Search

Background Childhood cancer survivors are vulnerable to long-term treatment-related health conditions, which can lead to poor quality of life. Little data exist on the overall health of long-term Australian and New Zealand childhood cancer survivors or on survivors' motivations for attending survivorship clinics. Methods This study administers a cross-sectional questionnaire to long-term survivors ≥5 years from their primary diagnosis. We compared participant-reported number of late effects by a cancer diagnosis, and identified clinical (eg, treatment) and demographic (eg, age) factors that were associated with late effects burden and engagement in cancer survivorship care. Results A total of 634 participants completed questionnaires (48% male, mean age = 21.7 years). Most participants (79%) reported at least one cancer-related late effect, most commonly fatigue (40%) and memory/learning difficulties (34%). Brain tumor survivors reported a higher total number of late effects than survivors with other diagnoses (mean = 5.7 vs. 3.2, P  < .001). Participants' most commonly reported motivators for engaging in care were to understand problems that may occur later in life because of their cancer and/or treatment (98.5%) and to get reassurance about one's health (97.4%). The proportion of survivors endorsing each motivating factor was similar across cancer diagnoses, with the exception of learning more about insurance and pensions (highest in brain tumor survivors = 80%). In multivariable analyses, survivors were more likely to report being engaged in survivorship care if they were younger (P  < .001), less time had elapsed since their diagnosis (P  < .001), or they reported a higher number of motivating factors (P  = .016). Conclusion Survivors report a range of health problems decades after treatment completion. Understanding the burden of late effects, and motivators for seeking survivorship care to manage these health problems, is important for ensuring that tailored interventions or services are available to meet the needs of this growing population and to design effective models of survivorship care. [ABSTRACT FROM AUTHOR]

Background and Hypothesis Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, yet a significant proportion of individuals on clozapine continue to experience disabling symptoms, despite being treated with an adequate dose. There is a need for adjunct treatments to augment clozapine, notably for negative and cognitive symptoms. One such potential agent is the glutathione precursor N -acetylcysteine (NAC). Study Design A randomized double-blind, multi-center, placebo-controlled trial for clozapine patients with enduring psychotic symptoms (n = 84) was undertaken to investigate the efficacy of adjunctive NAC (2 g daily) for negative symptoms, cognition and quality of life (QoL). Efficacy was assessed at 8, 24, and 52 weeks. Study Results NAC did not significantly improve negative symptoms (P =.62), overall cognition (P =.71) or quality of life (Manchester quality of life: P =.11; Assessment of quality of life: P =.57) at any time point over a 1-year period of treatment. There were no differences in reported side effects between the groups (P =.26). Conclusions NAC did not significantly improve schizophrenia symptoms, cognition, or quality of life in treatment-resistant patients taking clozapine. This trial was registered with "Australian and New Zealand Clinical Trials" on the 30 May, 2016 (Registration Number: ACTRN12615001273572). [ABSTRACT FROM AUTHOR]

Background People with chronic conditions experience high psychological distress. Methods Using the National Health Survey in Australia during 2017–18, the study assessed whether and which health literacies moderated the relationship between chronic conditions and psychological distress for diabetes, chronic kidney disease (CKD), cardiovascular disease (CVD), arthritis, other musculoskeletal conditions, asthma, other chronic lower respiratory diseases and cancer. Psychological distress was regressed on chronic diseases, health literacy domains and their interactions, controlling for demographic, socioeconomic and health factors. Results Of 5790 adults, 4212 (72.75%) aged 18–64; 846 (14.6%) had high or very high psychological distress, 1819 (31.4%) had diabetes, CKD or CVD, 2645 (45.7%) musculoskeletal conditions, and 910 (15.7%) lower respiratory conditions. Having sufficient information from healthcare providers was associated with the lowest level of psychological distress for CKD and cancer. Social support was associated with significantly lower levels of psychological distress for cardiovascular, musculoskeletal and lower respiratory conditions. Understanding health information was associated with the largest improvement in psychological distress for diabetes. Conclusions Higher health literacies were associated with reduced risks of psychological distress among individuals managing chronic conditions. Interventions for improving self-management and health inequalities should incorporate disease-specific health literacy enhancement strategies at individual and organizational levels. [ABSTRACT FROM AUTHOR]

Background globally, falls and fall-related injuries are the leading cause of injury-related morbidity and mortality in older people. In our ageing society healthcare costs are increasing, therefore programmes that reduce falls and are considered value for money are needed. Objective to complete an economic evaluation of an e-Health balance exercise programme that reduced falls and injurious falls in community-dwelling older people compared to usual care from a health and community-care funder perspective. Design a within-trial economic evaluation of an assessor-blinded randomised controlled trial with 2 years of follow-up. Setting StandingTall was delivered via tablet-computer at home to older community-dwelling people in Sydney, Australia. Participants five hundred and three individuals aged 70+ years who were independent in activities of daily living, without cognitive impairment, progressive neurological disease or any other unstable or acute medical condition precluding exercise. Main outcome measures cost-effectiveness was measured as the incremental cost per fall and per injurious fall prevented. Cost-utility was measured as the incremental cost per quality-adjusted life year (QALY) gained. Main results the total average cost per patient for programme delivery and care resource cost was $8,321 (standard deviation [SD] 18,958) for intervention participants and $6,829 (SD 15,019) for control participants. The incremental cost per fall prevented was $4,785 and per injurious fall prevented was $6,585. The incremental cost per QALY gained was $58,039 (EQ5D-5L) and $110,698 (AQoL-6D). Conclusion this evaluation found that StandingTall has the potential to be cost-effective in specific subpopulations of older people, but not necessarily the whole older population. Trial registration ACTRN12615000138583. [ABSTRACT FROM AUTHOR]

Background: Good primary care for people with substance use disorders (SUDs) is crucial given the high prevalence of SUDs and overdose deaths.Objective: To explore general practice care for people with a history of SUDs from the perspectives of women involved with the criminal justice system.Methods: Qualitative interview study with pre- and postrelease interviews, undertaken in Australian prisons and community settings. We utilized thematic analysis informed by constructivist grounded theory.Results: We undertook 65 interviews with 39 women. Access to and experience of general practitioner (GP) care was affected by perceived welcomeness, decisions around disclosure, and consultation experiences related to medication prescription. Participants reported that they were not as welcome as other patients, welcome could be conditional on not disclosing SUDs or only requesting unrelated healthcare, and GPs did not always differentiate between past and current drug use. Participants perceived difficulty finding general practices where the potential benefit of disclosing SUDs outweighed the risks of stigmatized reactions and lack of GP skills and interest. Participants did not always recognize that care beyond physical health could occur in general practice. The pejorative implications of labelling patients as "doctor shoppers" were challenged by participants, as they considered it could be necessary to attend multiple GPs to find a welcoming practice.Conclusions: People with histories of SUDs do not uniformly experience welcomeness in general practice, perpetuating poor engagement in healthcare and poor outcomes related to SUDs. Programmes targeting prescription drug misuse through general practice should also promote welcomeness for people with SUDs. [ABSTRACT FROM AUTHOR]

