant in psychosis patients. The possibility that these metacognitive beliefs are evoked by psychotic experiences, rather than primarily functioning as a driver of them, warrants greater attention. Practitioner points Clinical Implications Metacognitive beliefs appear at least equally associated with delusion-proneness as hallucination-proneness., Negative metacognitive beliefs appear more central to delusion-proneness than hallucination-proneness in the general population., When controlling for alternate symptom, no individual metacognitive belief appears reliably able to predict symptom-proneness in psychosis patients., Limitations Consistent with existing literature on metacognitions in psychosis, this study adopted a cross-sectional design, meaning we were unable to determine the causal direction of the observed associations between metacognitive beliefs and symptom-proneness., Although a strength of this study design was its control for alternate psychotic symptoms, we did not control for non-psychotic symptoms, particularly, anxiety and depression., The symptom measures used were developed primarily for assessment of psychosis-proneness within the general population; thus, their use by people with established psychosis may have been less sensitive to clinical manifestations of these phenomena. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the use of mifepristone combined with buccal misoprostol in women undergoing early medical abortion (EMA) in Australia. The study found a 3.5 percent EMA failure rate, with incomplete abortions requiring surgical aspiration. Complications associated with EMA include medium or heavy bleeding and moderate or severe pain/cramps.

Mental health difficulties are easily the key health issue faced by adolescents and young adults in the developed world today. Epidemiological studies have shown that the incidence and prevalence of the mental disorders, as well as their contribution to the overall burden of disease, is highest in those in the 15 to 24 year age group, and yet young people in this age range are the least likely to access services for mental health problems. This issue is particularly problematic given that untreated, or poorly treated, mental disorders are associated with ongoing disability, including impaired social functioning, poor educational achievement, unemployment, substance abuse, and violence that all too often leads to a cycle of dysfunction and disadvantage that is difficult to break. Young people tend to be reluctant to discuss emotional concerns with a general practitioner if indeed they have a regular doctor, and the traditional mental health services, which cater to the needs of children or older adults, are highly alienating to young people. A new approach to mental health services for young people is clearly needed-one that considers young people's unique developmental issues, their help-seeking needs and behaviors, and the complex and evolving patterns of symptoms and morbidity common in this age group. This article describes Australian innovation in the provision of youth mental health services, which has been informed by an evidence-based approach and dedicated advocacy, that seeks to contribute to this much needed reform process. [ABSTRACT FROM AUTHOR]

In the rather chaotic history of United Nations' peacekeeping operations, where results have not always matched the efforts of the international community, East Timor stands as an undeniable success, as of March 10, 2004. In two and a half years, from November 1999 to May 2002, this totally devastated country was entirely reconstructed. In the space of twenty-eight months, this country saw its external and internal security assured, and the establishment of central and district administrations, a police force, a judicial system, legal and regulatory codes, a central bank, a fiscal system, an educational system, agricultural development, the renegotiation of oil agreements with Australia, and a constitution. In the months after independence on 20 May 2002, an outside observer could have been forgiven for concluding that East Timor's new state institutions were failing.

The article offers information on abortion statistics and long-acting reversible contraception (LARC) in Australia. Topics discussed include the annual abortion rate in the country; the public provision and minimal residency requirements for abortion; and overstatement of abortion statistics in the country.

The authors comment on the article "The National Mental Health Commission Report: Evidence based or ideologically driven?" by S. Allison and others in a 2015 issue. Topics discussed include review of mental health programmes and services by National Mental Health Commission; funding of headspace organization and youth early psychosis programme (YEPP) by Commonwealth Government; and a telehealth model that provides consultant psychiatrist input to sites.

The authors comment on the article "How effective are headspace youth mental health services?" by A.F. Jorm and others in a 2015 issue. Topics discussed include headspace National Youth Mental Health Foundation for redesign of mental health care in Australia; accessibility and acceptability of headspace centres to young people; and the views of professor Anthony Jorm.

The article discusses the highlights of the National Environmental Protection Council (NEPC) of Australia's annual air quality National Environmental Protection Measures (NEPM) report for 2012-2013. Topics discussed include the objective of the NEPC's promulgation of air quality standards and monitoring compliance of each state or territory, assessment of the NEPM effectiveness and the goals of the Ambiant Air Quality NEPM.

