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For clinicians working in mental health services, 'aggression management' training is generally prioritised, and often mandated. Traditional 'aggression management' training has the potential to reinforce the perception that violence and aggression are inevitable, and thus defensive and coercive practices are needed. This paper outlines the principles and processes that underpinned the development of two training programs designed as recovery-oriented and trauma-informed alternatives to traditional 'aggression management' training. The focus of the paper is on exploring how 'aggression management' training can be aligned with best practice principles. The programs were developed in a metropolitan and rural mental health service and aimed to reduce the need for defensive and coercive practices by promoting therapeutic engagement. A key feature of both programs is an orientation towards safety rather than risk. By embedding the principles of recovery and trauma-informed care in their development and orienting training towards enhancing safety, clinicians are provided with a new way of conceptualising and responding to 'aggression'. Experiential methods in the delivery of the training, and the co-design and co-delivery with peer (consumer) educators were important in supporting attitudinal change. To promote safety, the language and content of training programs must reflect contemporary principles and approaches such as trauma-informed care and recovery. This paper illustrates that to be effective, these principles and approaches must not just be described, but modelled in the development, design, and delivery of the training. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Research suggests that the Dynamic Appraisal of Situational Aggression (DASA) is a useful risk assessment instrument to identify individuals who might be at risk of aggression in mental health inpatient units.Although, risk assessment research has typically focused on an individual's risk of aggression, recent research has begun exploring whether the DASA could be used to assess the likelihood that a group of patients would be aggressive. What the paper adds to existing knowledge: While the DASA was useful for assessing whether an individual was likely to be aggressive, the group average score was not a useful indicator for the likelihood of aggression once the individual DASA score was taken into consideration.Unexpectedly, patients who were assessed as high risk on the DASA were more likely to be aggressive on settled units compared to unsettled units, which included other individuals whose risk was elevated. What are the implications for practice: There is not enough evidence to suggest that the group DASA average improves the identification of aggression above the individual DASA score. Introduction: The Dynamic Appraisal of Situational Aggression (DASA) is an inpatient aggression risk assessment instrument. Recently, research explored whether the unit atmosphere, as indicated by a unit's average DASA score, was related to inpatient aggression risk, but failed to control for individual risk. Aim: Investigate whether the DASA unit average score or an interaction between the unit average and an individual patient's DASA score was related to the likelihood that an individual would act aggressively. Method: Cox regression with repeated assessments and recurrent events was used to analyse 11,243 DASA risk assessments of 113 inpatients collected via retrospective file review. Results: The unit DASA average score was not related to aggression towards staff. There was a negative interaction between the individual and the unit DASA average scores when identifying patient‐to‐patient aggression; high‐risk patients engaged in less aggression when the unit average was heightened relative to units with lower DASA average scores. Discussion: It is possible that there were more nursing interventions and/or patients engaged in greater self‐regulation on unsettled units, thus reducing aggression. Implications for Practice: Currently, there is insufficient evidence to suggest that the unit average score should be used to supplement individual DASA scores to identify aggression risk. [ABSTRACT FROM AUTHOR]

Background: Chemical restraint (CR) (also known as rapid tranquilisation) is the forced (non‐consenting) administration of medications to manage uncontrolled aggression, anxiety, or violence in people who are likely to cause harm to themselves or others. Our population of interest was adults with mental health disorders (with/without substance abuse). There has been a growing international movement over the past 22 years towards reducing/eliminating restrictive practices such as CR. It is appropriate to summarise the research that has been published over this time, identify trends and gaps in knowledge, and highlight areas for new research to inform practice. Aims: To undertake a comprehensive systematic search to identify, and describe, the volume and nature of primary international research into CR published since 1995. Methods: This paper reports the processes and overall findings of a systematic search for all available primary research on CR published between 1 January 1996 and 31 July 2018. It describes the current evidence base by hierarchy of evidence, country (ies) producing the research, CR definitions, study purpose, and outcome measures. Results: This review identified 311 relevant primary studies (21 RCTs; 46 non‐controlled experimental or prospective observational studies; 77 cross‐sectional studies; 69 retrospective studies; 67 opinion pieces, position or policy statements; and 31 qualitative studies). The USA, UK, and Australia contributed over half the research, whilst cross‐country collaborations comprised 6% of it. The most common research settings comprised acute psychiatric wards (23.3%), general psychiatric wards (21.6%), and general hospital emergency departments (19.0%). Discussion A key lesson learnt whilst compiling this database of research into CR was to ensure that all papers described non‐consenting administration of medications to manage adults with uncontrolled aggression, anxiety, or violence. There were tensions in the literature between using effective CR without producing adverse events, and how to decide when CR was needed (compared with choosing non‐chemical intervention for behavioural emergencies), respecting patients' dignity whilst safeguarding their safety, and preserving safe workplaces for staff, and care environments for other patients. The range of outcome measures suggests opportunities to standardise future research. [ABSTRACT FROM AUTHOR]

Objective: Resident-to-resident aggression (RRA) in nursing homes is a matter of serious and profound concern, yet action to eliminate or mitigate RRA is hampered by a paucity of research. The aim of this study was to explore key stakeholders' knowledge and perceptions of RRA in Australian nursing homes. Methods: A qualitative cross-sectional study design was used, and semistructured telephone interviews were conducted. Participants were purposively and conveniently sampled with replacement from a range of aged care, healthcare and legal professional bodies, as well as advocacy organisations. The interview contained 12 closed-ended questions and six open-ended questions about participants' knowledge, experiences, perceptions and attitudes to RRA. Participant characteristics and responses to closed-ended questions were aggregated and proportions calculated, and thematic analysis was conducted by two independent researchers using a directed content approach. Results: Fifteen participants (11 females; 73.3%) in senior management positions were interviewed. All were familiar with the concept of RRA and just over half (n = 8; 53.3%) had witnessed an incident. Major themes included the nature and causes of RRA and attitudes and responses to RRA. Potential causes of RRA included maladaptation to nursing home life, transfer of pre-existing issues into the nursing home environment, physical environment and staffing-related issues. RRA was commonly viewed by participants as dangerous and unpredictable or, conversely, as expected behaviour in a nursing home setting. A person-centred care approach was considered most effective for managing and responding to RRA. Conclusion: The research demonstrates that understanding perceptions of RRA among key stakeholders is critical to identifying the nature and scope of the problem and to developing and implementing appropriate prevention strategies. What is known about the topic?: RRA is common in nursing homes, with potentially fatal consequences for residents involved, and has serious implications for nursing home staff, managers, providers, and regulators. Despite this, the prevalence, impact, and prevention of RRA remains under-recognised and under-researched in Australia. What does this paper add?: This is the first Australian study to produce qualitative findings on the knowledge and perceptions of RRA in nursing homes among key stakeholders. This paper reports on the knowledge and perceptions of individuals in senior management and policy roles in aged care and related fields in relation to four themes: nature; causes; attitudes; and responses to RRA. Our findings highlight the complex and multifactorial nature of RRA. What are the implications for practitioners?: A movement towards person-centred care that promotes understanding of individual care needs is favoured as an approach to reducing RRA. Increased reporting of both minor and major incidents of RRA will help to identify patterns and inform appropriate responses. However, a cultural shift is first required to recognise RRA as a manageable and preventable health care and adult safeguarding issue. [ABSTRACT FROM AUTHOR]

