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Background: A growing body of evidence suggest an association between physical activity levels and students psychological well-being. A number of research studies have evaluated playground interventions that aim to increase physical activity levels, decrease conflict and bullying, and improve students behaviour. The HAPPY Study will evaluate the success of an intervention combining environmental modifications, teacher development, and peer support that can culminate in an easy to implement, low cost and effective model for increasing physical activity, and improving psychological well-being for children.Methods/design: Data will be collected at six New South Wales (NSW) primary schools, on physical activity levels, on-task time during classes, and social support for physical activity during a 12 month Cluster Controlled Trial (CT). Three quantitative data collection tools will be used to capture student's physical activity levels during lunch and recess breaks (the SOPARC tool), student's on-task behaviour during classes following recess and lunch breaks (the BOSS tool) and where students receive the most encouragement to be physically active from (the Physical Activity Social Support Scale survey). Baseline data will be analysed against follow-up data, collected after an intervention that is rolled out in all schools as part of a stepped wedge CT design.Discussion: A review of relevant Australian and New Zealand literature suggests that playground interventions can be successful at increasing physical activity levels, increasing social and conflict resolution skills in students, and decreasing incidences of bullying. This study will investigate any correlation between physical activity levels, and student behaviour during classes following breaks.Trial Registration: Australian and New Zealand Clinical Trials Register ACTRN12616000575437 , registered May 2016. [ABSTRACT FROM AUTHOR]

Background: Current evidence suggests that chlamydia screening programmes can be cost-effective, conditional on assumptions within mathematical models. We explored differences in cost estimates used in published economic evaluations of chlamydia screening from seven countries (four papers each from UK and the Netherlands, two each from Sweden and Australia, and one each from Ireland, Canada and Denmark).Methods: From these studies, we extracted management cost estimates for seven major chlamydia sequelae. In order to compare the influence of different sequelae considered in each paper and their corresponding management costs on the total cost per case of untreated chlamydia, we applied reported unit sequelae management costs considered in each paper to a set of untreated infection to sequela progression probabilities. All costs were adjusted to 2013/2014 Great British Pound (GBP) values.Results: Sequelae management costs ranged from £171 to £3635 (pelvic inflammatory disease); £953 to £3615 (ectopic pregnancy); £546 to £6752 (tubal factor infertility); £159 to £3341 (chronic pelvic pain); £22 to £1008 (epididymitis); £11 to £1459 (neonatal conjunctivitis) and £433 to £3992 (neonatal pneumonia). Total cost of sequelae per case of untreated chlamydia ranged from £37 to £412.Conclusions: There was substantial variation in cost per case of chlamydia sequelae used in published chlamydia screening economic evaluations, which likely arose from different assumptions about disease management pathways and the country perspectives taken. In light of this, when interpreting these studies, the reader should be satisfied that the cost estimates used sufficiently reflect the perspective taken and current disease management for their respective context. [ABSTRACT FROM AUTHOR]

Background: Early identification and intervention for hearing loss is important for supporting language development. Despite this, parents are required to overcome barriers to access hearing assessments for their children. Aims: To identify the enablers and barriers to accessing hearing assessments for Australian children identified by their parents, and to compare between metropolitan, regional and rural areas. Methods & Procedures: This sequential, explanatory mixed‐methods study was undertaken online and included participants in metropolitan, regional and rural area of Queensland, New South Wales, Victoria, South Australia, Western Australia and the Northern Territory. A total of 56 participants participated in the surveys, and 10 participated in semi‐structured interviews. Outcomes & Results: Participants in metropolitan areas were more likely to have services in their area; however, access to hearing assessment was related more to individual circumstances (including health literacy skills) rather than geographical location. Many participants experienced long wait times, reduced flexibility, and a lack of audiologists experienced in working with children. Conclusions & Implications: Barriers to hearing assessments (which assist with early identification and intervention for hearing loss) should be addressed so that children have access to clear auditory information to assist with their speech and language development. WHAT THIS PAPER ADDS: What is already known on the subject: Poor audiological input can lead to poor speech, language and literacy outcomes for children. What this paper adds to the existing knowledge: Although previous research indicates that people in regional and remote locations experience difficulty accessing health services within a reasonable timeframe, in this study barriers were experienced regardless of geographical location, and were dependent on individual circumstances. Many parents are unaware of the impact of hearing on speech and language. What are the potential or actual clinical implications of this work?: Further research might examine how health literacy affects access to hearing assessment. Parents shared several potential solutions to these access barriers which should be considered by service providers. [ABSTRACT FROM AUTHOR]

Objective: Professional sport occupies a prominent cultural position in societies across the globe and commercial organisations make use of this to promote their products. The present scoping review explores existing academic literature on the relationship between professional sports clubs and food and drink marketing and considers how this relationship may impact upon the public's health.Design: The scoping review searched six databases. Experts were also consulted. Records written in languages other than English were excluded. We also excluded records relating to mega events (e.g. Olympics, Football World Cup) and alcohol marketing, because of the attention already given to these.Setting: Professional sports clubs.Results: We identified 18 166 titles, reviewed 163 abstracts and read twenty-six full texts. We included six papers in the review. Four were from Australia and New Zealand. The Australasian literature focused largely on the marketing of foods and beverages to children and the potential impact on consumption. Single papers from researchers in Turkey and the USA were identified. The Turkish paper analysed shirt sponsorship in football leagues internationally and showed food and beverage (including alcohol) companies were the most common sponsors. The US paper examined a mixed reaction to a football team named after an energy drink.Conclusions: Commercial relationships between professional sports clubs and Big Food corporations have largely eluded scrutiny in much of the world. The current review highlights the lack of public health research on these relationships. Research exploring the interdependent commercial practices of food and drink companies and professional sports clubs is urgently needed. [ABSTRACT FROM AUTHOR]

Background: Cross-sectoral collaborations are considered necessary to address detrimental health, social, educational and economic outcomes that impact marginalised and disadvantaged populations. There is a strong relationship between the health of children and their educational attainment; good health promotes positive learning. This paper reports cross-sectoral executive and senior management level systems changes required to enable the design of a collaborative primary healthcare service model for children and young people in rural Australia. Methods: A descriptive qualitative design was used. Data were collected from executive and senior managers from three organisations (Education, Health and a University Department of Rural Health [ n = 6]) through individual semi-structured interviews. Data were analysed using an inductive, thematic approach. The study draws on Lewin's Model of Change. Results: Three overarching themes were generated from the data: an embedded challenge and experimental solutions; building a shared language and understanding; and the role of relationships and trust. Despite the unique geographical and social context of the study area, strategies emerged from the data on how a solution to an embedded challenge, through design of a primary healthcare model, was established and how the strategies described could be transferred and scaled to other rural and remote communities. Conclusion: Contextual differences make each rural and remote area unique. In this study, strategies that are described in the managing change literature were evident. The authors conclude that drawing on strong management of change principles could mean that a service model designed for one remote community might be transferrable to other communities. There is a strong relationship between children's health and their educational attainment. Poorer health, educational and social attainment are experienced by children and young people residing within the study area. Despite unique geographical contexts and demography, strategies that align strong leadership and effective management of change across three organisations were key and may make it possible to transfer a primary health care model designed to improve health and education outcomes for children and young people to other rural and remote communities. [ABSTRACT FROM AUTHOR]