Background: Brief interventions (BIs) delivered in primary care can reduce harmful alcohol consumption. Yet, clinicians do not routinely offer BIs to reduce harmful alcohol use.Objective: We explored the perspectives of clinicians and patients about the use of alcohol BIs during consultations in Australian primary care.Methods: Semi-structured interviews and focus groups (face-to-face and virtual) were undertaken with 34 general practitioners, eight practice nurses and 17 patients. Field notes were made from audio-recordings and themes were identified using a descriptive qualitative approach with the field notes as the point of data analysis.Results: Participants identified barriers within the consultation, practice setting and wider healthcare system plus across the community which reduce the delivery of BIs in primary care including: Australian drinking norms; inconsistent public health messaging around alcohol harm; primary care not recognized as a place to go for help; community stigma towards alcohol use; practice team culture towards preventive health, including systems for recording alcohol histories; limitations of clinical software and current patient resources.Conclusion: Multiple layers of the healthcare system influence the use of BIs in primary care. Identified facilitators for embedding BIs in primary care included: (i) raising community and clinician awareness of the health harms of alcohol, (ii) reinforcing a primary care culture that promotes prevention and, (iii) supportive resources to facilitate discussion about alcohol use and strategies to reduce intake. Alcohol BIs in primary care could be further supported by community public health messages about alcohol use. [ABSTRACT FROM AUTHOR]

Summary. We compare two Australian studies which ask households to report on the incidence of specific events of financial difficulty such as failure to pay the utility bill on time or seeking help from welfare agencies. Although collected within the same year, the two studies use markedly different survey methodologies. One study uses a written self-completion questionnaire completed after a face-to-face interview, asks about individual experience of financial difficulty and interviews each member of the household over the age of 15 years. The other study uses a computer-assisted face-to-face interview and asks one randomly selected member of the household about household level experience of financial difficulty. We find substantial differences in response rates, even after controlling for individual and household characteristics. The self-completion questionnaire elicits 33% more reports of financial difficulty for singles and 36% more for couple-headed households. [ABSTRACT FROM AUTHOR]

Background The global population is ageing, and rates of multimorbidity and chronic illness are rapidly rising. Given specialist palliative care has been shown to improve overall care and reduce health care costs, how best to provide this care to older people is internationally significant. Aim To examine the knowledge, attitudes and practices of geriatricians in providing palliative care and working with specialist palliative care services. We also aimed to capture self-reported barriers, confidence and satisfaction in providing palliative care. Design A prospective cross-sectional study surveying Australasian geriatricians was conducted. Setting/Participants This was a voluntary anonymous online survey, distributed to all full members of the Australian and New Zealand Society of Geriatric Medicine. Results A total of 168 completed responses were received; 58.3% were female and 36.6% had over 20 years of clinical experience. Most geriatricians (85%) reported caring for patients in their last 12 months of life represented a substantial aspect or most of their practice. Geriatricians overwhelmingly believed they should coordinate care (84%) and derived satisfaction from providing palliative care (95%). The majority (69%) believed all patients with advanced illness should receive concurrent specialist palliative care. Regarding knowledge, participants scored an average of 13.5 correct answers out of 18 in a Modified Palliative Care Knowledge Test. Conclusions Geriatricians find reward in providing generalist palliative care to their patients; however, potential exists for improved collaborations with specialist palliative care services. An evidence base for geriatric patients who benefit most from specialist palliative care services is needed to improve resourcing, collaborative practice and ultimately palliative care delivery. [ABSTRACT FROM AUTHOR]

Background: Despite generally high smoking prevalences, stemming from colonization, the relationship of smoking to mortality has not been quantified reliably in an Indigenous population. We investigate smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia, where current adult daily smoking prevalence is 40.2%.Methods: A prospective study of 1388 cardiovascular disease- and cancer-free Aboriginal adults aged ≥45 years, of the 267 153 45 and Up Study participants randomly sampled from the New South Wales general population over 2006-09. Questionnaire and mortality data were linked (through the Centre for Health Record Linkage) to mid-2019. Adjusted hazard ratios (called relative risks, RRs) for all-cause mortality-among current- and past- versus never-smokers-were estimated overall, by smoking intensity and by age at cessation. Smoking-attributable fractions and associated deaths were estimated.Results: Over 14 586 person-years' follow-up (median 10.6 years), 162 deaths accrued. Mortality RRs [95% confidence interval (CI)] were 3.90 (2.52-6.04) for current- and 1.95 (1.32-2.90) for past- versus never-smokers, with age heterogeneity. RRs increased with smoking intensity, to 4.29 (2.15-8.57) in current-smokers of ≥25 cigarettes/day. Compared with never-smokers, RRs were 1.48 (0.85-2.57) for those quitting at <45 years of age and 2.21 (1.29-3.80) at 45-54 years. Never-smokers lived an average >10 years longer than current-smokers. Around half of deaths among adults aged ≥45 years were attributable to smoking, exceeding 10 000 deaths in the past decade.Conclusions: In this population, >80% of never-smokers would survive to 75 years, versus ∼40% of current-smokers. Quitting at all ages examined had substantial benefits versus continuing smoking; those quitting before age 45 years had mortality risks similar to never-smokers. Smoking causes half of deaths in older Aboriginal and Torres Strait Islander adults; Indigenous tobacco control must receive increased priority. [ABSTRACT FROM AUTHOR]

Background Social disadvantage is a key determinant of multimorbidity. Pathways through which social disadvantage leads to multimorbidity are yet undefined. In this study, we first examined the causal effect of moving into financial hardship on multimorbidity among Australian adults, and then the role of social support as a mediator of the relationship between financial hardship and multimorbidity. Methods Data were obtained from the Household, Income and Labour Dynamics in Australia (HILDA) Survey (2009–2013). We identified individuals who moved into financial hardship between 2010 and 2011 (n  = 5775). Inverse probability treatment weighting with regression adjustment was used to examine the relationship between financial hardship and multimorbidity. Causal mediation analysis was applied to decompose the total effect of financial hardship on multimorbidity into the proportion attributable to social support and the proportion not occurring through measured pathways. We accounted for baseline covariates including age, sex, marital status, educational attainment, employment status, income, country of birth, multimorbidity and social support. Bootstrapping with 1000 replications was used to calculate 95% confidence intervals (CIs). Results The risk of multimorbidity was higher in those with financial hardship by 19% [relative risk 1.19 (95% CI: 1.02–1.37) and absolute risk difference 0.036 (95% CI: 0.004–0.067)] than those without financial hardship. Social support accounted for 30% of the total effect of financial hardship on multimorbidity, risk difference 0.009 (95% CI: 0.003–0.018). Conclusions Financial hardship leads to increased risk of multimorbidity. Interventions directed at increasing social support among those in financial hardship may reduce their risk of multimorbidity. [ABSTRACT FROM AUTHOR]

