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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]

Objective: The aim of this study was to identify the factors contributing to high-quality clinical supervision of the allied health workforce in rural and remote settings. Methods: This quantitative study was part of a broader project that used a mixed-methods sequential explanatory design. Participants were 159 allied health professionals from two Australian states. Quantitative data were collected using an online customised survey and the Manchester Clinical Supervision Scale (MCSS-26). Data were analysed using regression analyses. Results: Supervisee's work setting and choice of supervisor were found to have a positive and significant influence on clinical supervision quality. Supervisee profession and time in work role were found to have a negative and significant influence on the quality of clinical supervision. Conclusions: High-quality clinical supervision is essential to achieve quality and safety of health care, as well as to support the health workforce. Information on high-quality clinical supervision identified in this study can be applied to clinical supervision practices in rural and remote settings, and to professional support policies and training to enhance the quality of supervision. What is known about the topic?: There is mounting evidence on the benefits of clinical supervision to health professionals, organisations and patients. Clinical supervision enhances recruitment and retention of the health workforce. However, there are still gaps regarding the factors that contribute to high-quality clinical supervision, especially for rural and remote health professionals. What does this paper add?: This study, the first of its kind, recruited rural and remote health professionals from seven allied health disciplines across two Australian states. It investigated the factors that influence high-quality clinical supervision in this under-resourced group. This paper outlines specific factors that contribute to clinical supervision quality for rural and remote allied health professionals. What are the implications for practitioners?: Effective and high-quality clinical supervision of the rural and remote allied health workforce can enhance recruitment and retention in those areas. Healthcare organisations can facilitate effective clinical supervision delivery by using the evidence gathered in this study in clinical supervision policy, training and practice. [ABSTRACT FROM AUTHOR]

Objective: The aims of this paper were to report on the global psychosocial functioning of 5-year-old DHH children and examine the risk and protective factors that predict outcomes. Design: A cross-sectional analysis of data collected from a prospective, population-based longitudinal study. Study sample: Parents/caregivers of 356 children completed questionnaires on psychosocial development (CDI, SDQ), functional communication (PEACH) and demographic information. Children completed standardized assessments of non-verbal cognitive ability (WNV) and language (PLS-4). Results: On average, global psychosocial functioning was within the range of typically developing children; however, variability was high and 12% of children had scores that were more than 2 SDs below the norm. Non-verbal cognitive ability, presence of additional disabilities, language and functional communication significantly predicted outcomes. In contrast, type of hearing device, severity of hearing loss and age at intervention did not. Conclusion: The global psychosocial functioning of this cohort of 5-year-old DHH children fell within the range of typically developing children. The findings suggest that spoken language ability and functional communication skills are vital for healthy psychosocial development. [ABSTRACT FROM AUTHOR]

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]

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]

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]

This study investigated the association of resilience on caregiver burden and quality of life in informal caregivers of patients with severe traumatic musculoskeletal injuries. A prospective cohort study of eligible caregivers and acutely injured trauma patients was conducted during 2018 in South East Queensland, with follow-up 3 months after patient discharge. Resilience was examined using the 10-item Connor Davidson Resilience Scale. The primary outcomes, caregiver burden and quality of life were measured respectively, using the Caregiver Strain Index and the Short Form Version 12 Health Survey. Baseline measures were completed with fifty-three (77%) patient/carer dyads. Thirty-eight (28%) were available for follow up at 3 months. Significant reductions from baseline were found at follow up, for levels of resilience, mental health, physical exercise and community support. In multiple regression models, caregiver resilience at follow-up independently predicted lower caregiver burden (β = −0.74, p = 0.008) and higher levels of patient physical health and function (β = −0.69, p = 0.003). Upon commencing informal care, caregivers' resilience, mental health and support systems are adversely affected. Higher levels of caregiver resilience appear to be protective against caregiver burden and declines in patient physical function. Early evaluation of caregivers' resilience, their physical and mental health and socio-ecological networks could improve carer and patient health outcomes. After 3 months of providing informal care to severely injured musculoskeletal trauma patients, there are apparent declines in their mental health, resilience, community support and physical activity levels. However, those with higher levels of resilience compared to lower levels could be protected against caregiver burden. Higher caregiver resilience could also prevent declines in patients' physical function. The rehabilitation of severe trauma patients should additionally include routine assessment and management of informal caregivers with the aim to prevent caregiver burden. Early clinical assessment of caregiver resilience using a valid resilience measurement tool could identify caregivers at risk of caregiver burden and flag vulnerable caregivers for ongoing support in the community. Early assessment of caregivers' physical and mental health and health related behaviours could flag the need for health promotion interventions aimed at supporting caregivers' physical and mental health. [ABSTRACT FROM AUTHOR]