Background: The No Germs on Me (NGoM) Social Marketing Campaign to promote handwashing with soap to reduce high rates of infection among children living in remote Australian Aboriginal communities has been ongoing since 2007. Recently three new television commercials were developed as an extension of the NGoM program. This paper reports on the mass media component of this program, trialling an evaluation design informed by the Theory of Planned Behaviour (TPB).Methods: A survey questionnaire taking an ecological approach and based on the principals and constructs of the TPB was developed. Surveys were completed in six discrete Aboriginal communities immediately before and on completion of four weeks intensive televising of the three new commercials.Results: Across the six communities access in the home to a television that worked ranged from 49 to 83 % (n = 415). Seventy-seven per cent (n = 319) of participants reported having seen one or more of the new commercials. Levels of acceptability and comprehension of the content of the commercials was high (97 % n = 308). Seventy-five per cent (n = 651) of participants reported they would buy more soap, toilet paper and facial tissues if these were not so expensive in their communities. For TPB constructs demonstrated to have good internal reliability the findings were mixed and these need to be interpreted with caution due to limitations in the study design.Conclusions: Cultural, social-economic and physical barriers in remote communities make it challenging to promote adults and children wash their hands with soap and maintain clean faces such that these behaviours become habit. Low levels of access to a television in the home illustrate the extreme level of disadvantage experienced in these communities. Highlighting that social marketing programs have the potential to increase disadvantage if expensive items such as television sets are needed to gain access to information. This trial of a theory informed evaluation design allowed for new and rich information to be obtained about community members' beliefs, attitudes and intentions towards teaching and assisting children so safe hygiene behaviours become habit. Findings will support an evidence-based approach is taken to plan future NGoM program activities. [ABSTRACT FROM AUTHOR]

Background: Pacific people living in New Zealand, Australia, United States, and the Pacific region continue to experience a disproportionately high burden of long-term conditions, making culturally contextualised behaviour change interventions a priority. The primary aim of this study was to describe the characteristics of behaviour change interventions designed to improve health and effect health behaviour change among Pacific people.Methods: Electronic searches were carried out on OVID Medline, PsycINFO, PubMed, Embase and SCOPUS databases (initial search January 2019 and updated in January 2020) for studies describing an intervention designed to change health behaviour(s) among Pacific people. Titles and abstracts of 5699 papers were screened; 201 papers were then independently assessed. A review of full text was carried out by three of the authors resulting in 208 being included in the final review. Twenty-seven studies were included, published in six countries between 1996 and 2020.Results: Important characteristics in the interventions included meaningful partnerships with Pacific communities using community-based participatory research and ensuring interventions were culturally anchored and centred on collectivism using family or social support. Most interventions used social cognitive theory, followed by popular behaviour change techniques instruction on how to perform a behaviour and social support (unspecified). Negotiating the spaces between Eurocentric behaviour change constructs and Pacific worldviews was simplified using Pacific facilitators and talanoa. This relational approach provided an essential link between academia and Pacific communities.Conclusions: This systematic search and narrative synthesis provides new and important insights into potential elements and components when designing behaviour change interventions for Pacific people. The paucity of literature available outside of the United States highlights further research is required to reflect Pacific communities living in New Zealand, Australia, and the Pacific region. Future research needs to invest in building research capacity within Pacific communities, centering self-determining research agendas and findings to be led and owned by Pacific communities. [ABSTRACT FROM AUTHOR]

Background/aim: Web 2.0 internet technology has great potential in promoting physical activity. This trial investigated the effectiveness of a Web 2.0-based intervention on physical activity behaviour, and the impact on website usage and engagement.Methods: 504 (328 women, 126 men) insufficiently active adult participants were randomly allocated to one of two web-based interventions or a paper-based Logbook group. The Web 1.0 group participated in the existing 10 000 Steps programme, while the Web 2.0 group participated in a Web 2.0-enabled physical activity intervention including user-to-user interaction through social networking capabilities. ActiGraph GT3X activity monitors were used to assess physical activity at four points across the intervention (0, 3, 12 and 18 months), and usage and engagement were assessed continuously through website usage statistics.Results: Treatment groups differed significantly in trajectories of minutes/day of physical activity (p=0.0198), through a greater change at 3 months for Web 2.0 than Web 1.0 (7.3 min/day, 95% CI 2.4 to 12.3). In the Web 2.0 group, physical activity increased at 3 (mean change 6.8 min/day, 95% CI 3.9 to 9.6) and 12 months (3.8 min/day, 95% CI 0.5 to 7.0), but not 18 months. The Logbook group also increased physical activity at 3 (4.8 min/day, 95% CI 1.8 to 7.7) and 12 months (4.9 min/day, 95% CI 0.7 to 9.1), but not 18 months. The Web 1.0 group increased physical activity at 12 months only (4.9 min/day, 95% CI 0.5 to 9.3). The Web 2.0 group demonstrated higher levels of website engagement (p=0.3964).Conclusions: In comparison to a Web 1.0 intervention, a more interactive Web 2.0 intervention, as well as the paper-based Logbook intervention, improved physical activity in the short term, but that effect reduced over time, despite higher levels of engagement of the Web 2.0 group.Trial Registration Number: ACTRN12611000157976. [ABSTRACT FROM AUTHOR]

This paper presents findings from the evaluation of an Australian trial of self‐managed home aged care. The self‐management model was codesigned by advocacy organisation COTA Australia, consumers and service providers. The primary aim of the evaluation was to examine whether self‐management improved consumers' perceptions of their choice, control, and wellbeing. The secondary aim was to examine whether provider prior experience with self‐managed packages significantly influenced consumers' perceptions of choice, control and wellbeing, thereby confounded trial effects. A pre‐test post‐test quasi‐experimental design and mixed‐methods design were used to collect data over nine months in 2018–2019. The pre‐trial methods and findings have been published. The post‐trial evaluation replicated the pre‐trial data collection method of an online survey (n = 60) and semi‐structured telephone interviews with consumers (n = 9), family carers (n = 13), and consumers and carers jointly (n = 2), totalling 24 interviews. Semi‐structured telephone interviews were also conducted with CEOs and senior managers from each of the seven providers (n = 14). Three providers had prior experience supporting self‐management. Parametric and non‐parametric tests examined the statistical data. Qualitative data were analysed thematically and framed according to self‐determination principles and ecological systems theory. Both datasets demonstrated that consumers reported greater choice and control at post‐trial than pre‐trial. This finding was not affected by providers' prior experience with self‐management; therefore, it was not a confounding factor. Participants reported improved wellbeing in interviews, however this was not reinforced statistically. Key desirable features of self‐management included greater autonomy and control over spending, recruiting support staff and paying lower administration fees. There was no evidence of increased risks or fraud. The research limitations included a small sample size, convenience sampling with providers recruiting interview participants, no control group and differences in trial implementation. The findings support the expansion of self‐management opportunities and more comprehensive evaluations that use mixed methods. [ABSTRACT FROM AUTHOR]

Informal caregiving for a person living with glioma can be both rewarding and multidimensionally challenging, given the potential for debilitating symptoms, cognitive impairment or personality changes, as early as diagnosis. There is growing evidence that, due to the demands of care, experiences and feelings of loneliness and isolation among informal caregivers are widespread, and opportunities for quality or meaningful social connectedness are lacking. While considerable research has quantified the causes and effects of loneliness and isolation in informal care contexts, the lived experience of loneliness has received relatively little attention. The aim of this study was to better understand the everyday experiences of a group of home‐based informal caregivers of people living with glioma in Queensland, Australia. Drawing on in‐depth interviews with 32 informal caregivers, purposively sampled, and recruited through a tertiary hospital, in this paper, we explore how the various experiences, demands, and social and relational dynamics in/of informal care (re)produce forms of isolation and loneliness. Using the framework approach to thematic analysis, we derived four themes: (a) the 'need' to be near the care recipient, and the implications for caregiver mobility; (b) the strong sense of responsibility for care, and the virtues of 'good' caring; (c) experiences of loneliness in the company of others and (d) postponement of social connection and minimising the self. The findings, we argue, are reflective of broader social and moral norms and expectations within experiences of home‐based informal care. [ABSTRACT FROM AUTHOR]