An introduction is presented in which the editor discusses various reports within the issue on topics including history of air quality in Australia and New Zealand, air quality science, and ongoing discussion surrounding National Clean Air Agreement for Australia.

Background: Personal recovery is a persisting concern for people with psychotic disorders. Accordingly, mental health services have adopted frameworks of personal recovery, prioritizing adaptation to psychosis alongside symptom remission. Group acceptance and commitment therapy (ACT) for psychosis aims to promote personal recovery alongside improved mood and quality of life., Aims: The objectives of this uncontrolled, prospective pilot study were to determine whether 'Recovery ACT' groups for adults are a feasible, acceptable and safe program within public mental health services, and assess effectiveness through measuring changes in personal recovery, wellbeing, and psychological flexibility., Method: Program feasibility, acceptability and safety indicators were collected from referred consumers ( n =105). Adults ( n =80) diagnosed with psychotic disorders participated in an evaluation of 'Recovery ACT' groups in Australian community public mental health services. Participants completed pre- and post-group measures assessing personal recovery, wellbeing, and psychological flexibility., Results: Of 101 group enrollees, 78.2% attended at least one group session ( n =79); 73.8% attended three or more, suggesting feasibility. Eighty of 91 first-time attendees participated in the evaluation. Based on completer analyses ( n =39), participants' personal recovery and wellbeing increased post-group. Outcome changes correlated with the linear combination of psychological flexibility measures., Conclusions: 'Recovery ACT' groups are feasible, acceptable and safe in Australian public mental health services. 'Recovery ACT' may improve personal recovery, wellbeing, and psychological flexibility. Uncontrolled study design, completer analyses, and program discontinuation rates limit conclusions.

Objectives: To examine access and equity to induced abortion services in Australia, including factors associated with presenting beyond nine weeks gestation., Methods: Cross-sectional survey of 2,326 women aged 16+ years attending for an abortion at 14 Dr Marie clinics. Associations with later presentation assessed using multivariate logistic regression., Results: Over a third of eligible women opted for a medical abortion. More than one in 10 (11.2%) stayed overnight. The median Medicare rebated upfront cost of a medical abortion was $560, compared to $470 for a surgical abortion at ≤9 weeks. Beyond 12 weeks, costs rose considerably. More than two-thirds (68.1%) received financial assistance from one or more sources. Women who travelled ≥4 hours (AdjOR: 3.0, 95%CI 1.2-7.3), had no prior knowledge of the medical option (AdjOR: 2.1, 95%CI 1.4-3.1), had difficulty paying (AdjOR: 1.5, 95%CI 1.2-1.9) and identified as Aboriginal and/or Torres Strait Islander (AdjOR: 2.1, 95%CI 1.2-3.4) were more likely to present ≥9 weeks., Conclusions: Abortion costs are substantial, increase at later gestations, and are a financial strain for many women. Poor knowledge, geographical and financial barriers restrict method choice. Implications for public health: Policy reform should focus on reducing costs and enhancing early access., (© 2017 The Authors.)

Background: We examined the baseline prevalence of penile, scrotal, perineal/perianal, and intra-anal human papillomavirus (HPV) infection in human immunodeficiency virus (HIV)-seronegative men who have sex with men (MSM)., Methods: Data were analyzed from 602 MSM aged 16-27 years with ≤ 5 lifetime sexual partners. Serum samples were tested for antibodies to HPV6/11/16/18. Swab samples were collected separately from several anogenital areas for detection of HPV6/11/16/18/31/33/35/39/45/51/52/56/58/59 DNA., Results: The prevalence of any tested HPV type was 18.5% at the penis, 17.1% at the scrotum, 33.0% at the perineal/perianal region, 42.4% in the anal canal, and 48.0% at any site. Overall, 415 MSM (69.7%) were negative to HPV 6, 11, 16, and 18 at enrollment by both serology and DNA detection. Men residing in Europe and Latin America had significantly increased risk of HPV infection at external genital sites and the anal canal compared to men from Australia. Tobacco use and greater number of lifetime sexual partners was associated with higher HPV infection prevalence., Conclusions: The prevalence of HPV infection is high among young sexually active MSM, with the anal canal being the most common site of infection. Lifetime number of sexual partners was the most important modifiable risk factor for anogenital HPV infection.