When nurses practise recovery‐focused care, they contribute positively to the consumer's mental health recovery journey and empower the person to be actively engaged in the management of their illness. While using recovery‐focused care is endorsed in mental health policy, many health professionals remain uncertain about its application with consumers who have a risk for aggression during their admission to an acute mental health inpatient setting. This paper reports on Australian research using Q‐methodology that examined the knowledge and skill components of recovery‐focused care that nurses use to reduce the risk for aggression. The data from forty mental health nurses revealed five factors that when implemented as part of routine practice improved the recovery outcomes for consumers with risk of aggression in the acute mental health settings. These factors were as follows: (I) acknowledge the consumers' experience of hospitalization; (II) reassure consumers who are going through a difficult time; (III) interact to explore the impact of the consumer's negative lived experiences; (IV) support co‐production to reduce triggers for aggression; and (V) encourage and support consumers to take ownership of their recovery journey. These findings provide nurses with a pragmatic approach to use recovery‐focused care for consumers with risk for aggression and contribute positively to the consumers' personal recovery. [ABSTRACT FROM AUTHOR]

Addressing bullying victimization of students with disability is a significant challenge for schools. While social support can protect against bullying victimization in the general population, its role in mediating the relationship between disability and bullying is under-researched. This paper examined covert bullying prevalence (encompassing relational, social and indirect aggression) and its relationship to social support (peer, family, and teacher) among a national sample of 4,753 Australian 8–14 year olds, 490 of whom self-identified as living with disability. Positive teacher and peer support predicted the reduced probability of bullying victimization among students overall, but low support levels among students with disability negated this effect. Interventions to address covert bullying of students with disability need to focus on whole-school approaches that reduce opportunities for victimization of students with disability. [ABSTRACT FROM AUTHOR]

People brought in by police (BIBP) to the ED are a potentially vulnerable group. This narrative scoping review aimed to identify, evaluate and summarise current literature regarding the frequency of presentation, demographic and clinical profile of patients (including reason for presentation), care delivery, and outcomes for people BIBP to the ED, and identify current gaps in knowledge. The review involved searching EMBASE, CINAHL and PubMed using a combination of terms: emergency/ED coupled with police custody/watch house or police presentation, for papers published in English language from January 2006 to November 2017. A total of 20 studies met the inclusion criteria. These included 17 observational (non‐randomised controlled trials) quantitative studies and three descriptive case reports. The proportion of presentations to ED that were BIBP varied depending on the study design and sampling frame. People BIBP often presented with mental health problems, substance use problems, aggressive behaviour and injury caused by self or others. Of studies focused specifically on patients arriving to the ED in mental health crisis (i.e. suicidal ideation or self‐harm), 18–27% were BIBP. ED presentations BIBP were mostly male and typically younger than people arriving by other means. The nature of care provided in the ED and outcomes of the acute episode of care were typically not well described. Limited research regarding people BIBP to the ED limits the ability to comprehensively understand their demographic and clinical profile and outcomes of emergency care. Further research is required to inform if and where in the patient's journey further improvements may be targeted. [ABSTRACT FROM AUTHOR]

Aims: This exploratory paper investigates the demographic profile of patrons who may be underrepresented in face-to-face interviews by employing a brief version of an interview. Method: Patron interviews (n = 8,664) were conducted in seven Australian cities; 63% completed the full interview and 37% completed the brief interview. Assessed correlates of interview type comprised gender, age, pre-drinking, consumption of alcohol mixed with energy drinks, illicit drug use, involvement in verbal or physical aggression, alcohol-related injuries, and blood alcohol concentration (BAC). Results: Using a brief interview increased the response rate by 34%. Multi-level logistic regression models indicated compared to those who completed the full interview, brief interview respondents were more likely to be: male, have a BAC of ≥0.05 to <0.10 or ≥0.10 g/100 ml, report pre-drinking, and report involvement in physical aggression. Respondents were also less likely to compete the brief interview with each 1 year increase in age. Conclusion: Compared to longer interviews, brief patron interviews can capture a different and more at-risk demographic group and increase the overall response rate. These findings raise questions about the representativeness of long interview samples describing young drinkers who experience aggression. The study also provides the groundwork for future validation of brief interviews. [ABSTRACT FROM AUTHOR]

Hospitals are places where patients are unwell, where patients and their families may be upset, confused, frustrated, in pain, and vulnerable. The likelihood of these experiences and emotions manifesting in anger and aggressive behaviour is high. In this paper, we describe the involvement of a clinical ethics service responding to a request to discuss family aggression within a rehabilitation department in a large paediatric hospital in Australia. We suggest two key advantages of involving a clinical ethics service in discussions about how to respond to family aggression. First, the process of ethics deliberation provides an opportunity for clinicians to be involved in the solution by articulating their perspectives, tolerance levels, and general concerns about the effects of family aggression towards staff. Second, supporting clinicians to articulate and identify the impact of parental aggression directly counters the disadvantages of the more blunt zero-tolerance policy response, which is necessarily imposed from the top down. [ABSTRACT FROM AUTHOR]

Aims: The aims of the study were to determine the types and prevalence of forensic mental health nurse exposure to patient aggression and explore the impact of these exposures on their physical and mental health and work absences. Design: Cross-sectional survey conducted January to April 2020. Methods: All 205 nurses working in an Australian high-security inpatient forensic mental health hospital were invited to participate. An online survey included the Perception of Prevalence of Aggression Scale to measure respondent exposure to types of patient aggression, and the SF-36v2 to measure mental and physical health. Absence from work and other work and individual characteristics were also explored. Results: Sixty-eight respondents completed the survey. Verbal abuse was the most experienced aggression type, followed by physical violence and observing violence, patient self-harming behaviours and sexual violence. Nurses who worked in acute units experienced significantly more exposure to overall aggression than nurses in non-acute units. Higher level of aggression was associated with number of days sick leave taken and days off due to aggression or violence. Higher level of aggression was associated with poorer mental health, and patient self-harming behaviour was associated with poorer physical health. Conclusions: Nurses in acute units experience higher levels of inpatient aggression and are therefore at increased risk of being impacted by the exposure. Findings indicate a psychological impact of exposure to frequent aggression and potential for an accumulative effect of exposure to traumatic events on nurse well-being. Nurses who are victim of, or witness, physical violence are most likely to take time off work. Impact: This study provides further evidence that forensic mental health nurses are frequently exposed to various forms of patient aggression. For some nurses, this exposure to patient aggression negatively impacted their mental and physical health. Employing organizations should therefore prioritize provision of formal support for nurses. No patient or public contribution. [ABSTRACT FROM AUTHOR]