Study Question: What self-management factors are associated with quality of life among women with endometriosis?Summary Answer: Greater self-efficacy was associated with improved physical and mental quality of life.What Is Known Already: Women with endometriosis have an impaired quality of life compared to the general female population. However, most studies have investigated quality of life in a hospital or clinic setting rather than a community setting and the association between self-management factors and quality of life have not, to date, been investigated.Study Design, Size, Duration: A cross-sectional, population-based online survey was performed, which was advertised through women's, community and endometriosis-specific groups.Participants/materials, Setting, Methods: A total of 620 women completed the survey for this study. Mental and physical quality of life was assessed using the standardized SF36v2 questionnaire. Self-management factors included self-efficacy, partners in health (active involvement in managing the condition) and performance of self-care activities. Treatment approaches included the use of hormonal treatment, pain medications and complementary therapies and whether the participant had a chronic disease management plan. Hierarchical regression analyses were used to examine whether self-management and treatment factors were associated with quality of life.Main Results and the Role Of Chance: Both physical and mental quality of life were significantly lower among women with endometriosis compared to the mean scores of the general Australian female population (P < 0.001). Physical quality of life was positively associated with income sufficiency (P < 0.001) and greater self-efficacy (P < 0.001), but negatively associated with age (P < 0.001), pain severity (P < 0.001), use of prescription medications (P < 0.001), having a chronic disease management plan (P < 0.05) and number of self-care activities (P < 0.05). Mental quality of life was positively associated with being older (P < 0.001), partnered (P < 0.001), having a university education (P < 0.05), increasing self-efficacy (P < 0.001) and higher partners in health scores (P < 0.001).Limitations, Reasons For Caution: Results are derived from a cross-sectional study and can only be interpreted as associations not as causal relationships. The sample was more educated, more likely to speak English and be born in Australia than the general Australian female population of the same age, which may influence the generalizability of these results.Wider Implications Of the Findings: This study investigated a knowledge gap by investigating quality of life of women with endometriosis in a large community sample. Self-efficacy was significantly associated with both physical and mental quality of life. Supporting women with endometriosis to improve self-efficacy through a structured chronic disease management programme may lead to improvements in this aspect of wellbeing.Study Funding/competing Interest(s): R.O. undertook this research as part of her PhD at Monash University, which was supported by an Australian Government Research Training Program Stipend. J.F. is the Finkel Professor of Global Public Health, which was supported by the Finkel Family Foundation. There are no conflicts of interest to declare.Trial Registration Number: NA. [ABSTRACT FROM AUTHOR]

In Australia, as in many industrialized countries, the past 50 years have been marked by increasing female labor-force participation. It is popularly speculated that this might impose a mental-health burden on women and their children. This analysis aimed to examine the associations between household labor-force participation (household employment configuration) and the mental health of parents and children. Seven waves of data from the Longitudinal Study of Australian Children were used, comprising 2004–2016, with children aged 4–17 years). Mental health outcome measures were the Strengths and Difficulties Questionnaire (children/adolescents) and 6-item Kessler Psychological Distress Scale (parents). A 5-category measure of household employment configuration was derived from parental reports: both parents full-time, male-breadwinner, female-breadwinner, shared-part-time employment (both part-time) and father full-time/mother part-time (1.5-earner). Fixed-effects regression models were used to compare within-person effects, controlling for time-varying confounders. For men, the male-breadwinner configuration was associated with poorer mental health compared with the 1.5-earner configuration (β = 0.21, 95% confidence interval: 0.05, 0.36). No evidence of association was observed for either women or children. This counters prevailing social attitudes, suggesting that neither children nor women are adversely affected by household employment configuration, nor are they disadvantaged by the extent of this labor-force participation. Men's mental health appears to be poorer when they are the sole household breadwinner. [ABSTRACT FROM AUTHOR]

Background: The ways children spend their time is one of the most valuable inputs for healthy child development. It is unknown which time investment yields the greatest return for children's language and behavioural outcomes at school entry.Methods: We used data from the first three waves (2004, 2006, 2008) of the Longitudinal Study of Australian Children (n = 4253). At every wave, parents completed 24-h time-use diaries on one randomly selected week and one weekend day. The amount of time children spent on 11 activities at ages 0-1, 2-3 and 4-5 years was analysed. Receptive vocabulary was assessed using the Peabody Picture Vocabulary Test, and externalizing behaviours were measured by the Strengths and Difficulties Questionnaire, completed by parents and teachers at 4-5 years. To identify which time investment in the first 5 years of life mattered most for children's outcomes, a new production function was developed. This production function was estimated using a log-log linear regression model.Results: Relative to other time investments, time spent on educational activities at 2-3 years of age was the most important time investment for receptive vocabulary and behavioural outcomes at school entry. After adjusting for confounding, every 1 h invested in educational activities at 2-3 years was associated with a 0.95% [95% CI (confidence interval): 0.62, 1.28] increase in receptive vocabulary, and a -5.72% (95% CI: -7.71, -3.73) and -9.23% (95% CI: -12.26, -6.20) reduction in parent- and teacher-reported externalizing problem behaviours. Time invested in play was also important to both receptive vocabulary and behaviour. One hour invested in play at 2-3 and 4-5 years was associated with a 0.68% (95% CI: 0.38, 0.98) and 0.71% (95% CI: 0.39, 1.03) increase in children's receptive vocabulary at school entry. In addition, time invested in play at 2-3 and 4-5 years was associated with reduced problem behaviours at school entry. In contrast, screen time at all ages was associated with poorer parent- and teacher-reported externalizing problem behaviours.Conclusions: These results suggest that time invested in educational activities at 2-3 years of age yield the greatest return for children's receptive vocabulary and behaviour at school entry. [ABSTRACT FROM AUTHOR]

