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Objectives: The rate of mental health services provided to children and young people is increasing worldwide, including in Australia. The aim of this study was to describe patterns of hospital and ambulatory mental health service use among a large population cohort of adolescents followed from birth, with consideration of variation by age, sex and diagnosis. Methods: Characteristics of services provided for children with mental disorder diagnoses between birth and age 17.5 years were ascertained for a population cohort of 85,642 children (52.0% male) born between 2002 and 2005, from 'Admitted Patients', 'Emergency Department' and 'Mental Health Ambulatory' records provided by the New South Wales and Australian Capital Territory Health Departments. Results: A total of 11,205 (~13.1%) children received at least one hospital or ambulatory health occasion of service for a mental health condition in the observation period. More than two-fifths of children with mental disorders had diagnoses spanning multiple categories of disorder over time. Ambulatory services were the most heavily used and the most common point of first contact. The rate of mental health service contact increased with age across all services, and for most categories of mental disorder. Girls were more likely to receive services for mental disorders than boys, but boys generally had an earlier age of first service contact. Finally, 3.1% of children presenting to mental health services experienced involuntary psychiatric inpatient admission. Conclusions: The extent of hospital and ambulatory-based mental healthcare service among children emphasises the need for primary prevention and early intervention. [ABSTRACT FROM AUTHOR]

Objective: Women living with mental health conditions have lower cervical cancer screening rates and higher mortality. More evidence is needed to target health system improvement efforts. We describe overall and age-specific cervical cancer screening rates in mental health service users in New South Wales. Methods: Cervical cancer screening registers were linked to New South Wales hospital and community mental health service data. Two-year cervical screening rates were calculated for New South Wales mental health service users aged 20–69 years (n = 114,022) and other New South Wales women (n = 2,110,127). Rate ratios were compared for strata of age, socio-economic disadvantage and rural location, and overall rates compared after direct standardisation. Results: Only 40.3% of mental health service users participated in screening, compared with 54.3% of other New South Wales women (incidence rate ratio = 0.74, 95% confidence interval = [0.74, 0.75]). Differences in age, social disadvantage or rural location did not explain screening gaps. Screening rates were highest in mental health service users aged <35 years (incidence rate ratios between 0.90 and 0.95), but only 15% of mental health service users aged >65 years participated in screening (incidence rate ratio = 0.27, 95% confidence interval = [0.24, 0.29]). Conclusion: Women who use mental health services are less likely to participate in cervical cancer screening. Rates diverged from population rates in service users aged ⩾35 years and were very low for women aged >65 years. Intervention is needed to bridge these gaps. New screening approaches such as self-testing may assist. [ABSTRACT FROM AUTHOR]

Despite reporting elevated rates of posttraumatic stress disorder (PTSD), refugees are less likely than other groups to seek psychological treatment. Relatively little attention has been paid to the role of negative help-seeking beliefs in influencing treatment uptake. The current study sought to develop and psychometrically validate a novel measure indexing negative help-seeking beliefs for refugees (Help-Seeking Beliefs Scale [HSBS]). In this study, 262 Arabic-speaking refugee participants completed an online survey consisting of the HSBS along with measures indexing similar constructs (self-stigma of PTSD and help-seeking, perceived stigma, negative help-seeking attitudes, and help-seeking intentions). Factor analysis revealed a three-factor structure aligning with key themes identified in the literature: (a) Fear of Negative Consequences, (b) Inappropriateness, and (c) Perceived Necessity. The scale demonstrated excellent internal consistency, convergent validity, and predicted reduced help-seeking intentions. Results support the utility of a novel measure capturing a prominent help-seeking barrier in a population with high psychopathology and low treatment uptake. [ABSTRACT FROM AUTHOR]

Objective: To identify factors associated with receiving electroconvulsive therapy (ECT) for serious psychiatric conditions. Methods: Retrospective observational study using hospital administrative data linked with death registrations and outpatient mental health data in New South Wales (NSW), Australia. The cohort included patients admitted with a primary psychiatric diagnosis between 2013 and 2022. The outcome measure was receipt of ECT. Results: Of 94,950 patients, 3465 (3.6%) received ECT. The likelihood of receiving ECT was higher in older (hazard ratio [HR] = 1.03), female (HR = 1.24) patients. Compared to depression, patients with schizophrenia/schizoaffective disorder (HR = 0.79), schizophrenia-related disorders (HR = 0.37), mania (HR = 0.64) and other mood disorders (HR = 0.45) had lower odds of receiving ECT. Patients with depression and one other serious psychiatric condition had higher odds of receiving ECT than depression alone. Bipolar disorder likelihood of ECT did not differ from depression. A higher number of mental health outpatient visits in the prior year and an involuntary index admission with depression were also associated with receiving ECT. Likelihood of receiving ECT increased with year of admission (HR = 1.32), private patient status (HR = 2.06), higher socioeconomic status (HR = 1.09) and being married (HR = 1.25). Conclusions: ECT use for depression and bipolar disorder in NSW aligns with clinical national guidelines. Patients with schizophrenia/schizoaffective, schizophrenia-related disorders, mania and other mood disorders had lower likelihood of ECT than depression, despite ECT being recommended by clinical guidelines for these diagnoses. Variations in ECT were strongly associated with healthcare access, with private patients twice as likely to receive ECT than their public counterparts, suggesting a need to explore ECT accessibility. [ABSTRACT FROM AUTHOR]

Background: Contact with health services prior to offences committed by people with mental illness is an opportunity for intervention and prevention. This study examines the pattern and correlates of health service contact by people with severe mental illness before a serious offence. Method: Linkage of a cohort of 477 Forensic Patients found not guilty due to mental illness between 1990 and 2016, and statewide databases of contact with emergency departments, hospital admission and outpatient mental health services in the state of New South Wales, Australia. Results: A total of 84% of the sample had contact with any health service and 76% had contact with an outpatient mental health service prior to the index offence. About two-thirds of the sample had contact with a mental health service in the year before the offence. Factors independently associated with the absence of contact at any point prior to the index offence were non-English-speaking background, being engaged in employment or study, and an absence of childhood abuse or neglect. Although nearly every Forensic Patient had a psychotic illness at the time of the index offence, psychosis was not diagnosed at the time of 61/106 (57.5%) emergency department presentations, in 54/174 (31.0%) hospital admissions and 149/222 (67.1%) attendances at outpatient mental health services prior to the offence. Conclusions: Most Forensic Patients had contact with health services prior to their offences but many were not identified as having a psychotic illness. Although the symptoms of psychosis may have emerged in the period between contact and the offence, the findings suggest that emerging or underlying psychosis were missed or attributed to other conditions. [ABSTRACT FROM AUTHOR]