Depression and perceived ethnic discrimination (PED) are both implicated in type 2 diabetes mellitus (T2DM) risk in some migrant populations. The role of these factors remains understudied in sub-Saharan African migrants, who comprise a significant at-risk group for T2DM in Australia. To assess interactions between PED, depression scores and elevated blood glucose levels among sub-Sahara African immigrants in North-Eastern Australia. Face to face surveys were used to assess PED and depressive tendencies in a purposive sample of 170 adults (aged ≥18 year). Fasting blood glucose levels (FBGL) were measured at the time of interviews. Prevalence of elevated FBGL (≥6.1 mmol/L), PED and severe depression (SD) were: 17.6% (n = 30), 14.7% (n = 25) and 18.8% (n = 32), respectively. Prevalence of elevated FBGL, PED and SD were all higher in males than females. The highest prevalence of elevated BGL, PED and SD each occurred in the 40–50 year age group. Strong positive correlations of both high level PED and SD with elevated FBGL were observed. There was also a strong positive association between PED and SD. Depression score was found to mediate partially the strong association between PED and elevated FBGL (β-value for PED dropped from β = 0.452 to β = 0.246, p < 0.01 and the associated between FBGL and SD remained strong β = 0.554, p < 0.01). The strong association between elevated FBGL and PED seems to be moderated by SD, indicating that interventions to attenuate depression and PED may be a useful adjunct to diabetes prevention programs in this population. Interventions targeted to specific age groups may also be warranted. [ABSTRACT FROM AUTHOR]

Background: Multiple micronutrient supplement use in the Australian pregnant population is rising, despite little evidence of benefit in low‐risk women. While some supplement recommendations are grounded in high‐quality evidence, others warrant further investigation. This highlights a research gap regarding appropriate use of supplements during pregnancy in the Australian population. Aims: To describe micronutrient supplement use during pregnancy in the context of current evidence and national recommendations in a population of south‐east Queensland women. Material and Methods: A cross‐sectional observational design was used to examine data gathered from pregnant women aged 16–44 years residing in south‐east Queensland, Australia. Women were recruited to the study between 23 May 2016 and 30 September 2017. Results: Pregnancy multivitamin use was declared by 42% of the cohort, with 26.8% declaring multivitamins in combination with individual micronutrients and 9.8% declaring specific micronutrient supplement use. Nulliparous women were more likely to declare use of supplements than their multiparous peers (adjusted odds ratio (aOR) 1.938, 95% CI 1.053–3.571, P = 0.034); smoking (aOR 2.717, 95% CI 1.011–7.302, P = 0.047) and low socio‐economic status were associated with no supplement use (aOR 2.451, 95% CI 1.010–5.949, P = 0.048). Conclusions: Current recommendations regarding micronutrient supplements throughout pregnancy are based on varying degrees of evidence, resulting in supplement advice of poor cohesion and consistency. Adherence to micronutrient supplement recommendations in the peri‐conception period in this population was poor; second and third trimester supplement use was high. Contemporary empirical research is required to determine what constitutes appropriate supplementation in high‐income regions and the populations they will benefit most. [ABSTRACT FROM AUTHOR]

Aims: Early childhood anaemia, usually attributed to iron deficiency, is associated with persistent detrimental effects on child development. This study investigates the association of anaemia between age six and 23 months with indicators of childhood development at school‐age among children of remote Aboriginal and Torres Strait Islander communities of Far North Queensland. Methods: The triennial Australian Early Development Census (AEDC) encompasses five domains of early childhood development—physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school‐based), communication skills and general knowledge. AEDC 2012 and 2015 assessments were linked with health information for children and their mothers from remote Aboriginal and Torres Strait Islander communities of Far North Queensland. Results: AEDC assessments were available for 250 children who had measurements of haemoglobin recorded at age 6 to 23 months. More children who had had early childhood anaemia (n = 66/143, 46.2%, [37.9%, 54.4%]) were developmentally vulnerable on two or more domains compared to those who had not been anaemic (n = 25/107, 23.4% [15.2%, 31.5%], P <.001). Multivariable analysis confirmed that early childhood anaemia more than doubled the risk of developmental vulnerability (OR 2.2 [1.1, 4.3] P =.020) at school age. Conclusions: Early childhood anaemia is a risk factor for developmental vulnerability at school‐age in this setting. Interventions combining nutrition promotion and multi‐micronutrient food fortification, are effective in prevention of early childhood anaemia. Such interventions could also improve early childhood development and subsequent educational achievement. [ABSTRACT FROM AUTHOR]