Background People with disabilities often face a range of social and economic adversities. Evidence suggests that these disadvantages result in poorer mental health. Some research also indicates that people with disabilities are more likely experience thoughts about suicide than people without disability, although most of this research is based on small cross-sectional samples. Methods We explored the relationship between self-reported disability (measured at baseline) and likelihood of reporting thoughts of suicide (measured at follow up) using a large longitudinal cohort of Australian males. A logistic regression model was conducted with thoughts of suicide within the past 12 months (yes or no) as the outcome and disability as the exposure. The models adjusted for relevant confounders, including mental health using the SF-12 MCS, and excluded males who reported thoughts of suicide at baseline. Results After adjustment, there was a 1.48 (95% CI: 0.98–2.23, P = 0.063) increase in the odds of thoughts of suicide among men who also reported a disability. The size of association was similar to that of being unemployed. Conclusions Males reporting disability may also suffer from thoughts of suicide. We speculate that discrimination may be one explanation for the observed association. More research on this topic is needed. [ABSTRACT FROM AUTHOR]

Time-related stressors, such as long working hours, are recognized as being detrimental to health. We considered whether time spent commuting to work was a risk factor for poor mental health. Data from the Household, Income Labour Dynamics in Australia Survey were used to conduct fixed-effects longitudinal regression analyses. The outcome variable was the Mental Health Inventory, and the main exposure represented hours per week traveling to and from a place of paid employment. Effect modifiers included sex, low job control, high demands, and low job security. Compared with when a person commuted for ≤2 hours per week, there was a small decline (coefficient = -0.33, 95% CI: -0.62, -0.04; P = 0.025) in the Mental Health Inventory score when they commuted for over 6 hours per week. Compared with persons with high job control, persons working in jobs with low job control experienced significantly greater declines in the Mental Health Inventory score when commuting 4 to 6 hours per week and when commuting over 6 hours per week. We found no influence from the other hypothesized effect modifiers. These results suggest the importance of considering commuting time as an additional work-related time stressor. [ABSTRACT FROM AUTHOR]

Initially submitted February 1, 2016; accepted for publication August 4, 2016. The ability to classify people according to their underlying genetic susceptibility to a disease is increasing with new knowledge, better family data, and more sophisticated risk prediction models, allowing for more effective prevention and screening. To do so, however, we need to know whether risk associations are the same for people with different genetic susceptibilities. To illustrate one way to estimate such gene-environment interactions, we used prospective data from 3 Australian family cancer cohort studies, 2 enriched for familial risk of breast cancer. There were 288 incident breast cancers in 9,126 participants from 3,222 families. We used Cox proportional hazards models to investigate whether associations of breast cancer with body mass index (BMI; weight (kg)/height (m)2) at age 18-21 years, BMI at baseline, and change in BMI differed according to genetic risk based on lifetime breast cancer risk from birth, as estimated by BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm) software, adjusted for age at baseline data collection. Although no interactions were statistically significant, we have demonstrated the power with which gene-environment interactions can be investigated using a cohort enriched for persons with increased genetic risk and a continuous measure of genetic risk based on family history. [ABSTRACT FROM AUTHOR]

Binge drinking is associated with deleterious health, social and economic outcomes. This study explored the lay understanding of the causes of binge drinking in members of the general public in the United Kingdom and Australia. Participants in the United Kingdom (N = 133) and Australia (N = 102) completed a network diagram exercise requiring them to draw causal paths and provide path strength ratings between 12 candidate factors (24-h opening, age, alcohol advertizing, alcohol availability, boredom, drinking culture, income, low cost, parental influence, peer pressure, stress and supermarket discounts) and binge drinking. Results indicated good consistency in paths across samples, although differences in frequency and strength ratings for some paths were found. Drinking culture, peer pressure and low alcohol cost were perceived as direct causes of binge drinking in both samples. Low alcohol cost and drinking culture weremost frequently viewed as direct causes of binge drinking in UK and Australian participants, respectively. Supermarket discounts and low cost of alcohol were most frequently viewed as indirect causes of binge drinking by UK and Australian samples. Findings reflect general awareness and prominence of factors affecting binge drinking in both national groups. Findings may inform the development of campaigns to promote public support policies to curb binge drinking. [ABSTRACT FROM AUTHOR]

Background: The Australian after-hours house-call (AHHC) services has grown rapidly in the past few years. Even though recent studies have looked at aspects of the service as it concerns the medical personnel involved, no national study has explored patient satisfaction with the service.Objective: This study aims to assess patient satisfaction with Australian AHHC services and its predictors, with the hope of improving quality and patient outcomes. The findings might also have international relevance, given the developing nature of the AHHC in most countries.Methods: A cross-sectional survey of all 10838 patients known to have patronized the AHHC service in Australia over a 1-week period. The main outcome measure was the Patient Satisfaction Questionnaire 18 (PSQ-18).Results: A total of 1228 questionnaires were returned. General Satisfaction (GS) level was found to be 85.2% (mean 4.16/5). Other Scales of Satisfaction, in decreasing order, were 'Financial Aspects, FA' (87.4%; 4.36/5), 'Communication, CM' (87.3%; 4.18), 'Technical Quality, TA' (82.1%; 4.09), 'Time Spent with Doctor, TSD' (77.7%; 3.91), 'Interpersonal Manner, IM' (75.7%; 3.87) and 'Accessibility and Convenience, A&C' (72.9%; 3.82). The major predictor of increased satisfaction was the time it took the doctor to arrive, with increased satisfaction on GS (T < 4 hours; P < 0.01), IM (T < 30 minutes; P = 0.03), FA (T < 2 hours; P = 0.01), TSD (T < 2 hours; P < 0.01) and A&C (T < 4 hours; P < 0.01). Other positive predictors of aspects of satisfaction included 'being a student', 'age of patient ≤ 16' and 'being Australian born', while 'being on a pension' was negatively associated with Communication (P = 0.03). No associations were found with gender, marital status, employment status, family income or having children in the household.Conclusions: This study concludes that satisfaction in Australian AHHC is high on all scales but recommends that the service providers should aim to attend to patients within 4 hours of their initial calls. [ABSTRACT FROM AUTHOR]

Objectives: to estimate the effect of factors that influence decisions to transfer residents of aged care facilities to an emergency department (ED) for acute medical emergencies. Design and participants: a discrete choice experiment with residents (N = 149), the relatives of residents (N = 137) and staff members (N = 128) of aged care facilities. Setting: aged care facilities in three Australian states. Outcome measures: using random parameter logit models, parameter estimates and odds ratios were estimated, and resultant utility functions for ED and alternate care were constructed. Results: all attributes (including waiting time, complication rates, symptom relief and time spent alone) significantly influence choice for accessing acute care. There is a strong overall preference for ED care (odds ratio 1.73, 95% confidence interval 1.57-1.92), but this varies by clinical scenario, being the strongest for pneumonia and weakest for wrist fracture. Relatives of residents were less tolerant of reductions in care quality than staff members or residents themselves. Conclusion: underlying preference for ED transfer of aged care facility residents in acute medical emergencies is strong and independent of commonly used quality of care measures. [ABSTRACT FROM AUTHOR]