Objective: The objective was to describe mental health service and psychotropic medicine use among a cohort of Aboriginal young people and quantify their relation to sociodemographic, family and health factors. Methods: In a prospective cohort study with data linkage, 892 Aboriginal children aged 0–17 years living in urban and regional areas of New South Wales, Australia, were included. We assessed mental health–related service use, paediatric service use and psychotropic medicine dispensing claims covered by the Australian Government Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme from July 2012 to June 2017. Results: Most children (71%) did not have a record of mental health service or psychotropic medication use. 18.7% had ⩾1 mental health–related service claim; 26.7% had ⩾1 paediatric service claim; and 20.3% had ⩾1 psychotropic medicine dispensing claim. General practitioner services were the most accessed mental health–related service (17.4%) and 12.7% had been dispensed attention-deficit hyperactivity disorder medicines. Child characteristics associated with treatment included emotional and behavioural problems (prevalence ratio: 1.97, 95% confidence interval = [1.46, 2.64] for mental health services; prevalence ratio: 2.87, 95% confidence interval = [2.07, 3.96] for medicines) and risky behaviour (prevalence ratio: 1.56, 95% confidence interval = [1.12, 2.16] for mental health services; prevalence ratio: 2.28, 95% confidence interval = [1.54, 3.37] for medicines). Parent-related factors included chronic illness (prevalence ratio: 1.42, 95% confidence interval = [1.03, 1.95] for mental health services; prevalence ratio: 2.00, 95% confidence interval = [1.49, 2.69] for medicines) and functional limitations (prevalence ratio: 1.61, 95% confidence interval = [1.16, 2.24] for mental health services; prevalence ratio: 1.86, 95% confidence interval = [1.34, 2.59] for medicines). Conclusions: Most Aboriginal children and young people did not have claims for mental health services or medicines. Aboriginal children with emotional and behavioural problems, or parents with health problems were more likely to have mental health service or medicine claims. [ABSTRACT FROM AUTHOR]

Background: The health and well-being of children in the first 2000 days has a lasting effect on educational achievement and long-term chronic disease in later life. However, the lack of integration between high-quality data, analytic capacity and timely health improvement initiatives means practitioners, service leaders and policymakers cannot use data effectively to plan and evaluate early intervention services and monitor high-level health outcomes. Objective: Our exploratory study aimed to develop an in-depth understanding of the system and clinical requirements of a state-wide paediatric learning health system (LHS) that uses routinely collected data to not only identify where the inequities and variation in care are, but also to also inform service development and delivery where it is needed most. Method: Our approach included reviewing exemplars of how administrative data are used in Australia; consulting with clinical, policy and data stakeholders to determine their needs for a child health LHS; mapping the existing data points collected across the first 2000 days of a child's life and geospatially locating patterns of key indicators for child health needs. Results: Our study identified the indicators that are available and accessible to inform service delivery and demonstrated the potential of using routinely collected administrative data to identify the gap between health needs and service availability. Conclusion: We recommend improving data collection, accessibility and integration to establish a state-wide LHS, whereby there is a streamlined process for data cleaning, analysis and visualisation to help identify populations in need in a timely manner. [ABSTRACT FROM AUTHOR]

Background: Electronic medical records (EMRs) have been widely implemented in Australian hospitals. Their usability and design to support clinicians to effectively deliver and document care is essential, as is their impact on clinical workflow, safety and quality, communication, and collaboration across health systems. Perceptions of, and data about, usability of EMRs implemented in Australian hospitals are key to successful adoption. Objective: To explore perspectives of medical and nursing clinicians on EMR usability utilising free-text data collected in a survey. Method: Qualitative analysis of one free-text optional question included in a web-based survey. Respondents included medical and nursing/midwifery professionals in Australian hospitals (85 doctors and 27 nurses), who commented on the usability of the main EMR used. Results: Themes identified related to the status of EMR implementation, system design, human factors, safety and risk, system response time, and stability, alerts, and supporting the collaboration between healthcare sectors. Positive factors included ability to view information from any location; ease of medication documentation; and capacity to access diagnostic test results. Usability concerns included lack of intuitiveness; complexity; difficulties communicating with primary and other care sectors; and time taken to perform clinical tasks. Conclusion: If the benefits of EMRs are to be realised, there are good reasons to address the usability challenges identified by clinicians. Easy solutions that could improve the usability experience of hospital-based clinicians include resolving sign-on issues, use of templates, and more intelligent alerts and warnings to avoid errors. Implications: These essential improvements to the usability of the EMR, which are the foundation of the digital health system, will enable hospital clinicians to deliver safer and more effective health care. [ABSTRACT FROM AUTHOR]

This article examines the inclusion of the right to self-determination in existing models of state and territory human rights legislation and proposes its inclusion in a future human rights act in New South Wales (NSW), to advance the rights of First Peoples in the criminal justice system. I explore how this would provide a mechanism for state restraint and a legal framework for prioritising self-determined First Nations critique, research and service delivery in carceral systems. The role of courts in holding the state to account and developing legal pluralism in rights jurisprudence is also discussed. [ABSTRACT FROM AUTHOR]

In this paper, we present guidelines for researchers working with individuals with mild intellectual disability (MID) based on the challenges and learnings from our University of Wollongong (UOW) Community Engagement Grant (2010) project where we collaborated with representatives from the Disability Sector, Cancer Council NSW and the vulnerable community of people with MID to overcome the difficulties that they face in interpreting mainstream cancer prevention messaging and take ownership of their skin cancer checking behaviour by using co-created resources that could be easily understood and acted upon by the target audience. As a result of our project, nearly 20% of our vulnerable population sample (employees of Greenacres, a disability employment provider) checked themselves for skin cancer spots for the first time after having been given a "What's that Spot?" book and accompanying resources (bathroom mirror stickers, hand held mirrors). The successful uptake can be directly attributed to the researchers putting aside their assumptions and overcoming the biases (conscious and unconscious) from their academic training to partner with the target population in a respectful manner and genuinely embrace the concept of inclusive research, ensuring that this overlooked and vulnerable group are afforded cancer prevention resources that work for them. This inclusive approach is evidenced by the co-creation of our "thumbs up scale" to overcome the limitations of traditional Likert scale use for our target population. Further, the generation of "trust" between researchers, participants and necessary carers should be at the forefront of all research methodology designs for those wishing to conduct research with members of the MID community. [ABSTRACT FROM AUTHOR]

Creative practice is frequently being deployed in research by cultural geographers. This article explores one such deployment, centering on a participatory community art exhibition titled 'Wheelability'. The exhibition was organized by non-disabled geographers for people who use powered mobility devices in the Northern Rivers region of New South Wales, Australia. The article illustrates the distinctive contribution art can make to disability mobility justice. It uses the personal stories and mobile creative expressions of one co-researcher and their carer to explore how engaging in creative activities provides opportunities to understand the emotional aspects of everyday mobility challenges and what emotions can do. Thinking through the emotional geographies of a mobile form of creative practice allows us to illustrate how dominant social norms are confirmed, ruptured, and reconfigured by the co-researcher. In conclusion, we discuss the implications of creative practices for conducting geographical research that promotes justice for individuals with mobility disabilities. [ABSTRACT FROM AUTHOR]