Objective: We investigated the factors influencing speech perception in babble for 5-year-old children with hearing loss who were using hearing aids (HAs) or cochlear implants (CIs). Design: Speech reception thresholds (SRTs) for 50% correct identification were measured in two conditions - speech collocated with babble, and speech with spatially separated babble. The difference in SRTs between the two conditions give a measure of binaural unmasking, commonly known as spatial release from masking (SRM). Multiple linear regression analyses were conducted to examine the influence of a range of demographic factors on outcomes. Study sample: Participants were 252 children enrolled in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. Results: Children using HAs or CIs required a better signal-to-noise ratio to achieve the same level of performance as their normal-hearing peers but demonstrated SRM of a similar magnitude. For children using HAs, speech perception was significantly influenced by cognitive and language abilities. For children using CIs, age at CI activation and language ability were significant predictors of speech perception outcomes. Conclusions: Speech perception in children with hearing loss can be enhanced by improving their language abilities. Early age at cochlear implantation was also associated with better outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study examined language and speech outcomes in young children with hearing loss and additional disabilities. Design: Receptive and expressive language skills and speech output accuracy were evaluated using direct assessment and caregiver report. Results were analysed first for the entire participant cohort, and then to compare results for children with hearing aids (HAs) versus cochlear implants (CIs). Study sample: A population-based cohort of 146 five-year-old children with hearing loss and additional disabilities took part. Results: Across all participants, multiple regressions showed that better language outcomes were associated with milder hearing loss, use of oral communication, higher levels of cognitive ability and maternal education, and earlier device fitting. Speech output accuracy was associated with use of oral communication only. Average outcomes were similar for children with HAs versus CIs, but their associations with demographic variables differed. For HA users, results resembled those for the whole cohort. For CI users, only use of oral communication and higher cognitive ability levels were significantly associated with better language outcomes. Conclusions: The results underscore the importance of early device fitting for children with additional disabilities. Strong conclusions cannot be drawn for CI users given the small number of participants with complete data. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study was to describe demographic and clinical characteristics including features that were consistent with subarachnoid hemorrhage ( SAH), use of diagnostic tests, emergency department ( ED) discharge diagnoses, and disposition of adult patients presenting with an acute headache to EDs statewide across Queensland, Australia. In addition, potential variations in the presentation and diagnostic workup between principal-referral and city-regional hospitals were examined. Methods A prospective cross-sectional study was conducted over 4 weeks in September 2014. All patients ≥ 18 years presenting to one of 29 public and five private hospital EDs across the state with an acute headache were included. The headache had to be the principal presenting complaint and nontraumatic. The 34 study sites attend to about 90% of all ED presentations statewide. The treating doctor collected clinical information at the time of the ED visit including the characteristics of the headache and investigations performed. A study coordinator retrieved results of investigations, ED discharge diagnoses, and disposition from state databases. Variations in presentation, investigations, and diagnosis between city-regional and principal-referral hospitals were examined. Results There were 847 headache presentations. Median (range) age was 39 (18-92) years, 62% were female, and 31% arrived by ambulance. Headache peaked instantly in 18% and ≤ 1 hour in 44%. It was 'worst ever' in 37%, 10/10 in severity in 23%, and associated with physical activity in 7.4%. Glasgow Coma Scale score was < 15 in 4.1%. Neck stiffness was noted on examination in 4.8%. Neurologic deficit persisting in the ED was found in 6.5%. A computed tomography ( CT) head scan was performed in 38% (318/841, 95% CI = 35% to 41%) and an lumbar puncture in 4.7% (39/832, 95% CI = 3.4% to 6.3%). There were 18 SAH, six intraparenchymal hemorrhages, one subdural hematoma, one newly diagnosed brain metastasis, and two bacterial meningitis. Migraine was diagnosed in 23% and 'primary headache not further specified' in 45%. CT head scans were more likely to be performed in principal-referral hospitals (41%) compared to city-regional hospitals (33%). The headache in patients presenting to the latter was less likely to be instantly peaking or associated with activity, but was no less severe in intensity and was more frequently accompanied by nausea and vomiting. Their diagnosis was more likely to be a benign primary headache. Variations in CT scanning could thus be due to differences in the case mix. The median (interquartile range) ED length of stay was 3.1 (2.2 to 4.5) hours. Patients was discharged from the ED or admitted to the ED short-stay unit prior to discharge in 57 and 23% of cases, respectively. Conclusions The majority of patients had a benign diagnosis, with intracranial hemorrhage and bacterial meningitis accounting for only 3% of the diagnoses. There are variations in the proportion of patients receiving CT head scans between city-regional and principal-referral hospitals. As 38% of headache presentations overall underwent CT scanning, there is scope to rationalize diagnostic testing to rule out life-threatening conditions. [ABSTRACT FROM AUTHOR]

