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Aims: This study compared two dose frequency conditions of an explicit intervention with 50 trials per session designed to improve past tense marking in early school‐aged children with developmental language disorder (DLD). The influence of allomorphs on intervention effects was also examined. Methods: Data from previously conducted intervention studies were combined and analysed. Participants included nine children (mean age = 6;5 years) who received 20–30‐min intervention sessions provided twice per week for 10 weeks (1000 trials; 400–600 min) and 20 children (mean age = 6;6) who received 20–30‐min intervention sessions provided once per week for 10 weeks (500 trials; 200–300 min). Repeated measures included criterion‐referenced probes for production of untrained past tense verbs collected throughout baseline, intervention, and maintenance phases. The rate of progress in each phase was analysed using logistic regression. The proportion of participants who produced past tense allomorphs correctly at pre‐intervention, post‐intervention, and maintenance testing points was analysed. Results: Logistic regression showed a stable baseline, highly significant progress during the intervention phase, and a marginally significant shallow decline during the maintenance phase. Those in the twice per week group showed a greater rate of progress during the intervention phase leading to significantly higher scores in the maintenance period when compared with the once per week group. The allomorphic category of past tense verbs did not appear to influence outcomes. Conclusions: Participants receiving intervention twice per week appeared to demonstrate a greater rate of progress with intervention than those receiving it once per week, although once per week was also effective. However, these results should be interpreted with caution. Limitations to study design indicate that a larger randomised controlled trial is required. All past tense allomorphs improve to a similar degree when treated with this intervention. What this paper adds: What is already known on the subject: Understanding the parameters of dosage and intensity are important for clinical practice.Research evaluating the efficacy and/or effectiveness of interventions delivered in different dose/intensity conditions is scarce.There appears to be different interpretations of what constitutes dosage and intensity in published research. What this paper adds to existing knowledge: This study retrospectively compared dosage and intensity conditions of intervention provided twice per week to intervention provided once per week. Both dose frequencies could be delivered in clinical settings.Results from this study were analysed by grouping data from multiple testing points, rather than comparing pre‐post results. This approach demonstrated the variability of individual performance that would otherwise be lost with conventional methods of analysis.This study demonstrated that all past tense allomorphs improve to a similar degree when treated with this intervention. What are the potential or actual clinical implications of this work?: Parameters of dosage and intensity are still not clearly defined well enough for translation to clinical practice. In consideration of current research, this intervention may be more effective if delivered twice per week.If clinicians are treating past tense, all allomorphs should be considered as priorities for intervention targets. [ABSTRACT FROM AUTHOR]

Aim: To compare hospital admission patterns after the first year of life in Australian children with developmental disabilities and children with no known disability, according to maternal country of birth and Indigenous status.Method: This was a retrospective cohort study using linked data across health, disability, and hospital admission databases. The study investigated 656 174 children born in Western Australia between 1983 and 2008 with a total of 1 091 834 records of hospital admissions.Results: Children with no known disability born to Indigenous mothers had the highest rate of hospital admissions compared to children of non-Indigenous mothers. Children of foreign-born mothers from low-income countries had the highest rate of hospital admissions if disability was present. Children with cerebral palsy (CP) with or without associated intellectual disability had the highest rate of hospital admissions among children with developmental disability, especially if mothers were foreign-born.Interpretation: Children with CP and intellectual disability, particularly from minority backgrounds (Indigenous Australian and foreign-born mothers), were at higher risk of being admitted to hospital after the first year of life.What This Paper Adds: Hospital admissions in Australian children with and without disabilities differ according to maternal country of birth. Hospital admission rates in children without a developmental disability were greatest for Australian-born Indigenous children. Disabled Australian-born children of foreign-born mothers from low-income countries had the highest hospital admission rates. Hospital admission risk was greatest for Australian-born children with cerebral palsy, especially if mothers were foreign-born. [ABSTRACT FROM AUTHOR]

