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

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

Objective: To explore reasons for survival disparities for patients with prostate cancer in the Barwon South West area of Victoria. Design, Setting and Participants: We have described incidence, diagnostics, treatment pathways, and survival for four regions of the Barwon South Western Victoria. Analysis included all newly diagnosed prostate cancer patients from 2009 to 2015 in the Evaluation of Cancer Outcomes Barwon South West Registry. Regions included 1: Queenscliffe 2: Geelong, Colac Otway and Corangamite 3: Moyne, Warrnambool and Southern Grampians and 4: Glenelg. Across the four regions, variables were compared using a chi square statistic or analysis of variance and survival data was assessed with the Kaplan–Meier curves. Main Outcome Measures: Incidence, treatment pathways and survival for prostate cancer patients. Results: A total of 1776 patients were diagnosed with prostate cancer from 2009 to 2015 in the Barwon South West area. In regions 1–4, there were 298 (1.04%), 1085 (0.92%), 273 (0.97%) and 120 (1.2%) cases, respectively. There was no significant difference in Gleason score and treatment. The 5‐year survival rate was 85%, 76%, 71% and 80%, respectively, as compared with the national average of 95%. PSA scores >20 ng/ml at diagnosis, as a surrogate for high‐risk disease, occurred in 23%, 29%, 22% and 21%, respectively (p < 0.01). The proportions presenting with stage IV disease were 17%, 26%, 21% and 6%, respectively (p = 0.10). Conclusion: Men diagnosed with prostate cancer in South West Victoria have a considerably lower 5‐year survival compared with the national average with later disease at presentation in some areas. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has necessitated alterations in provision of health care and how patients access it. Telehealth has replaced traditional face‐to‐face outpatient clinics in an unprecedented manner. This study aimed to assess overall patient and clinician satisfaction with telehealth consultations, to establish acceptability of telehealth during pandemic and non‐pandemic times, and document feedback. Materials and Methods: A prospective observational study involving women presenting to a general gynaecology outpatient department was performed. Women who attended for consultation between 13 July and 4 September 2020 were invited to participate in a questionnaire following their telehealth appointment. Clinicians consulting in the outpatient department were invited to complete a questionnaire at the end of the eight‐week study period. Satisfaction, utility and acceptability data were obtained using visual analogue scales (VAS). Results: Twenty‐six out of 56 (46.4%) clinicians and 124/870 (14.3%) patients completed the questionnaire. Patients who responded were older and more likely to have been born in Australia than women who did not (P = 0.0355 and P = 0.005, respectively). Overall patient satisfaction with telehealth was high (median VAS (interquartile range), 8.6 (5.6–9.8)). More women found telehealth to be acceptable during a pandemic than afterward (8.9 vs 6.6, P < 0.0001). Clinicians were less satisfied with telehealth than patients (7.1 vs 8.6, P = 0.02); however, most would be happy to continue using telehealth in non‐pandemic times (7.0 (6.2–9.8)). Conclusion: Telehealth consultations allow provision of gynaecological care at a time when reducing risk of infection to patients and staff is paramount. Telehealth gynaecology consultations are efficient and convenient without significant detriment to patient or clinician satisfaction. [ABSTRACT FROM AUTHOR]

Objective There is little evidence that useful electronic data could be collected at Australian small rural emergency services. If in future their funding model changed to the Activity- Based Funding model, then they would need to collect and submit more data. We determine whether it is possible to collect episode-level data at six small rural emergency services and quantify the accuracy of eight fields. Design A prospective cross-sectional study. Setting South-West Victoria, Australia. Participants Six small rural emergency services. Intervention We collected and audited episode-level emergency data from participating services between 1 February 2011 and 31 January 2012. A random sample of these data were audited monthly. Research assistants located at each service supported data entry and audited data accuracy for four hours per week. Main outcome measures Rates for data completeness, accuracy and total accuracy were calculated using audit data. Results Episode-level data were collected for 20 224 presentations across six facilities. The audit dataset consisted of 8.5% (1504/17 627) of presentations from five facilities. For all fields audited, the accuracy of entered data was high (>93%).Triage category was deemed appropriate for 95.9% (95% confidence interval ( CI): 94.9-96.9%) of the patient records reviewed. Some procedures were missing (28.7%, 95% CI: 27.2-30.3%). No significant improvement in data accuracy over 12 months was observed. Conclusion All six services collected useful episode-level data for 12-months with four hours per week of assistance. Data entry accuracy was high for all fields audited, and data entry completeness was low for procedures. [ABSTRACT FROM AUTHOR]

