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Objective: Living in regional/rural areas can impact outcomes for people with head and neck cancer (HNC). Using a comprehensive state‐wide dataset, the impact of remoteness on key service parameters and outcomes for people with HNC was examined. Methods: Retrospective quantitative analysis of routinely collected data held within the Queensland Oncology Repository. Design: Quantitative methods (descriptive statistics, multivariable logistic regression and geospatial analysis). Setting: All people diagnosed with HNC in Queensland, Australia. Participants: The impact of remoteness was examined in 1991 people (1171 metropolitan, 485 inner‐regional, 335 rural) with HNC cancer diagnosed between 2013 and 2015. Main Outcome Measures: This paper reports key demographics and tumour characteristics (age, gender, socioeconomic status, First Nations status, co‐morbidities, primary tumour site and staging), service use/uptake (treatment rates, attendance at multidisciplinary team review and timing to treatment) and post‐acute outcomes (readmission rates, causes of readmission and 2‐year survival). In addition to this, the distribution of people with HNC across QLD, distances travelled and patterns of readmission were also analysed. Results: Regression analysis revealed remoteness significantly (p < 0.001) impacted access to MDT review, receiving treatment, and time to treatment commencement, but not readmission or 2‐year survival. Reasons for readmission did not differ by remoteness, with dysphagia, nutritional inadequacies, gastrointestinal disorders and fluid imbalance indicated in the majority of readmissions. Rural people were significantly (p < 0.0001) more likely to travel to care and to readmit to a different facility than provided primary treatment. Conclusions: This study provides new insights into the health care disparities for people with HNC residing in regional/rural areas. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify factors associated with an emergency department (ED) length of stay ≥4 hours (h) and hospital admission for people with a mental health problem brought in by police. Methods: We undertook a retrospective, observational cohort study of state-wide adult ED mental health presentations brought in by police from 1 January 2012 to 31 December 2017. We used multivariable logistic regression to determine factors associated with an ED length of stay ≥4 h and hospital admission. Results: In total, 9325 ED presentations with a mental health problem brought in by police to Queensland EDs were included. Factors most strongly associated with an ED length of stay ≥4 h included an Australasian Triage Score (ATS) of 1, an age of 85 years or older, night shift arrival and subsequent hospital admission. For hospital admission, an ATS of 1, an age of 85 years or older and an ED length of stay ≥4 h were the strongest factors. Conclusion: Findings indicate opportunities for targeted mental health models of care to better support people brought in by police to an ED. Such models should involve ED, pre-hospital providers (police and ambulance) and mental health services to support early intervention and potentially reduce the likelihood of a long ED length of stay and subsequent hospital admission. What is known about the topic? Some people with mental health problems are brought in by police to an emergency department (ED). People brought in by police are recognised as having poorer health profiles compared to other arrival modes. What does this paper add? Several patient and clinical factors influence ED length of stay and hospital admission for people with a mental health problem brought in by police, indicating a need for targeted health care that addresses these factors. What are the implications for practitioners? This study justifies the need to develop specialised pre-hospital models of care and embed early assessment processes in an ED for people with mental health problems brought in by police. [ABSTRACT FROM AUTHOR]

The objective of this case study is to evaluate the effectiveness of the Wide Bay region coronavirus vaccination program in preventing hospitalisation for coronavirus disease 2019 (COVID-19). Population vaccination data and the vaccination status of patients hospitalised with confirmed COVID-19 have been used to evaluate preventable hospitalisations and risk reduction during and after a 2 month period following the outbreak of COVID-19 in Wide Bay after removal of public health measures in Queensland in December 2021. Wide Bay is a rural region of Queensland including K'Gari (formerly Fraser Island) to the east, the North Burnett farming region in the west and extending from the Fraser Coast to the Discovery Coast. Two local regional hospitals received and managed hospitalised COVID-19 patients. The region had, at this time, 171 365 people 20 years and older eligible for coronavirus vaccination. The risk reduction for hospitalisation of those receiving fewer than two vaccinations, two vaccinations and three vaccinations was calculated to determine the vaccination program effectiveness. The program achieved 90% effectiveness for people with two or more vaccinations (those with two vaccinations and those receiving boosters of third or more vaccination), and 97% effectiveness for those having received three vaccinations, in preventing hospitalisation for COVID-19 during the period. This translated into a significant risk reduction for hospitalisation for those receiving two or more vaccinations, preserving capacity to enable the health service to manage all cases locally. What is known about the topic? The real-world effectiveness of coronavirus vaccination program in preventing COVID-19 hospitalisation is 43–86% but this does not include regional programs and health services. What does this paper add? Individual absolute risk reduction for vaccinated local people was modest, but the overall local program effectiveness was substantial in preventing hospitalisations after removal of border quarantine. What are the implications for practitioners? Maintaining coronavirus vaccination programs in rural and regional areas is highly effective in preventing hospitalisations from COVID-19 after quarantine-based public health measures are removed. [ABSTRACT FROM AUTHOR]