This study investigates the nature of the social interaction profiles observed among youth with intellectual disabilities (ID), defined while considering their relationships with their parents, peers, and teachers, as well as the implication of these profiles for self-esteem, aggressive behaviors, and prosocial behaviors. A sample of 393 youth with mild (48.2%) to moderate (51.8%) levels of ID, aged between 11 and 22 (M = 15.70), was recruited in Canada (n = 141) and Australia (n = 253). Our results revealed four profiles, corresponding to Socially Isolated (23.24%), Socially Integrated (39.83%), Socially Rejected (28.37%) and Socially Connected (8.57%) youth with ID. The socially integrated and connected profiles both presented higher self-esteem, more prosocial behaviors, and less aggressive behaviors than the socially isolated and rejected profiles. [ABSTRACT FROM AUTHOR]

This paper reports on the findings from a qualitative research study that explored how young people prepared to minimise and/or avoid alcohol-related harm while attending a Schoolies Festival (SF). SFs are mass gatherings at which young people (schoolies) celebrate their graduation from high school. The attendance of schoolies, in various Australian communities, ranges between 10 000 and 30 000 individuals during the event. The literature suggests that schoolies are at higher than normal risk of harm at SF from misuse of alcohol, unsafe sex, aggressive behaviour, and other risk-taking factors. As a result of these concerns, SF organisers developed an infrastructure that treats alcohol-related harm, and provides on-site care (first aid stations) by St John Ambulance staff. This study used focus groups to identify strategies used by schoolies to avoid alcohol-related harm during SFs. Data revealed that schoolies did not actively seek health information before attending the event and did not display an interest in doing so. It is important to note that schoolies planned to use alcohol to celebrate and have a good time. Therefore a harm minimisation approach with a focus on providing the necessary infrastructure at SFs to minimise the dangers associated with excess alcohol use is important. Schoolies indicated that they had no desire for information about the hazards of alcohol ingestion. If any health messages were to be used by health authorities, it would be far more appropriate to promote the message of 'take care of your mate', to contribute to building a supportive environment at the event. This may be of more benefit to minimise harm at SFs than funding other health messages. [ABSTRACT FROM AUTHOR]

This study intends to analyze the relationship between military culture, masculine norms, attitude toward women, and workplace aggression. By using a paper-pencil survey in the Austrian Armed Forces, we show that overall 6.5 percent of all soldiers in the sample suffer from severe, long-term collective aggression (bullying). The detailed analysis suggests that systematic workplace aggression is associated with a culture with high power orientation and adherence to traditional (masculine) military norms. It occurs most often within socialization processes in training centers as well as in combat units. Conversely, culture in support units has high levels of task orientation with a comparably positive attitude toward female soldiers and less reported workplace aggression. The data reveal the gender dimension of workplace aggression in the Austrian Armed Forces: women are significantly more vulnerable to bullying. Almost every second soldier declares to have observed and every tenth soldier admits to have conducted aggressive acts against women. [ABSTRACT FROM PUBLISHER]

This paper discusses the degree to which recently reported relationships between the classroom management techniques and coping styles of Australian teachers apply in two other national settings: China and Israel. Little is known about which teacher characteristics relate to their approach to classroom management, although researchers in Australia have recently found that teachers' coping styles appear to predict the management techniques they utilize in classrooms. In this study, 772 teachers from a range of schools in Australia, China, and Israel completed questionnaires asking how frequently they use six classroom management techniques-hinting, discussion, involvement, recognition and reward, punishment, and aggression-and how often they use a range of coping behaviours. The analysis showed that some of the Australian findings were replicated only in Israel and others only in China, revealing national variations in the links between management techniques and coping styles, which have wider implications for investigations in this area. The implications of these findings are discussed, as are their potential ramifications for future research. [ABSTRACT FROM AUTHOR]

Abstract Most clinical nurses, particularly those working in mental health areas, have to deal on a regular basis with offensive language including swearing. Despite its prevalence, there has been little academic research concerning the extent of verbal aggression within health care settings, and none about the legal aspects of swearing in a nursing context. This paper is intended to give nurses practising in Australia a better understanding of definitional aspects of swearing and offensive language, the relevant law, and the basis of policy. This will then be followed by a critical examination of the management of offensive language in health care settings. [ABSTRACT FROM AUTHOR]

Despite seclusion being described as one of the most ethically- and legally-controversial management options available, it remains a widely-used clinical strategy for managing disruptive, aggressive, and violent behaviour. This study sought to determine how frequently seclusion was used, the common characteristics of those secluded and not secluded, and the degree to which the Level of Service Inventory - Revised: Screening Version (LSI-R: SV) could predict seclusion. The study was retrospective, covering the first 2 years of operation of a statewide forensic psychiatry hospital in Victoria, Australia. Data were collected from individual case files, electronic databases, and paper copies of records pertaining to violent incidents and episodes of seclusion. Eighty five (44%) of the 193 patients admitted during this period were secluded. Those secluded were significantly younger and had a more established psychiatric history. LSI-R: SV scores were significantly and positively associated with being secluded. A statistical model containing three LSI-R: SV items, along with age on admission and psychiatric history, achieved an area under the curve of 0.74. Seclusion is used on a regular basis in response to a range of different forms of aggressive behaviour of different severity. The LSI-R: SV demonstrated moderate-to-good accuracy in predicting seclusion and warrants further research using detailed prospective methodologies. [ABSTRACT FROM AUTHOR]

Across the industrialised world, there is evidence that both the incidence and the severity of occupational violence and bullying are increasingly being reported over time. While there have been few substantive scientific studies in Australia, all the available evidence shows a similar increasing level of risk. It has long been assumed that those who suffer a physical assault during the course of violent events are more likely to he emotionally traumatised by the experience than are those who are merely threatened or bullied at work. However, there are no substantive data published to date. In this paper the authors aim to elucidate and quantify the extent of emotional injury/stress suffered as a result of different forms of occupational violence, based on empirical data collected during face- to-face interviewing of 800 Australian workers employed in the tertiary education, health and long-haul transport industry sectors. The authors conclude that the impact from more coven forms of occupational violence (such as bullying) can, in many instances, at least equal the emotional trauma following assaults on-the-job. [ABSTRACT FROM AUTHOR]