Behavioural assessment units (BAU) have been established in emergency departments (EDs) to provide short‐term observation, treatment, and care to people experiencing acute behavioural disturbance. A prospective observational study was conducted in a cohort of adult patients admitted to one BAU located within an ED (July–December 2017) to compare clinical characteristics, treatment outcomes, and use of restrictive interventions for those who received a specialist mental health (MH) assessment with those who did not. Of the 457 patients, 61.5% received a specialist MH assessment. This group had a lower acuity (Australasian Triage Score 10.4%; CI 0.2–2.0% vs 13.6%; CI 9.3–19.5%); more arrived with police (28.8%; CI 23.8–34.3 vs 5.1%; CI 2.7–9.4%); and were subjected to restrictive interventions while in the BAU. Security responses for unarmed threat (code grey) were higher (10.9%; CI 7.8–15.0% vs 4.4%; CI 2.3–8.5%), as was the use of chemical restraint (4.2%; CI 2.4–7.2 vs 0.0% CI 0.0 – 2.1%). Those requiring specialist MH assessment had a longer length of stay (12.7 vs 5.2 hours). Further development of the BAU model of care must include targeted, evidence‐based strategies to minimize the use of restrictive interventions and ensure timely access to acute mental health services. [ABSTRACT FROM AUTHOR]

Background and purpose: Due to global ageing, more people will suffer from hip fracture in the future, and many will be left with permanent physical impairments. The care burden for people post hip fracture is high. The aim of this study is to measure longitudinal changes in physical activity levels and fear of falling in people after hip fracture who return home after inpatient rehabilitation. Methods: Longitudinal observational study. Participants were recruited from three rehabilitation centres in Victoria, Australia. Self‐reported fear of falling (Short Falls Efficacy Scale – International) and physical activity levels (Human Activity Profile – Adjusted Activity Score and Frenchay Activity Index) were assessed at 2 weeks, 3 and 6 months after discharge. Mobility (walking speed) and balance (Timed Up‐and‐Go test and Step Test) were measured at discharge from rehabilitation. Results: Thirty‐four participants (mean age: 82 years [SD 8]; 62% female) with unilateral hip fracture were recruited. Participants had moderately impaired balance and mobility at discharge compared to age‐matched normative data; they were all discharged with a walking aid and were 40% slower in their walking speed. Participants had increased fear of falling and reduced physical activity 2 weeks after discharge, which improved significantly (p < 0.01) over the following 6 months, but scores were still lower than the normative values. At 6 months, participants also had moderate to high levels of fear of falling and were less active than the general population of similar age. Discussion: Although fear of falling and physical activity improved in the 6 months following discharge, both remained negatively affected compared to normative data. Rehabilitation post hip fracture should include routine assessment of fear of falling as a potential barrier for return of physical activities. [ABSTRACT FROM AUTHOR]

Background: Severe postpartum haemorrhage (PPH) is a serious clinical problem that is increasing in incidence. Aim: To identify risk factors for severe PPH. Materials and Methods: Population‐based retrospective cohort study of all women who gave birth in Victoria in 2009–2013 using the validated Victorian Perinatal Data Collection. Three multivariable logistic regression models estimated the adjusted risk of severe PPH. Adjusted odds ratios (aOR) and their 95% confidence intervals are reported. The primary outcome was severe PPH (estimated blood loss of ≥1500 mL). Results: Severe PPH occurred in 1.4% of all births (n = 5122). Maternal characteristics significantly associated with severe PPH included: multiple pregnancy; older maternal age; overweight/obesity; first births. Other risk factors included placental complications, macrosomia, instrumental vaginal birth, third and fourth degree perineal lacerations, in‐labour caesarean section, birth at a gestation other than 37–41 weeks, duration of labour 12 to <24 h, and use of oxytocin infusions in labour. Planned pre‐labour caesarean section was associated with reduced odds of severe PPH. Severe PPH also occurred in 0.7% (n = 104) of women with none of the identified risk factors. Conclusions: Numerous risk factors for severe PPH are identified but some cases are not modifiable or predictable. Limiting use of oxytocin infusions in labour to cases with clear indications, and strategies to prevent severe perineal lacerations would prevent some severe PPHs. Close surveillance of all women in the hours immediately following birth is crucial to detect and manage excessive blood loss and reduce severe PPH and associated morbidity. [ABSTRACT FROM AUTHOR]