Objective To explore the role of women in fishing industry organisations and communities in promoting best-practice health behaviours among fishers in Australia. Design This paper reports aspects of research that examined how the fishing industry can best support physical health and mental well-being of fishers. The study employed a mixed-methods, multisite case study approach. Data were gathered from face-to-face and phone interactions. Setting Two sites in Victoria and one in Western Australia. Participants Thirty-one male fishers, including commercial licence owners, skippers, deckhands, three female family members, three fishing association representatives, one local government representative, two health care providers, and three regional health planning and funding bodies. Interventions Not applicable. Main outcome measures Not applicable. Results Often unrecognised, women associated with the fishing industry are integral to the promotion of good health for fishers. They are key to identifying health issues (particularly mental health issues) and proposing community-based health and well-being strategies. They often do so by incorporating health information and activities into 'soft entry points' - informal, non-health service mechanisms by which fishers can access health information and health services. Conclusions While not working at the industry coalface, women have a stake, and are key players, in the commercial fishing industry. Their knowledge of, and credibility within, fishing enterprises makes them valuable sources of information about health issues facing the industry and effective strategies to address them. This expertise should be applied in conjunction with industry associations and health providers to achieve better health outcomes for fishers and their families. [ABSTRACT FROM AUTHOR]

Background and aims The alcohol industry produces 'responsible drinking' advertising campaigns. There is concern that these may promote drinking while persuading governments and the general public that the industry is acting responsibly. This paper examined young people's thoughts and feelings in response to one of these campaigns in Australia. Design A qualitative analysis of introspection data provided by young drinkers after exposure to a responsible drinking advertisement produced by DrinkWise called 'How to Drink Properly'. Setting Perth, Western Australia. Participants Forty-eight 18-21-year-old drinkers. Measurements The qualitative data were imported into NVivo10 and coded according to the various stages of advertising effects frameworks. A thematic analysis approach was used to identify patterns in the data relating to (i) perceptions of the source and purpose of the advertisement and (ii) any resulting attitudinal or behavioural outcomes. Findings Despite the sample comprising mainly high-risk drinkers, participants were generally unable to relate to the heavy drinkers depicted in the DrinkWise advertisement. This disassociation resulted in a perceived lack of need to modify their own drinking behaviours. Instead, the study participants found the advertisement to be entertaining and supportive of existing social norms relating to heavy drinking among members of this age group. Conclusions The 'How to Drink Properly' advertisement by Drinkwise in Australia may reinforce existing drinking attitudes and behaviours among young drinkers. [ABSTRACT FROM AUTHOR]

This paper reports a two-round Delphi study undertaken to identify the research priorities of midwives at five public maternity hospitals in Western Australia's metropolitan area of Perth. In round one, 117 midwives identified 64 different problems or issues for research. Using thematic content analysis, these problems were grouped together and then collapsed to develop 17 specific research topics within four major categories. In round two, 152 midwives were asked to rank how important each of the topic statements were to women, their families and midwives. Research focusing on ‘the postnatal experience’ was ranked by midwives as the most important to the care of women and their families. From a midwife's perspective, the highest ranked topic was ‘examining the professional issues that impact on midwives’ clinical practice’ (e.g. midwifery and medical collaboration, potential litigation and horizontal violence in the workplace). The results of the study show that Western Australian midwives, like their national and international colleagues, are concerned about the delivery and organization of maternity services, the invisibility of the postnatal experience and how to operationalize evidence-based care in the clinical area. [ABSTRACT FROM AUTHOR]

Objective: This paper reports on medication use and factors affecting use in a cohort of preschool children attending long daycare in centres and family daycare in homes.Methodology: A survey of parents representing 846 children under 6 years old in two types of childcare in Perth, Western Australia. The data were analysed using descriptive and logistic regression techniques to elucidate factors associated with use of medication.Results: Seventy-three per cent of the children were reported to have used over-the-counter medication at some time, whilst current regular use of prescribed medication was 11%. This proportion is comparable to the limited available data for children of similar ages in Western Australia. For both medication categories, the use of medication was higher in long daycare than family daycare. In addition, many other characteristics differed between children in long daycare and family daycare. Initial analysis showed a number of significant associations between child and family factors and both categories of medication. Multivariable analyses indicated that the most important associations with medication use were with children's illnesses. There was no significant difference between long daycare and family daycare for use of over-the-counter medication but attending long daycare was significantly associated with increased use of prescribed medication (OR=2.13; 95% CI 1.24-3.67) after illnesses had been taken into account.Conclusion: Medication use in children attending childcare is closely related to reported illness in the child. [ABSTRACT FROM AUTHOR]