Despite recent changes to mental health policy in Australia and overseas, physical restraint continues to be widely employed in mental health services. While mental health nurses have a critical role to play in supporting initiatives designed to reduce restraint, it is unclear how they feel about moves to restrict the use of prone restraint. In this qualitative study, focus group interviews were conducted with mental health nursing staff and lived experience workers (LEWs) to gain their perspectives on the use of physical restraint in general and the restrictions being placed on prone ('face down') restraint. Five themes emerged: justifying the need for restraint, reliance on the prone position, the position is not the issue, time limits, and the psychological impact. Although mental health nurses were concerned about the risks associated with physical restraint, they provided strong justification for continued use of the prone position. LEWs raised concerns about the psychological impact of prone restraint and noted the need for a greater emphasis on de‐escalation and other restraint avoidance strategies. The findings highlight the complexities and challenges to be considered when developing initiatives to reduce reliance on the use of restraint in general, and prone in particular. [ABSTRACT FROM AUTHOR]

Research investigating how cognition influences youth intimate partner abuse (IPA) remains limited. Understanding cognitive risk markers is theoretically important and can inform intervention to maximize the chance of behavior change. The current article investigated cognition regarding general antisociality, relationships, and gender-role attitudes on youth IPA perpetration among 275 (123 female) 14- to 18-year-olds. Theoretically derived relationships (based on social information processing theory and the General Aggression Model) were hypothesized, which furthered understanding of how cognition contributes to relationship aggression in adolescents, while controlling for common behavioral correlates. Results showed that, overall, other experiences of aggressive behavior more strongly related to youth IPA perpetration than cognitive correlates. Among boys, general antisocial cognition was more strongly associated with youth IPA perpetration than relationship-specific cognition, with the reverse being true for girls. These findings suggest there is value in exploring theoretically indicated cognitive risk markers for youth IPA in a gender-sensitive and dynamic manner. Findings also provide direction for future studies considering cognition and youth IPA in a more predictive manner and areas for consideration in intervention. [ABSTRACT FROM AUTHOR]

We test whether genetic influences that explain individual differences in aggression in early life also explain individual differences across the life-course. In two cohorts from The Netherlands (N = 13,471) and Australia (N = 5628), polygenic scores (PGSs) were computed based on a genome-wide meta-analysis of childhood/adolescence aggression. In a novel analytic approach, we ran a mixed effects model for each age (Netherlands: 12–70 years, Australia: 16–73 years), with observations at the focus age weighted as 1, and decaying weights for ages further away. We call this approach a 'rolling weights' model. In The Netherlands, the estimated effect of the PGS was relatively similar from age 12 to age 41, and decreased from age 41–70. In Australia, there was a peak in the effect of the PGS around age 40 years. These results are a first indication from a molecular genetics perspective that genetic influences on aggressive behavior that are expressed in childhood continue to play a role later in life. [ABSTRACT FROM AUTHOR]

This study examined the associations between schema modes and aggression in 59 male forensic psychiatric inpatients. Two instruments were used to assess schema modes: One measured modes through self-report, the Schema Mode Inventory (SMI), and one measured modes via observer (nurse) judgments, the Mode Observation Scale (MOS). Aggression was measured in two ways: Self-reported aggression during participants' lifetimes was assessed using the Life History of Aggression-Self-Report-Aggression Scale (LHA-S-A), and incidents of aggression during hospitalization in the month following schema mode assessment, were identified through review of medical records. Self-reported (SMI) and observer-reported (MOS) measures of schema modes were poorly related and produced disparate associations with aggression. As hypothesized, the observer-reported MOS Angry-Child and MOS Impulsive-Undisciplined-Child modes were significantly associated with aggression during the follow-up. A number of other schema modes (MOS-Healthy-Adult, SMI-Angry-Child, MOS-Complaining-Protector, SMI-Undisciplined-Child, and MOS-Angry-Protector) were unexpectedly associated with aggression. [ABSTRACT FROM AUTHOR]

Aim and objectives: To evaluate and examine the utility of the Violence Prevention Climate scale by generalist healthcare professionals. Background: Workplace violence in general hospital settings remains a challenge for healthcare organisations. High rates of violence are still being reported towards healthcare workers, despite organisational violence prevention strategies being implemented. There is a major challenge to healthcare organisation in the measurement of the effectiveness of these interventions, traditionally completed via the reporting and monitoring of workplace violent incidents. A novel approach to measuring workplace violence is by studying hospital atmosphere or climate. Design: A cross‐sectional survey using the STARD guidelines was used. Methods: The Violence Prevention Climate scale was completed by 194 healthcare staff working in the emergency department, medical/surgical wards, respiratory/infectious disease, spinal care, renal unit, corrections health, and rehabilitation and community services of a major Australian tertiary referral hospital. The Violence Prevention Climate scale has previously been validated and used in mental health settings, but not general hospital settings. A content analysis of an open‐ended question on violence prevention management strategies was also conducted. Results: Comprising of 14 items with two factors (patients and staff), the study revealed a 9‐item staff factor scale that can be used in the general hospital setting, the patient factor did not show adequate reliability. The content analysis revealed seven categories of staff identified violence prevention and management strategies. Conclusions: The use of the 9‐item scale across an organisation annually, or added to existing organisational workforce surveys, could prove to be practical way of measuring the social climate of violence in a general hospital setting. Relevance to clinical practice: The results of which could guide clinical practice, workplace safety, policy and educational initiatives for the prevention and management of workplace violence. [ABSTRACT FROM AUTHOR]

Hotter weather is associated with aggressive crime. However, it is not well known if similar relationships apply to online aggression. This study uses anger counts derived from Twitter posts (tweets) and assault counts in New South Wales, Australia, to investigate if they share a similar relationship with temperature, and to determine if online anger is a predictor of assault. Results indicated that the relationships were largely inverse—assault counts were higher in summer than winter, while angry tweet counts were lower. As daily maximum temperatures rose, assault counts increased while angry tweet counts decreased. Angry tweet counts were inversely associated with assaults, with an increase in tweets signaling decreasing assaults. There are several plausible explanations for the dissimilarities including the impact of temperature on behavior, socio-demographic differences, and data collection methods. The findings of this study add to the growing literature in social media emotion and its relationship with temperature. [ABSTRACT FROM AUTHOR]

Objective: In 2018, we developed and implemented a novel approach to recognition and response to occupational violence and aggression (OVA). It included routine use of the Brøset Violence Checklist for all ED patients integrated with a score‐based notification and response framework. The present study evaluated the impact of the new process on staff knowledge, perceptions and confidence regarding OVA in ED and the rate of security events related to OVA. Methods: The present study was conducted in a metropolitan hospital ED in Australia. Evaluation was by online before and after survey of nursing staff, point prevalence study of risk classification and comparison of OVA‐related events involving security in the year before implementation and the year after the programme was embedded. Results: One percent of patients were assessed as high violence risk with a further 4% at moderate risk. The introduction of the Brøset Violence Checklist increased documentation of violence risk assessment. It also improved staff perception of organisational support and awareness of behaviours associated with the risk of violence. There was a statistically significant reduction in unplanned OVA‐related security responses (relative risk 0.75, 95% confidence interval 0.62–0.89). There was also a statistically significant shift to proactive management through early detection and intervention (relative risk 2.22, 95% confidence interval 1.85–2.66). Conclusion: A process including routine OVA risk assessment and a notification and response framework reduced unplanned security events due to OVA and increased staff confidence in recognition and management of OVA. This approach may be suitable for use more broadly in ED. [ABSTRACT FROM AUTHOR]