Social impact assessment as a concept and practice is generally framed as a process for delivering socially equitable outcomes, and in particular, a vehicle for improving the lives of society's most vulnerable and marginalised people. For example, the International Association for Impact Assessment 2015 guidance document makes the normative statement that projects should benefit local communities and be a 'force for positive social change and beneficial social development'. Yet most guidance provides little prescription for what this looks like in practice. More recently, the New South Wales 2021 guideline includes distributive equity as a principle for social impact assessment, but its application is yet to be tested. This article discusses key dimensions of equity concepts, drawing on international social impact assessment guidance documents, academic literature on equity, fairness and justice, and case studies in Australia. We elaborate process/procedural/participative and outcome/distributive dimensions of equity. We further argue that, to reflect the International Association for Impact Assessment position, social impact assessment needs to defend its normative purpose of advancing equity, rather than simply 'considering' equity impacts. [ABSTRACT FROM AUTHOR]

In this paper, we offer a conjunctural analysis of policing and incarceration, examining their expansion in relation to structural economic conditions over the last 50 years and interrogating how the sudden onset of the Covid-19 pandemic enabled extraordinary growth in policing powers in the Australian jurisdictions of New South Wales (NSW) and Victoria (VIC). We examine how popular support for police-led responses to crisis and fines as a common-sense solution to social problems were sought during the period that the Public Health Orders were in effect in the two states. We argue that the discursive project of naturalizing the police-led response to the pandemic—via official communications from the state governments as well as media coverage of the pandemic—attempts to further entrench a vision of law and order governance in which infrastructures of discipline and punishment are necessary and inevitable. We identify this vision as a direct barrier to abolition and a significant limit on the capacity to imagine alternative frameworks for justice. We end by considering a small archive of tweets from users in NSW and VIC published on the social media platform formerly known as Twitter (now called X) in 2020–21. We argue that this archive registers the way the common-sense status of the fine as an efficient, effective, and equitable punishment gives way to punitive fantasies about police and prisons. We read this archive alongside the broad refusal to pay Covid-related fines and the ongoing legal disputes contesting the legitimacy of their issuance, concluding by proposing that the conjunctural moment of the Covid-19 pandemic has given rise to unresolved contradictions between the naturalized logic of law and order crisis management and the potential for this logic to come undone. [ABSTRACT FROM AUTHOR]

In this commentary on Beveridge and Koch's 'Seeing Democracy Like a City', I draw their stimulating ideas into dialogue with Sydney's green ban movement – a remarkable enactment of urban democracy from 50 years ago whose legacy remains enshrined in the built fabric and in the political imaginary of my city. This dialogue is used to offer some reflections on elements of their argument concerning the role of institutions in urban democratic theory and practice, the historicity of the association between the urban and democracy, and the place of equality in democratic forms of organisation and self-governance. [ABSTRACT FROM AUTHOR]

Background: Pulmonary embolism (PE) can be fatal yet difficult to diagnose in pregnancy. Computed tomography pulmonary angiogram (CTPA) or ventilation/perfusion (V/Q) scans are often conducted, potentially leading to low positive scan rates. Methods: Retrospective data analysis was conducted for pregnant women and non-pregnant age-matched control who underwent CTPA and/or V/Q scan for investigation of PE. The main outcomes were the positive and non-diagnostic imaging rates. Results: In total, 440 women underwent V/Q or CTPA scans, 86 of whom were pregnant (19.5%). The positive scan rate was 3.5% and 8.8% in the pregnant and non-pregnant groups, respectively (p = 0.1). The non-diagnostic scan rate was similar between pregnant and non-pregnant groups (13.9% vs 9.9%, p = 0.3). Within the pregnant group, there were more non-diagnostic CTPAs than V/Q scans (p = 0.005). Conclusion: Our study confirms a low positive imaging rate and a relatively high non-diagnostic CTPA rate in pregnancy. Newer strategies are needed to reduce the number of negative imaging studies conducted. [ABSTRACT FROM AUTHOR]

Colonization is understood as a determinant of health for Indigenous people globally. Understanding colonization through a lens of historical trauma offers new insights into the field of Aboriginal young peoples' health and wellbeing. Grounded in the Indigenous research paradigm, this study conducted interviews with 15 Aboriginal young people living on Gamilaroi Country, New South Wales, Australia. Three stories are presented to explain how Aboriginal young people understand their resilience, strength and resistance as an integral component of historical trauma. Aboriginal young people identified the need to connect and to continue to draw strength from their ancestors and to be cognizant of the hope and strengths they have as Aboriginal people and describe how this strength can ensure Aboriginal culture is sustained for generations to come. [ABSTRACT FROM AUTHOR]

Background: There is a lack of data regarding the long-term clinical outcomes of open repair of humeral avulsion of the glenohumeral ligament (HAGL). Purpose: To examine the long-term patient outcomes, prevalence of related shoulder lesions, and return to sports in patients who have had open HAGL repair. Study Design: Case series; Level of evidence, 4. Methods: Included were 47 patients who underwent open repair of an HAGL lesion between 1995 and 2013. Clinical results were assessed using the Western Ontario Shoulder Instability Index (WOSI). Recurrence of instability, additional surgeries, confidence in the shoulder, level and type of sport before and after surgery, and return to sports were documented. Results: The mean follow-up duration was 105 months (range, 16-247 months). The mean postoperative WOSI score was 410. Postoperatively, 10 patients experienced a recurrence of instability. Subgroup analysis of patients who reported recurrence demonstrated significantly worse WOSI scores compared with patients who did not experience recurrence (730 [95% CI, 470-990] vs 320 [95% CI, 210-430], respectively; P =.007). Before surgery, 33 patients participated in competitive sports, compared with 22 patients after surgery. No postoperative neurologic or vascular complications were recorded. In 51% of patients, a labral tear was noted as a concomitant injury. Conclusion: Open repair of an HAGL lesion restored shoulder stability with good results. However, recurrence was significant (21%) with longer follow-up, and return to sports was affected. Associated lesions were prevalent. [ABSTRACT FROM AUTHOR]

Globally, there is increasing evidence that Indigenous peoples have manipulated plant and animal populations over millennia. The Bunya Pine (Araucaria bidwillii Hook.) is a coniferous tree native to subtropical and tropical eastern Australia, which produces 30–100 large, edible seeds within a large cone weighing 5–10 kgs. Endemic Bunya populations occur as two disjunct populations: one in south-eastern Queensland/north-east New South Wales and the other in northern Queensland. We investigated possible pre- and postcolonial Bunya seed dispersal within and between the two separate populations by utilising multidisciplinary methods to examine Aboriginal cultural connections with Bunya. Analysis of historical sources and ethnographic interviews conducted with Aboriginal knowledge holders provided strong evidence for localised deliberate dispersal within the southern population but no solid evidence for dispersal in the north, suggesting two distinct modes of Aboriginal interaction with this species. Early European colonial records documented the Indigenous cultural significance of southern Bunya, evidenced by large feast gatherings, creation Stories, Aboriginal familial tree connections, seed carrying and planting, and storage in camps. The continued cultural attachment post-colonisation was evident from ethnographic interviews with Indigenous knowledge holders that revealed plantings of this species on Aboriginal missions and modern grave sites. The development of an overarching effective biocultural management plan to conserve the biological and cultural importance of this species is therefore particularly important for the southern population, especially in the face of new threats from pathogenic dieback. The individal tree connections of certain Aboriginal families also warrant deeper ethnographic study to target planting and restoration efforts that preserve these kin-based biocultural connections. [ABSTRACT FROM AUTHOR]