Objective: High‐quality data regarding the prevalence of chronic disease in rural areas are essential in understanding the challenges faced by rural populations and for informing strategies to address health care needs. This study compared the prevalence of a range of self‐reported chronic conditions and utilisation of GP services and emergency department in a regional Victorian setting between two studies conducted in the same region in 2001‐2003 and 2014. Design: Repeat cross‐sectional studies conducted over a decade apart. Setting: The projects were conducted in the Goulburn Valley in regional Victoria. Participants: The earlier study randomly selected households from local government lists. The later study randomly selected householders from the telephone directory. Main outcome measures: Participants were asked whether they had been diagnosed with a range of chronic health conditions and how often they had visited a general practitioner or emergency department in the past 12 months. Results: The age‐standardised prevalence of depression was higher in the 2014 study than the 2001‐2003 study in men (increased by 8.0% (95% CI 4.5, 11.5%)) and women (increased by 13.7% (95% CI 8.4, 19.0%)). Similarly, the prevalence of age‐standardised diabetes and hypertension was higher in 2014 than 2001‐2003 (men increased by 3.6% (95% CI 0.7, 6.5% (diabetes)) and 13.6% (95% CI 8.6, 18.6% (hypertension)), women increased by 3.1% (95% CI 0.3, 6.5% (diabetes)) and 8.4% (95% CI 2.3, 14.5% (hypertension))). Conclusion: The results of this study indicate that the prevalence of self‐reported depression, diabetes and hypertension has increased in this regional Victorian area over the past 13 years. The reasons for these observed increases and the subsequent impact on the health care needs of regional communities warrants further investigation. [ABSTRACT FROM AUTHOR]

In the present study, we explored the predictive validity of the Dynamic Appraisal of Situational Aggression ( DASA) assessment tool in male ( n = 30) and female ( n = 30) patients admitted to the acute units of a forensic mental health hospital. We also tested the psychometric properties of the original DASA bands and novel risk bands. The first 60 days of each patient's file was reviewed to identify daily DASA scores and subsequent risk-related nursing interventions and aggressive behaviour within the following 24 hours. Risk assessments, followed by documented nursing interventions, were removed to preserve the integrity of the risk-assessment analysis. Receiver-operator characteristics were used to test the predictive accuracy of the DASA, and generalized estimating equations ( GEE) were used to account for repeated risk assessments, which occurs when analysing short-term risk-assessment data. The results revealed modest predictive validity for males and females. GEE analyses suggested the need to adjust the DASA risk bands to the following (with associated odds ratios ( OR) for aggressive behaviour): 0 = low risk; 1, 2, 3 = moderate-risk OR, 4.70 (95% confidence interval ( CI): 2.84-7.80); and 4, 5, 6, 7 = high-risk OR, 16.13 (95% CI: 9.71-26.78). The adjusted DASA risk bands could assist nurses by prompting violence-prevention interventions when the level of risk is elevated. [ABSTRACT FROM AUTHOR]

The sexual health of people with mental illness is commonly overlooked, neglected or inadequately addressed in mental health care, despite evidence showing that people with severe mental illness are more vulnerable to sexually transmitted infections (including HIV), sexual side-effects, and sexual dysfunction than the general population. This article reports a study that investigated sexual health screening in five community mental health clinics within a large a regional health service in Victoria, Australia. The aim of the study was to examine the extent to which sexual health screening is currently undertaken on newly admitted case-managed consumers, and to identify the types of screening undertaken. An exploratory design using retrospective file audit was used in the study. A total of 186 medical records met the study inclusion criteria. The study found that less than 40% of consumers were provided with sexual health screening during their first 12 weeks of case management. The study also found that sexual side-effects, issues of fertility, sexual self-esteem, safe sexual practices, and sexual dysfunction were rarely screened for. Poor sexual health screening has implications for the safety and quality of mental health care and requires targeted research to improve understandings and approaches to care. [ABSTRACT FROM AUTHOR]

The article examines the extent and source of occupational violence and aggression (OVA) experienced by nursing and caring professionals. Topics discussed include analysis of the relative contributions of demographic characteristics and workplace and individual safety factors in predicting OVA; online survey of employees in the nursing and caring professions in Victoria; and healthcare workers experiencing OVA.