Background: The residual effects of cancer and its treatment can profoundly affect women's quality of life. This paper presents results from a multisite randomized controlled trial that evaluated the clinical benefits of an e-health enabled health promotion intervention (the Women's Wellness after Cancer Program or WWACP) on the health-related quality of life of women recovering from cancer treatment.Methods: Overall, 351 women previously treated for breast, blood or gynaecological cancers were randomly allocated to the intervention (WWACP) or usual care arms. The WWACP comprised a structured 12-week program that included online coaching and an interactive iBook that targeted physical activity, healthy diet, stress and menopause management, sexual wellbeing, smoking cessation, alcohol intake and sleep hygiene. Data were collected via a self-completed electronic survey at baseline (t0), 12 weeks (post-intervention, t1) and 24 weeks (to assess sustained behaviour change, t2). The primary outcome, health-related quality of life (HRQoL), was measured using the Short Form Health Survey (SF-36).Results: Following the 12-week lifestyle program, intervention group participants reported statistically significant improvements in general health, bodily pain, vitality, and global physical and mental health scores. Improvements were also noted in the control group across several HRQoL domains, though the magnitude of change was less.Conclusions: The WWACP was associated with improved HRQoL in women previously treated for blood, breast, and gynaecological cancers. Given how the synergy of different lifestyle factors influence health behaviour, interventions accounting for the reciprocity of multiple health behaviours like the WWACP, have real potential for immediate and sustainable change.Trial Registration: The protocol for this randomised controlled trial was submitted to the Australian and New Zealand Clinical Trials Registry on 15/07/2014 and approved on 28/07/2014 ( ACTRN12614000800628 ). [ABSTRACT FROM AUTHOR]

Universities around the world face a common challenge - producing graduates with the necessary practical skills for employment. Cooperative education and work-integrated learning (WIL) make a valuable contribution to increasing graduate employability, however, there are differences in the level of cooperation from industry and government commitment. A comparative study of WIL in Germany, Australia, and South Korea, focusing predominantly on three universities, showed differences in the approaches to achieving practical experience and increasing graduate employability. The data underlying the research was derived from questionnaires, a focus group session, and the development of a descriptive, multi-case study. This allowed comparisons and contrasts between the three universities to be identified. The results and conclusions outlined in this paper aim to highlight best practice in cooperative education and WIL and provide recommendations for the future development of cooperative education, in order to improve graduate employability. [ABSTRACT FROM AUTHOR]

This paper uses secondary analysis to understand how COVID-19 shaped people's experiences with psychosocial support services in Australia. Data are drawn from questionnaires (n = 66) and semi-structured interviews (n = 62), conducted for a national service evaluation, with 121 people living with enduring mental health conditions and using psychosocial support services. Data relating to COVID-19 were inductively coded and analysed using constant comparative analysis. Most people's experiences included tele-support. While some people described minimal disruption to their support, many reported reduced engagement. People's wellbeing and engagement were influenced by: their location, living situation and pre-COVID lifestyles; physical health conditions; access to, comfort with, and support worker facilitation of technology; pre-COVID relationships with support workers; and communication from the organisation. The findings can help services prepare for future pandemics, adjust their services for a 'COVID-normal' world, and consider how learnings from COVID-19 could be incorporated into a flexible suite of service delivery options. [ABSTRACT FROM AUTHOR]

Purpose: This paper responds to the call for more research to fully understand out of pocket (OOP) costs for cancer patients by providing a detailed discussion of such costs for adult haematology patients from Queensland, Australia.Methods: The descriptive qualitative research was based on in-depth interviews with 45 (n = 45) haematology patients from regional, rural and remote areas.Results: The discussion itemises the OOP costs under four categories including the costs associated with travel and accommodation, the costs associated with family and friends during relocation, the costs associated with diagnosis and treatment, and the costs of parking.Conclusions: The paper provides evidence of the categories of financial burden experienced by haematology patients who have to relocate for specialist treatment by detailing the extensive range of OOP costs. The expectation is that the itemisation of OOP cost variables will contribute to future efforts of quantification. [ABSTRACT FROM AUTHOR]

Background The 'Down to Test (DTT)' campaign is a sexually transmissible infection (STI) social marketing intervention delivered through outdoor music festival activations and supported by digital media communications in New South Wales, Australia. This paper investigates whether and how the tailored messages reached the intended audience. Methods Data was collected through three annual rounds of online surveys post campaign exposure, targeting young people (aged 15-29years) attending 14 music festivals in NSW from October 2017 to March 2020. Descriptive statistics, principal component analysis and multivariable logic regression were applied to identify the key client segment and factors associated with a strong intention for future STI screening. Results Of the 10044 participants with a valid urine specimen submitted, 261 (2.8%) tested positive for chlamydia. Altogether, 1776 participants (median age=22) self-completed the evaluation surveys online with more being female (73.4%) than male (26.2%). Participants were mostly Australian-born (89.5%), heterosexual (82.6%) and the majority being sexually active (96.7%). Rates of self-reported lifetime STI testing (70.4%) and intention for future STI screening ('definitely yes' in the next 12months, 39.0%) were also high. The most significant factor associated with future intention for STI testing is the Sexual Experience and Perception Factor (adjusted odds ratio [AOR]=2.02; 95%CI 1.76-2.32; P<0.001), followed by the Sexual Beliefs and Attitudes Factor (AOR=1.14; 95% CI 1.01-1.30; P<0.05). Conclusions The NSW state-wide DTT campaign has largely reached sexually active youth who are attentive to sexual health promotion messages and contributed to enhanced STI screening in a fun and peer-supportive environment. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to investigate whether the content of annual Victorian quality of care reports had an increased consumer participation focus following the introduction of the National Safety and Quality Health Service (NSQHS) Partnering with Consumers standard. Methods: A mixed-methods approach comprising a comparative descriptive observational study design with quantitative data analysis was used. Nine large Victorian metropolitan public health services' annual quality of care reports from 2011 and 2014 were analysed using a newly devised analysis framework consisting of elements of the NSQHS 'Partnering with Consumers' standard and minimal requirements for Quality of Care reporting by the Department of Health and Human Services. Results: Of the nine 2014 quality of care reports, in only three were total scores higher compared with scores in the 2011 reports; in one of the 2014 reports, the total scores remained the same, and in the remaining five reports total scores were lower than in the 2011 reports. Overall, there was an improved total score for the 2014 reports compared with the 2011 reports, corresponding to a higher consumer participation focus. Conclusion: Overall, the present study demonstrated mixed findings and, in some cases, lower scores for the 2014 reports, which was after the introduction of the Partnering with Consumers NSQHS standard, compared with the 2011 reports. Overall, there is future scope to enhance the degree of consumer participation evident within the quality of care reports. What is known about the topic?: Partnering with consumers has been associated with improved clinical outcomes, decreased readmission rates and rates of hospital-acquired infections, and improved adherence to treatment recommendations and health literacy. Engaging consumers has been recognised as a means to increase the accessibility and appropriateness of healthcare to individuals. Public reporting is a tool through which health services communicate with and engage their consumers in order to improve the quality of care they provide, and is a key element in Australia of the NSQHS Partnering with Consumers standard. What does the paper add?: This paper links the principles of consumer participation with public reporting. The paper highlights the potential for healthcare organisations to use their public reporting media to engage with consumers and communicate about the quality of care they deliver. What are the implications for practitioners?: The unexpected findings of a lower emphasis on consumer participation suggests the need for Victorian health services to review the purpose and processes for developing the publicly reported quality of care reports in order to improve their compliance. [ABSTRACT FROM AUTHOR]