Spinal deformities in finfish have the potential to impact aquaculture industries and wild populations by increasing morbidity, mortality, and reducing growth rates. Myxobolus acanthogobii has been implicated in causing scoliosis and lordosis in various aquatic species in Japan. We investigated 4 cases of spinal deformity in 2 flathead (Platycephalus) species that were submitted to the Elizabeth Macarthur Agricultural Institute (EMAI) in New South Wales (NSW), Australia, between 2015 and 2021. Flathead are commercially significant species that are popular among Australian consumers, and are also sought-after species targeted by recreational fishers. Gross deformities are concerning to the community and may impact the quality and quantity of specimens available for consumption. Three blue-spotted flathead (P. caeruleopunctatus) and one marbled flathead (P. marmoratus) were submitted, all with marked scoliosis and kyphosis; 1–2-mm cysts were present on the dorsum of the brain, most often over the optic lobe or cerebellum. Cytology and differential interference microscopy of cyst material revealed numerous oval spores, x̄ 14 ± SD 0.75 µm × x̄ 11.5 ± SD 0.70 µm, with 2 pyriform polar capsules, the morphology of which is consistent with a Myxobolus sp. PCR assay and 18S rDNA sequencing of the cyst material identified a Myxobolus sp. with 96% identity to M. acanthogobii. The identification of this Myxobolus sp. confirms the presence of parasites with the potential to cause spinal deformity in significant aquatic species in NSW waterways. [ABSTRACT FROM AUTHOR]

Sexual violence is prevalent on university campuses globally. In this article, we report a qualitative insider research study examining practices for addressing sexual violence at four universities across Australia and Aotearoa New Zealand. We collected, analysed, and synthesised descriptive information about the practices at each institution. We found unique institutional approaches that nonetheless share some commonalities, yieldingseveral themes that are central to practice. In reflecting on our findings, we conclude with an outline of critical considerations and a call to action for future efforts to address campus-based sexual violence, particularly as this field remains underdeveloped across Australia and Aotearoa New Zealand. [ABSTRACT FROM AUTHOR]

In Australia, imprisonment remains a popular form of crime control amidst rising costs in prison expenditure and high rates of prison return. While changes to crime rates and to policing policy have impacted the growing prisoner population in recent years, less is known about the language underpinning the courts' decision to imprison. This article presents the results of a critical discourse analysis on 124 sentencing remarks on imprisonment from the District Court of New South Wales in 2017. Three discourses were identified in the texts as facilitating the justification of a prison sentence: the discourse of control, the discourse of safety and the discourse of duty. These findings highlight the ways in which the prison is constructed and legitimated in the courts, which has implications not only for sentencing policy and practice but also for conceptions and applications of justice more broadly. [ABSTRACT FROM AUTHOR]

Objectives: To provide a brief biography of Dr Richard Greenup and to explore the legacy he has left to one of Australia's longest operating psychiatric services. Methods: This history was obtained by consulting staff working within Cumberland Hospital, New South Wales and by examining primary and secondary sources. Results: Greenup was the second surgeon superintendent of 'The Parramatta Lunatic Asylum' from 1852 until 1866 when he was fatally stabbed with a pair of scissors by a patient. Greenup was involved in establishing The University of Sydney and advocated for expanded and improved services for people diagnosed with mental disorders. Conclusions: Greenup recognised the needs of the mentally ill and sought to address similar social and demographic determinants of health to those that we face today. The challenges he faced, and his tragic end remind us of the importance of delivering patient-centred care whilst being mindful of associated risks. [ABSTRACT FROM AUTHOR]

Objectives: To explore the usage and awareness of the FIFA 11 + (11 +) across multiple stakeholders involved with amateur football. Methods: Coaches, players, non-coaching staff and medical personnel in New South Wales (NSW), Australia, were invited to complete a cross-sectional online survey, which was disseminated using a targeted email to two Football NSW member organisations and a social media campaign. Categorical data (including age-groups and sex) are presented as counts and percentages and analysed using a Chi-square or Fisher's exact test. A significance level of 0.05 was used for all analyses. Results: In total 328 players, 55 coaches, 37 non-coaching staff and 16 medical personnel completed the survey (n = 436). Awareness of the 11 + was lowest among non-coaching staff (16.2%) and players (32.6%) but higher among coaches (52.7%) and medical personnel (93.8%). Once aware of the 11 +, 75.8% of all respondents used the program although 89.5% of them did so with modifications. In addition, only 40.0% of players reported completing all three parts of the 11 + program. Veteran players were less likely to complete any type of warm-up compared with junior players (63.7% vs. 96.3%, respectively). Conclusions: Although awareness of the 11 + varied amongst survey respondents, 3 out of 4 respondents who were aware of the 11 + adopted the program. However, respondents reported modifying the 11 + and not completing the program as intended, which suggests modification guidance is required to maintain the efficacy of the 11 +. [ABSTRACT FROM AUTHOR]

Objective: Equitable elimination of cervical cancer in Australia within the next decade will require high National Cervical Screening Program (NCSP) participation by all subgroups of women. The aim of this study was to examine the participation of immigrants compared to Australian-born women. Methods: Participation in the NCSP (≥1cytology test) over a 3-year (2010–2012) and 5-year (2008–2012) period, by place of birth and time since immigration was examined using individually linked data of 67,350 New South Wales (NSW) women aged ≥45 enrolled in the 45 and Up Study. Results: Three-year cervical screening participation was 77.0% overall. Compared to Australian-born women (77.8%), 3-year participation was lower for women born in New Zealand (adjusted odds ratio 0.77, 95% confidence interval 0.69–0.87), Oceania (0.67, 0.51–0.89), Middle East/North Africa (0.76, 0.60–0.97), South-East Asia (0.72, 0.60–0.87), Chinese Asia (0.82, 0.69–0.97), Japan/South Korea (0.68, 0.50–0.94), and Southern/Central Asia (0.54, 0.43–0.67), but higher for women from Malta (2.85, 1.77–4.58) and South America (1.33, 1.01–1.75). Non-English-speaking-at-home women were less likely to be screened than English-speaking-at-home women (0.85, 0.78–0.93). Participation increased with years lived in Australia but remained lower in immigrant groups compared to Australian-born women, even after ≥20 years living in Australia. Similar results were observed for 5-year participation. Conclusions: Women born in New Zealand, Oceania, and parts of Asia and the Middle East had lower NCSP participation, which persisted for ≥20 years post-immigration. The NCSP transition to primary HPV screening, and the introduction of the universal self-collection option in 2022, will offer new opportunities for increasing screening participation for these groups. [ABSTRACT FROM AUTHOR]