Objective To investigate if parental disapproval of alcohol use accounts for differences in adolescent alcohol use across regional and urban communities. Design Secondary data analysis of grade-level stratified data from a random sample of schools. Setting High schools in Victoria, Australia. Participants A random sample of 10 273 adolescents from Grade 7 (mean age = 12.51 years), 9 (14.46 years) and 11 (16.42 years). Main outcome measures The key independent variables were parental disapproval of adolescent alcohol use and regionality (regional/ urban), and the dependent variable was past 30 days alcohol use. Results After adjusting for potential confounders, adolescents in regional areas were more likely to use alcohol in the past 30 days ( OR = 1.83, 1.44 and 1.37 for Grades 7, 9 and 11, respectively, P < 0.05), and their parents have a lower level of disapproval of their alcohol use ( b = −0.12, −0.15 and −0.19 for Grades 7, 9 and 11, respectively, P < 0.001). Bootstrapping analyses suggested that 8.37%, 23.30% and 39.22% of the effect of regionality on adolescent alcohol use was mediated by parental disapproval of alcohol use for Grades 7, 9 and 11 participants respectively ( P < 0.05). Conclusions Adolescents in urban areas had a lower risk of alcohol use compared with their regional counterparts, and differences in parental disapproval of alcohol use contributed to this difference. [ABSTRACT FROM AUTHOR]

Aims Methamphetamine-related harms in Victoria have increased recently in the context of stable or declining use prevalence. We determine how changes in price and purity of methamphetamine compared to other drugs such as heroin may, in part, explain these divergent patterns. Methods Detailed methamphetamine and heroin purchase price data from 2152 participant interviews from the Melbourne Injecting Drug User cohort study were used to generate drug price series for the period January 2009- June 2013. Data on drug purity from 8818 seizures made within Victoria were used to generate drug purity series during the same period. Purity-adjusted price data for methamphetamine and heroin were obtained for the period 2009-13 by combining the two data sets. Results While the average purity of heroin seizures remained consistent and low, the average purity of powder and of crystal methamphetamine seizures increased from 12% [95% confidence interval ( CI) = 10-14%] to 37% (95% CI = 20-54%) and 21% (95% CI = 18-23%) to 64% (95% CI = 60-68%), respectively. Crystal methamphetamine purity was bimodal, with observations generally less than 20% or greater than 70%. The average unadjusted price per gram for heroin decreased from $374 (95% CI = $367-381) to $294 (95% CI = $280-308), powder methamphetamine did not change significantly from $252 (95% CI = $233-271), and crystal methamphetamine increased substantially from $464 (95% CI = $416-511) in 2009 to $795 (95% CI = $737-853) in 2011. This increase was offset by an even greater increase in purity, meaning the average purity-adjusted price per gram declined. Furthermore, pure prices of both methamphetamine forms were similar, whereas their unadjusted prices were not. The pure price of heroin fluctuated with no ongoing trends. Conclusions Decreases in methamphetamine purity-adjusted price along with the bimodality of crystal methamphetamine purity may account for some of the recent increase in methamphetamine-related harm. For a given amount spent, methamphetamine purchase power has increased and the presence of extreme purity variations may challenge individuals' control of consumption. [ABSTRACT FROM AUTHOR]