Background Hepatitis C virus (HCV) infection is increasingly reported among gay and bisexual men. However, little is known about the personal and social dimensions of HCV-related experience among these men in Australia. Methods An online survey of 474 Australian gay and bisexual men was conducted from August to December 2013. A subsample of 48 HCV mono-infected and HIV/HCV co-infected men was analysed to explore HCV knowledge, sources of information, unmet information needs and use of HCV-related services. Results More than half of respondents in the subsample were unaware that HIV infection increases the risk of sexually acquired HCV and most wanted information about how to prevent the sexual transmission of HCV A majority of respondents requested gay-specific HCV services, and approximately similar proportions of men indicated that they would like these services delivered by a hepatitis organization, a lesbian, gay, bisexual, transgender and intersex(LGBTI) organization and a HIV organization. Men in receipt of HIV antiretroviral treatments were most likely to request that gay-specific HCV information and support services be delivered by a LGBTI or HIV organization (OR = 8.63). Conclusion These findings suggest that a variety of organizations a re required to address the information and support needs of Australian gay and bisexual men with HCV. [ABSTRACT FROM AUTHOR]

Background: Despite the growing popularity of after-hours house calls (AHHCs) in Australia, no previous study had ever looked at satisfaction among the involved practitioners. The high number of overseas-trained doctors in Australia makes this a subject of international significance.Objective: To determine the levels of satisfaction and its significant associations among doctors in AHHCs.Methods: Design, Setting and Participants: A quantitative, questionnaire-based survey of all 300 doctors engaged in AHHCs through the National Home Doctor Service (NHDS), Australia's largest home-visit doctor service provider.Main Outcome Measure: Satisfaction was assessed using the modified, 10-item Warr-Cook-Wall tool.Results: A total of 168 valid responses (56.0% response rate) were received. Mean satisfaction scores for each of the 10 items ranged from 3.02 to 3.86, indicating 'moderate' to 'very satisfied' levels. Overall satisfaction was 85.9%, mostly related to 'freedom of work and independence', 'amount of responsibility' and 'income'. Doctors in existing legal unions are more satisfied than the single, separated or widowed ones on the 'amount of responsibility' [odds ratio (OR) = 6.50, P = 0.02, confidence interval (CI): 1.33-31.72], while those engaged for <24 hours/week are less satisfied on 'income' than full-time ones (OR = 0.30, P = 0.01, CI: 0.13-0.71). The 'adoption of protective measures', being 'aged >40', being 'male' and 'working in Brisbane, Adelaide or the Gold Coast' are other doctor variables associated with increased satisfaction.Conclusions: Satisfaction levels among AHHC GPs in Australia are comparable to the levels seen among their colleagues in regular-hour jobs, but there is still room for improvement. [ABSTRACT FROM AUTHOR]

Background: Detection of lifestyle risk factors by GPs is the first step required for intervention. Despite significant investment in preventive health care in general practice, little is known about whether GP detection of lifestyle risk factors have improved over time.Objectives: To examine whether sensitivity and specificity of GP detection of smoking, risky alcohol consumption and overweight and obesity has increased in patients presenting to see their GP, by comparing results from four Australian studies conducted between 1982 and 2011.Methods: Demographic characteristics of patient and GP samples and the prevalence, sensitivity and specificity of detection of each risk factor were extracted from published studies. Differences between GP and patient sample characteristics were examined. To identify trends over time in prevalence of risk factors, sensitivity and specificity of detection across studies and the Cochran-Armitage test for trend were calculated for each risk factor for the overall sample and by male and female subgroups.Results: There were no statistically significant changes in the sensitivity of GP detection of smoking or overweight or obesity over time. Specificity of detection of smoking increased from 64.7% to 98% (P < 0.0001) and decreased for overweight or obesity from 92% to 89% (P = 0.01). There was a small decrease in the sensitivity of detection of alcohol consumption (P = 0.02) and an increase in specificity (P = 0.01).Conclusions: Despite significant investment to increase GP detection and intervention for lifestyle risk factors, accurate detection of smoking, risky alcohol consumption and overweight and obesity occurs for less than two-thirds of all patients. [ABSTRACT FROM AUTHOR]

A challenge for population health surveillance systems using telephone methodologies is to maintain representative estimates as response rates decrease. Raked weighting, rather than conventional post stratification methodologies, has been developed to improve representativeness of estimates produced from telephone-based surveillance systems by incorporating a wider range of sociodemographic variables using an iterative proportional fitting process. This study examines this alternative weighting methodology with the monthly South Australian population health surveillance system report of randomly selected people of all ages in 2013 (n = 7,193) using computer-assisted telephone interviewing. Post stratification weighting used age groups, sex, and area of residence. Raked weights included an additional 6 variables: dwelling status, number of people in household, country of birth, marital status, educational level, and highest employment status. Most prevalence estimates (e.g., diabetes and asthma) did not change when raked weights were applied. Estimates that changed by at least 2 percentage points (e.g., tobacco smoking and mental health conditions) were associated with socioeconomic circumstances, such as dwelling status, which were included in the raked-weighting methodology. Raking methodology has overcome, to some extent, nonresponse bias associated with the sampling methodology by incorporating lower socioeconomic groups and those who are routinely not participating in population surveys into the weighting formula. [ABSTRACT FROM AUTHOR]

Objective There is increasing concern about the appropriateness of prescribing pharmaceutical opioids for chronic non-cancer pain (CNCP), given the risks of problematic use and dependence. This article examines pharmaceutical opioid dose and dependence and examines the correlates of each. Design Baseline data were obtained from a national sample of 1,424 people across Australia (median 58 years, 55% female and experiencing pain for a median of 10 years), who had been prescribed opioids for CNCP. Current opioid consumption was estimated in oral morphine equivalent (OME; mg per day), and ICD-10 pharmaceutical opioid dependence was assessed using the Composite International Diagnostic Interview. Results Current opioid consumption varied widely: 8.8% were taking <20 mg OME per day, 52.1% were taking 21-90 mg OME, 24.3% were taking 91-199 mg OME, and 14.8% were taking >= 200 mg OME. Greater daily OME consumption was associated with higher odds of multiple physical and mental health issues, aberrant opioid use, problems associated with opioid medication and opioid dependence. A significant minority, 8.5%, met criteria for lifetime ICD-10 pharmaceutical opioid dependence and 4.7% met criteria for past year ICD-10 pharmaceutical opioid dependence. Multivariate analysis found past-year dependence was independently associated with being younger, exhibiting more aberrant behaviors and having a history of benzodiazepine dependence. Conclusions In this population of people taking opioids for CNCP, consumption of higher doses was associated with increased risk of problematic behaviors, and was more likely among people with a complex profile of physical and mental health problems. [ABSTRACT FROM AUTHOR]