Drug use has been shown to interact in complex ways with the occurrence and prevalence of family and domestic violence (FDV), with illicit drug use being associated with an increased risk for FDV. The current study aims to extend upon the literature by investigating the role of illicit drugs in intimate partner violence (IPV), family violence (FV), and other violence (violence between people other than partners or family) within a representative Australian sample (n = 5,118). Participants were recruited through an online survey panel and completed an online self-report survey assessing the role of alcohol and other drugs on violence, with a specific focus on FDV. Binary logistic regression showed that respondents who reported having used any illicit drug in the past 12 months (with or without alcohol use) had over three times the odds of experiencing any violence in the past 12 months (OR = 3.18, 95% confidence interval (CI) = [2.25, 4.48]) compared with those not using illicit drugs. Furthermore, drug involvement in FDV (IPV or FV) was significantly more likely than other violent incident types (OR = 1.65, 95% CI = [1.25, 2.19]). For the most recent FDV incident, age group was the only significant demographic predictor of drug involvement at this incident; younger age groups were over twice as likely to report drug involvement than those over 65 years of age. Drug involvement at the most recent FDV incident was also associated with over twice the odds of injury (OR = 2.38, 95% CI = [1.67, 3.38]) and significantly greater negative life impact. The findings that drug use increases both the risk for and impact of FDV indicate the need for policy that advocates for interventions addressing both drug use and violence in combination. [ABSTRACT FROM AUTHOR]

International research has shown that intimate partner abuse affects many young people throughout adolescence. Despite a recent focus on family and intimate partner violence in Australia, there is almost no Australian data on the frequency or nature of youth intimate partner abuse (YIPA). The current study sought to better understand the frequency and nature of YIPA in Australian adolescents. To this end, 423 participants aged between 14 and 18 from Victorian (Australian) high schools completed an anonymous questionnaire regarding experiences of perpetration and victimization in their most difficult intimate relationship. Results showed high rates of both YIPA victimization and perpetration among boys and girls who had been in intimate relationships. As was expected, verbally and psychologically aggressive behaviors were reported more frequently than physically or sexually aggressive actions. Mutual YIPA was detected more frequently than unidirectional YIPA, and most commonly involved high severity reciprocal aggression. The current study further confirmed that YIPA is a complex and heterogeneous issue, involving a range of behaviors, patterns of use, and severities. A gender-sensitive approach to the current study allowed for consideration of the similarities and differences between male and female experiences of YIPA. The current study provides a novel method of ascertaining both the frequency and severity of YIPA experiences in a sample of young people, expands on both Australian and international literature, and identifies important gender considerations for future research. [ABSTRACT FROM AUTHOR]

Anthropological studies of mortuary ceremonies have focused primarily on their social and structural correlates and functions. Little attention has been given to their role in facilitating the expression and resolution of grief by the bereaved. The elaborate and extended mortuary rites of the people of northeastern Arnhem Land, Australia (the "Murngin") have several characteristics which promote and structure the mourning process and facilitate the full reintegration of the bereaved into the social life of the community. [ABSTRACT FROM AUTHOR]

Objective: To explore trends in presentation and key performance indicators with respect to children seeking mental health services at The Prince Charles Hospital Children's Emergency Department (TPCH‐CED), Brisbane. Methods: A retrospective audit was performed utilising data obtained from the local Emergency Department Information System for all mental health presentations between 1 January 2013 and 1 January 2018 to TPCH‐CED. Results: A total of 1078 children presented to TPCH‐CED requiring mental health review between 2013 and 2018. Mental health presentations almost doubled over the 5 years (185 attendances in 2013; 342 in 2017); however, as a proportion of overall presentations, there was no significant increase. The percentage of mental health presentations meeting the National Emergency Access Target criteria dropped from 63% in 2013 to 39% in 2017 (P < 0.0001). Those requiring a mental health inpatient stay were more likely to have very extended length of stay within the CED. Suicidal ideation was the most common presenting complaint (72% of mental health presentations). Violence and aggression were noted in a consistent proportion of mental health presentations (4.4–12%). Conclusions: Despite failing to demonstrate an interval increase in the proportion of children presenting to TPCH‐CED requiring mental health services, it is clear that children with mental health needs, like their adult counterparts, disproportionately experience delays to appropriate care when compared with children presenting with other emergency conditions. Ongoing research is warranted to assess standards of care and the impact of mental health presentations on CEDs. [ABSTRACT FROM AUTHOR]

Receiver operating characteristic curve analysis was used to examine and compare the diagnostic accuracy of the Conners 3–Parent Short Form (C 3-P(S)), and the Conners 3–Teacher Short Form (C 3-T(S)) inattention and hyperactivity/impulsivity scales, and the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) attention problems scales, to distinguish those with and without attention deficit/hyperactivity disorder (ADHD). It also examined and compared the diagnostic accuracy of the C 3-P(S) and C 3-T(S) Aggression (AG) scales, and the CBCL and TRF Aggressive Behavior (AB) scales, to distinguish those with and without oppositional defiant disorder (ODD). The study used archival data (N = 150-261) involving a large group of clinic-referred children aged between 6 and 11 years who had been interviewed for clinical diagnosis of ADHD and ODD using the Anxiety Disorders Interview Schedule for Children (ADISC-IV) as the reference standard, and then administered one or more of the screening measures. The findings provided empirical support for the use of the C 3-P(S) and CBCL for identifying ADHD and ODD, with the CBCL aggressive behavior scale having better ability to detect ODD. The implications of the findings for using the screening scales for diagnoses of ADHD and ODD are discussed. [ABSTRACT FROM AUTHOR]

Little is known about how children's value priorities develop over time. This study identifies children's value priority profiles and follows their development during middle childhood. Australian children (N = 609; ages 5-12 at Time 1) reported their values over 2 years. Latent Transition Analysis indicated four profiles: Social-Focus, Self-Focus, Growth-Focus and Undifferentiated. Within person development was characterized by profile stability or transfer to the Social-Focus profile. Younger children were more likely to have an Undifferentiated profile (or Self-Focus among boys) than older ones. Girls were more likely to have a Social-Focus profile or transfer to it, and less likely to have a Self- or Growth-Focus profile than boys. Social-Focus profile membership over time predicted more prosocial and less aggressive behavior. [ABSTRACT FROM AUTHOR]