Objective: The harmful use of alcohol is a global issue. This study aimed to describe and compare the profiles, emergency department (ED) clinical characteristics, and outcomes of alcohol-related ED presentations (ARPs) and non-alcohol-related ED presentations (NARPs). Methods: A multi-site observational study of all presentations to four EDs between 4 April 2016 and 31 August 2017, was conducted. Routinely collected ED clinical, administrative and costings data were used. Classification of ARPs were prospectively recorded by clinicians. Analysis was performed at the presentation, rather than person level. Univariate tests were undertaken to compare demographics, ED clinical characteristics and outcomes between ARPs and NARPs. Results: A total of 418 051 ED presentations occurred within the 17-month study period; 5% (n = 19 875) were ARPs. Presentations made by people classified as ARPs were younger, more likely to be male, present on weekends or at night, and arrive by ambulance or police compared to NARPs. Compared with NARPs, ARPs had a longer median ED length of stay of over 20 min (95% CI 18–22, median 196 min vs 177 min, P < 0.001), a 5.5% (95% CI 4.9–5.3) lower admission rate (36% vs 42%, P < 0.001), and a AUD69 (95% CI 64–75) more expensive ED episode-of-care (AUD689 vs AUD622, P < 0.001). Conclusion: Clinically meaningful differences were noted between alcohol-related and non-alcohol-related ED presentations. The higher cost of care for ARPs likely reflects their longer time in the ED. The healthcare and economic implications of incidents of alcohol-related harm extend beyond the ED, with ARPs having higher rates of ambulance and police use than NARPs. What is known about the topic? The harmful use of alcohol is a major health issue globally contributing to morbidity and mortality. What does this paper add? The demographic profile, clinical characteristics, and outcomes of people presenting to emergency departments with alcohol-related harm differ to people arriving for other reasons. What are the implications for practitioners? Indicating alcohol as a cause of an ED presentation, as standard practice, may foster quality assurance/improvement activities. [ABSTRACT FROM AUTHOR]

Patients who miss scheduled appointments reduce clinical productivity and delay access to care for other patients. Reminders have improved attendance for healthcare appointments previously, but it is not known if short message service (SMS) implementation reduces incidence of patients unable to attend (UTA) or who fail to attend (FTA) appointments in the public dental service. This paper studied the effectiveness of SMS reminders in increasing appointment attendance at outpatient public dental services in Queensland. Data were sourced from the adult service and the children and adolescent oral health service (CAOHS) at West Moreton Hospital and Health Service, a public dental service in Queensland. A total of 63,238 appointments pre‐implementation of SMS reminders and 55,028 appointments post‐implementation over a period of 2 years were analysed for rates of attendance, UTA and FTA. Characteristics of UTA and FTA appointments were analysed to identify factors that hindered improvement after implementation of reminders. For the CAOHS, the attendance rate decreased 4% (95% CI: 2%, 6%) following SMS implementation. The UTA rate also increased by 20% (95% CI: 15%, 25%). Following SMS implementation in the adult service, the attendance rate increased from 73.5 (95% CI: 72.6, 74.4) to 77.7 (95% CI: 76.6–78.8) per 100 appointments. The FTA rate post‐implementation was 1.08 (95% CI: 1.00, 1.16) times that from pre‐intervention, and the UTA rate decreased from 21.7 (95% CI: 21.2, 22.2) to 17.1 (95% CI: 16.6, 17.7) per 100 appointments. The SMS reminders had a mixed effect on the attendance, UTA and FTA rates for the CAOHS and adult services. Reminders reduced the rates of UTA for the CAOHS service and increased the rate of attendance for the adult service. There was an increase in the FTA rate for both services. [ABSTRACT FROM AUTHOR]