Background: The Australian Early Development Census (AEDC) provides a measure of early child development upon school entry. Understanding which combination of factors influences Aboriginal child neurodevelopment is important to inform policy and practice.Objective: The primary objective was to use latent class analysis (LCA) to model AEDC profiles and identify the highest need profiles. The secondary objective was to determine the associations of these high need profiles on the likelihood of a child becoming developmentally vulnerable.Methods: We designed a prospective population-based birth cohort study (n = 2715) using linked data sets with information on Aboriginal cohort children, and their mothers and siblings in Western Australia. Specific developmental indicators in the 2009 and 2012 AEDC were used to assess developmental vulnerability. LCA methods were used to determine need profiles and their association with developmental vulnerability.Results: 49.3% of Aboriginal children were vulnerable on at least one developmental domain, and 37.5% were vulnerable on two or more domains. LCA found six unique profiles. High needs family, High needs young mother, and Preterm infant comprised 42% of the cohort and were considered to have high need configurations. These groups were at least 1.7 times as likely to have children who had at least one or two developmental vulnerabilities compared with the Healthy family group.Conclusion: Many Aboriginal children in Western Australia enter school with at least one developmental vulnerability. This study highlights a range of unique profiles that can be used to empower Aboriginal families for change and develop targeted programmes for improving the early development of young Aboriginal children. [ABSTRACT FROM AUTHOR]

Objective: While prior experience, favourable location and anticipation of high quality care are known to influence patient choice to attend a private ED, it is likely that decision‐making is also influenced by other persons. In particular, patients arriving by ambulance are under the care of paramedics, whose values towards healthcare and rationale for choosing one ED over another have not been studied. This study aimed to describe reasons why paramedics choose to bring patients to a private ED. Methods: Exploratory, qualitative study using semi‐structured, face‐to‐face interviews with paramedics bringing patients to a private ED from the community. Two primary questions reinforced by structured prompts were asked: 'Why did you choose to come to this emergency department?' and 'What are your general expectations of this emergency department visit?' Interviews were audio recorded, transcribed verbatim and analysed thematically. Results: Fifty paramedics were interviewed with 48 interviews able to be transcribed and used in analysis. Four factors were identified to increase the likelihood of a private ED destination: specific direction, institutional allegiance, hospital logistics and systems and receiving hospital service ethos. Conclusions: Paramedics take into consideration when possible patient's wishes and are more likely to bring a patient to a private ED if they have specific direction from the patient or the patient's family or GP. The likelihood of presenting to a private ED is increased if the patient has an allegiance with the facility and the paramedics perceive favourably the hospital logistics and systems as well as service ethos. [ABSTRACT FROM AUTHOR]