Background/aim Clinical supervision is important for effective health service delivery, professional development and practice. Despite its importance there is a lack of evidence regarding the factors that improve its quality. This study aimed to investigate the factors that influence the quality of clinical supervision of occupational therapists employed in a large public sector health service covering mental health, paediatrics, adult physical and other practice areas. Methods A mixed method, sequential explanatory study design was used consisting of two phases. This article reports the quantitative phase (Phase One) which involved administration of the Manchester Clinical Supervision Scale ( MCSS-26) to 207 occupational therapists. Results Frequency of supervision sessions, choice of supervisor and the type of supervision were found to be the predictor variables with a positive and significant influence on the quality of clinical supervision. Factors such as age, length of supervision and the area of practice were found to be the predictor variables with a negative and significant influence on the quality of clinical supervision. Conclusion Factors that influence the perceived quality of clinical supervision among occupational therapists have been identified. High quality clinical supervision is an important component of clinical governance and has been shown to be beneficial to practitioners, patients and the organisation. Information on factors that make clinical supervision effective identified in this study can be added to existing supervision training and practices to improve the quality of clinical supervision. [ABSTRACT FROM AUTHOR]

Previous research has shown an association between children's development of psychosocial and motor skills. This study evaluated the development of these skills in 301 three-year-old deaf and hard of hearing children (M: 37.8 months) and considered a range of possible predictors including gender, birth weight, age at first fitting with hearing devices, hearing device used, presence of additional disabilities, severity of hearing loss, maternal education, socio-economic status (SES), language ability, and communication mode. Caregivers reported on children's development using the Child Development Inventory (CDI). On average, both psychosocial and motor development quotients were within the typical range for hearing children, with large individual differences. There was a positive correlation between language ability and both social and motor development, and also between social and motor development. Age at first fitting of hearing aids (as an indicator of age at identification of hearing loss), SES, degree of hearing loss, and maternal education were not significant predictors of social skill or motor development, whereas presence of additional disabilities and birth weight were. Girls performed better than boys on all but the Gross Motor subscale of the CDI. Children with hearing aids tended to perform better than those with cochlear implants on the Gross Motor subscale. [ABSTRACT FROM AUTHOR]

Background Research has identified associations between serum 25( OH) D and a range of clinical outcomes in chronic kidney disease and wider populations. The present study aimed to investigate vitamin D deficiency/insufficiency in dialysis patients and the relationship with vitamin D intake and sun exposure. Methods A cross-sectional study was used. Participants included 30 peritoneal dialysis (PD) (43.3% male; 56.87 ± 16.16 years) and 26 haemodialysis (HD) (80.8% male; 63.58 ± 15.09 years) patients attending a department of renal medicine. Explanatory variables were usual vitamin D intake from diet/supplements ( IU day−1) and sun exposure (min day−1). Vitamin D intake, sun exposure and ethnic background were assessed by questionnaire. Weight, malnutrition status and routine biochemistry were also assessed. Data were collected during usual department visits. The main outcome measure was serum 25( OH) D (n m). Results Prevalence of inadequate/insufficient vitamin D intake differed between dialysis modality, with 31% and 43% found to be insufficient (<50 n m) and 4% and 33% found to be deficient (<25 n m) in HD and PD patients, respectively ( P < 0.001). In HD patients, there was a correlation between diet and supplemental vitamin D intake and 25( OH)D (ρ = 0.84, P < 0.001) and average sun exposure and 25( OH)D (ρ = 0.50, P < 0.02). There were no associations in PD patients. The results remained significant for vitamin D intake after multiple regression, adjusting for age, gender and sun exposure. Conclusions The results highlight a strong association between vitamin D intake and 25( OH)D in HD but not PD patients, with implications for replacement recommendations. The findings indicate that, even in a sunny climate, many dialysis patients are vitamin D deficient, highlighting the need for exploration of determinants and consequences. [ABSTRACT FROM AUTHOR]