Aims: To assess the degree to which relationships with heavy drinkers affect health and well-being of the Chilean population, and how this compares with previously published analyses of an Australian sample in order to establish intercultural differences in the effects of others' heavy drinking. Method: Data are from a face-to-face survey of 1500 Chileans. Respondents were asked to identify people in their lives who were heavy drinkers. Information on respondents' well-being and health was collected using the Personal Well-Being Index and the EuroQol Group 5-Dimension Self-Report Questionnaire score (EQ-5D) index. Sociodemographic information was also gathered. Bivariate and multivariate analyses were performed to determine whether heavy drinkers in the respondents' lives (both living in or out of their household) were related to health and well-being. Results were contrasted with those for Australia reported by Livingston et al. [in (2010) Impact of heavy drinkers on others' health and well-being. J Stud Alcohol Drugs 71, 778-785]. Results: Heavy drinkers inside the household negatively affect the health and well-being of Chileans. Heavy drinkers outside the household have a negative but smaller effect on their health and well-being. This contrasts with Australia where most of the harm seems to arise from heavy drinkers identified outside the household. Conclusions: In both countries, health and well-being are affected by others' heavy drinking. The particular structure of harm may vary across cultures: in Chile, heavy drinkers identified inside the household are the most harmful, whereas in Australia those identified outside the household are the most harmful. This should have an impact on the policy design. [ABSTRACT FROM AUTHOR]

Objectives. This study aimed to determine the effect of perceived exercise benefits and barriers on exercise levels among women who have been treated for breast cancer and have not participated in a formal exercise intervention. Design. This was an anonymous, national, online cross-sectional survey study. Methods. Four hundred thirty-two women treated for breast cancer completed an online survey covering their treatment and demographic background, current exercise levels, and perceived exercise benefits and barriers. Each perceived benefit and barrier was considered in a binary logistic regression against reported exercise levels to ascertain significant relationships and associative values (odds ratio [OR]). Results. Agreement with 16 out of 19 exercise barriers was significantly related to being more likely to report insufficient exercise levels, whereas agreement with 6 out of 15 exercise benefits was significantly related to being less likely to report insufficient levels of exercise. Feeling too weak, lacking self-discipline, and not making exercise a priority were the barriers with the largest association to insufficient exercise levels (OR=10.97, 95% confidence interval [CI] =3.90, 30.86; OR=8.12, 95% CI=4.73, 13.93; and OR=7.43, 95% CI=3.72, 14.83, respectively). Conversely, exercise enjoyment, improved feelings of well-being, and decreased feelings of stress and tension were the top 3 benefits associated with being less likely to have insufficient exercise levels (OR=0.21, 95% CI=0.11, 0.39; OR=0.21, 95% CI=0.07, 0.63; and OR=0.31, 95% CI=0.15, 0.63, respectively). Limitations. Self-reported data measures were used to collect exercise data. Conclusions. Targeting exercise barriers specific to women treated for breast cancer may improve exercise participation levels in this cohort. Awareness of the impact of exercise barriers identified in the present study will enable physical therapists to better plan exercise interventions that support all women treated for breast cancer. [ABSTRACT FROM AUTHOR]

BACKGROUND: Current treatments for low back pain have small effects. A research priority is to identify patient characteristics associated with larger effects for specific interventions. OBJECTIVE: The aim of this study was to identify simple clinical characteristics of patients with chronic low back pain who would benefit more from either motor control exercises or graded activity. DESIGN: This study was a secondary analysis of the results of a randomized controlled trial. METHODS: One hundred seventy-two patients with chronic low back pain were enrolled in the trial, which was conducted in Australian physical therapy clinics. The treatment consisted of 12 initial exercise sessions over an 8-week period and booster sessions at 4 and 10 months following randomization. The putative effect modifiers (psychosocial features, physical activity level, walking tolerance, and self-reported signs of clinical instability) were measured at baseline. Measures of pain and function (both measured on a 0-10 scale) were taken at baseline and at 2, 6, and 12 months by a blinded assessor. RESULTS: Self-reported clinical instability was a statistically significant and clinically important modifier of treatment response for 12-month function (interaction: 2.72; 95% confidence interval=1.39 to 4.06). Participants with high scores on the clinical instability questionnaire (≥9) did 0.76 points better with motor control exercises, whereas those who had low scores (<9) did 1.93 points better with graded activity. Most other effect modifiers investigated did not appear to be useful in identifying preferential response to exercise type. LIMITATIONS: The psychometric properties of the instability questionnaire have not been fully tested. CONCLUSIONS: A simple 15-item questionnaire of features considered indicative of clinical instability can identify patients who respond best to either motor control exercises or graded activity. [ABSTRACT FROM AUTHOR]

We investigated whether being in temporary employment, as compared with permanent employment, was associated with a difference in Short Form 36 mental health and whether transitions from permanent employment to temporary employment were associated with mental health changes. We used fixed-effects regression in a nationally representative Australian sample with 10 waves of data collection (2001–2010). Interactions by age and sex were tested. Two forms of temporary employment were studied: “casual” (no paid leave entitlements or fixed hours) and “fixed-term contract” (a defined employment period plus paid leave). There were no significant mental health differences between temporary employment and permanent employment in standard fixed-effects analyses and no significant interactions by sex or age. For all age groups combined, there were no significant changes in mental health following transitions from stable permanent employment to temporary employment, but there was a significant interaction with age (P = 0.03) for the stable-permanent-to-casual employment transition, because of a small transition-associated improvement in mental health for workers aged 55–64 years (β = 1.61, 95% confidence interval: 0.34, 2.87; 16% of the standard deviation of mental health scores). Our analyses suggest that temporary employment is not harmful to mental health in the Australian context and that it may be beneficial for 55- to 64-year-olds transitioning from stable permanent employment to casual employment. [ABSTRACT FROM PUBLISHER]