Abstract: The association between oral health, self‐esteem and quality of life is well established yet there is limited research on the impact of addressing the poor oral health of people living with mental health disorders. Greater consideration is warranted on how enhancing oral health in the course of mental healthcare might reduce the burden of a person's ill health. The role of mental health professionals is important in this regard yet uncertainty persists about the role these providers can and should play in promoting oral health care for people with mental health disorders. This qualitative study explored the issue of oral health and mental health with community based mental health professionals in Perth, Western Australia. It examined their views on the oral health status and experiences of their clients, and the different and alternative ways to improve access to care, knowledge and preventative regimens. Findings indicated participants’ ambivalence, reluctance and lack of training in raising oral health issues, despite its acknowledged importance, indicating a siloed approach to care. Findings offer an opportunity to reflect on whether a more integrated approach to oral health care for people with mental health disorders would improve health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare outcomes of patients with pure adenocarcinoma-in-situ (AIS) and mixed AIS/CIN 2/3 lesions including the incidence of AIS persistence, recurrence and progression to adenocarcinoma.Design: Retrospective cohort study.Setting: Statewide population in Western Australia.Population: Women diagnosed with AIS between 2001 and 2012.Methods: We conducted a retrospective, population-based cohort study.Main Outcome Measures: De-identified linked data were utilised to ascertain the association between patient age at excisional treatment, margin status, lesion type, lesion size, and risk of persistent AIS (defined as the presence of AIS <12 months from treatment), recurrent AIS (≥12 months post-treatment), and adenocarcinoma.Results: 636 patients were eligible for analysis. The mean age was 32.3 years and median follow-up interval was 2.5 years. Within the study cohort, 266 patients (41.8%) had pure AIS and 370 (58.2%) had mixed AIS/CIN 2/3. Overall, 47 patients (7.4%) had AIS persistence/recurrence and 12 (1.9%) had adenocarcinoma. Factors associated with persistence/recurrence were pure AIS (hazard ratio (HR) 2.3; 95%CI 1.28-3.94; P = 0.005), age >30 years (HR 2.1; 95%CI 1.16-3.81; P = 0.015), positive endocervical margins (HR 5.8; 95%CI 3.05-10.92; P = <0.001) and AIS lesions >8 mm (HR 2.5; 95%CI 1.00-6.20; P = 0.049). A histologically positive AIS ectocervical margin was not associated with persistence/recurrence.Conclusion: In this study, pure AIS was associated with greater risk of persistence/recurrence than was mixed AIS/CIN 2/3. AIS lesions >8 mm and positive endocervical margins were significant predictors for persistent or recurrent disease.Tweetable Abstract: Pure cervical adenocarcinoma-in-situ (AIS) may have greater risk of recurrence than AIS co-existing with CIN 2/3. [ABSTRACT FROM AUTHOR]

Background Children with severe disability often develop osteoporosis and have an increased risk of fracture. In Rett syndrome, the prevalence of fracture is four times greater than in the general population, and the femur is commonly affected. This study used qualitative methods to investigate the regaining of mobility within 12 months following femoral fracture in Rett syndrome and parent caregiver experiences. Methods Caregivers ( n = 14) of cases registered with the Australian Rett Syndrome Database with a daughter with Rett syndrome were recruited if their daughter sustained a femoral fracture between 2009 and 2014. Median (interquartile range) age at fracture was 11 years and 4 months (8 years and 8 months to 22 years and 3 months). Qualitative methods were used to investigate parent/caregiver experiences and their daughter's recovery following fracture. Themes in the interview data were identified with thematic analysis. Results Operative management was chosen for those walking independently and non-operative management for most of the remaining. All who walked independently and one of the four who required assistance recovered pre-operative walking skills within 6 months. Themes identified by caregivers related to the complexities of pain recognition, the caregiver emotional journey and later rebuilding of relationships with service providers. Conclusions Those who walked with assistance were vulnerable to loss of this skill. Difficulties in pain recognition increased time to diagnose fracture, and the acute episode was associated with heightened caregiver stress. Service providers can use family-centred practice models to support the strengthening of family functioning following this acute event that is surprisingly common in those with severe disability. [ABSTRACT FROM AUTHOR]

Issue addressed Indigenous Australians are 14 times more likely than non-Indigenous Australians to develop diabetic retinopathy (DR). Blindness can be prevented in 98% of cases if DR is identified and treated early. While the National Health and Medical Research Council recommend annual screening for Indigenous Australians, screening attendance rates remain low. The objective of this study was to evaluate whether a targeted health promotion intervention improved patient compliance and screening rates. Methods Bad Sugars, Bad Eyes - a culturally appropriate video targeting DR awareness and the importance of screening among Indigenous Australians - was developed at the Lions Eye Institute, Western Australia. The study used a patient questionnaire pre and post viewing of the video, as well as semi-structured interviews with Aboriginal Health Workers, to explore the influence the resource had on patient knowledge and attitudes. Eighty-four participants, currently involved in DR screening programs, were recruited from Aboriginal Medical Services (AMS) and Aboriginal Community Controlled Health Services (ACCHS). Results The video was found to increase patient knowledge about key DR issues as well as alter patient attitudes identified as potential barriers to screening. The areas most affected by the video resource were knowledge of recommended screening intervals, the severity of potential visual complications if DR is left undiagnosed and untreated and that screening is needed even when asymptomatic. Aboriginal Health Workers positively evaluated the video, all rating it as 'very' culturally appropriate, understandable and relatable. Conclusion The findings of this study suggest that Indigenous DR screening attendance rates could be increased through the expanded use of this video. So what? Indigenous DR screening attendance rates remain low, despite annual recommendations by the National Health and Medical Research Council. This gap needs to be addressed. [ABSTRACT FROM AUTHOR]