Aims Susceptibility to food insecurity can vary over a life course; however, a potential period of particular vulnerability is while studying at a tertiary institution. This pilot study aimed to assess the prevalence, severity and potential determinants of food insecurity among tertiary students attending a Victorian-based institution. Methods The present study employed a cross-sectional design, involving use of a self-reported questionnaire. The survey, conducted in 2012, was administered to a sample of 124 Deakin University students and contains measures of food insecurity status, demographics and other potential explanatory factors. Descriptive and regression analysis was undertaken to investigate the prevalence of food insecurity and associations with factors that may support or hinder a student's ability to procure food, such as living arrangements, income and knowledge of support services. Results Food insecurity without hunger was reported by 18% of Deakin University students, while an additional 30% reported experiencing the more severe form of food insecurity (with hunger). A lower odds of being food insecure was reported among students living with their family (without hunger OR 0.35; 95% CI 0.12-0.99; with hunger OR 0.29; 95% CI 0.12-0.70), while a higher odds was found among those receiving government support (with hunger OR 2.52; 95% CI 1.05-6.04). Conclusions The reported prevalence of food insecurity among the tertiary student sample was greater than the general Australian population, suggesting they are a vulnerable group. This may be attributable to financial pressures faced when students are not living with their parents. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND This article examines the effect of early adolescent alcohol use on mid-adolescent school suspension, truancy, commitment, and academic failure in Washington State, United States, and Victoria, Australia. Also of interest was whether associations remain after statistically controlling for other factors known to predict school outcomes. METHODS State-representative student samples were surveyed in 2002 (grade 7; N = 1858) and followed up annually to 2004 (grade 9) in both sites. Students completed a modified version of the Communities That Care survey to report alcohol use, school outcomes, and risk and protective factors. Response rates were above 74% and retention rates exceeded 98% in both places. RESULTS Controlling for grade 7 risk factors, grade 7 current alcohol use, and heavy episodic drinking were associated with grade 8 school suspension. Grade 7 current and frequent alcohol use and heavy episodic drinking were linked to grade 9 truancy. In fully adjusted analyses, associations between early alcohol use and academic failure and low school commitment did not remain. CONCLUSIONS Although alcohol use is one factor influencing school performance and connection, there are other risk factors that need to be targeted to improve school outcomes. [ABSTRACT FROM AUTHOR]

Background Coconsumption of alcohol with energy drinks ( AED) is becoming increasingly popular among adolescents and young adults and has been associated with a range of harms. Motivations related to determined drunkenness and hedonistic drinking are potentially important in explaining both alcohol and AED consumption, given that a relationship has been identified between AED use and heavy alcohol consumption. This study aimed to explore motives for combined AED consumption, as well as their relationship with alcohol dependence and experiences of harm and aggression. Methods Students ( n = 594) enrolled at Deakin University, Victoria, Australia, completed an anonymous online survey in 2012. Approximately two-thirds of the sample (66.5%) were female, and the mean age was 22.3 ( SD = 4.5), consistent with 2012 Deakin University enrollment. Results Principal axis factor analysis of 14 items measuring motivations for AED use identified 4 factors, categorized as 'hedonistic,' 'social,' 'energy/endurance,' and 'intoxication-reduction' motives. Multinomial and binary logistic regression analyses demonstrated that hedonistic motives for AED use significantly predicted increases in alcohol and energy drink coconsumption during AED episodes, risk of alcohol dependence, as well as experiencing harm and aggression. Intoxication-reduction motives significantly predicted harm outcomes. Conclusions Hedonistic motives specific to sensation and pleasure ideals are implicated in negative consequences associated with coconsumption of alcohol and energy drinks. Further, consumers who reported using AEDs to reduce alcohol intoxication were at increased risk of negative outcomes, a finding indicating that consumer knowledge of the effects of AED use may be limited. [ABSTRACT FROM AUTHOR]

Background Current molar hypomineralisation ( MH) indices do not guide clinicians in management of affected dentitions, and treatment is based on individual judgment. Aim The aims of this study were to describe characteristics of MH and molar incisor hypomineralisation ( MIH) and trial the new Molar Hypomineralisation Severity Index ( MHSI). Design First permanent molars ( FPMs) and permanent incisors ( PIs) in 283 affected children were examined for hypomineralisation characteristics [defect colour, location, post-eruptive breakdown ( PEB); restorations placed/replaced/atypical; sensitivity]. The MHSI scores were compared with treatment received (152 children). Results Mean ( SD) affected teeth/dentition were as follows: FPMs: 3.2 (1.0) and PIs: 1.6 (1.6). Affected FPMs showed no arch or quadrant predilection; maxillary central PIs were affected particularly. As affected FPMs/dentition increased, MIH diagnoses also increased ( P = 0.009). Among FPMs, defects most prevalent were brown (47%) and cuspal (74%); 67% showed PEB. Before study entry, 43% of FPMs had restorations placed/replaced. Among PIs, white defects were common (65%) on smooth surfaces; sensitivity was rare. Affected FPMs received more restorations and extractions than unaffected FPMs ( P = 0.0001). As MHSI scores increased, FPM treatments/dentition increased (number, invasiveness). All characteristics were significant in predicting treatment (logistic regression model). Conclusions A spectrum from MH to MIH occurred. The MHSI characteristics were predictive of the treatment of affected FPMs and can guide management. [ABSTRACT FROM AUTHOR]