Objectives: To explore the attitudes of direct care staff in residential aged care when interacting with, and responding to, residents exhibiting behavioural and psychological symptoms of dementia (BPSD). Methods: Cross‐sectional survey (n = 70). Results: Participants favoured a person‐centred approach to their management of residents with BPSD and were aware of the causes of BPSD. There were significant differences between personal care workers' (PCWs) and enrolled nurses' (ENs) perceptions of the impact of interpersonal relationships and the physical environment on aggressive behaviours, and between registered nurses and both PCWs and ENs regarding the use of medications for aggressive behaviour and a medical approach to care. Conclusions: The attitudes of participants reflected an awareness of BPSD and its causes. Participants recognised the benefits of a person‐centred paradigm, but more education directed towards ENs and PCWs regarding appropriate administration and potential risks of psychotropic medication for BPSD may be beneficial. [ABSTRACT FROM AUTHOR]

Risk assessment is a pre‐requisite for violence prevention in mental health settings. Extant research concerning risk assessment and nursing intervention is limited and has focused on the predictive validity of various risk assessment approaches and instruments, with few attempts to elucidate and test interventions that might prevent aggression, and reduce reliance on coercive interventions. The integration of risk assessment and violence prevention strategies has been neglected. The aim of this feasibility study was to test a novel Aggression Prevention Protocol designed to prioritize the instigation of less restrictive interventions on an acute forensic mental health unit for female patients. A prospective quasi‐experimental study was designed to test an Aggression Prevention Protocol, linked to an electronic application of the Dynamic Appraisal of Situational Aggression (DASA). Following introduction of the DASA and Aggression Prevention Protocol, there were reductions in verbal aggression, administration of Pro Re Nata medication, the rate of seclusion, and physical and mechanical restraint. There was also an increase in documented nursing interventions. Overall, these results support further testing of the electronic application of the DASA and the Aggression Prevention Protocol. [ABSTRACT FROM AUTHOR]

Despite their widespread use, typical visual observation practices are not evidence‐based and adverse events – such as self‐harm and absconding – still occur even under the most intense forms of observation. This study aimed to (i) develop and implement an engagement‐focused systematized model of clinical risk management in an adult acute psychiatric inpatient unit; and (ii) prospectively evaluate its effect on rates of violence, self‐harm, absconding, sexually inappropriate behaviour, and seclusion. A new model of engagement‐focused clinical risk management was developed using a participatory action research framework and implemented in an adult acute psychiatric inpatient unit. Using a mirror‐image design, rates of violence/aggression, self‐harm, absconding, sexually inappropriate behaviour, and seclusion were compared before and after implementation, and staff satisfaction levels were measured. The clinical engagement‐based model was introduced, and 1087 admissions before implementation (24 months) were compared with 965 admissions post‐implementation (18 months). The new model was associated with significantly reduced rates of absconding (pre: 10.5/1000 occupied bed days, 95% CI [9.0, 12.1] compared with post: 6.5/1000 occupied bed days [5.2, 8.1], P < 0.001) and seclusion (pre: 43.7/1000 occupied bed days, 95% CI [40.6, 46.9] compared with post: 30.9/1000 occupied bed days [27.9, 34.1], P < 0.0001). Rates of aggression, deliberate self‐harm, and sexually inappropriate behaviour were non‐significantly decreased. Findings suggest that this engagement‐focused model of clinical risk management in an adult psychiatric inpatient unit significantly reduced adverse patient events and was preferred by staff over current practice. Other psychiatric inpatient facilities may see a reduction in adverse events following the introduction of this well‐tolerated risk management model. [ABSTRACT FROM AUTHOR]

Researchers explored nurses' attitudes toward clinical aggression in medical-surgical units before and after an education program. Findings indicated a shift after the intervention toward participants agreeing with attitudinal statements on several factors. Future research is recommended related to impact on practice. [ABSTRACT FROM AUTHOR]

The article focuses on the robotic seal named Paro, invented by Takanori Shibata for the social support and engaging activity of the people with dementia. Topics discussed include issue of loosing interest in activities, cognitive deficits, and lack of companionships, benefits of interacting with Paro, include conversation starter, emotional attachments, and personification.

This article examines perceptions of environmental cues to crime, violence, and injuries in barroom settings, and how they differ between bar fight participants and non-participants. Bouncer friendliness, patron sex composition, and room temperature were chosen as experimental variables based on three criteria: (a) emerged as a theme in bar user focus groups, (b) unclear effects in the literature, and (c) policy relevant and easy to modify. These experimental variables were manipulated in written vignettes set in a bar. A three-part online questionnaire recorded 681 male university students' responses to questions on demographics, the experiment, drinking and clubbing habits, and the Snell Masculinity Scale. A 2 × 2 × 2 randomized independent groups factorial design with covariates was embedded in the questionnaire, measuring the effects of the experimental variables on bar users' perceived fear of victimization, likelihood and frequency of crime, venue preference, and perceived severity of injuries after accounting for prior bar fight participation and masculinity. Participants generally rated perceived fear of victimization, likelihood and frequency of crime, and severity of injuries to be highest when the bouncer was unfriendly, the temperature was hot, and patrons were majority male. Only main effects were significant (p < .01). Masculinity scale responses were not related to participant perceptions. While fight participants (9.8% of the sample) and non-participants had similar perceptions of the risk associated with certain environmental cues, fight participants were significantly (a) less fearful of victimization in settings they perceived as dangerous and (b) more willing to drink in any hypothetical venue. [ABSTRACT FROM AUTHOR]

Bullying in schools is associated with an extensive public health burden. Bullying is intentional and goal oriented aggressive behavior in which the perpetrator exploits an imbalance of power to repeatedly dominate the victim. To differentiate bullying from aggressive behavior, assessment must include a valid measure of power imbalance as perceived by the victim. And yet, to date, there remains no agreement as to how to most accurately measure power imbalance among preadolescent children. This qualitative study explored children’s (age 9 to 11) understanding of power imbalance through thematic analysis of focus group discussions. Subthemes that emerged as influencing power imbalance include: age of victim, peer valued characteristics, and group membership and position. Subthemes of empathy and peer valued characteristics emerged as protecting against the negative impact of power imbalance. [ABSTRACT FROM AUTHOR]

Objectives:: The aim of this study is to understand better the service implications of patients presenting to an inner city Australian Emergency Department (ED) and Acute Psychiatric Inpatient Service (AIS) with a history of recent crystal methamphetamine use.Methods:: An audit was taken of all patients with recent crystal methamphetamine use presenting to St Vincent's Hospital Melbourne ED and AIS over the month of September 2017. Recorded information included patient demographics, diagnosis, aggressive episodes, restrictive interventions and other risk incidents.Results:: Methamphetamine was related to 21.7% of AIS admissions. Of these individuals, half were involved in aggression towards staff. In the ED, 65.7% of patients with amphetamine use were aggressive to staff and 50% were aggressive towards other patients. There were high rates of physical (69.2%) and mechanical restraint (61.5%) in the ED setting. Methamphetamine use in the AIS was commonly associated with enduring psychotic disorders, whilst those managed exclusively in the ED were most commonly in an acute intoxicated state.Conclusions:: Methamphetamine use presents a significant challenge to EDs and acute mental health services. Additional resources are required to manage these patients and their impact on the health system needs to be factored into future service planning. [ABSTRACT FROM AUTHOR]