Background: Oral health problems are common, but often overlooked, among people receiving palliative care. Aim: To better understand how oral health can be addressed in this population, this study aimed to explore the perceptions of oral health care among medical practitioners who provide palliative care to inform the development of a palliative oral health care program. Design: A descriptive qualitative design was adopted. Setting/participants: A single focus group was conducted with 18 medical practitioners at a palliative care facility in Sydney, Australia. All participants had experience providing palliative care services to clients. The focus group was audio recorded, transcribed and thematically analysed. Results: The results from the inductive thematic analysis identified four themes. The themes highlighted that participants were aware of the oral health needs of people receiving palliative care; however, they also reflected on the complexity in delivering oral health care across the healthcare settings, as well as the challenges around cost, lack of appropriate dental referral pathways, time constraints and limited awareness. Participants also provided recommendations to improve the delivery of oral health care to individuals receiving palliative care. Conclusions: To improve the provision of oral health care in this population, this study highlighted the need for oral health training across the multidisciplinary team, standardised screening assessments and referrals, a collective responsibility across the board and exploring the potential for teledentistry to support oral health care provision. [ABSTRACT FROM AUTHOR]

Introduction: Effective primary healthcare services have been identified by the World Health Organization as the most equitable approach to enhancing universal healthcare. Robust models of mentoring for registered nurses (RNs) transitioning to primary healthcare roles have yet to be described in the Australian context. A robust mentoring model can support RNs to fulfill their potential, bridging the gap between theory and practice. In 2015, the peak body for nurses in primary health care (PHC) began developing a transition to practice program, including embedded mentoring to support newly graduated and more experienced registered and enrolled nurses. This quality improvement study reports the experiences and perspectives of nurses participating as mentors in two separate offerings of the program delivered between 2019 and 2021. Method: A two-phase concurrent mixed methods evaluation utilized data from pre- and post online surveys and post program meetings. Quantitative items underwent descriptive analyses. Thematic analysis of free-text responses and comments was conducted independently by two researchers. Mentors voluntarily provided self-report data and were informed that data is routinely collected to support continuous quality improvement processes for all programs. An Information Sheet informed mentors of data usage, confidentiality, and options to withdraw without penalty from the program at any time. Results: Seventy-nine mentors were recruited to support two groups of nurses (N = 111). Mentor self-rated overall satisfaction with program participation was 86.67% (very or extremely satisfied). Mentors described being "witness to mentee growth," "having facilitated access to learning" and receiving "unexpected benefits" including personal and professional growth and enhanced enthusiasm for their role in PHC. Conclusion: The embedded mentoring reported in this article combined a focus on skills acquisition and professional identity with the provision of a range of resources and support activities. Sustainable mentoring programs will be an important mechanism for supporting the expanding roles required of nurses working in primary health. [ABSTRACT FROM AUTHOR]

External events are commonly known as interventions that often affect times series of counts. This research introduces a class of transfer function models that include four different types of interventions on integer-valued time series: abrupt start and abrupt decay (additive outlier), abrupt start and gradual decay (transient shift), abrupt start and permanent effect (level shift) and gradual start and permanent effect. We propose integer-valued transfer function models incorporating a generalized Poisson, log-linear generalized Poisson or negative binomial to estimate and detect these four types of interventions in a time series of counts. Utilizing Bayesian methods, which are adaptive Markov chain Monte Carlo (MCMC) algorithms to obtain the estimation, we further employ deviance information criterion (DIC), posterior odd ratios and mean squared standardized residual for model comparisons. As an illustration, this study evaluates the effectiveness of our methods through a simulation study and application to crime data in Albury City, New South Wales (NSW) Australia. Simulation results show that the MCMC procedure is reasonably effective. The empirical outcome also reveals that the proposed models are able to successfully detect the locations and type of interventions. [ABSTRACT FROM AUTHOR]

Objective: The Review of health services for children, young people and families within the NSW Health system identified that novel models of care were needed to improve access to clinical management for people with ADHD. The present study aimed to evaluate GPs' knowledge of and attitudes towards ADHD and the challenges and opportunities for a more substantial role for GPs in ADHD management. Method: An online survey of Australian GPs was conducted, with recruitment via email invitation. Results: Out of 230 respondents, 213 surveys could be analysed. Of these, 97% believed ADHD was a genuine condition, with 90% identifying inattention as a primary symptom. Most (92%) had seen and diagnosed ADHD within the past year. Prevalent concerns included inadequate access to specialist assessment and treatment; 77% felt that GPs should have a more substantial role in ADHD management. Barriers included lack of time, knowledge and experience. Conclusions: There was willingness amongst respondents take on a greater role in managing individuals with ADHD. However, a need for further training and education was highlighted. The Australian Evidence-Based Clinical Practice Guideline for ADHD may resolve an identified need for clinical guidance. [ABSTRACT FROM AUTHOR]

Young people in OOHC have complex mental health concerns, therefore the South Western Sydney Local Health District (SWSLHD) has trialled a tiered model of mental health care. Under this model the OOHC mental health team (OOHC-MHT) provides specialist tier four service delivery for those with the most severe, intense mental health needs. OOHC consumers with a reduced level of severity access services at a tier three centre-based iCAMHS. This study aims to understand the characteristics of young people in OOHC accessing different service provision options in Sydney, Australia. Sixty-six OOHC consumers 8–17 years accessing mental health services across SWSLHD from January 2020–December 2021 participated in the study. Group differences in OOHC-MHT and iCAMHS outcome measures were compared. HoNOSCA scores were significantly worse for OOHC-MHT than iCAMHS, indicating more severe psychopathology for OOHC-MHT at baseline. In OOHC-MHT, HoNOSCA decreased significantly from admission to discharge and scores on the CGAS increased significantly, indicating significant improvements in psychopathology and functioning. In the iCAMHS group scores on the HoNOSCA significantly decreased indicating improved psychopathology over this period. These findings support a tiered model of service delivery for OOHC consumers, with this tailored level of care resulting in significantly improved outcomes across a range of complexity. [ABSTRACT FROM AUTHOR]

Research has shown that using telehealth for rehabilitation assessment can be an effective approach. The COVID-19 pandemic and subsequent lockdowns led to many rehabilitation counselors pivoting to telehealth assessment with their clients. This study explores rehabilitation counselors' use of rehabilitation assessments and telehealth since the beginning of the COVID-19 pandemic. Using a mixed-methods approach, the researchers analyzed data from 41 rehabilitation counselors across Australia. Participants were asked which measures they used prior to the pandemic, how their use of the measures changed during telehealth, and how their work changed due to the COVID-19 pandemic. The Depression Anxiety Stress Scales and the Occupational Search Inventory were the most commonly used tests. Theoretical analysis demonstrated that participants utilized tests based on their usefulness in comprehensive assessment and rehabilitation planning, for engaging the client in the assessment process, out of necessity (mandated tests), and due to attributes of the test the counselor valued. Participants described the impact of COVID-19 on assessment practice, demonstrating that despite challenges to telehealth, there were also benefits and that assessment measures could be altered for use in telehealth. Although telehealth had an impact on how rehabilitation counselors provided assessments, many found ways to make it work at a distance. [ABSTRACT FROM AUTHOR]