Despite the numerous challenges of ageing in a foreign land, many older immigrants are fairly resilient and report experiencing good wellbeing. The key question that the present paper addresses is how this is achieved. Drawing on frameworks from cross-cultural and social identity literatures, the present study proposes and tests a model of serial multiple mediation that identifies possible mechanisms supporting the wellbeing of older immigrants who have resided in the host country for some time. In this model, it is predicted that new group memberships acquired post-migration enable access to social support that in turn provides the basis for perceived integration, which enhances wellbeing. This model was tested in a survey study with 102 older people, whose mean age was 80.3 years and who had migrated to Australia from Asian, European, and Central and South American countries on average 36 years previously. The survey assessed cultural identity, social group memberships acquired post-migration, perceived social support, perceived integration and wellbeing. Results supported the hypothesised model, indicating that joining new heritage culture and wider groups in Australia post-migration provided a platform for social support and integration, which enhanced life satisfaction and reduced loneliness. The implications of these findings for theory and adapting successfully to both migration and ageing are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Suicide is a leading cause of maternal mortality. Suicidality during and around the time of pregnancy can have detrimental impacts on a child's development and outcomes. This paper examines prevalence, demographic characteristics, and timing of initial contact with first responders and health services for a cohort of women who experienced suicidality during and around the time of pregnancy. Methods: Findings are drawn from the Partners in Prevention (PiP) study, a population-wide linked data set of suicide-related attendances by police or paramedics in Queensland, Australia. A sub-cohort of women was identified, who were between 6 months preconception and 2 years postpartum at the time of a suicide-related contact with police or paramedics (PiP-Maternal). Findings are compared to other girls and women who had a suicide-related contact with police or paramedics (PiP-Female). Prevalence, demographic characteristics, timing of contact with first responders and health services, re-presentations, and mortality are reported. Results: The PiP-Maternal cohort comprised 3020 individuals and 3400 births. Women in the PiP-Maternal cohort were younger, more likely to be of Aboriginal and/or Torres Strait Islander descent and live outside of a major city than the PiP-Female cohort. There were high rates of out-of-hours calls to police and ambulance, and similar perceived seriousness of the call between women in the PiP-Maternal and PiP-Female cohorts. Women in the PiP-Maternal cohort were less likely to be admitted to an emergency department within 24 hours, even after matching on covariates. Prevalence of suicidality for women who were pregnant and up to 2 years postpartum was 1.32% (95% CI = [1.27, 1.37]). Conclusion: Vulnerabilities and high rates of contact with police or paramedics, coupled with lower levels of follow-up, highlight the critical need to improve service responses for women with mental health needs during these phases of life. [ABSTRACT FROM AUTHOR]

Background: Patient Assessment of Care in Chronic Conditions (PACIC+), included in some Australian guidelines, has been shown reliable for measuring patient engagement and perception of their care in primary care settings. Various studies have focussed on PACIC+ use in specific conditions. This study aims to expand PACIC+ to measure patient empowerment to self-manage their chronic condition and validate it in the broader Australian primary care population. This study aims to evaluate internal consistency and reliability of PACIC+ and six new supplementary items proposed to assess patient wellbeing and empowerment to self-manage their chronic condition. Methods: A repeated-measures correlation design study assessed the expanded PACIC+ over three time-points. Particpants were patients with at least one chronic disease, referred by consultant physician, or recruited by advertisement posters in hospital clinic areas. Results: PACIC+ (26-item) had acceptable internal consitency (Cronbach's alpha 0.96). Test–retest reliability (Time-1 and 2, P < 0.01) was acceptable: Total score r (48) = 0.43; and New supplementary items: Confidence r (48) = 0.54; Understanding r (48) = 0.62; Support r (48) = 0.43; Overall Health r (48) = 0.42; Overall Health Change r (48) = −0.31, P = 0.03; and Acute Episodes of Care in 1-month r (48) = 0.42, P < 0.01. Four factors from the original PACIC+ accounted for 66.5% of the variance. Conclusions: The expanded PACIC+ is an improved psychometric tool providing for the patient's voice in a shared health journey. It is a valid, reliable tool to monitor and measure self-management of chronic conditions in Australian population clinic and primary healthcare settings. Six new supplementary patient empowerment and health status measures proved reliable and, in combination with the PACIC+ psychometric tool, could offer a method to monitor and measure the self-management of chronic conditions in the Australian clinic setting and for future research. [ABSTRACT FROM AUTHOR]