Problematic anger is often the outward manifestation and expression of deeper mental health issues in young men with strong links to depression, aggression, and suicide. Few studies have explored adolescent anger and aggression from the perspective of adolescent males and even fewer studies focus specifically on a rural context. This research aimed to understand the role of anger and aggression from the perspective of Australian rural adolescent males. Mental health nurses can build upon this knowledge to promote more adaptive ways of coping with anger therefore identifying specific interventions for the prevention of violence and promotion of mental health in this cohort. One hundred and eighty‐seven rural adolescent males participated in focus groups that were conducted during their participation in the Rock and Water Program (RWP). Participants identified a number of factors they felt contributed to the aggression they both witnessed and experienced with eight themes emerging in response to the research questions. Four themes related to personological factors, that is racism, homophobia, family influences, and media influence. A further four themes related to situational factors, that is alcohol, territorialism, school context, and peer pressure. The study identified that racist and homophobic attitudes and beliefs were evident and clearly contributed to aggressive scripts as did family and media messages that normalized aggressive behaviour by way of endorsing stereotypical images of an aggressive masculinity. Situational factors such as alcohol use, territorialism, school context, and peer pressure were directly linked by participants to aggressive incidents embedded within their notions of masculinity. [ABSTRACT FROM AUTHOR]

Aims: To examine the relationship between workplace violence perpetrated by clients, their innate neurophysiological response to dis‐ease and the resulting interactions with healthcare providers. Background: Client‐on‐worker violence remains a problem globally. Workplace violence risk factors have been documented. A gap remains in understanding what has happened to clients that perpetrate violence, and the link between adverse childhood experiences (ACE), the neuroscience of threat and trauma‐informed care. Design: This explanatory study was part of a larger descriptive study. Methods: Managers, directors, health/safety staff, nurses and educators (n = 99) from Australian rural and metropolitan health services participated in individual and group interviews. Following inductive thematic analysis, a secondary analysis, informed by understandings of ACE, polyvagal theory and trauma‐informed care, was conducted. Analysis was guided by the question: What happens to clients that causes them to instigate violence against healthcare workers? Reporting of this research adheres to the COREQ guidelines. Results: Clients can react aggressively when under perceived threat. Themes included are as follows: client stress and trauma, previous client trauma, impact of care provision on client and trauma‐informed care. Conclusion: Healthcare services can be experienced as stressful environments. Coupled with high incidences of past trauma, clients' assessment of risk and safety can be compromised resulting in inappropriate reactivity when staff are trying to provide care. Care provision can be perceived as a threat to clients' physical and psychological safety, activating the fight protective response resulting in aggression. Understanding and applying neuroscience and implementing a cultural change of trauma‐informed care have the potential to reduce workplace violence. Even with these understandings, it is imperative that healthcare staff are protected and feel safe at work. Relevance to clinical practice: Understanding trauma and the neuroscience of threat and safety can assist staff to understand what happens to clients that causes them to instigate violence against healthcare providers and implement systems and strategies to respond to such threat. [ABSTRACT FROM AUTHOR]

Background: Prior research indicates that patterns of combined alcohol and methamphetamine use may be associated with experiencing subjective feelings of aggression or hostility during methamphetamine use episodes. Objectives: This study examines whether subjective effects of methamphetamine use (i.e., aggression or hostility and paranoia) are associated with aggressive behavior while under the influence of any illicit drugs, controlling for combined alcohol andmethamphetamine use and a number of other potential predictors. Methods: Data from a population-based sample of Australian young adult methamphetamine users (n = 101) collected in 2010 was analyzed. A prediction model of aggressive behavior under the influence of illicit drugs was developed using penalized maximum likelihood logistic regression. Results: Over one-third (34.7%) of methamphetamine users had engaged in verbal and/or physical aggression under the influence of illicit drugs in the last 12 months. In the prediction model, recurrent feelings of aggression or hostility attributed to methamphetamine use (≥3 times in the last 12 months) were associated with aggressive behavior (adjusted odds ratio 4.95, 95% confidence interval 1.67, 14.69). This association was independent of methamphetamine-attributed paranoia, combined alcohol and methamphetamine use, methamphetamine, ecstasy, cocaine, and cannabis use patterns, heavy episodic drinking, gender, and age. No association was found for combined alcohol andmethamphetamine use. Conclusions: These findings indicate a link between methamphetamine-related subjective feelings of aggression or hostility and self-reported aggressive behavior while under the influence of illicit drugs. This suggests that subjective feelings of aggression or hostility may distinguish those who are involved in aggression from other methamphetamine users. [ABSTRACT FROM AUTHOR]

In this study, we tested social identity complexity theory (Roccas & Brewer, 2002) in relation to attitudes toward diversity and the associated variables of patriotism, nationalism, religiosity, aggression, and sense of self (well-being) in a cross-cultural study of 398 Malaysian, 239 Australian, and 201 Puerto Rican students. Puerto Ricans reported the most positive attitudes toward diversity, followed by Australians, and finally Malaysians. For Puerto Ricans, pro-diversity attitudes were predicted by a positive correlation with constructive patriotism and a negative correlation with blind patriotism. For Australians, pro-diversity attitudes were predicted by a positive association with constructive patriotism, a negative association with traditional nationalism, and a negative association with physical aggression. For Malaysians, pro-diversity attitudes were predicted by positive relationships with all of the following variables: constructive patriotism, traditional nationalism, verbal aggression, hostility, and the need to bolster self through idealizing others. These results support social identity complexity theory and partially support associated predictions for Australians, Puerto Ricans, and some of the predictions for Malaysians. The results are explained in terms of local cultural contexts that may not easily be understood by a simple understanding of the variables that were measured. [ABSTRACT FROM AUTHOR]

Abstract: Rationale, aims, and objectives: Minimizing the risks and distress arising from aggression in after‐hours house call (AHHC) services will help improve service quality in the industry. Unfortunately, no national study has ever evaluated this in Australian AHHCs. Apart from reducing this gap, findings from this work will have global relevance given the rising popularity of the AHHC industry worldwide. Methods: A survey of all 300 doctors employed by the National Home Doctor Service, Australia's largest AHHC service provider. A validated electronic questionnaire was used to examine the doctors' experiences over a 12‐month period. Results: There were 168 valid responses (56% response rate). Aggression prevalence was 47.1%, and just over half (51.8%) of the cases came from the patients. “Verbal aggression” was the commonest (48.3%). Others are “threats” (26.6%), “vexatious complaints” (13.3%), “property damage” (4.2%), “physical violence” (4.2%), “sexual harassment” (2.8%), and “stalking” (0.7%). Majority of the respondents were concerned (90.2%) and apprehensive (75.2%) regarding the risks. Doctors who have experienced aggression were more likely to express apprehension (OR = 3.99; CI = 1.54–10.31; P = 0.004), while those that have attained Postgraduate Fellowships (Vocationally Registered) were less likely to report experiences of aggression (OR = 0.28; CI = 0.09–0.84; P = 0.02). Even though a higher proportion of females were concerned (92.3% vs 89.6%) and apprehensive (82.1% vs 73.6%) compared with males, these differences were not statistically significant (Fisher's Exact Tests: P = 1.000 and 0.469, respectively). Conclusion: Aggression in Australian AHHC affects nearly 1‐in‐2 practitioners, with high levels of concern and apprehension being expressed. Concerned companies should do more to ensure that their doctors attain PG fellowships, as this is linked to lower reports of aggression. Where possible, family and friends need to be involved in patient care, as nearly half of the reported aggressions come from them. [ABSTRACT FROM AUTHOR]