Background: Depression is an established risk factor for dementia in later life, but it is unclear if this relationship is causal. This study aimed to determine if clinically significant depressive symptoms are likely to be causally related to cognitive impairment in later life.Methods: Observational cohort study of 4568 men aged 70-89 years living in Perth, Western Australia, who were free of cognitive impairment at the beginning of follow-up. Current clinically significant depressive symptoms were defined by a score of 7 or more on the Geriatric Depression Scale 15 items. Past depression was ascertained via electronic medical records, by self-report or use of antidepressants. A score of 27 or less on the Telephone Interview for Cognitive Status modified or a recorded diagnosis of dementia in electronic medical records established the presence of cognitive impairment.Results: During the 5-year follow-up, 534 men developed cognitive impairment, 811 died and 1455 were lost. The presence of clinically significant depressive symptoms at study entry was associated with increased risk rate (RR) of cognitive impairment (RR = 2.59, 95% confidence interval: 95%CI = 1.57-4.27), death (RR = 5.07, 95%CI = 3.32-7.75) and loss to follow-up (RR = 2.03, 95%CI = 1.32-3.13). These associations remained statistically significant after adjustment for age, country of birth, education, smoking history, and prevalence hypertension, diabetes, coronary heart disease and stroke. History of past clinically significant depressive symptoms was not associated with incident cognitive impairment (RR = 1.09, 95%CI = 0.78-1.52).Conclusions: The lack of association between past depression and cognitive impairment suggests that the link between depression and cognitive impairment is not causal and that the presence of clinically significant depressive symptoms in later life may herald the onset of cognitive impairment in at least some people. [ABSTRACT FROM AUTHOR]

Cyberbullying is a major public health problem associated with serious mental, social, and academic consequences for young people. To date, few programs addressing cyberbullying have been developed and empirically tested. The Cyber Friendly Schools (CFS) group-randomized controlled trial measured the longitudinal impact of a whole-school online cyberbullying prevention and intervention program, developed in partnership with young people. Non-government secondary schools in Perth, Western Australia, (N = 35; 3,000+ students) were randomized to an intervention (n = 19) or usual practice control group (n = 16 schools). Students completed online questionnaires in 2010, 2011, and at 1-year follow-up in 2012, measuring their cyberbullying experiences during the previous school term. The intervention group received the program in Grades 8 and 9 (aged 13-14 years). Program effects were tested using two-part growth models. The program was associated with significantly greater declines in the odds of involvement in cyber-victimization and perpetration from pre- to the first post-test, but no other differences were evident between the study conditions. However, teachers implemented only one third of the program content. More work is needed to build teacher capacity and self-efficacy to effectively implement cyberbullying programs. Whole-school cyberbullying interventions implemented in conjunction with other bullying prevention programs may reduce cyber-victimization more than traditional school-based bullying prevention programs alone. Aggr. Behav. 42:166-180, 2016. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: Early childhood psychosocial experiences determine future health and health-care use. Identifying psychosocial predictors in cystic fibrosis may inform intervention strategies that can reduce health-care utilization.Design: The study was designed as a prospective cohort study.Setting: The study was set in the only cystic fibrosis clinic in Western Australia.Patients: The patients were children up to 6 years diagnosed with cystic fibrosis in Western Australia between 2005 and 2011.Main Outcome Measures: Psychosocial data collected for each year of life were compared with Australian population data and analysed as predictors of annual hospital, emergency and outpatient visits.Results: Compared with the Australian population, cystic fibrosis families demonstrated lower socio-economic status and labour supply (P < 0.001), increased residential mobility (P < 0.001) and trends towards increased rates of parental separation (P = 0.066). Marital discord and maternal and child psychological stress significantly predicted increased hospital admissions, emergency and outpatient visits.Conclusions: Social gradients may exist for families of young children with cystic fibrosis in Western Australia with potential implications for child health. Family psychological and relationship stress predicted increased child cystic fibrosis-related health-care use. [ABSTRACT FROM AUTHOR]