Background: The online BeUpstanding™ program is an eight-week workplace-delivered intervention for desk-based workers to raise awareness of the benefits of sitting less and moving more and build a supportive culture for change. A workplace representative (the "champion") delivers the program, which includes a workshop where teams collectively choose their sit less/move more strategies. A toolkit provides the champion with a step-by-step guide and associated resources to support program uptake, delivery, and evaluation. Here we report on the main findings from the Australian national implementation trial of BeUpstanding. Methods: Recruitment (12/06/2019 to 30/09/2021) was supported by five policy and practice partners, with desk-based work teams from across Australia targeted. Effectiveness was measured via a single arm, repeated-measures trial. Data were collected via online surveys, toolkit analytics, and telephone calls with champions. The RE-AIM framework guided evaluation, with adoption/reach (number and characteristics); effectiveness (primary: self-reported workplace sitting time); implementation (completion of core components; costs); and, maintenance intentions reported here. Linear mixed models, correcting for cluster, were used for effectiveness, with reach, adoption, implementation, and maintenance outcomes described. Results: Of the 1640 website users who signed-up to BeUpstanding during the recruitment period, 233 were eligible, 198 (85%) provided preliminary consent, and 118 (50.6%) champions consented and started the trial, with 94% (n = 111 champions) completing. Trial participation was from across Australia and across industries, and reached 2,761 staff, with 2,248 participating in the staff survey(s): 65% female; 64% university educated; 17% from a non-English speaking background. The program effectively changed workplace sitting (-38.5 [95%CI -46.0 to -28.7] minutes/8-hour workday) and all outcomes targeted by BeUpstanding (behaviours and culture), with small-to-moderate statistically-significant effects observed. All participating teams (n = 94) completed at least 5/7 core steps; 72.4% completed all seven. Most champions spent $0 (72%) or >$0-$5 (10%) per team member; most (67/70 96%) intended to continue or repeat the program. Conclusions: BeUpstanding can be adopted and successfully implemented by a range of workplaces, reach a diversity of staff, and be effective at creating a supportive culture for teams of desk-based workers to sit less and move more. Learnings will inform optimisation of the program for longer-term sustainability. Trial registration: ACTRN12617000682347. [ABSTRACT FROM AUTHOR]

The utilisation of telehealth among culturally and linguistically diverse communities in Australia remains unexplored. We aimed to describe telehealth (telephone and videoconference) utilisation within a major health service and identify sociodemographic factors that may contribute to limited telehealth access. Methods. A cross-sectional study was performed using service activity data from four metropolitan hospitals in Queensland, Australia. Outpatient department data (January to December 2021) were examined. These data included patients (N = 153 427) of all ages who had an outpatient appointment within 10 speciality services (i.e. Hepatology, Gastroenterology, Immunology and Psychology) that were the most frequent videoconference users. This study measured telehealth utilisation across the four tertiary hospitals and its association with sociodemographic factors. Descriptive statistics and regression analysis were used. Multivariate regression models were adjusted by sex, socioeconomic level and language use. Results. Overall, 39% of appointments were delivered through telehealth, with 65% of all reported telehealth services involving a telephone consultation. People who required interpreter services were 66% less likely to use telehealth services (OR adjusted 0.33, 95% CI 0.31–0.36, P < 0.05) than English-speaking people. Among those using telehealth, people requiring interpreter services were 13% less likely to use videoconference than phone (OR adjusted 0.87, 95% CI 0.77–0.98, P < 0.005). Conclusion. There is a gap in Australian telehealth service use for people with culturally diverse backgrounds and limited English proficiency. This study highlights a critical need to determine how people from culturally diverse backgrounds would like to engage with digital care options such as telehealth and the necessary support to enable this. [ABSTRACT FROM AUTHOR]

Introduction: The WHO estimates the incidence of iron deficiency anaemia in Australia is 25%. However there is considerable variation during pregnancy and in regional areas. Objective: The aim of this investigation is to quantify the incidence of iron deficiency anaemia during pregnancy within Far North Queensland. Design: This is a single‐centre retrospective cohort study. Cairns Hospital is the main referral centre for complex maternity care in Far North Queensland with an estimated population of 280‐000, which includes many people from rural and remote communities and a high proportion who identify as Aboriginal or Torres Strait Islander. This study included all births at the Cairns Hospital in 2018, a total of 2190 deliveries. Findings: The study randomly sampled 551 mothers from the cohort, and the incidence of iron deficiency anaemia was 34.9%. 48.7% of women who identified as Aboriginal or Torres Strait Islander within the region were anaemic. This was significantly higher than an incidence of 28.9% for the rest of the population. Other risk factors include booking appointment after 28‐weeks, Asian ethnicity and age less than 25‐years. A BMI greater than 35 was protective Discussion: This study will inform antenatal care providers within the region and improve obstetric outcomes by increasing awareness. Identifying risk factors will also facilitate prompt treatment and improve maternity care for vulnerable patient groups. On a broader level, the study provides new data to inform population health estimates both nationally and internationally. Conclusion: The incidence of iron deficiency anaemia during pregnancy in Far North Queensland is significantly higher than previous estimates. [ABSTRACT FROM AUTHOR]