Background: Food neophobia, the rejection of unknown or novel foods, may result in poor dietary patterns. This study investigates the cross-sectional relationship between neophobia in children aged 24 months and variety of fruit and vegetable consumption, intake of discretionary foods and weight. Methods: Secondary analysis of data from 330 parents of children enrolled in the NOURISH RCT (control group only) and SAIDI studies was performed using data collected at child age 24 months. Neophobia was measured at 24 months using the Child Food Neophobia Scale (CFNS). The cross-sectional associations between total CFNS score and fruit and vegetable variety, discretionary food intake and BMI (Body Mass Index) Z-score were examined via multiple regression models; adjusting for significant covariates. Results: At 24 months, more neophobic children were found to have lower variety of fruits (β = −0.16, p = 0.003) and vegetables (β = −0.29, p < 0.001) but have a greater proportion of daily energy from discretionary foods (β = 0.11, p = 0.04). There was no significant association between BMI Z-score and CFNS score. Conclusions: Neophobia is associated with poorer dietary quality. Results highlight the need for interventions to (1) begin early to expose children to a wide variety of nutritious foods before neophobia peaks and (2) enable health professionals to educate parents on strategies to overcome neophobia. [ABSTRACT FROM AUTHOR]

This study examined the extent to which young adolescent alcohol use was related to alcohol-related norms and law enforcement of underage alcohol use, after accounting for known strong parent and peer correlates. Our sample consisted of 7,674 students (X¯ age = 12 years) from 30 Australian communities. Two-level (individuals nested within communities) binary logistic regression was used to examine relationships between recent alcohol use (last 30 days) and perceived community norms about alcohol use, perceived law enforcement of underage alcohol use, parent alcohol use, parent permissiveness of adolescent alcohol use, peer alcohol use, and demographic factors. Results indicated that community norms and perceived law enforcement of alcohol use were associated with alcohol use and this association was independent of parent and peer factors. After accounting for proximal social correlates, community factors were significantly associated with alcohol use among very young adolescents. [ABSTRACT FROM PUBLISHER]

Context: Chronic opiate dependence has been linked with premature appearance of many chronic age-related disorders and blood-borne biomarkers of ageing. Objective: To determine if clinical opiate substance use disorder (SUD) was associated with elevations of serum calcium and phosphate and their various products. Methods: Chemical pathology records were traced retrospectively. Results: A total of 1747 SUD patients were compared with 6454 non-SUD (NSUD) patients. The mean (±SD) ages were 32.06 ± 6.64 and 32.13 ± 8.12 years, respectively ( p = 0.74). The two groups were 69.5% and 54.6% male ( p < 0.000 1). The mean serum calcium levels were 2.40 ± 0.11 and 2.37 ± 0.10 mmol/l ( p < 0.000 1). This significant difference was unrelated to albumin levels, and also occurred for phosphate: 1.17 ± 0.22 and 1.15 ± 0.22 ( p < 0.000 1). Both the calcium-phosphate product and the calcium-phosphate solubility product were also elevated. These elevations persisted at multiple regression against age in both additive and interactive models with age (most p < 0.000 1). At age 35, the corrected calcium and phosphate were equivalent to a 75.1% and 13.5% age advancement, respectively. Conclusion: Opiate dependence is associated with significant elevations of calcium and phosphate both in absolute terms, and after correction for serum albumin and age. Their product and their solubility product are similarly elevated. [ABSTRACT FROM AUTHOR]

Aims To test a model that delineates advanced practice nursing from the practice profile of other nursing roles and titles. Background There is extensive literature on advanced practice reporting the importance of this level of nursing to contemporary health service and patient outcomes. Literature also reports confusion and ambiguity associated with advanced practice nursing. Several countries have regulation and delineation for the nurse practitioner, but there is less clarity in definition and service focus of other advanced practice nursing roles. Design A statewide survey. Methods Using the modified Strong Model of Advanced Practice Role Delineation tool, a survey was conducted in 2009 with a random sample of registered nurses/midwives from government facilities in Queensland, Australia. Analysis of variance compared total and subscale scores across groups according to grade. Linear, stepwise multiple regression analysis examined factors influencing advanced practice nursing activities across all domains. Results There were important differences according to grade in mean scores for total activities in all domains of advanced practice nursing. Nurses working in advanced practice roles (excluding nurse practitioners) performed more activities across most advanced practice domains. Regression analysis indicated that working in clinical advanced practice nursing roles with higher levels of education were strong predictors of advanced practice activities overall. Conclusion Essential and appropriate use of advanced practice nurses requires clarity in defining roles and practice levels. This research delineated nursing work according to grade and level of practice, further validating the tool for the Queensland context and providing operational information for assigning innovative nursing service. [ABSTRACT FROM AUTHOR]