Developing and delivering effective rehabilitation programs that meet the specific needs of First Nations people and overcome barriers to engagement has been suggested as a way to address the overrepresentation of First Nations Australians in the correctional system. This project used a critical realist epistemology to understand perceptions of First Nations people participating in rehabilitation programs to contribute to improvements in treatment responsivity. Semi-structured interviews were conducted with five First Nations people serving community-based orders and five First Nations Program Facilitators. The data were analyzed thematically. Four overarching themes emerged: (a) the importance of culture and colonization, (b) intrinsic motivation to change, (c) communication and language: the role of the First Nations facilitator, and (d) connection: life after jail. These findings highlight the need for cultural healing as a crucial factor for programs aimed at First Nations Australians. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the potential impact of the recently announced 'Safeguards' initiative on mental health-related emergency department presentation rates for children and adolescents (0−17 years). This state-funded initiative aims to establish 25 Child and Adolescent Acute Response Teams across New South Wales. Methods: We estimated the effects of the 'Safeguards' initiative using a state-level dynamic model of child and adolescent acute mental health care. Potential reductions in total numbers of mental health-related emergency department presentations and re-presentations (i.e. presentations within 3 months of an initial presentation) were assessed via a series of simulation experiments in which we systematically varied the total number of Child and Adolescent Acute Response Teams and the mean duration of care per patient. Results: Assuming a mean treatment duration of 6 weeks per patient, 25 Child and Adolescent Acute Response Teams are projected to reduce total numbers of mental health-related emergency department presentations and re-presentations over the period 2022–2031 by 15.0% (95% interval, 12.0−18.2%) and 31.7% (26.2−37.8%), respectively. Increasing the total number of Child and Adolescent Acute Response Teams above 25 has minimal additional impact on projected reductions in numbers of emergency department presentations and re-presentations, provided the mean duration of care is no more than 8 weeks. However, where the mean duration of care is greater than 4 weeks, a decrease in the number of Child and Adolescent Acute Response Teams below 25 reduces the potential effectiveness of the 'Safeguards' initiative significantly. Conclusion: Our simulation results indicate that full and timely implementation will be critical if the potentially substantial impact of the 'Safeguards' initiative on demand for hospital-based emergency mental health care is to be realised. [ABSTRACT FROM AUTHOR]

Objective: We investigated patterns of service contact for self-harm and suicidal ideation recorded by a range of human service agencies – including health, police and child protection – with specific focus on overlap and sequences of contacts, age of first contact and demographic and intergenerational characteristics associated with different service responses to self-harm. Methods: Participants were 91,597 adolescents for whom multi-agency linked data were available in a longitudinal study of a population cohort in New South Wales, Australia. Self-harm and suicide-related incidents from birth to 18 years of age were derived from emergency department, inpatient hospital admission, mental health ambulatory, child protection and police administrative records. Descriptive statistics and binomial logistic regression were used to examine patterns of service contacts. Results: Child protection services recorded the largest proportion of youth with reported self-harm and suicidal ideation, in which the age of first contact for self-harm was younger relative to other incidents of self-harm recorded by other agencies. Nearly 40% of youth with a health service contact for self-harm also had contact with child protection and/or police services for self-harm. Girls were more likely to access health services for self-harm than boys, but not child protection or police services. Conclusion: Suicide prevention is not solely the responsibility of health services; police and child protection services also respond to a significant proportion of self-harm and suicide-related incidents. High rates of overlap among different services responding to self-harm suggest the need for cross-agency strategies to prevent suicide in young people. [ABSTRACT FROM AUTHOR]

Objective: The Pathways to Community Living Initiative (PCLI) aims to reform mental health care for people with severe and persistent mental illness (SPMI) and complex needs. This study reports independent evaluation findings on transitions from hospital and practice change in mental health services. Methods: Data for this mixed-methods evaluation were obtained from administrative collections and semi-structured interviews with PCLI program managers, teams and executive leads; aged care managers; and leaders in inpatient, community and older people's mental health services. Results: Between July 2015 and December 2020, 674 participants (67% of those eligible for the PCLI) were transitioned from hospital to community. Of those transitioned, 21 required subsequent long-stay admissions. The PCLI introduced resources, clearly defined processes, and state-wide networks to guide changes in practice which are becoming embedded in the operations and governance of mental health services across New South Wales. Conclusions: Severe and persistent mental illness and complex needs can be managed in community settings with highly individualised planning and care, supported by specialised clinical teams in partnership with mental health, aged care and disability services. Evaluation findings highlight the importance of continued investment in rehabilitation psychiatry. [ABSTRACT FROM AUTHOR]

Objective: This paper outlines the evolution of mental health rehabilitation in NSW, where allocation of health resources has repeatedly contradicted the policy intention to reorient services from inpatient to community-based services, leaving community rehabilitation the poor and disconnected cousin of inpatient services. The expanding role of community-managed organisations (CMOs) in psychosocial rehabilitation, the introduction of the National Disability Insurance Scheme (NDIS), and emerging service models have helped foster a maturing housing and social care environment, but present reality and the integration of health and social care services remains at a distance from best evidence practice. Conclusion: The challenge of the next decade of mental health reform is to embrace and consolidate greater service diversity and complexity. Understanding what factors influenced present reality is important in providing guardrails for the future, enabling the current wave of renewal and reinvestment in NSW to build on the strengths of past developments and steer a course around their weaknesses. [ABSTRACT FROM AUTHOR]

We analyse the 'law and order' response to the COVID-19 pandemic in New South Wales and suggest that pandemic policing was just one example of the reflexive reach by governments for a punitive response to a social challenge. The pandemic response followed a trend toward securitisation, criminalisation and pre-emption of risk. This trend is also evident in a range of other laws and policing practices – the STMP, bail compliance checks, consorting laws and protest policing. We argue these are policy choices that are increasingly common in what has been described as the 'preventive state', where pre-emption of risk has become central. We suggest that, instead, the pandemic response should have focused on the needs of community and capacity building. This lesson must be applied to address the cascading physical and economic impacts of climate change. [ABSTRACT FROM AUTHOR]