Background: The long-term mental and physical health consequences of childhood maltreatment have been well documented. Less known are the longer-term consequences of childhood maltreatment, specifically the extent to which childhood maltreatment predicts adult life success. Objectives: To prospectively assess the extent to which childhood experiences of physical, sexual, emotional abuse and childhood neglect predict life success at 30 years of age. Participants and Setting: Data are from the Mater-University of Queensland Study of Pregnancy (MUSP), a pre-birth cohort study which follows children from conception to 30 years of age. Methods: Details of childhood maltreatment are from two sources; child safety agency notifications (and substantiations) linked to the survey data with self-reports of childhood experiences of maltreatment obtained at the 30-year follow-up using the Child Trauma Questionnaire (CTQ). Life success is a 9-item composite measure (alpha = 0.76) obtained at the 30-year follow-up. We use logistic regression models (with control for covariates) to examine the association between overall as well as specific forms of childhood maltreatment on adult life success. We further test these models using different cut-offs and propensity analyses to adjust for loss to follow-up. Results: Childhood maltreatment whether measured by agency report or self-report predicts overall low life success; agency substantiation OR = 1.88(1.14,3.08) & self-report OR = 2.60 (2.10,3.25). Self-report physical abuse, OR = 2.37(1.72,3.28); sexual abuse, OR = 2.85(2.05,3.96); emotional abuse, OR = 2.53(1.85,3.45) and neglect, OR = 2.36(1.83,3.03) all predict higher levels of low life success. Conclusions: Our findings suggest that the long-term consequences of childhood maltreatment extend to a wide range of day-to-day circumstances and extend into mid- to later life. [ABSTRACT FROM AUTHOR]

Background: Preventative strategies for preterm birth are lacking. Recent evidence proposed COVID‐19 lockdowns may have contributed to changes in preterm birth. Aims: To determine the prevalence of preterm birth and birth outcomes during and after the COVID‐19 lockdown at the Sunshine Coast University Hospital and the overall state of Queensland, Australia. Methods: Retrospective cohort analysis of all births in Queensland including the Sunshine Coast University Hospital, during two epochs, April 1–May 31, 2020 (lockdown) and June 1–July 31, 2020 (post‐lockdown), compared to antecedent calendar‐matched periods in 2018–2019. Prevalence of preterm birth, stillbirth, and late terminations were examined. Results: There were 64 989 births in Queensland from April to July 2018–2020. At the Sunshine Coast University Hospital, there was a significantly higher chance of birth at term during both lockdown (odds ratio (OR) 1.81, 95% CI 1.17, 2.79; P = 0.007) and post‐lockdown (OR 2.01, 95% CI 1.27, 3.18; P = 0.003). At the same centre, prevalence of preterm birth was 5.5% (30/547) during lockdown, compared to 9.1% (100/1095) in previous years, a 40.0% relative reduction (P = 0.016). At this centre during lockdown, emergency caesareans concurrently decreased (P < 0.01) and instrumental vaginal births increased (P < 0.01). In Queensland overall, there was a nonsignificant decrease in the prevalence of preterm birth during lockdown. Conclusions: There is a link between lockdown and a reduction in the prevalence of preterm birth on the Sunshine Coast. The cause is speculative at present, although increased influenza vaccination rates, decreased transmission of infections, and improved air quality may have been favourable in reducing preterm birth. Further research is needed to determine a causal link. [ABSTRACT FROM AUTHOR]

Objective(s): The objective of the study was to validate a clinical aid to guide the assessment and management of a patient's listed beta‐lactam antibiotic allergy for use in rural areas of Australia. Design: Rural generalists, pharmacists and junior doctors completed an online assessment of eight patient case studies using the tool. Setting: The study was conducted in the Southern Downs, QLD. Participants: Twenty‐seven rural generalists, nine pharmacists and eight junior doctors. Main outcome measures: The sensitivity of the selected allergy phenotype and management option for each case study was calculated by profession and overall. Hazardous responses were reported by management category and profession. Results: The sensitivity overall for phenotype selection was 82.4% (95% CI, 78.0–86.2) and for management 88.1% (95% CI, 84.2–91.2). The sensitivity for phenotype selection was lower for junior doctors than other professions 73.4% (95% CI, 60.9–83.7), but did not reach statistical significance (p = 0.08). A total of 10/308 responses for management recommended the least restrictive option of direct delabelling or oral challenge, where the correct answer was skin prick testing or referral to an allergist. Conclusion(s): With further education the tool could be a key component of increased antimicrobial stewardship in rural areas in Australia. [ABSTRACT FROM AUTHOR]