This study investigates the association between family relationships, anger, alcohol use, and self-reported intimate partner violence (IPV). Participants were 55 male prisoners who completed a survey about their family relationships, anger, alcohol use, and aggression. Exposure to parental IPV predicted rates of self-reported perpetration of IPV, suggesting the importance of understanding more about the developmental pathways to IPV if effective prevention, intervention, and assessment strategies are to be developed for use with this high-risk population. [ABSTRACT FROM AUTHOR]

Objective: Past research associates heavy episodic drinking (HED), trait aggression, and conformity to masculine norms with increased risk of barroom aggression (BA) perpetration by men. Such studies have mostly employed university samples, limiting the generalizability of these findings to other male groups. This study assessed the association of HED, trait aggression, and masculine norms with BA perpetration in a sample of male tradespeople. Method: Australian tradesmen aged 18–35 years (N = 221, Mage = 21.92, SDage = 4.08, 81.5% apprentices) completed an individual interview at their place of work or training, assessing past-month HED and past-year verbal and physical BA perpetrations, as well as the short Buss-Perry Aggression Questionnaire and items from the Conformity to Masculine Norms Inventory-46. Results: Participants reported high levels of verbal (35.1%) and physical (27%) BA perpetration. Negative binomial regression analyses found that HED, trait aggression, and Winning, Risk-taking, and Playboy norms predicted increased risk of both verbal and physical BA perpetrations, while Violence was negatively associated with verbal BA perpetration. Conclusions: Trait aggression was the strongest predictor of both verbal and physical BA perpetrations. Dispositional aggression, HED, and norms endorsing competitiveness, risk-taking, and promiscuity increase the risk of male tradespeople engaging in BA. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the present study was to investigate differences in prevalence, as well as risk and protective factors, for exposure to workplace aggression between male and female clinicians in Australian medical practice settings. Methods. In a cross-sectional, self-report study in the third wave of the Medicine in Australia: Balancing Employment and Life survey (2010-11), 16 327 medical practitioners were sampled, with 9449 (57.9%) respondents working in clinical practice. Using backward stepwise elimination, parsimonious logistic regression models were developed for exposure to aggression from external (patients, patients' relatives or carers and others) and internal (co-workers) sources in the previous 12 months. Results. Overall, greater proportions of female than male clinicians experienced aggression from external (P < 0.001) and internal (P < 0.01) sources in the previous 12 months. However, when stratified by doctor type, greater proportions of male than female general practitioners (GPs) and GP registrars experienced external aggression (P < 0.05), whereas greater proportions of female than male specialists experienced external (P < 0.01) and internal (P < 0.01) aggression. In logistic regression models, differences were identified in relation to age for males and experience working in medicine for females with external and internal aggression; working in New South Wales (vs Victoria) and internal aggression for females; a poor medical support network and external aggression, and perceived unrealistic patient expectations with internal aggression for males; warning signs in reception and waiting areas with external aggression for males; and optimised patient waiting conditions with external and internal aggression for females. Conclusions. Differences in risk and protective factors for exposure to workplace aggression between male and female clinicians, including in relation to state and rural location, need to be considered in the development and implementation of efforts to prevent and minimise workplace aggression in medical practice settings. [ABSTRACT FROM AUTHOR]

Sports wagering has been identified as a gambling product which may pose particular risks for young men, because of the aggressive marketing tactics used to promote these products, and the alignment with culturally valued sporting activities. However, there is very limited information about the socio-cultural processes that may contribute to the normalisation of sports wagering for this population. Using semi-structured interviews with 50 Australian young men who gambled on sport, we explored the way in which peer group behaviours influenced attitudes towards, and the consumption of, gambling products. Four thematic clusters emerged from the interviews. First, young men perceived that sports wagering was a ‘normal’ and socially accepted activity, and a natural ‘add on’ to sports. Second, there were clear indicators that sports wagering was becoming embedded within existing peer based sporting rituals, with the emergence of gambling clubs, and online forums. The third finding related to the shaping of gambling/sport discussions, which created a sense of identity and a point of conversation for peers. Finally, some participants spoke of the social pressure to gamble to ‘fit in’ with their friends. This study suggests that sports wagering poses a new health threat for young men, with sports wagering quickly being normalised as an embedded activity in young male sports fans' peer groups. There are clear lessons from the Australian experience for other countries, relating to the ways in which industry marketing tactics may combine with culturally valued activities such as sport, to influence risky gambling behaviours. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is controversy about whether central nervous system stimulant (CNS) medication is an effective method of treating acquired attention deficits in children with acquired brain injury (ABI). OBJECTIVE: The primary objective was to determine the effectiveness of stimulants on attention, concentration and executive function in children with ABI. METHODS: Randomised, double-blind, placebo-controlled, multi-centre n-of-1 trials of stimulants assessing effect on attention, concentration and executive function in 53 children and adolescents with ABI who were outpatients of three tertiary hospitals in Australia. Trials consisted of 3 two-week cycles, each cycle consisting of stimulant medication at doses titrated by physician (1 week) and placebo (1 week) in random order. The effect on parent and teacher Conners' 3 and Behaviour Rating Inventory of Executive Function (BRIEF) was analysed using hierarchical Bayesian methods. RESULTS: Overall, Teacher Conners' Hyperactivity/Impulsivity and Teacher BRIEF Global Executive scales showed important improvement (T-score mean change 2.6; 95% credible interval (CI): 0.4, 4.9; posterior probability of mean change > 0 : 0.99; T-score mean change 3.1; 95% CI: -0.1, 6.4; posterior probability of mean change > 0 : 0.97). There were no important improvements in parent/guardian-reported primary outcomes. There was heterogeneity in response identified through individual results of the N-of-1 trials. CONCLUSIONS: N-of-1 trials have a clear role in identifying those children/adolescents with ABI and secondary Attention Deficit Hyperactivity Disorder (ADHD) who have important improvements, or worsening on stimulants. The results can only be generalized to children/adolescents who have an apparent pre-trial clinical effect from stimulants. [ABSTRACT FROM AUTHOR]