Background: People from ethnically diverse backgrounds living with HIV are susceptible to adverse health and wellbeing outcomes, particularly as a consequence of HIV-related stigma and discrimination (HSD), though relatively little is known about experiences in Australia.Methods: This paper reports on HSD in ethnically diverse communities in South Australia and impacts on health and wellbeing. Interviews and focus groups were conducted with 10 individuals living with HIV from ethnically diverse backgrounds, 14 ethnically diverse community leaders, and 50 service providers. Data were analysed thematically.Results: Findings indicated that HIV is a highly stigmatised condition in ethnically diverse communities due to fear of moral judgment and social isolation, and was experienced at the intersections of gender, sexual orientation, religion, culture, and immigration status. Experiences of HSD were damaging to health and wellbeing through non-disclosure, reduced social support, delayed testing, service access barriers, impacts on treatment adherence, and directly to mental health.Conclusions: Actions addressing the impacts of HSD on people from ethnically diverse backgrounds are crucial. [ABSTRACT FROM AUTHOR]

This paper examines the effects of parental health on cognitive and noncognitive development in Australian children. The underlying nationally representative panel data and a child fixed effects estimator are used to deal with unobserved heterogeneity. We find that only father's serious mental illness worsens selected cognitive and noncognitive skills of children. Maternal poor health also deteriorates some cognitive and noncognitive outcomes of children of lone mothers only. Our results demonstrate that either failing to account for parent-child fixed effects or using child noncognitive skills reported by parents could overestimate the harmful impact of poor parental health on child development. [ABSTRACT FROM AUTHOR]

This paper analyses doctors' supply of after-hours care (AHC), and how it is affected by personal and family circumstances as well as the earnings structure. We use detailed survey data from a large sample of Australian General Practitioners (GPs) to estimate a structural, discrete choice model of labour supply and AHC. This allows us to jointly model GPs' decisions on the number of daytime-weekday working hours and the probability of providing AHC. We simulate GPs' labour supply responses to an increase in hourly earnings, both in a daytime-weekday setting and for AHC. GPs increase their daytime-weekday working hours if their hourly earnings in this setting increase, but only to a very small extent. GPs are somewhat more likely to provide AHC if their hourly earnings in that setting increase, but again, the effect is very small and only evident in some subgroups. Moreover, higher earnings in weekday-daytime practice reduce the probability of providing AHC, particularly for men. Increasing GPs' earnings appears to be at best relatively ineffective in encouraging increased provision of AHC and may even prove harmful if incentives are not well targeted. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to describe the development and technical specifications of a framework and national key performance indicators (KPIs) for Australian mental health Court Liaison Services (CLSs) by the National Mental Health Court Liaison Performance Working Group (Working Group).Methods: Representatives from each Australian State and Territory were invited to form a Working Group. Through a series of national workshops and meetings, a framework and set of performance indicators were developed using a review of literature and expert opinion.Results: A total of six KPIs for CLSs have been identified and a set of technical specifications have been formed.Conclusions: This paper describes the process and outcomes of a national collaboration to develop a framework and KPIs. The measures have been developed to support future benchmarking activities and to assist services to identify best practice in this area of mental health service delivery. [ABSTRACT FROM AUTHOR]

Background Pelvic inflammatory disease (PID) is under-diagnosed globally, particularly in primary care, and if untreated may cause reproductive complications. This paper investigates PID diagnosis by Australian general practitioners (GPs) and barriers to their conducting a pelvic examination.Methods: An online survey investigating Australian GPs' chlamydia management, including PID diagnosis, was conducted in 2019. From 323 respondents, 85.8% (n = 277) answered multiple-choice questions about PID and 74.6% (n = 241) answered a free-text question about barriers to conducting pelvic examinations. Using multivariable logistic regression, we identified factors associated with conducting pelvic examinations. Barriers to performing pelvic examinations were explored using thematic analysis.Results: Most GPs indicated that they routinely ask female patients with a sexually transmissible infection about PID symptoms, including pelvic pain (86.2%), abnormal vaginal discharge (95.3%), abnormal vaginal bleeding (89.5%), and dyspareunia (79.6%). Over half reported routinely conducting speculum (69.0%) and bimanual pelvic (55.3%) examinations for women reporting pelvic pain. Female GPs were more likely to perform speculum [adjusted odds ratio (AOR) 4.6; 95%CI: 2.6-8.2] and bimanual pelvic examinations (AOR 3.7; 95%CI: 2.1-6.5). GPs with additional sexual health training were more likely to routinely perform speculum (AOR 2.2; 95%CI: 1.1-4.2) and bimanual pelvic examinations (AOR 2.1; 95%CI: 1.2-3.7). Barriers to pelvic examinations were patient unwillingness and/or refusal, GP gender, patient health-related factors, time pressures, and GP reluctance.Conclusion: Although GPs typically ask about PID symptoms when managing patients with chlamydia, they are not consistently able or willing to perform pelvic examinations to support a diagnosis, potentially reducing capacity to diagnose PID. [ABSTRACT FROM AUTHOR]

Background: The Australian Longitudinal Study on Male Health (Ten to Men) was established in 2011 to build the evidence base on male health to inform policy and program development.Methods: Ten to Men is a national longitudinal study with a stratified multi-stage cluster random sample design and oversampling in rural and regional areas. Household recruitment was conducted from October 2013 to July 2014. Males who were aged 10 to 55 years residing in private dwellings were eligible to participate. Data were collected via self-completion paper questionnaires (participants aged 15 to 55) and by computer-assisted personal interview (boys aged 10 to 14). Household and proxy health data for boys were collected from a parent via a self-completion paper-based questionnaire. Questions covered socio-demographics, health status, mental health and wellbeing, health behaviours, social determinants, and health knowledge and service use.Results: A cohort of 15,988 males aged between 10 and 55 years was recruited representing a response fraction of 35 %.Conclusion: Ten to Men is a unique resource for investigating male health and wellbeing. Wave 1 data are available for approved research projects. [ABSTRACT FROM AUTHOR]

Aim: To compare hospital admission patterns after the first year of life in Australian children with developmental disabilities and children with no known disability, according to maternal country of birth and Indigenous status.Method: This was a retrospective cohort study using linked data across health, disability, and hospital admission databases. The study investigated 656 174 children born in Western Australia between 1983 and 2008 with a total of 1 091 834 records of hospital admissions.Results: Children with no known disability born to Indigenous mothers had the highest rate of hospital admissions compared to children of non-Indigenous mothers. Children of foreign-born mothers from low-income countries had the highest rate of hospital admissions if disability was present. Children with cerebral palsy (CP) with or without associated intellectual disability had the highest rate of hospital admissions among children with developmental disability, especially if mothers were foreign-born.Interpretation: Children with CP and intellectual disability, particularly from minority backgrounds (Indigenous Australian and foreign-born mothers), were at higher risk of being admitted to hospital after the first year of life.What This Paper Adds: Hospital admissions in Australian children with and without disabilities differ according to maternal country of birth. Hospital admission rates in children without a developmental disability were greatest for Australian-born Indigenous children. Disabled Australian-born children of foreign-born mothers from low-income countries had the highest hospital admission rates. Hospital admission risk was greatest for Australian-born children with cerebral palsy, especially if mothers were foreign-born. [ABSTRACT FROM AUTHOR]