This study explored the epidemiology and health literacy of people affected by viral hepatitis (VH) from migrant culturally and linguistically diverse (CALD) backgrounds attending a community-based general practitioner and specialty hepatology shared-care (HEPREACH) clinic in Brisbane, Australia. Patient-reported data on health literacy and clinical information from adult patients (n = 66) of CALD background recruited from the liver clinic were analyzed. Health literacy was assessed using a 5-question, 12-point scale. Variance weighted multiple linear regression was used to identify factors associated with knowledge about VH. About three-quarters of patients (74.2%) were diagnosed with hepatitis B. The median knowledge score was 7.8 (interquartile range [IQR] 6‒9). One in five patients did not understand the infective nature of VH, 30.3% did not understand mother-to-child transmission risk, and 30–40% of patients thought activities such as kissing, sharing food or mosquito bites could spread VH. Only 6% of patients understood the risk of liver cancer and the need for regular screening. Higher educational level (secondary, β = 4.8, p < 0.0001 or tertiary, β = 8.1, p < 0.0001 vs. primary) was associated with better knowledge, and transition through a refugee camp (vs. not, β = − 1.2, p = 0.028) and country of diagnosis (overseas vs. Australia, β = − 1.9, p = 0.016) were associated with poorer knowledge. Country of origin, refugee status and opportunities for tertiary education impact patients' understanding of VH. Ensuring delivery of culturally appropriate care and education is critical to improve knowledge, reduce misconceptions to improve care and outcomes for VH in CALD migrant communities. [ABSTRACT FROM AUTHOR]

Hospital‐acquired skin tear prevalence is under‐reported; thus, the aim of this study was to analyse skin tear point prevalence and characteristics in a tertiary acute care hospital in Queensland, Australia, over a 10‐year period. All consenting adult inpatients received a full skin inspection and skin tear category, site, cause, treatment, and whether it was documented as hospital‐ or community‐acquired were recorded. Eleven prevalence audits were analysed with a total sample of 3626 patients. An overall pooled prevalence of 8.9% (95% confidence interval [CI] 7.5‐10.4) with an associated hospital‐acquired pooled prevalence of 5.5% (95% CI 4.5‐6.7) was found. In total, 616 skin tears were reported, of which 374 (60.7%) were hospital‐acquired. Over a third of patients (38.7%) had multiple skin tears and most patients (84.8%) with at least one skin tear were aged ≥70 years. The largest proportion of skin tears (40.1%) was those with no skin flap. Of those documented, most were caused by falls or collisions, suggesting combined skin tear and falls prevention strategies may be effective. Over a decade, there was a downward trend in hospital‐acquired skin tear, which is encouraging. Skin tear prevalence is recommended as a measure of care quality with an emphasis on good quality documentation. [ABSTRACT FROM AUTHOR]

Background: Immediate postpartum long‐acting reversible contraception (LARC) has been shown to reduce unintended pregnancy but uptake of this type of contraception in Australia is low compared to European counterparts. Aims: To assess self‐reported continuation rates, complications and satisfaction in patients having immediate postpartum hormonal intrauterine device (IUD) inserted at caesarean section (CS) or after vaginal birth (VB). Materials and methods: Retrospective cohort study of all patients with immediate postpartum hormonal IUD insertion over three years at a tertiary maternity service. Primary outcomes were patient satisfaction, continuation and expulsion rates. Secondary outcomes were reason for discontinuation, patient‐reported complications, attendance for postpartum check with a general practitioner (GP) and rate of unplanned pregnancy. Simple descriptive statistics were used to analyse the data. Results: One hundred and ninety‐three women had a hormonal IUD inserted and 143 consented to involvement (CS n = 79; VB n = 64). Six and 12 months continuation rates for CS were 60.8% and 54.4%, and VB were 46.9% and 39.1%. The most common reasons for removal were: pain (34.5%), heavy or irregular bleeding (25.9%) and partial expulsion (24.1%). Expulsion was more likely after VB (34.1%) than CS (10.1%), (odds ratio 2.72; 95% CI 1.07–6.90; P = 0.036). There were 60.8% of women post‐CS and 56.3% of women post‐VB who were satisfied with their decision to have immediate postpartum insertion and most women attended routine postpartum follow‐up with their GP (89.5%). Conclusion: Immediate postpartum hormonal IUD insertion in this cohort is associated with higher rates of expulsion and lower satisfaction rates compared to those documented in the literature for delayed postpartum insertion cohorts. [ABSTRACT FROM AUTHOR]

Objective: This study compares the well‐being of rural caregivers with that of the general population and explores the potential drivers of poorer outcomes. Method: Patient–caregiver dyads (n = 241) residing in regional or remote Queensland, Australia, reported on QoL, chronic illness, caregiver burden, depression, anxiety and stress. Caregiver outcomes were compared with population norms and patient outcomes. Multiple regressions were conducted to identify factors associated with poorer caregiver outcomes. Results: Caregivers reported lower mental health‐related QoL (M = 0.436, 95% CI = 0.410–0.462) in comparison with age‐matched population norms (M = 0.556, 95% CI = 0.532–0.580). No differences existed between caregiver and population norms for anxiety, stress and depression. Caregiver chronic illness and higher burden were associated with poorer mental and physical QoL, depression, anxiety and stress (η2s ranging from 0.03 to 0.30). These associations were slightly stronger for male caregivers when compared with female caregivers (η2s ranging from 0.03 to 0.08). Conclusion: It is vital that efforts are made to improve rural caregivers' mental and emotional well‐being. Interventions that support caregivers with chronic conditions reduce caregiver burden and take into consideration the unique experience of male caregivers will go some way to addressing this. Future research is needed to identify other drivers of health outcomes in this group. [ABSTRACT FROM AUTHOR]