Aim: To determine if subjects' cholesterol levels tracked relative to their peers from early childhood to adult mid-life.Methods: Longitudinal study using subjects from the Busselton Population Study. Data were available from 1967 on a triennial basis until 1983, and a re-survey held in 1994. The study included 1764 subjects aged 5-18 y at first measurement. Pearson's correlation coefficient, adjusted for age and survey year, was used to examine cholesterol tracking. The proportion of children who persisted with cholesterol measurements in the extreme high quartile was assessed over time before and after adjusting data for regression to the mean. The variability of the children's cholesterol level was examined by track width using the method of Porkka.Results: The correlation coefficients for tracking were from 0.35 to 0.55. Stronger correlations coincided with shorter time periods between measurements. Before adjustment for regression to the mean, 55-60% of children from the highest quartile at first measurement remained in the same quartile 27 y later. After adjustment for regression to the mean, the number of children with levels in the extreme high quartile decreased, but 80% of these persisted in that quartile.Conclusion: Intra-individual variations in cholesterol levels have an important influence on population tracking levels and need to be considered when interpreting tracking results from early childhood to adult mid-life. However, removing the effect of regression to the mean by taking multiple measurements of cholesterol will probably improve prediction for individuals. [ABSTRACT FROM AUTHOR]

Aim: To report updated rates of breastfeeding in Perth through 2002/3 and to compare them to those from 1992/3.Methods: Design: A 12-mo longitudinal study.Setting: Two public maternity hospitals in Perth, Australia.Subjects: Eligible mothers of healthy newborn infants delivered between mid-September 2002 and mid-July 2003.Interventions: All eligible mothers were asked to participate in a 12-mo longitudinal study of infant feeding. While in hospital, participating mothers completed a questionnaire that included questions on how they were feeding their newborn.Main Outcomes Measures: Prevalence of ever breastfeeding, and breastfeeding at discharge.Results: A total of 587 mothers, or 55% of those eligible, participated in the study. At hospital discharge, 93.8% of mothers in 2002/3 were breastfeeding compared with 83.8% in 1992/3. Significant increases were observed across all socio-demographic groups, with the biggest increase seen amongst younger mothers and those born outside of Australia. The national target of having in excess of 90% of mothers breastfeeding at discharge from hospital has been achieved in Perth. The challenge for health professionals and the community is to help maintain and further improve these breastfeeding practices. [ABSTRACT FROM AUTHOR]

The School Health and Alcohol Harm Reduction Project (SHAHRP study) aimed to reduce alcohol-related harm in secondary school students. The study used a quasi-experimental research design in which randomly selected and allocated intervention and comparison groups were assessed at eight, 20 and 32 months after baseline. Metropolitan, government secondary schools in Perth, Western Australia. The sample involved over 2300 students. The retention rate was 75.9% over 32 months. The evidence-based intervention, a curriculum programme with an explicit harm minimization goal, was conducted in two phases over a 2-year period. Knowledge, attitude, total alcohol consumption, risky consumption, context of use, harm associated with own use and harm associated with other people's use of alcohol. There were significant knowledge, attitude and behavioural effects early in the study, some of which were maintained for the duration of the study. The intervention group had significantly greater knowledge during the programme phases, and significantly safer alcohol-related attitudes to final follow-up, but both scores were converging by 32 months. Intervention students were significantly more likely to be non-drinkers or supervised drinkers than were comparison students. During the first and second programme phases, intervention students consumed 31.4% and 31.7% less alcohol. Differences were converging 17 months after programme delivery. Intervention students were 25.7%, 33.8% and 4.2% less likely to drink to risky levels from first follow-up onwards. The intervention reduced the harm that young people reported associated with their own use of alcohol, with intervention students experiencing 32.7%, 16.7% and 22.9% less harm from first follow-up onwards. There was no impact on the harm that students reported from other people's use of alcohol. The results of this study support the use of harm reduction goals and classroom approaches in school drug education. [ABSTRACT FROM AUTHOR]