Background The Assistance to Participate Scale ( APS) was designed to measure the primary carer's estimate of the amount of assistance that their school-aged child with a disability requires to participate in play and leisure activities. Previous research suggests that the 8-item APS has good internal consistency. The construct validity of the scale is supported by strong correlations with instruments measuring similar constructs and discrimination between groups of children with developmental disability, based on extent of need for caregiver assistance. Aim The aim of this current study was to undertake further evaluation of the psychometric properties of the APS using Rasch analysis. Method Rasch analysis was conducted using the RUMM2030 program to assess the APS items in terms of their overall fit to the Rasch model, individual item fit, response format, targeting and dimensionality. Results Rasch analysis showed good fit to the model, with no misfitting items and good internal consistency ( PSI = 0.85). There was no differential item functioning across mothers' age, education level or child's age. Dimensionality testing supported the combination of all items to create a total score. Most items showed disordered thresholds, suggesting some inconsistencies in the way respondents used the response scale options. Conclusions The APS has been subjected to substantial psychometric testing during development and evaluation, revealing a sound, brief and easy-to-use scale. The APS has a number of potential clinical and research uses measuring the amount of additional assistance that children require from their primary care giver to participate in play activities. [ABSTRACT FROM AUTHOR]

Evidence now suggests that improved empathic behaviors can have a positive impact on healthcare outcomes. Therefore, having psychometrically-sound empathy scales is important for healthcare educators. In this study, the factor structure of the 20-item Jefferson Scale Empathy-Health Profession Students' version, when completed by a group of undergraduate paramedic students from a large Australian university, was investigated. Data from the Scale completed by 330 paramedic students were analyzed using principal components analysis followed by a maximum likelihood confirmatory factor analysis to test goodness of fit to the sample data. Two factors emerged from the principal components analysis, 'compassionate care' and 'perspective taking', accounting for 44.2% of the total variance. The 17-item two-factor model produced good model fit and good reliability estimates. Three of the original items did not fit the model. Results from the confirmatory factor analysis suggest that the 17-item Jefferson Scale Empathy-Health Profession Students' version is a valid and reliable measure for undergraduate paramedic students' empathy levels. [ABSTRACT FROM AUTHOR]

International Journal of Paediatric Dentistry 2013; 23: 48-55 Background. Demarcated hypomineralization lesions are not uncommon in second primary molars. Data on the prevalence of hypomineralized second primary molars (HSPM) are scarce. Aim. To investigate the prevalence of HSPM, assess the relationship between HSPM and first permanent molars previously diagnosed with demarcated lesions and to determine the severity of HSPM in relation to dental caries severity. Design. A cluster sample of 809, 7- to 9-year-old children was examined. The scoring criteria proposed by the European Academy of Paediatric Dentistry for hypomineralization in permanent dentition were adapted to score HSPMs. The International Caries Detection and Assessment System was used to assess caries status in the second primary molar of the children diagnosed with demarcated defects. The examination was carried out in schools by a calibrated dentist. Results. Of the children examined, 53 (6.6%) had hypomineralization defects in at least one second primary molar. Combinations of affected first permanent and second primary molars were reported in 21 (39.6%) of cases. Severe carious lesions were found mostly in teeth with enamel breakdown. Conclusions. The prevalence of HSPM was 6.6%. Over one-third of affected second primary molars were associated with demarcated lesions in the first permanent molars. The chance of severe caries increased with the increase in the demarcated lesion severity. [ABSTRACT FROM AUTHOR]