Purpose: Different health state utility (HSU) instruments produce different utilities for the same individuals, thereby compromising the intended comparability of economic evaluations of health care interventions. When developing crosswalks, previous studies have indicated nonlinear relationships. This paper inquires into the degree of nonlinearity across the four most widely used HSU-instruments and proposes exchange rates that differ depending on the severity levels of the health state utility scale.Methods: Overall, 7933 respondents from six countries, 1760 in a non-diagnosed healthy group and 6173 in seven disease groups, reported their health states using four different instruments: EQ-5D-5L, SF-6D, HUI-3 and 15D. Quantile regressions investigate the degree of nonlinear relationships between these instruments. To compare the instruments across different disease severities, we split the health state utility scale into utility intervals with 0.2 successive decrements in utility starting from perfect health at 1.00. Exchange rates (ERs) are calculated as the mean utility difference between two utility intervals on one HSU-instrument divided by the difference in mean utility on another HSU-instrument.Results: Quantile regressions reveal significant nonlinear relationships across all four HSU-instruments. The degrees of nonlinearities differ, with a maximum degree of difference in the coefficients along the health state utility scale of 3.34 when SF-6D is regressed on EQ-5D. At the lower end of the health state utility scale, the exchange rate from SF-6D to EQ-5D is 2.11, whilst at the upper end it is 0.38.Conclusion: Comparisons at different utility levels illustrate the fallacy of using linear functions as crosswalks between HSU-instruments. The existence of nonlinear relationships between different HSU-instruments suggests that level-specific exchange rates should be used when converting a change in utility on the instrument used, onto a corresponding utility change had another instrument been used. Accounting for nonlinearities will increase the validity of the comparison for decision makers when faced with a choice between interventions whose calculations of QALY gains have been based on different HSU-instruments. [ABSTRACT FROM AUTHOR]

Background: Lone parents and their children experience higher than average levels of adverse health and social outcomes, much of which are explained by high rates of poverty. Many high income countries have attempted to address high poverty rates by introducing employment requirements for lone parents in receipt of welfare benefits. However, there is evidence that employment may not reduce poverty or improve the health of lone parents and their children.Methods: We conducted a systematic review of qualitative studies reporting lone parents' accounts of participation in welfare to work (WtW), to identify explanations and possible mechanisms for the impacts of WtW on health and wellbeing. Twenty one bibliographic databases were searched. Two reviewers independently screened references and assessed study quality. Studies from any high income country that met the criteria of focussing on lone parents, mandatory WtW interventions, and health or wellbeing were included. Thematic synthesis was used to investigate analytic themes between studies.Results: Screening of the 4703 identified papers and quality assessment resulted in the inclusion of 16 qualitative studies of WtW in five high income countries, USA, Canada, UK, Australia, and New Zealand, covering a variety of welfare regimes. Our synthesis found that WtW requirements often conflicted with child care responsibilities. Available employment was often poorly paid and precarious. Adverse health impacts, such as increased stress, fatigue, and depression were commonly reported, though employment and appropriate training was linked to increased self-worth for some. WtW appeared to influence health through the pathways of conflict and control, analytical themes which emerged during synthesis. WtW reduced control over the nature of employment and care of children. Access to social support allowed some lone parents to manage the conflict associated with employment, and to increase control over their circumstances, with potentially beneficial health impacts.Conclusion: WtW can result in increased conflict and reduced control, which may lead to negative impacts on mental health. Availability of social support may mediate the negative health impacts of WtW. [ABSTRACT FROM AUTHOR]

Background: Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women's satisfaction with care across the maternity continuum.Methods: Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating.Results: Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88% in the caseload group and 74% in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95% CI 2.79, 4.03), intrapartum care (OR 2.14; 95% CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95% CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95% CI 2.64, 3.85).Conclusion: For women at low risk of medical complications, caseload midwifery increases women's satisfaction with antenatal, intrapartum and postpartum care.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN012607000073404 (registration complete 23rd January 2007). [ABSTRACT FROM AUTHOR]

There is a growing appetite for large complex databases that integrate a range of personal, socio-demographic, health, genetic and financial information on individuals. It has been argued that 'Big Data' will provide the necessary catalyst to advance both biomedical research and health economics and outcomes research. However, it is important that we do not succumb to being data rich but information poor. This paper discusses the benefits and challenges of building Big Data, analysing Big Data and making appropriate inferences in order to advance cancer care, using Cancer 2015 (a prospective, longitudinal, genomic cohort study in Victoria, Australia) as a case study. Cancer 2015 has been linked to State and Commonwealth reimbursement databases that have known limitations. This partly reflects the funding arrangements in Australia, a country with both public and private provision, including public funding of private healthcare, and partly the legislative frameworks that govern data linkage. Additionally, linkage is not without time delays and, as such, achieving a contemporaneous database is challenging. Despite these limitations, there is clear value in using linked data and creating Big Data. This paper describes the linked Cancer 2015 dataset, discusses estimation issues given the nature of the data and presents panel regression results that allow us to make possible inferences regarding which patient, disease, genomic and treatment characteristics explain variation in health expenditure. [ABSTRACT FROM AUTHOR]

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

The aim of this study was to investigate how legal professionals in Australia responded to the mental distress experienced by clients with insecure visa status in the Fast Track Assessment (FTA) process. This article reports on survey findings obtained from 38 legal professionals followed up by focus groups and interviews with 16 participants. The participants were all involved in providing legal assistance to refugees and asylum seekers with insecure visa status, the majority delivering that assistance via pro bono or community law centre settings. An inductive thematic analysis was used to analyse the data. The study uncovered a complex interplay of practical challenges, emotions, and ethical dilemmas that legal professionals encounter while assisting asylum seekers in the FTA process. The study participants' experiences highlight that a migration law practice frequently becomes the initial setting where asylum seekers disclose mental distress. Legal professionals found themselves simultaneously witnessing human suffering and endeavouring to prevent re‐traumatisation of their clients. Responding to distress was difficult to achieve as the operational setting in which they provided legal assistance and the prevailing hardline political messaging by the Australian government toward asylum seekers who arrived by boat was hostile and (re)traumatising. There is a pressing need for more trauma‐informed education and training for both current and future legal professionals. Findings are discussed alongside practical suggestions for trauma‐informed interviewing for legal professionals who interview asylum seekers. [ABSTRACT FROM AUTHOR]

Background: Strict patient isolation in hospital is associated with adverse health outcomes. However, there is a lack of high‐quality evidence for effective interventions to improve safety and quality of care for these patients. Aims: To identify patient reported areas for improvement in the care of patients in hospital isolation and to determine the feasibility of collecting patient reported outcomes using validated tools. Methods: Design: An exploratory mixed methods study. Setting: A major metropolitan teaching hospital in Melbourne, Australia. Participants: Patients in hospital isolation for transmissible infections. Data collection: Data were collected by (1) phone interviews with patients in isolation and (2) seven validated measurement tools to assess cognition, loneliness, nutritional status, quality of life, anxiety and depression and physical activity. Data were collected between September and December 2021. Data analysis: Interviews were transcribed and analysed using thematic analysis. Quantitative data were analysed descriptively including participant characteristics and outcome data. Results: Participants identified areas for improvement including activities to decrease boredom, more contact with staff to mitigate loneliness and increase comfort care, and formalised communication about clinical treatment and discharge plan. Patients with gastrointestinal symptoms were happier to be alone. There were operational challenges within the health service including delays and miscommunication. Only 70% of the participants completed all questionnaires. Conclusion: This study identified areas for improvement in care of patients in isolation and demonstrated that collecting patient reported outcomes using validated tools was feasible. The results of this research will inform development of an intervention to manage adverse effects. Implications for the Profession and/or Patient Care: Patients in hospital isolation require additional consideration to ensure that their needs are met to avoid adverse outcomes. The patient experience and comfort can be negatively affected when fundamental care is lacking. Reporting Method (EQUATOR): EQUATOR guidelines for Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR‐RHS). Patient or Public Contribution: Thirteen patients in hospital isolation agreed to participate in this study, sharing their experiences through interviews and assessment. [ABSTRACT FROM AUTHOR]