Background. Pilates exercise is recommended for people with chronic low back pain (CLBP). In the literature, however, Pilates exercise is described and applied differently to treat people with CLBP. These differences in the definition and application of Pilates exercise make it difficult to evaluate its effectiveness. Objective. The aim of this study was to establish consensus regarding the definition and application of Pilates exercise to treat people with CLBP. Methods. A panel of Australian physical therapists who are experienced in treating people with CLBP using Pilates exercise were surveyed using the Delphi technique. Three electronic questionnaires were used to collect the respondents’ opinions. Answers to open-ended questions were analyzed thematically, combined with systematic literature review findings, and translated into statements about Pilates exercise for people with CLBP. Participants then rated their level of agreement with these statements using a 6-point Likert scale. Consensus was achieved when 70% of the panel members strongly agreed, agreed, or somewhat agreed (or strongly disagreed, disagreed, or somewhat disagreed) with an item. Results. Thirty physical therapists completed all 3 questionnaires and reached consensus on the majority of items. Participants agreed that Pilates exercise requires body awareness, breathing, movement control, posture, and education. It was recommended that people with CLBP should undertake supervised sessions for 30 to 60 minutes, twice per week, for 3 to 6 months. Participants also suggested that people with CLBP would benefit from individualized assessment and exercise prescription, supervision and functional integration of exercises, and use of specialized equipment. Limitations. Item consensus does not guarantee the accuracy of findings. This survey reflects the opinion of only 30 physical therapists and requires validation in future trials. Conclusion. These findings contribute to a better understanding of Pilates exercise and how it is utilized by physical therapists to treat people with CLBP. This information provides direction for future research into Pilates exercise, but findings need to be interpreted within the context of study limitations. [ABSTRACT FROM AUTHOR]

Schools can implement evidence-based sun protection policies that guide practices to help protect children from harmful sun exposure. This national study assessed the relationship between the existence and comprehensiveness of written policies and the comprehensiveness of sun protection practices. The impact of school demographics on the strength of the relationship was also examined, as was the possibility that ‘SunSmart’ membership would have an additional impact on practices, beyond having any formal policy. In 2011–12, staff members of 1573 schools catering to primary-age students completed a self-administered survey about sun protection policies and practices (response rate of 57%). Results showed that schools with a written policy had more comprehensive practices than schools without a written policy. The relationship between having a written policy and sun protection practices was stronger for remote schools compared with metropolitan and regional schools, and for schools catering to both primary and secondary students compared with primary students only. In addition, policy comprehensiveness was associated with practice comprehensiveness, and SunSmart membership was indirectly related to practice comprehensiveness via policy comprehensiveness. These results indicate that written policies relate to practice comprehensiveness, but the strength of the association can vary according to the characteristics of the organization. [ABSTRACT FROM PUBLISHER]

This research investigated the speech, language, and functional auditory outcomes of 119 3-year-old children with hearing loss and additional disabilities. Outcomes were evaluated using direct assessment and caregiver report. Multiple regressions revealed that type of additional disability and level of maternal education were significant predictors of language outcomes. Poorer outcomes were achieved in a combined group of children with autism, cerebral palsy, and/or developmental delay (DD) (Group A), compared with children with vision or speech output impairments, syndromes not entailing DD, or medical disorders (Group B). Better outcomes were associated with higher levels of maternal education. The association between better language outcomes and earlier cochlear implant switch-on approached significance. Further regression analyses were conducted separately for children with different types of additional disabilities. Level of maternal education was the only significant predictor of outcomes for Group A children, whereas degree of hearing loss was the strongest predictor for children in Group B. The findings highlight the variable impact that different types of additional disabilities can have on language development in children with hearing loss. [ABSTRACT FROM PUBLISHER]

Objectives: This study examined the extent to which a range of personal, professional, and work factors are associated with workplace aggression experienced by medical practitioners in Australian clinical practice settings. Methods: An exploratory, descriptive study of cross-sectional, self-report survey design was undertaken in the third wave of the Medicine in Australia: Balancing Employment and Life survey during 2010–2011. Of 16 327 medical practitioners sampled, 9951 (60.9%) responded and 9449 (57.9%) worked in clinical practice. Logistic regression was undertaken to detect statistically significant associations between a suite of personal, professional, and work variables and eight binary outcome variables measuring exposure to verbal or written and physical aggression from patients, patients’ relatives or carers, co-workers and others external to the workplace during the previous year. Results: Age was consistently negatively associated and external control orientation was consistently positively associated with workplace aggression exposure from each source. Key variables related to work conditions (total hours worked, unpredictable work hours, a poor support network of other doctors, patients with unrealistic expectations, patients with complex health and social problems) and the presence of workplace aggression prevention and minimization strategies (alerts to high risk of aggression, restricting or withdrawing access for aggressive persons and optimized patient waiting) were also associated with aggression exposure. Conclusions: A broader implementation of strategies to prevent and minimize the likelihood and consequences of workplace aggression is required and needs to take account of both the individual and sub-group profiles of medical practitioners. Strategies need to mitigate the more challenging aspects of medical work, including excessive work hours, inadequate access to professional support networks, and larger caseloads of patients with complex conditions. [ABSTRACT FROM AUTHOR]

Aims: This study tests whether enhancing alcohol risk messages with self-affirmation, the process of focusing on cherished aspects of oneself, increases intentions to reduce alcohol consumption and reduces actual alcohol consumption. It was also examined whether these effects differed by risk status as indicated by standard drinks consumed in an average week. Methods: Participants (n = 121) were randomly allocated to a self-affirmation or matched control condition before viewing emotive graphic alcohol warning posters in a questionnaire-based study. Results: Them were significant increases in intentions to reduce alcohol consumption in self-affirmed participants, and these effects were stronger in participants with higher behavioural risk. Intentions in turn significantly predicted a reduction in self-reported alcohol consumption. Conclusions: These findings support the use of self-affirmation to enhance alcohol awareness campaigns, particularly in individuals with high behavioural risk. [ABSTRACT FROM AUTHOR]

Observational studies suggest that people with a high serum 25-hydroxyvitamin D (25(OH)D) concentration may have reduced risk of chronic diseases such as osteoporosis, multiple sclerosis, type 1 diabetes, cardiovascular disease, and some cancers. The AusD Study (A Quantitative Assessment of Solar UV Exposure for Vitamin D Synthesis in Australian Adults) was conducted to clarify the relationships between ultraviolet (UV) radiation exposure, dietary intake of vitamin D, and serum 25(OH)D concentration among Australian adults residing in Townsville (19.3°S), Brisbane (27.5°S), Canberra (35.3°S), and Hobart (42.8°S). Participants aged 18–75 years were recruited from the Australian Electoral Roll between 2009 and 2010. Measurements were made of height, weight, waist:hip ratio, skin, hair, and eye color, blood pressure, and grip strength. Participants completed a questionnaire on sun exposure and vitamin D intake, together with 10 days of personal UV dosimetry and an associated sun-exposure and physical-activity diary that was temporally linked to a blood test for measurement of 25(OH)D concentration. Ambient solar UV radiation was also monitored at all study sites. We collected comprehensive, high-quality data from 1,002 participants (459 males, 543 females) assessed simultaneously across a range of latitudes and through all seasons. Here we describe the scientific and methodological issues considered in designing the AusD Study. [ABSTRACT FROM PUBLISHER]