International Journal of Paediatric Dentistry 2013; 23: 2-12 Background. Hypomineralised enamel is a prevalent, congenital defect vulnerable to deteriorate post-eruptively particularly in the presence of an unfavourable oral environment. Aims. To assess the influence of salivary characteristics on the clinical presentation of hypomineralisation lesions diagnosed in first permanent and second primary molars and to evaluate caries severity in relation to the defect's clinical presentation. Design. Recruitment consisted of 445 seven- to nine-year-old participants, of whom 152 were diagnosed as having molar hypomineralisation (MH); the remaining unaffected subjects ( N = 293) were considered their controls for saliva analysis. Dental caries status was assessed in 300 subjects of saliva sub-sample, equally divided as MH-affected and non-affected children. The International Caries Detection and Assessment System was used for caries detection. Salivary flow rates, viscosity, pH, and buffering capacity were determined. Results. Molar hypomineralisation-affected children have significantly higher mean caries scores compared to the non-affected group. Dentinal carious lesions were ten times more frequent in teeth with post-eruptive breakdown (PEB) than with teeth with opacities only. Low salivary flow rates (LSFR), moderately viscous saliva, and low pH were significantly more common in the affected group. LSFR and moderate and highly acidic saliva were more likely associated with PEB. Conclusion. Demarcated hypomineralised enamel is a dynamic defect highly influenced by individual characteristics of the oral environment. [ABSTRACT FROM AUTHOR]

Objective: Do undergraduate rural clinical rotations increase the likelihood of medical students to choose a rural career once pre-existent likelihood is accounted for? Design: A prospective, controlled quasi-experiment using self-paired scores on the SOMERS Index of rural career choice likelihood, before and after 3 years of clinical rotations in either mainly rural or mainly urban locations. Setting: Monash University medical school, Australia. Participants: Fifty-eight undergraduate-entry medical students (35% of the 2002 entry class). Main outcome measures: The SOMERS Index of rural career choice likelihood and its component indicators. Results: There was an overall decline in SOMERS Index score (22%) and in each of its components (12-41%). Graduating students who attended rural rotations were more likely to choose a rural career on graduation (difference in SOMERS score: 24.1 (95% CI, 15.0-33.3) P < 0.0001); however, at entry, students choosing rural rotations had an even greater SOMERS score (difference: 27.1 (95% CI, 18.2-36.1) P < 0.0001). Self-paired pre-post reductions in likelihood were not affected by attending mainly rural or urban rotations, nor were there differences based on rural background alone or sex. Conclusions: While rural rotations are an important component of undergraduate medical training, it is the nature of the students choosing to study in rural locations rather than experiences during the course that is the greater influence on rural career choice. In order to improve the rural medical workforce crisis, medical schools should attract more students with pre-existent likelihood to choose a rural career. The SOMERS Index was found to be a useful tool for this quantitative analysis. [ABSTRACT FROM AUTHOR]

Introduction: Rural areas require better use of existing health professionals to ensure capacity to deliver improved cardiovascular outcomes. Community pharmacists (CPs) are accessible to most communities and can potentially undertake expanded roles in prevention of cardiovascular disease (CVD). Objective: This study aims to establish frequency of contact with general practitioners (GPs) and CPs by patients at high risk of CVD or with inadequately controlled CVD risk factors. Design, setting and participants: Population survey using randomly selected individuals from the Wimmera region electoral roll and incorporating a physical health check and self-administered health questionnaire. Overall, 1500 were invited to participate. Results: The participation rate was 51% when ineligible individuals were excluded. Nine out of 10 participants visited one or both types of practitioner in the previous 12 months. Substantially more participants visited GPs compared with CPs (88.5% versus 66.8%). With the exception of excess alcohol intake, the median number of opportunities to intervene for every inadequately controlled CVD risk factor and among high risk patient groups at least doubled for the professions combined when compared with GP visits alone. Conclusion: Opportunities exist to intervene more frequently with target groups by engaging CPs more effectively but would require a significant attitude shift towards CPs. Mechanisms for greater pharmacist integration into primary care teams should be investigated. [ABSTRACT FROM AUTHOR]