Loneliness research has tended to focus on mainstream and older populations despite evidence that non‐mainstream groups, like those experiencing homelessness, may experience loneliness differently. Limited existing research indicates that (a) people who have been homeless experience loneliness as multidimensional (as a pluralistic, non‐unidimensional emotion, experienced specific to lacked relationships) and (b) mainstream loneliness scales may be inappropriate for this group. The current study piloted and appraised the feasibility the short version of the Social and Emotional Loneliness Scale for Adults (SELSA‐S) among 129 Australian adults with a lived experience of homelessness. Exploratory Factor Analysis and an observational questionnaire appraisal were used to assess factorial and content validity and showed the measure did not fit this sample as well as in mainstream samples. Removal of items that participants found difficult to comprehend/answer improved the factorial fit of the scale. In conclusion, the SELSA‐S may be inappropriate for measuring loneliness among people who have experienced homelessness. Further research needs to explore the potentially different structure of loneliness among marginalised groups so that a better understanding of loneliness can be reached. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper explores the manner in which two hospices - one located in Denmark and one in Australia - negotiate and determine the boundaries of volunteer workers vis-à-vis paid staff. A comparative case study approach was used to juxtapose organisations with similar activity fields located in different welfare state systems, i.e. a social democratic welfare state and a liberal welfare state. This study involved non-participant observation of volunteers at work and unstructured interviews with volunteers, staff and management in the hospices ( n = 41). Data were collected between August 2012 and February 2013. Data were managed using NVivo and analysed thematically. A key finding is that volunteers in the Danish hospice were excluded from all direct care work due to the effective monopoly of the professional care providers, whereas the Australian volunteers participated in the provision of care to the extent that risk could be eliminated or mitigated to an acceptable level. The findings suggest two different models of the roles of volunteers in tension with professional care providers. Both models recognise that volunteers add to the level of care delivered by the organisations and allow for a discussion that moves away from the normative discussions of 'not taking somebody's job', while also recognising that volunteers must be more than just the 'nice extra' if they are to be of any real value to the organisation and to care receivers. [ABSTRACT FROM AUTHOR]

Background: Undergraduate preparation is important in ensuring health care professionals are prepared to identify and respond to intimate partner violence (IPV). Previous studies confirm this education is highly variable and IPV-related content remains marginalised in undergraduate nursing, midwifery and paramedicine curricula. Aim: To investigate frontline academics' attitudes and beliefs in relation to the inclusion of IPV-related content in the aforementioned degrees. Design: A large multi-phase mixed methods Australian case study of Australian undergraduate nursing, midwifery and paramedicine degrees. In this paper, components of the survey and interviews from this study will be reported on. Methods: Quantitative comparative analysis of a 51-item on-line survey and qualitative thematic analysis of guided conversational interviews. Results: Across Australian universities IPV remains poorly embedded in nursing, midwifery and paramedicine programmes. Academics report a range of barriers to such inclusion, including an already overcrowded curriculum, a lack of confident and competent academics to teach this content area and a lack of support for this content inclusion. One factor statistically significant in its association with non-inclusion of IPV-related content was academic attitudes of professional role resistance. Gender was also identified as a significant factor associated with non-inclusion and resistant professional attitudes. Qualitative interviews revealed that only six of the 18 participants identified IPV-related care as within their scope of practice, with professional role resistance a common theme identified. Conclusion: Though professional organisation and policy makers now advocate for the inclusion of IPV-related content in the undergraduate preparation of nurses and midwives, work remains to address gendered and resistant attitudes amongst academics. [ABSTRACT FROM AUTHOR]

Regular exercise is reported to improve depressive symptoms and quality of life for people experiencing mental illness. For older adults, including strength and balance can also decrease falls. Mental health services seldom include funding for Accredited Exercise Physiologist programs. A 9-week Accredited Exercise Physiologist-led program for older adults receiving mental health treatment with a community Older People's Mental Health Service was trialed in regional Australia. This clinician-conceived small-scale feasibility study utilized a two-phase concurrent triangulation mixed-method design to evaluate physical and psychological program outcomes and identify factors related to engaging in physical activity. This tailored exercise program led to improvements in measures of psychological distress and physical and psychological function. These changes corresponded with participants identifying benefits of exercising as a group of adults living with mental illness. Such findings suggest a supervised, individualized program for older mental health consumers confers physical and psychological benefits; however, further research evaluating exercise interventions with this population is required. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous transluminal angioplasty (PTA) and surgical bypass (BYP) are treatment options for symptomatic peripheral arterial disease (PAD). PTA and BYP have different clinical outcomes and cost implications. This paper aims to compare hospital-related costs of PTA and BYP for PAD of the lower limbs in an Australian health service.Methods: A retrospective cost analysis using clinical and financial data from an urban, tertiary hospital was performed. Patient cohorts were matched to existing published studies and 3-year findings were calculated. Outcomes measured were mean initial admission cost; mean bed stay; mean complication rate; mean cost of re-intervention at 12 months and extrapolated mean cost at 3 years.Results: The mean total admission costs for PTA compared to BYP were $8758 vs. $27,849 (P < 0.001). Patients undergoing BYP were admitted for 10.25 vs. 3.77 nights (P < 0.001). The complication rate was greater in the BYP group for infection only. Re-intervention was required by 13% of the PTA group and 16% of the BYP group, at a mean cost of $11,798 and $14,728, respectively (P = 0.453). The extrapolated total mean cost at 3 years was higher in the BYP group for patients with both intermittent claudication ($26,764 vs. $11,402) and critical limb ischaemia ($27,719 vs. $12,655).Conclusions: In this cohort, PTA is a favourable alternative to BYP for PAD of the lower limbs as it is less costly, does not result in a greater re-intervention rate at 1 year and has been previously demonstrated to have comparable clinical outcomes. Given the limitations of this retrospective analysis, a prospective cost-effectiveness analysis is recommended. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Take-home naloxone (THN) programs commenced in Australia in 2012 in the Australian Capital Territory and programs now operate in five Australian jurisdictions. The purpose of this paper is to record the progress of THN programs in Australia, to provide a resource for others wanting to start THN projects, and provide a tool for policy makers and others considering expansion of THN programs in this country and elsewhere.Design and Methods: Key stakeholders with principal responsibility for identified THN programs operating in Australia provided descriptions of program development, implementation and characteristics. Short summaries of known THN programs from each jurisdiction are provided along with a table detailing program characteristics and outcomes.Results: Data collected across current Australian THN programs suggest that to date over 2500 Australians at risk of overdose have been trained and provided naloxone. Evaluation data from four programs recorded 146 overdose reversals involving naloxone that was given by THN participants.Discussion and Conclusions: Peer drug user groups currently play a central role in the development, delivery and scale-up of THN in Australia. Health professionals who work with people who use illicit opioids are increasingly taking part as alcohol and other drug-related health agencies have recognised the opportunity for THN provision through interactions with their clients. Australia has made rapid progress in removing regulatory barriers to naloxone since the initiation of the first THN program in 2012. However, logistical and economic barriers remain and further work is needed to expand access to this life-saving medication. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Little is known about the response of physicians to changes in compensation: Do increases in compensation increase or decrease labour supply? In this paper, we estimate wage elasticities for physicians. We apply both a structural discrete choice approach and a reduced-form approach to examine how these different approaches affect wage elasticities at the intensive margin. Using uniquely rich data collected from a large sample of general practitioners (GPs) and specialists in Australia, we estimate 3 alternative utility specifications (quadratic, translog, and box-cox utility functions) in the structural approach, as well as a reduced-form specification, separately for men and women. Australian data is particularly suited for this analysis due to a lack of regulation of physicians' fees leading to variation in earnings. All models predict small negative wage elasticities for male and female GPs and specialists passing several sensitivity checks. For this high-income and long-working-hours population, the translog and box-cox utility functions outperform the quadratic utility function. Simulating the effects of 5% and 10% wage increases at the intensive margin slightly reduces the full-time equivalent supply of male GPs, and to a lesser extent of male specialists and female GPs. [ABSTRACT FROM AUTHOR]