chaboyer w., ringdal m., aitken l. & kendall e. (2012) Self-care after traumatic injury and the use of the therapeutic self-care scale in trauma populations. Journal of Advanced Nursing 69(2), 286-294 doi: 10.1111/j.1365-2648.2012.06005.x. Abstract Aims. To report a correlational study of the relationship between gender, age, severity of injury, length of hospital stay and self-care behaviour in patients with traumatic injuries. Background. This study may provide a foundation for targeted nursing intervention and education programmes to help patients better recover from their injury, which is a fundamental aspect of nursing. Design. A longitudinal cohort study. Method. This study of patients hospitalized for traumatic injury was conducted from May 2006-November 2007. The Therapeutic Self Care Scale along with demographic and clinical data, were completed at 3 and 6 months after hospital discharge. Using data from the 3-month survey, the validity and reliability of the scale was calculated. Multiple regression was used to identify predictors of self-care at 3 and 6 months. Finding. Participants ( n = 125) completed the questionnaire at 3 months and 103 participants completed it at 6 months. Self-care was high on both occasions and high self-care at 3 months was related to high self-care at 6 months. Older participants reported higher self-care at 3 months compared with younger patients. Factor analysis of the scale revealed three clear components; taking medication, recognition and managing symptoms and managing changes in health conditions, which explained a total of 59·8% of the variance. The 10-item revised scale was reliable. Conclusion. The findings indicate that self-care remains fairly high and stable in the first 6 months after trauma. The revised Therapeutic Self Care Scale was valid and reliable in the trauma population. [ABSTRACT FROM AUTHOR]

Background/aim: Driving cessation has been recognised as affecting the health and wellbeing of older people. Further exploration of the impact of driving status on time use, role participation and life satisfaction was required. Methods: A cross-sectional survey of 234 older people (current drivers, retired drivers and people who have never driven) was employed. Time use in the previous week, role participation and life satisfaction were measured and compared between the groups, while controlling for sociodemographic variables (health status, activities of daily living and instrumental activities of daily living status, gender, age and living situation). Results: When compared to current drivers, retired drivers had significantly lower life satisfaction (P = 0.01), fewer present roles (P < 0.0001) and were less likely to participate in volunteer (P = 0.005) and family member roles (P = 0.009). Retired drivers spent less time on social leisure (P = 0.002) and away from home (P = 0.0001), and more time in solitary leisure (P = 0.0001). Comparing the participation of retired drivers with those who had never driven indicated that retired drivers spent significantly less time in volunteer work ( P = 0.009). Conclusions: The findings indicate that older non-drivers may require support for participation and wellbeing. [ABSTRACT FROM AUTHOR]

Prenatal maternal stress can adversely affect birth outcomes, likely reflecting effects of maternal stress hormones on fetal development. Maternal stress might also induce behavioural changes, such as dietary change, that might influence fetal development. Few studies have documented relationships between stress and dietary change in pregnancy. We analysed stress and dietary change among 222 pregnant women exposed to the 2011 Queensland Floods. We assessed women's objective hardship, subjective distress and cognitive appraisal of the disaster; changes in their diets and their associations with infants' gestational age, weight, length and head circumference at birth, head circumference to birth length ratio (HC/BL) and ponderal index. Greater objective hardship was correlated with more negative dietary change, skipped meals and skipped multivitamins. There were no direct effects of stress or dietary change on birth outcomes. However, we observed an interactive effect of dietary change and exposure timing on head circumference for gestational age (HC for GA) ( p = 0.010) and a similar trend for HC/BL ( p = 0.064). HC for GA and HC/BL were larger among children whose mothers experienced negative changes to their diet in early pregnancy compared with later pregnancy, consistent with a 'head-sparing' response with early gestation exposure. Further analyses indicated that dietary change mediates the relationship between objective hardship because of the floods and these outcomes. This is the first report of relationships among an independent stressor, dietary change and birth outcomes. It highlights another possible mechanism in the relationship between prenatal maternal stress and child development that could guide future research and interventions. [ABSTRACT FROM AUTHOR]