Objective: To describe travel burden and travel-related financial burden experienced by cancer patients over the first year after diagnosis. Design, setting, participants: Population-based longitudinal cohort of recent adult cancer patients diagnosed with the eight most incident cancers recruited from New South Wales and Victorian Cancer Registries. Self-report survey data were collected at 6 and 12 months after diagnosis from 1410 participants (city: n = 890; regional/remote: n = 520). Main outcome measures: Travel time to cancer treatment, living away from home for treatment, travel-related treatment decisions, extent of financial issues, unmet need for financial help. Results: During the first 12 months after diagnosis, outer regional/remote residents had the greatest travel burden; 61% (n = 79) travelled at least 2 hours one way to receive treatment, and 49% (n = 66) lived away from home to receive treatment. Strongest associates of travel burden were living in regional/remote areas (odds ratio (OR) = 18.9-135.7), having received surgery (OR = 6.7) or radiotherapy (OR = 3.6). Between 6 and 12 months after diagnosis, 2% (n = 24) of patients declined cancer treatment because of the time it would take to get to treatment. Patients who travelled more than 2 hours or lived away for treatment reported significantly greater financial difficulties (38%; 40%) than those who did not (12%; 14%), even after adjusting for covariates. Conclusions: Travel burden is greatest for rural patients, and is associated with greater financial burden. Appropriate and adequate provision of travel and accommodation assistance schemes remains paramount to achieving equitable delivery of cancer services. [ABSTRACT FROM AUTHOR]

Background: At least two-thirds of the world's children grow up in environments where more than one language is spoken. Despite the global predominance of multilingualism, much remains unknown regarding the language acquisition of children acquiring multiple languages compared with monolingual children. A greater understanding of multilingualism is crucial for speech-language pathologists given the increasing number of children being raised in linguistically diverse environments. Aims: To investigate the expressive morphological abilities of multilingual children acquiring English, compared with monolingual children, at 3 years of age. Methods & Procedures: Participants were 148 children (74 multilingual children; 74 matched monolingual children; mean age of 3 years 4 months) already participating in a larger prospective longitudinal cohort study of language development in Melbourne, Australia. Thirty-one languages in addition to English were represented within the embedded cohort. All participants completed a direct language assessment to measure their expressive abilities across a range of English morphemes. The parents of the multilingual participants completed an interview regarding the children's language backgrounds and experiences. Outcomes & Results: The Multilingual Group typically performed below the Monolingual Group in terms of their accurate use and mastery of English morphemes at 3 years of age, although variable expressive abilities were indicated within each group. The same morphemes were shown to be mastered by relatively higher proportions of each group. Likewise, the same forms were mastered by relatively lower proportions of each group. The results indicated similarities between the children's acquisition of English morphology, regardless of whether they were acquiring English only or in combination with another language(s) at 3 years of age. Conclusions & Implications: This study found a range of similarities and differences between multilingual compared with monolingual children's acquisition of English morphology at 3 years of age. The findings have important implications for researchers and clinicians involved in the management of linguistically diverse populations by advancing knowledge of early multilingual English morpheme acquisition and building awareness of acquisition patterns among multilingual and monolingual English-speaking children at 3 years of age. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop and validate a pressure ulcer risk assessment for acute hospitals. This tool was developed in a cohort of 342 patients with a mean age 63 years (SD 19.82) and validated in a second cohort of 165 patients with a mean age 68 years (SD 18.40). Risk factors for inclusion on The Northern Hospital Pressure Ulcer Prevention Plan (TNH-PUPP) were identified from the literature then examined and weighted using logistic regression. Risk factors included on the TNH-PUPP were requires assistance to move in bed (odds ratio [OR] 5.15; 95% confidence interval [CI]: 2.49-10.65), admission to intensive care during current admission (OR 2.98; 95% CI: 1.33-6.67), aged ≥65 years (OR 2.81; 95% CI: 1.24-6.36), reduced sensation (OR 2.29; 95% CI: 1.19-4.42), and cognitive impairment (OR 2.26; 95% CI: 1.09-4.67). The TNH-PUPP was validated in a prospective sample. The new tool had high diagnostic validity (area under the receiver operating curve=0.86), consistent in the validation sample (area under the receiver operating curve=0.90). The TNH-PUPP has a moderate positive predictive value (development=0.50; validation=0.13), and a high negative predictive value (development=0.94; validation=0.99) enabling low-risk patients to be screened out, as noncandidates for pressure ulcer prevention interventions. An accurate pressure ulcer risk assessment has been developed and validated, which identifies a high-risk group to whom limited pressure ulcer prevention resources should be directed. The TNH-PUPP facilitates effective resource allocation and is likely to reduce unnecessary patient harm and costs from pressure ulcers in acute hospitals. [ABSTRACT FROM AUTHOR]