Objective: Cancer in adolescents and young adults (AYAs) can interrupt important developmental milestones. Absence from school and time lost from work, together with the physical impacts of treatment on energy and cognition, can disrupt educational and vocational goals. The purpose of this paper is to report on AYA cancer survivors' experiences of reintegration into school and/or work and to describe perceived changes in their educational and vocational goals.Methods: Adolescents and young adults recruited from 7 hospitals in Australia, aged 15 to 26 years and ≤24 months posttreatment, were interviewed using the psychosocial adjustment to illness scale. Responses were analysed to determine the extent of, and explanations for, cancer's effect on school/work.Results: Forty-two AYA cancer survivors (50% female) participated. Compared with their previous vocational functioning, 12 (28.6%) were scored as experiencing mild impairment, 14 (33.3%) moderate impairment, and 3 (7.1%) marked impairment. Adolescents and young adults described difficulties reintegrating to school/work as a result of cognitive impacts such as concentration problems and physical impacts of their treatment, including fatigue. Despite these reported difficulties, the majority indicated that their vocation goals were of equal or greater importance than before diagnosis (26/42; 62%), and most AYAs did not see their performance as compromised (23/42; 55%). Many survivors described a positive shift in life goals and priorities. The theme of goal conflict emerged where AYAs reported compromised abilities to achieve their goals.Conclusions: The physical and cognitive impacts of treatment can make returning to school/work challenging for AYA cancer survivors. Adolescents and young adults experiencing difficulties may benefit from additional supports to facilitate meaningful engagement with their chosen educational/vocational goals. [ABSTRACT FROM AUTHOR]

Background: Hospital referral and admission in many- low and middle-income countries are not feasible for many young infants with sepsis/possible serious bacterial infection (PSBI). The effectiveness of simplified antibiotic regimens when referral to a hospital was not feasible has been shown before. We analysed the pooled data from the previous trials to compare the risk of poor clinical outcome for young infants with PSBI with the two regimens containing injectable procaine penicillin and gentamicin with the oral amoxicillin plus gentamicin regimen currently recommended by the World Health Organization (WHO) when referral is not feasible.Methods: Infant records from three individually randomised trials conducted in Africa and Asia were collated in a standard format. All trials enrolled young infants aged 0-59 days with any sign of PSBI (fever, hypothermia, stopped feeding well, movement only when stimulated, or severe chest indrawing). Eligible young infants whose caretakers refused hospital admission and consented were enrolled and randomised to a trial reference arm (arm A: procaine benzylpenicillin and gentamicin) or two experimental arms (arm B: oral amoxicillin and gentamicin or arm C: procaine benzylpenicillin and gentamicin initially, followed by oral amoxicillin). We compared the rate of poor clinical outcomes by day 15 (deaths till day 15, treatment failure by day 8, and relapse between day 9 and 15) in reference arm A with experimental arms and present risk differences with 95% confidence interval (CI), adjusted for trial.Results: A total of 7617 young infants, randomised to arm A, arm B, or arm C in the three trials, were included in this analysis. Most were 7-59 days old (71%) and predominately males (56%). Slightly over one-fifth of young infants had more than one sign of PSBI at the time of enrolment. Severe chest indrawing (45%), fever (43%), and feeding problems (25%) were the most common signs. Overall, those who received arm B had a lower risk of poor clinical outcome compared to arm A for both per-protocol (risk difference = -2.1%, 95% CI = -3.8%, -0.4%; P = 0.016) and intention-to-treat (risk difference = -1.8%, 95% CI = -3.5%, -0.2%; P = 0.031) analyses. Those who received arm C did not have an increased risk of poor clinical outcome compared to arm A for both per-protocol (risk difference = -1.1%, 95% CI = -2.8%, 0.6%) and intention-to-treat (risk difference = -0.8%, 95% CI = -2.5%, 0.9%) analyses. Overall, those who received arm B had a lower risk of poor clinical outcome compared to the combined arms A and C for both per-protocol (risk difference = -1.6%, 95% CI = -3.5%, -0.1%; P = 0.035) and intention-to-treat (risk difference = -1.4%, 95% CI = -2.8%, -0.1%; P = 0.049) analyses.Conclusions: Analysis of pooled individual patient-level data from three large trials in Africa and Asia showed that the WHO-recommended simplified antibiotic regimen B (oral amoxicillin and injection gentamicin) was superior to regimen A (injection procaine penicillin and injection gentamicin) and combined arms A and C (injection procaine penicillin and injection gentamicin, followed by oral amoxicillin) in terms of poor clinical outcome for the outpatient treatment of young infants with PSBI when inpatient treatment was not feasible.Registration: AFRINEST study [9] is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12610000286044. SATT Bangladesh study [10] is registered with ClinicalTrials.gov: NCT00844337. SATT Pakistan study [11] is registered at ClinicalTrials.gov: NCT01027429. [ABSTRACT FROM AUTHOR]

Children have been made a priority in Australian government obesity interventions, with programmes tending to focus on promoting behaviour change in food and exercise practices. This paper reports findings from ethnographic research with a group of Australian children aged 10–14 years living in a low socio-economic suburban setting. We propose that central to these children’s experiences of food and eating is the negotiation and management of hunger. Historically, disadvantage has been embodied and inscribed on children’s bodies in very visible ways, and the coexistence of hunger and obesity is part of this continuum. Despite considerable evidence of food insecurity in our research site, issues of hunger were absent in an obesity intervention underway at the time. We examine how hunger was felt in children’s lives, how it was managed and the ways in which messages about eating less, while eating more ‘healthy foods’, were at odds with the children’s experiences of hunger. Moreover, we argue that hunger and obesity in this context were doubly stigmatised, as children were very aware of how their hunger and their bodies marked them as different and disadvantaged. Attention to both the embodied and social impacts of hunger on children and their everyday relationships is key in formulating more sensitive, contextualised public health interventions. [ABSTRACT FROM PUBLISHER]

Background: Most countries face an ageing population, increasing chronic diseased, and constrictions on budget for providing health services. Involving patients in their own care by allowing them access to their patient data is a trend seen in many places.Methods: Data on the type and level of access citizens have to their own health data in three countries was gathered from public sources.Results: Data from each individual country is presented and the experiences of Denmark, Estonia and Australia are examined whilst similarities and differences explored. The discussion adopts a citizen-centred perspective to consider how the different e-portal systems support, protect and structure citizen interactions with their own health data in three key areas: Security, privacy and data protection; User support; and Citizen adoption and use.Conclusions: The paper highlights the impact of opt-in/opt-out approaches on citizen access and the lack of a structured approach to addressing differences in citizen health and e-health literacy. This research also confirms while current data provides detail on the availability and use of personal health data by citizens, questions still remain over the ultimate impact on patient outcomes of these initiatives. It is anticipated the insights generated from the three countries experiences, supporting citizen access to their health data will be useful to improve these initiatives and guide other countries aspiring to support similar initiatives. [ABSTRACT FROM AUTHOR]