This article is underpinned by the hypothesis that if Australia is to reassess and improve its relationship to and use of rivers and river systems, then more holistic ways of understanding rivers, and strategies for representing and communicating this understanding, must be developed and brought together. Held over two days in August 2019 at the Lismore campus of Southern Cross University, 'Speaking With the River' was an interdisciplinary symposium exploring the capacities of creative research practice to develop new understandings of rivers and river systems as simultaneously environmental, cultural, historical and economic phenomena. In this article, we bring together the voices and disciplinary insights from the symposium and the rivers of Northern New South Wales, and we reflect on the way that riverine language ran throughout our discussions and ideas, providing a connective model of confluences and conjunctions for the interdisciplinary enterprise we were engaged in. This article presents perspectives on rivers and river systems from law, history, art and science, exploring common ground and common purposes. Developing a legal framework for recognising the rights and 'voices' of rivers, that is informed by Indigenous knowledges, historical contexts, and scientific understanding, and that employs artistic innovation in representation and translation, is to us the ultimate goal of such an enquiry. While this paper does not undertake the formal steps of developing this framework, it provides the necessary background and instantiates its elements and working methods within the context of the Richmond River in Northern New South Wales. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the kinetics of the front arm in cricket fast bowling. Eighteen male fast bowlers (mean age = 17.2 ± 1.6 years; mean height = 1.89 ± 0.05 m; mean mass = 85.0 ± 10.0 kg) were recruited from NSW grade club level and their bowling actions recorded by a Cortex 2.0 motion analysis system (200 Hz). The interaction between joint power and joint angular velocity data was observed simultaneously for the front shoulder and elbow joints. A joint actuation strategy (active or controlled) was assigned to shoulder flexion–extension, abduction–adduction, and elbow flexion–extension motion to understand whether the joint kinematics followed the time-history of the joint torque. The results only partially agreed with the commonly prescribed coaching maxim of "pulling down" the front arm for faster ball speeds. Active extension and adduction of the front shoulder joint were observed during the delivery phase of the action, whereas the acceleration phase was marked by periods of controlled shoulder extension and active shoulder flexion. At the elbow joint, active elbow flexion was observed at a time when it may reduce the moment of inertia about the thoracic and lumbar spine rotation axes. Overall, combinations of active and controlled joint powers were observed for the front shoulder and elbow joints, implying that this sample of bowlers did not adhere to the traditional notion of "pulling down" the front arm as fast as possible. [ABSTRACT FROM AUTHOR]

Background: Women experiencing substance use disorders face barriers to treatment, including childcare, stigma and lack of gender/trauma-informed programming. Several non-government organizations in New South Wales run women-only treatment services to address these needs. Objectives: We aim to assess characteristics of women entering treatment in these services. Design: Data on client characteristics from six women-only non-government organization substance use disorder treatment services in New South Wales between 2014 and 2018 were extracted from a database containing demographics, drug use and treatment characteristics and psychological distress (Kessler-10 scale) of women entering the services. Logistic regression models were used to estimate unadjusted odds ratio and adjusted odds ratio for treatment completion and different drugs on entry. Results: Data were available for 1357 women. Most (91%) episodes were for residential treatment. Women's mean age was 35.4 years (standard deviation = 9.8; range = 17–67). Residential clients tended to be younger than non-residential clients (35.1 vs 38.5 years, p < 0.001). Methamphetamine (43%) and alcohol (32%) were the most reported principal drug of concern. Women (89%) reported high levels of psychological distress (median Kessler-10 scale score = 27.5, range = 10–50), highest for women reporting alcohol as their principal drug. Overall, 43% of episodes resulted in treatment completion, most commonly for women entering residential treatment (45% vs 22%, p < 0.001) and for alcohol treatment (adjusted odds ratio = 1.42; confidence interval = 1.07–1.90; p < 0.001). Women with Kessler-10 scale scores indicating anxiety or depression at treatment entry were less likely to complete treatment than those with lower scores (adjusted odds ratio = 0.56; confidence interval = 0.38–0.80; p < 0.001). Conclusion: Women entering women-only residential treatment tend to be younger and report methamphetamine as principal drug of concern. Women enter treatment with high degrees of psychological distress. Women's services need to ensure their programmes can respond to diverse needs of younger women presenting with methamphetamine use disorder and older women with alcohol use disorder experiencing high levels of psychological distress. [ABSTRACT FROM AUTHOR]

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an intensive but effective treatment for malignant and non-malignant diseases. However, long-term survival often comes at a cost, with survivors experiencing chronic morbidity and are at risk of relapse and secondary malignancy. This study aimed to describe decisional regret in a large cohort of Australian long-term allo-HSCT survivors. A cross-sectional survey was conducted with 441 adults in New South Wales, assessing quality of life (QoL), psychological, social, demographic, and clinical variables. Less than 10% of survivors expressed regret, with chronic graft-versus-host disease being the most important clinical factor. Psycho-socioeconomic factors such as depression, lower QoL scores, lower household income, higher treatment burden, and not resuming sex post-HSCT were also associated with regret. Findings highlight the need for valid informed consent and ongoing follow-up and support for allo-HSCT survivors dealing with life post-transplant. Nurses and healthcare professionals play a critical role in addressing decisional regret in these patients. [ABSTRACT FROM AUTHOR]

A key issue for policy makers and practitioners is finding a way to identify what constitutes a rehabilitative prison. In this study, aspects of a carceral experience that successfully ignite desistance journeys, or that "assist" desistance are identified and measured. We report the findings of a measure to do this, the Macquarie Assisted Desistance Instrument (MADI), which was co-designed with staff and residents in two correctional centers in New South Wales, Australia. Analysis of data from both prison staff and residents (N = 604) revealed that the measure was generally coherent (unidimensional), internally consistent, and stable across time. In addition, those who felt their desistance journeys were being more strongly assisted reported a greater sense of self-efficacy, providing support for the idea that custodial experiences can lead to better rehabilitative outcomes. Suggestions for how to improve prison practice and more meaningfully to assist people to desist from crime are proposed. [ABSTRACT FROM AUTHOR]

Few studies have investigated the experience of male carers of people with dementia and fewer specifically examined whether male and female carers of people with dementia differ in their approach to the caring role. As such, this research set-out to investigate whether male carers of people with dementia approach the caring role differently to female carers. Data from 167 survey participants (24 males and 143 females) were analysed using a mixed research methodology. Participants' demographics and scores on standardised burden and coping scales were analysed using linear regression. Participants' written responses to open-ended questions were analysed using thematic analysis anchored in theories of hegemonic masculinity. No significant gender differences were identified in carers' coping strategies or self-reported carer burden. However, qualitative analysis revealed strong thematic gender differences like: gendered barriers to help-seeking; gendered service preference; gendered considerations about residential care; gendered expression of burden; and themes of the absent son and exhausted daughter. This research identified that male carers of people with dementia approach help-seeking differently to female carers, typically focusing on addressing functional tasks and refraining from showing emotions, this despite reporting similar carer burden. Rapport building with male carers should start with conversations around functional issues rather than assessing the emotional impact of the caring role. The findings reinforce the need for more qualitative research into the unmet needs of male carers of people with dementia, to inform the design of male-friendly interventions which could facilitate timely access to services by male carers. [ABSTRACT FROM AUTHOR]

Objective: This paper updates clinicians and service leaders on evidence bases relevant to rehabilitation for older Australians with mental illness. Methods: Narrative review of literature and relevant public domain data supported by reflections on NSW service development. Results: There is a paucity of high-quality evidence regarding mental health rehabilitation in older people. Available evidence supports integrating lessons from physical healthcare with adaptations of 'adult' mental health rehabilitation. Adaptation is required to respond to the specific needs, strengths and service use of older people with mental illness. Challenges for older people include ageism, increased physical and cognitive comorbidities, lower access to mental health services and earlier residential aged care entry. Strengths of older people include an ongoing desire for recovery, ongoing developmental change and often closer connections with carers and GPs. Evidence is consistent with evaluation of relevant NSW service models and initiatives including the Pathways to Community Living Initiative. Integration of recovery-oriented practice and wellness models may provide a framework for future innovative inpatient and community-based models. Conclusions: There is sufficient evidence to guide development of models of rehabilitation with older people, but innovation and evaluation are essential if older people are to have equal opportunities in their recovery journeys. [ABSTRACT FROM AUTHOR]