Background. People released from prison have poorer health than the general public, with a particularly high prevalence of mental illness and harmful substance use. High-frequency use of hospital-based services is costly, and greater investment in transitional support and primary care services to improve the health of people leaving prison may therefore be cost-effective. Methods. A prospective cohort study of 1303 men and women released from prisons in Queensland, Australia, between 2008 and 2010, using linked data was performed. We calculated healthcare costs and the cost of re-incarceration. We compared healthcare costs to the general public, and assessed the impact of past mental illness, substance use disorder, and dual diagnosis on both healthcare and criminal justice costs. Results. Healthcare costs among the cohort were 2.1-fold higher than expected based on costs among the public. Dual diagnosis was associated with 3.5-fold higher healthcare costs (95% CI 2.6-4.6) and 2.8-fold higher re-incarceration costs (95% CI 1.6-5.0), compared with no past diagnosis of either mental illness or substance use disorder. Conclusions. People released from prison incur high healthcare costs, primarily due to high rates of engagement with emergency health services and hospital admissions. Comorbid mental illness and substance use disorders are associated with high health and criminal justice costs among people recently released from prison. [ABSTRACT FROM AUTHOR]

Objective. To examine the characteristics and circumstances of admitted patients with disability who require individualised supports to leave hospital and who experience interim discharge arrangements. Methods. The study used a retrospective exploratory design. Medical chart reviews of patients with disability who required funded support to leave hospital were conducted. The records of 224 patients admitted to one of three hospital facilities in South-East Queensland, Australia, between May 2017 and January 2020 were reviewed. Information about hospital facility, demographic characteristics, disability type, support needs, discharge destination, and reasons for interim discharges were extracted for analysis. Results. Forty of 224 patients were discharged to an interim destination. Inter-hospital transfers were the most common interim discharge arrangement. Being divorced or separated was the only demographic variable associated with having an interim discharge arrangement for admitted patients with disability. More patients with disability who experienced an interim discharge required accommodation supports and behavioural supports compared to patients who were not involved in interim discharges. Conclusions. Patients with disability with minimal informal support and who rely on a sophisticated mix of individualised supports to leave hospital may be more susceptible to interim discharge arrangements. Early identification of these patients and formal mechanisms for ensuring continuous coordination of ongoing transitions and supports is critical to avoid sub-optimal outcomes. Future research is needed to capture a complete picture of the series of transitions of interim discharged patients with disability leaving acute care facilities and the quality of their supports and outcomes. [ABSTRACT FROM AUTHOR]

Background: A significant barrier to the access of safe abortion is the lack of trained abortion providers. Recent studies show that with appropriate education, nurses and midwives can provide abortions as safely as medical practitioners. Aims: To examine the attitudes and practices of registered midwives (RMs) and sexual health nurses (SHNs) in Queensland toward abortion. Materials and Methods: A cross‐sectional mixed‐methods questionnaire was distributed to RMs and SHNs from the Queensland Nursing and Midwifery Union. Data were described and analysed both quantitatively and qualitatively. Results: There was a 20% response rate (n = 624) to the survey from the overall study population. There were 53.5% who reported they would support the provision of abortion in any situation at all; 7.4% held views based on religion or conscience that would make them completely opposed to abortion. There were 92.9% who felt that education surrounding abortion should be part of the core curriculum for midwifery and/or nursing students in Australia. The qualitative responses demonstrated a variety of views and suggestions regarding the practice of abortion. Conclusions: There was a wide variation in views toward induced abortion from RMs and SHNs in Queensland. While a proportion of respondents opposed abortion in most circumstances, a significant group was in support of abortion in any situation and felt involvement in initiating and/or performing abortion would be within the scope of RMs and SHNs. [ABSTRACT FROM AUTHOR]