Background: In Australia, dementia is a national health priority. With the rising number of people living with dementia and shortage of formal and informal carers predicted in the near future, developing approaches to coordinating services in quality-focused ways is considered an urgent priority. Key worker support models are one approach that have been used to assist people living with dementia and their caring unit coordinate services and navigate service systems; however, there is limited literature outlining comprehensive frameworks for the implementation of community dementia key worker roles in practice. In this paper an optimised key worker framework for people with dementia, their family and caring unit living in the community is developed and presented.Methods: A number of processes were undertaken to inform the development of a co-designed optimised key worker framework: an expert working and reference group; a systematic review of the literature; and a qualitative evaluation of 14 dementia key worker models operating in Australia involving 14 interviews with organisation managers, 19 with key workers and 15 with people living with dementia and/or their caring unit. Data from the systematic review and evaluation of dementia key worker models were analysed by the researchers and the expert working and reference group using a constant comparative approach to define the essential components of the optimised framework.Results: The developed framework consisted of four main components: overarching philosophies; organisational context; role definition; and key worker competencies. A number of more clearly defined sub-themes sat under each component. Reflected in the framework is the complexity of the dementia journey and the difficulty in trying to develop a 'one size fits all' approach.Conclusions: This co-designed study led to the development of an evidence based framework which outlines a comprehensive synthesis of components viewed as being essential to the implementation of a dementia key worker model of care in the community. The framework was informed and endorsed by people living with dementia and their caring unit, key workers, managers, Australian industry experts, policy makers and researchers. An evaluation of its effectiveness and relevance for practice within the dementia care space is required. [ABSTRACT FROM AUTHOR]

Background: The Pediatric Quality of Life Inventory™ 4.0 Short Form 15 Generic Core Scales (hereafter the PedsQL) and the Child Health Utility-9 Dimensions (CHU9D) are two generic instruments designed to measure health-related quality of life in children and adolescents in the general population and paediatric patient groups living with specific health conditions. Although the PedsQL is widely used among paediatric patient populations, presently it is not possible to directly use the scores from the instrument to calculate quality-adjusted life-years (QALYs) for application in economic evaluation because it produces summary scores which are not preference-based.Objective: This paper examines different econometric mapping techniques for estimating CHU9D utility scores from the PedsQL for the purpose of calculating QALYs for cost-utility analysis.Methods: The PedsQL and the CHU9D were completed by a community sample of 755 Australian adolescents aged 15-17 years. Seven regression models were estimated: ordinary least squares estimator, generalised linear model, robust MM estimator, multivariate factorial polynomial estimator, beta-binomial estimator, finite mixture model and multinomial logistic model. The mean absolute error (MAE) and the mean squared error (MSE) were used to assess predictive ability of the models.Results: The MM estimator with stepwise-selected PedsQL dimension scores as explanatory variables had the best predictive accuracy using MAE and the equivalent beta-binomial model had the best predictive accuracy using MSE.Conclusions: Our mapping algorithm facilitates the estimation of health-state utilities for use within economic evaluations where only PedsQL data is available and is suitable for use in community-based adolescents aged 15-17 years. Applicability of the algorithm in younger populations should be assessed in further research. [ABSTRACT FROM AUTHOR]

Background: Men use health services less often than women and frequently delay seeking help even if experiencing serious health problems. This may put men at higher risk for developing serious health problems which, in part, may explain men's higher rates of some serious illnesses and shorter life span relative to women. This paper identifies factors that contribute to health care utilisation in a cohort of Australian men by exploring associations between socio-economic, health and lifestyle factors and the use of general practitioner (GP) services.Methods: We used data from Ten to Men, the Australian Longitudinal Study on Male Health. Health care utilisation was defined in two ways: at least one GP visit in the past 12 months and having at least yearly health check-ups with a doctor. Associations between these two measures and a range of contextual socio demographic factors (education, location, marital status, country of birth, employment, financial problems etc.) as well as individual health and lifestyle factors (self-rated health, smoking, drinking, healthy weight, pain medication) were examined using logistic regression analysis. The sample included 13,763 adult men aged 18 to 55 years. Analysis was stratified by age (18 to 34 year versus 35 to 55 years).Results: Overall, 81 % (95 % CI: 80.3-81.6) of men saw a GP for consultation in the 12 months prior to the study. The odds of visiting a GP increased with increasing age (p < 0.01), but decreased with increasing remoteness of residence (p < 0.01). Older men, smokers and those who rate their health as excellent were less likely to visit a GP in the last 12 months, but those on daily pain medication or with co-morbidities were more likely to have visited a GP. However, these factors were not associated with consulting a GP in the last 12 months among young men. Overall, 39 % (95 % CI: 38.3-39.9) reported having an annual health check. The odds of having an annual health check increased with increasing age (p < 0.01), but showed no association with area of residence (p = 0.60). Across both age groups, the odds of a regular health check increased with obesity and daily pain medication, but decreased with harmful levels of alcohol consumption.Conclusion: The majority of men (61 %) did not engage in regular health check-up visits, representing a missed opportunity for preventative health care discussions. Lower consultation rates may translate into lost opportunities to detect and intervene with problems early and this is where men may be missing out compared to women. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnoea is a common disorder with under-rated clinical impact, which is increasingly being recognised as having a major bearing on global disease burden. Men are especially vulnerable and become a priority group for preventative interventions. However, there is limited information on prevalence of the condition in Australia, its co-morbidities, and potential risk factors.Methods: We used data from 13,423 adult men included in the baseline wave of Ten to Men, an Australian national study of the health of males, assembled using stratified cluster sampling with oversampling from rural and regional areas. Those aged 18-55 years self-completed a paper-based questionnaire that included a question regarding health professional-diagnosed sleep apnoea, physical and mental health status, and health-related behaviours. Sampling weights were used to account for the sampling design when reporting the prevalence estimates. Odds ratios were used to describe the association between health professional-diagnosed sleep apnoea and potential correlates while adjusting for age, country of birth, and body-mass index (BMI).Results: Prevalence of self-reported health professional-diagnosed sleep apnoea increased from 2.2 % in age 18-25 years to 7.8 % in the age 45-55 years. Compared with those without sleep apnoea, those with sleep apnoea had significantly poorer physical, mental, and self-rated health as well as lower subjective wellbeing and poorer concentration/remembering (p < 0.001 for all). Sleep apnoea was significantly associated with older age (p < 0.001), unemployment (p < 0.001), asthma (p = 0.011), chronic obstructive pulmonary disease/chronic bronchitis (p = 0.002), diabetes (p < 0.001), hypercholesterolemia (p < 0.001), hypertension (p < 0.001), heart attack (p < 0.001), heart failure (p < 0.001), angina (p < 0.001), depression (p < 0.001), post-traumatic stress disorder (p < 0.001), other anxiety disorders (p < 0.001), schizophrenia (p = 0.002), overweight/obesity (p < 0.001), insufficient physical activity (p = 0.006), smoking (p = 0.005), and high alcohol consumption (p < 0.001).Conclusion: Health professional-diagnosed sleep apnoea is relatively common, particularly in older males. Associations between sleep apnoea and cardiovascular, metabolic, respiratory, and psychiatric disorders have important clinical and public health implications. As men are especially vulnerable to sleep apnoea as well as some of its chronic co-morbidities, they are potentially a priority group for health interventions. Modifiable lifestyle related factors such as smoking, alcohol consumption, level of physical activity and BMI are possible key foci for interventions. [ABSTRACT FROM AUTHOR]