This study investigated the effects of hearing status and age of signed language acquisition on signed language working memory capacity. Professional Auslan (Australian sign language)/English interpreters (hearing native signers and hearing nonnative signers) and deaf Auslan signers (deaf native signers and deaf nonnative signers) completed an Auslan working memory (WM) span task. The results revealed that the hearing signers (i.e., the professional interpreters) significantly outperformed the deaf signers on the Auslan WM span task. However, the results showed no significant differences between the native signers and the nonnative signers in their Auslan working memory capacity. Furthermore, there was no significant interaction between hearing status and age of signed language acquisition. Additionally, the study found no significant differences between the deaf native signers (adults) and the deaf nonnative signers (adults) in their Auslan working memory capacity. The findings are discussed in relation to the participants’ memory strategies and their early language experience. The findings present challenges for WM theories. [ABSTRACT FROM PUBLISHER]

We investigated critical beliefs to target in interventions aimed at improving sun-protective behaviours of Australian adults, a population at risk for skin cancer. Participants (N = 816) completed a Theory of Planned Behaviour belief-based questionnaire and a 1-week follow-up of sun-protective behaviour. A range of behavioural, normative and control beliefs correlated with sun-protective behaviour, with no and only minimal differences observed in correlations between beliefs and behaviour by gender and age, respectively. A range of key beliefs made independent contributions to behaviour; however, the behavioural belief about being less likely to tan (β = 0.09); normative belief about friends (β = 0.20); and control beliefs about forgetfulness (β = −0.14), inconvenience (β = −0.17), knowing I will be in the sun for a long time (β = 0.16) and more fashionable sun-protective clothing (β = 0.13) were significant critical beliefs guiding people’s sun-protective behaviour. Our study fills a gap in the literature by investigating an at-risk population for skin cancer and using an established theoretical framework to identify critical beliefs that guide Australian adults’ decisions to sun protect. Attention to these critical beliefs will assist health campaigns and interventions aimed at combating the increasing rates of skin cancer for adults. [ABSTRACT FROM PUBLISHER]

Measures of lexical frequency presuppose the existence of corpora, but true machine-readable corpora of sign languages (SLs) are only now being created. Lexical frequency ratings for SLs are needed because there has been a heavy reliance on the interpretation of results of psycholinguistic and neurolinguistic experiments in the SL research literature; yet, these experiments have been conducted without the benefit of such measures. In addition, measures of lexical frequency can also guide SL teachers by identifying which signs would be prioritized in early language instruction. I begin by a discussion of lexicalization and sign types in order to explain what constitutes a lexical sign in SLs. I then present the annotation method and results. In the discussion, I raise the potential limitations of previous studies of lexical frequency in terms of the discrimination of lexical signs from other kinds of signs, consistent lemma glossing, part of speech tagging, and the systematic treatment of depicting signs. I conclude in cautioning that descriptions of SL grammars that do not accommodate typical mixtures and sequences of signs as shown in data are likely to be unreliable. [ABSTRACT FROM PUBLISHER]

Background. Sternal precautions are utilized within many hospitals with the aim of preventing the occurrence of sternal complications (eg, infection, wound breakdown) following midline sternotomy. The evidence base for sternal precaution protocols, however, has been questioned due to a paucity of research, unknown effect on patient outcomes, and possible discrepancies in pattern of use among institutions. Objective. The objective of this study was to investigate and document the use of sternal precautions by physical therapists in the treatment of patients following median sternotomy in hospitals throughout Australia, from immediately postsurgery to discharge from the hospital. Design. A cross-sectional, observational design was used. An anonymous, Web-based survey was custom designed for use in the study. Methods. The questionnaire was content validated, and the online functionality was assessed. The senior cardiothoracic physical therapist from each hospital identified as currently performing cardiothoracic surgery (N=51) was invited to participate. Results. The response rate was 58.8% (n=30). Both public (n=18) and private (n=12) hospitals in all states of Australia were represented. Management protocols reported by participants included wound support (n=22), restrictions on lifting and transfers (n=23), and restrictions on mobility aid use (n=15). Factors influencing clinical practice most commonly included "workplace practices/protocols" (n=27) and "clinical experience" (n=22). Limitations. The study may be limited by response bias. Conclusions. Significant variation exists in the sternal precautions and protocols used in the treatment of patients following median sternotomy in Australian hospitals. Further research is needed to investigate whether the restrictions and precautions used are necessary and whether protocols have an impact on patient outcomes, including rates of recovery and length of stay. [ABSTRACT FROM AUTHOR]

This Australian study examined the communication, academic, and social outcomes of pediatric cochlear implantation from the perspectives of teachers working with children with cochlear implants. The children were aged from 1 to 18 years and attended a range of educational settings in early intervention, primary, and secondary schooling. One hundred and fifty-one teachers completed a survey on one child with a cochlear implant and 15 of these teachers were interviewed. Teachers reported their perceptions of children's functional outcomes in a range of communication, academic, social, independence, and identity areas. Reported achievements in literacy, numeracy, and social development were below class levels. Implications for educational authorities and professionals working with children with cochlear implants are discussed. [ABSTRACT FROM AUTHOR]

Background A high injury prevalence has been reported among veterinarians. Studies describing the factors associated with injury have been limited. Aims To describe the characteristics of serious injuries and the use of safety precautions at the time of injury in Australian veterinarians. Methods Graduates in veterinary medicine from Australian universities completed questionnaires asking about injuries during their professional career including type of injury and circumstances during which injury occurred. Results A total of 2188 significant injuries were reported. Injuries were most frequently sustained on farms (55%) and associated with undertaking procedural activities (37%) and examining and moving animals (37%). The hand (33%) was the commonest site involved. Injuries to the head and face regions accounted for 15% of all injuries. The most frequent injuries sustained were open wounds (36%), fractures and dislocations (27%) and soft tissue bruising (12%). There were 63 reports of intracranial injury and 19 traumatic amputations reported. Bites, kicks or strikes, animal contact and cutting or scratching were the most frequent mechanisms of injury reported. The major factors reported in association with injury were cattle (22%), horses (21%), dogs (20%) and cats (8%). Fifty-five per cent of veterinarians reported the use of safety precautions at the time of injury. Conclusions Veterinarians are a high-risk group for significant injury from animal contacts. The reported use of safety measures and their effectiveness when used by veterinarians appear less than optimal. Further efforts aimed at addressing injury prevention may include developing and implementing improved safe handling practices and safety precautions. [ABSTRACT FROM AUTHOR]