Objective: To quantify outcomes for patients of forensic psychiatric rehabilitation in NSW. Methods: Data on 245 conditionally released forensic patients was extracted from the Mental Health Review Tribunal (MHRT) files and matched to several state-wide datasets. Descriptive statistics were generated to establish the cohort characteristics, rates of reoffending and social and clinical outcomes. Results: At conditional release, social circumstances for the majority of patients were improved. Clinically, the cohort was more stable, though many did not remain stable over time. Only one-fifth of the sample received a further criminal charge. Conclusion: Preliminary evidence suggests that forensic rehabilitation services in NSW are effective. [ABSTRACT FROM AUTHOR]

Domestic and family violence is a significant issue in the Murrumbidgee region of New South Wales, Australia, mirroring national and international concerns about gender-based violence. Generally, there are known barriers associated with providing domestic and family violence (DFV) services in rural and remote communities; however, little research has considered the specific service needs and service barriers in the after-hours period. This is crucial. The already limited rural and remote services available during business hours are further constricted in the after-hours period. This article reports on research about after-hours service need and service challenges in six target communities in the Murrumbidgee region. [ABSTRACT FROM AUTHOR]

Objectives: Applying Bronfenbrenner's Bio-Ecological Systems Theory and PPCT model recommendations, this study examined whether specific or multiple factors were associated with participation status in Australian youth swimming; a context known for high dropout rates. Methods: Participants were continuing (N = 99) and former (N = 104) swimmers, aged 8–18 years, who competed at club-national level in New South Wales, Australia. Participants completed an online survey, examining socio-demographic, participation history, and coach-created motivational climate characteristics (using the EDMCQ-C). To identify influential factors, a combination of T-tests, Odds Ratios, and MANOVA analyses were used. To confirm the presence of coach-motivational climate types and their association with participant status, cluster analyses with follow-up Odds Ratios were used. Results: Except athlete age and sex, other socio-demographic, participation history, and family sport history participation were not associated with dropout. Meanwhile, EDMCQ-C analyses identified three cluster types of coach-created climate (empowering, disempowering, and neutral), with disempowering and empowering types, respectively, associated with dropout and continuation. The neutral climate was associated with low-moderate EDMCQ-C sub-scale scoring and was neither associated with dropout nor continuation. Conclusion: Findings identify the influence of coach-created motivational climates and not athlete-related factors on continued Australian youth swimming participation, highlighting coaching implications. [ABSTRACT FROM AUTHOR]

Little is known about children's participation in early childhood education (ECE) in regional and remote areas in Australia. This research addresses this gap by investigating the perspectives of early childhood centre directors and educators who work directly in ECE services in these areas. The study used a two-stage mixed methodology, including focus groups with 52 centre directors/educators of ECE services in regional and remote areas of NSW, followed by a survey completed by centre directors/educators in 37 services, to identify the most relevant and pressing barriers to children's participation, and their views on what can be done to support children's participation. Using Bronfenbrenner's ecological systems theory (1995), multi-tiered barriers to children's participation were identified, revealing that the entrenched problem of children's non-participation in high quality ECE requires a nuanced and holistic policy approach that operates at the familial, service, community and socio-political level, targeting the specific challenges faced by communities. [ABSTRACT FROM AUTHOR]

This study examines attempted suicide in older people between 1870 and 1908 in (NSW), Australia. Statistical Registers of NSW indicate persons aged 60+ had disproportionately high rates of apprehension (10.9%) and conviction (13.0%) for attempted suicide. Newspaper reports of 110 suicide attempts in older people indicate that alcohol misuse, poor health, depression, being tired of living, financial problems, relationship difficulties, loss events and insanity were the main issues. Most were treated compassionately with medical care and support, albeit sometimes in a gaol setting. Medical casebooks of persons aged 60+ years with suicide attempts (n = 49) or suicidal ideation (n = 43) admitted to hospitals for the insane indicated that over 75% were psychotic and 50% had melancholia. [ABSTRACT FROM AUTHOR]

Opioid analgesics prescribed for the management of acute pain following orthopaedic surgery may lead to unintended long-term opioid use and associated patient harms. This study aimed to examine the prevalence of opioid use at 90 days after elective orthopaedic surgery across major city, regional and rural locations in New South Wales, Australia. We conducted a prospective, observational cohort study of patients undergoing elective orthopaedic surgery at five hospitals from major city, regional, rural, public and private settings between April 2017 and February 2020. Data were collected by patient questionnaire at the pre-admission clinic 2–6 weeks before surgery and by telephone call after 90 days following surgery. Of the 361 participants recruited, 54% (195/361) were women and the mean age was 67.7 years (standard deviation 10.1 years). Opioid use at 90 or more days after orthopaedic surgery was reported by 15.8% (57/361; 95% confidence interval (CI) 12.2–20%) of all participants and ranged from 3.5% (2/57) at a major city location to 37.8% (14/37) at an inner regional location. Predictors of long-term postoperative opioid use in the multivariable analysis were surgery performed at an inner regional location (adjusted odds ratio 12.26; 95% CI 2.2–68.24) and outer regional location (adjusted odds ratio 5.46; 95% CI 1.09–27.50) after adjusting for known covariates. Long-term opioid use was reported in over 15% of patients following orthopaedic surgery and appears to be more prevalent in regional locations in Australia. [ABSTRACT FROM AUTHOR]

Opioid analgesics are commonly used by patients awaiting orthopaedic surgery, and preoperative opioid use is associated with a greater burden of postoperative pain, suboptimal surgical outcomes and higher healthcare costs. This study aimed to examine the prevalence of total opioid use before elective orthopaedic surgery with a focus on regional and rural hospitals in New South Wales, Australia. This was a cross-sectional, observational study of patients undergoing orthopaedic surgery conducted between April 2017 and November 2019 across five hospitals that included a mix of metropolitan, regional, rural, private and public settings. Preoperative patient demographics, pain scores and analgesic use were collected during pre-admission clinic visits, held between two and six weeks before surgery. Of the 430 patients included, 229 (53.3%) were women and the mean age was 67.5 (standard deviation 10.1) years. The overall prevalence of total preoperative opioid use was 37.7% (162/430). Rates of preoperative opioid use ranged from 20.6% (13/63) at a metropolitan hospital to 48.8% (21/43) at an inner regional hospital. Multivariable logistic regression showed that the inner regional setting was a significant predictor of opioid use before orthopaedic surgery (adjusted odds ratio 2.6; 95% confidence interval 1.0 to 6.7) after adjusting for covariates. Opioid use prior to orthopaedic surgery is common and appears to vary by geographical location. [ABSTRACT FROM AUTHOR]