Objectives: To identify the maternal and social characteristics associated with age standardised birthweight in a modern developed setting. Methods: Birth records (n = 414,478) were obtained for live, singleton births in the period 2007–2015 in Queensland, Australia. Age-standardised birth weights were calculated and a multinomial logistic regression was performed to obtain odds ratios and 95% confidence intervals for a range of maternal and social characteristics. Results: Mothers who smoke (OR 2.82, 95% CI 2.72–2.93), and mothers from Southern and Central Asia (OR 3.30, 95% CI 3.08–3.53) had the highest odds of delivering small for gestational age babies. Smoking alone accounted for 21% of low birthweight. Pre-existing diabetes (OR 5.98, 95% CI 5.12–6.99) had the highest odds ratio for large for gestational age births; however, maternal overweight and obesity accounted for 24% of all cases due to its greater prevalence in the population. Conclusion for practice: Smoking continues to be an important modifiable predictor of low birthweight. The predictors associated with large for gestational age are modifiable, with maternal overweight and obesity the largest contributor to high birthweight. Significance: Maternal characteristics are changing alongside broader population change, with mothers often older and heavier than in previous decades. This study provides an update to the role of maternal and social characteristics in optimal birthweight within a large developed population. The present study finds a range of traditional and emerging risk factors remain important. Population attributable risk fractions show that maternal overweight and smoking are the most important modifiable risk factors for birthweight extremes (foetal macrosomia and small for gestational age, respectively). Public health efforts to address these risk factors could reduce up to 20% of birth weight extremes. [ABSTRACT FROM AUTHOR]

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

Objective. The provision of medicines through state public hospitals is comparatively restrictive compared with the federally funded Pharmaceutical Benefits Scheme (PBS). Individual states are progressively moving towards statewide medicines formularies. Although a statewide formulary has existed in Queensland for some time. The effects of hospital formularies on medicines utilisation and policy in Australia has not been quantified. Thus, the aim of the present study was to quantify the effects of the Queensland Health List of Approved Medicines (LAM) on medicines utilisation in Queensland at a state and PBS-purchasing level and describe the implications for medicines policy. Methods. This study used a quasi-experimental design with an interrupted time series (with control for PBS) examining utilisation effects of medicines within the therapeutic classes of proton pump inhibitors and non-vitamin K oral anticoagulants with LAM listing or delisting. Results. The LAM was demonstrated to be highly effective at controlling utilisation within Queensland Health purchasing. Effects on PBS utilisation were evident, resulting in increases in generic utilisation (where available) and associated reduced total costs both within Queensland Health and to the PBS. The full benefit is likely underestimated due to limitations in the PBS datasets. Conclusion. The LAM is a highly effective state medicines policy tool with demonstrable effects on PBS utilisation. With increased use of statewide medicines formularies, this will be an increasingly relevant aspect of Australia's overall medicines policy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Focusing on employees with psychological strain, this research draws on Fredrickson's 'undoing hypothesis' to examine praise and recognition from one's supervisor as an organizational resource. OBJECTIVE: A model is tested in which psychological strain is a mediator in the positive relationship between role demands and employees' intentions to take sick leave and seek medical advice, and positions supervisor praise and recognition as a buffer of psychological strain on such intentions. METHODS: The model was tested using two Australian samples in the tourism sector, consisting of motel workers (n = 104) and museum workers (n = 168). RESULTS: For museum workers, but not motel workers, there was a positive indirect effect of each role demand on sick leave intentions through psychological strain that weakened as a function of supervisor praise and recognition. The proposed moderated mediated model was supported for both samples in regards to intentions to seek medical advice. CONCLUSIONS: This research contributes new evidence regarding the antecedents of employees' intentions to take sick leave and seek medical advice for work stress-related problems. It also contributes to the limited evidence regarding supervisor praise and recognition as a protective factor for employees exhibiting the symptoms of psychological strain. [ABSTRACT FROM AUTHOR]

Introduction: Extremely preterm births (EPT), require complex decision making and significant medical interventions. While environmental factors such as ambient temperature extremes have been associated with preterm births, little is known of the environmental associations with EPT births. The objective of this study is to explore whether ambient temperature is associated with increased risk of EPT birth. Methods: Birth records for 315,226 infants born in Queensland Australia (2007–2015) were matched to average maximum and minimum temperature for the last month of pregnancy. Odds ratios and 95% confidence intervals were calculated using a generalised linear model. Population attributable risk was calculated for a 5% reduction in maximum temperature. Results: Each one degree increase in maximum [aOR 1.03 (95% CI 1.01, 1.05)] and minimum temperature [aOR 1.02 (95% CI 1.01, 1.04)] was associated with an increase in odds for EPT birth. Increased odds for EPT births was found for maternal smoking [aOR 1.46 (95% CI 1.23, 1.72)], increasing plurality [OR 6.38 (95% CI 5.48, 7.42)] and stillbirth [aOR 342.99 (95% CI 295.53, 398.06)]. When stratified by birth status, the association was only found for live births. Discussion: Higher temperatures are associated with small increases in the odds of delivering an infant in the EPT period. The risk may be enhanced for women who smoke during pregnancy. Women at an increased risk of preterm births should be counselled around methods to reduce their exposure to excessive heat. [ABSTRACT FROM AUTHOR]