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Background: This study examines the perceptions of the Australian public canvassed in 2021 during the COVID‐19 pandemic about their health system compared to four previous surveys (2008, 2010, 2012 and 2018). Methods: In 2021, a nationwide online survey was conducted with a representative sample of Australians (N = 5100) recruited via market research panels. The results were compared to previous nationwide Australian survey samples from 2018 (N = 1024), 2012 (N = 1200), 2010 (N = 1201) and 2008 (N = 1146). The survey included questions consistent with previous polls regarding self‐reported health status and overall opinions of, and confidence in, the Australian health system. Results: There was an increase in the proportion of respondents reporting positive perceptions at each survey between 2008 and 2021, with a significantly higher proportion of respondents expressing a more positive view of the Australian healthcare system in 2021 compared to previous years (χ2(8, N = 9645) = 487.63, p < 0.001). In 2021, over two‐thirds of respondents (n = 3949/5100, 77.4%) reported that following the COVID‐19 pandemic, their confidence in the Australian healthcare system had either remained the same (n = 2433/5100, 47.7%) or increased (n = 1516/5100, 29.7%). Overall, respondents living in regional or remote regions, younger Australians (< 45 years) and women held less positive views in relation to the system. In 2021, the most frequently identified area for urgent improvement was the need for more healthcare workers (n = 1350/3576, 37.8%), an area of concern particularly for Australians residing in regional or remote areas (n = 590/1385, 42.6%). Conclusions: Irrespective of disruptions to the Australian healthcare system caused by the COVID‐19 pandemic, Australians' perceptions of their healthcare system were positive in 2021. However, concerns were raised about inadequate workforce capacity and the cost of healthcare, with differences identified by age groups and geographical location. Patient or Public Contribution: Health consumer representatives from the Consumers Health Forum of Australia contributed to the co‐design, deployment, analysis and interpretation of the results of this survey. J.A. and L.W. from the Consumers Health Forum of Australia contributed to the development of the paper. [ABSTRACT FROM AUTHOR]

Solute dynamics depend strongly on hydrologic flow paths and transit times within catchments. In this paper, we use a travel time tracking method to simulate stream salinity (as measured by electrical conductivity) in the Duck River catchment, NW Tasmania, Australia. The study couples storage selection function transit time modelling with two alternate approaches to model electrical conductivity (EC). The first approach assumes the catchment has a cyclic salt balance (i.e., rainfall source, stream flow sink) that is in dynamic equilibrium and evapoconcentration of salt is the only process changing concentration. The second approach assumes that the salinity of water in catchment storages is a function of water age in those stores, without explicitly simulating salt mass balance processes. The paper compares these alternate approaches in terms of EC simulation performance, simulated stream water age distributions, and simulated storage age distributions. A split sample calibration‐validation analysis was conducted using the 2008 and 2009 water years. Both EC simulation approaches reproduced stream EC variations very well under both calibration and validation. The simulations using the age‐related EC simulation approach produced less biased results and, consequently, higher model coefficient of efficiency for validation periods. This approach also produced more consistent model parameter estimates between periods. There were systematic differences in the resultant age distributions between models, particularly for the solute balance‐based simulations where parameters (catchment storage size) changed more between the two calibration periods. The effect of time varying versus static storage selection functions were compared, with clear evidence that time varying storage selection functions with parameters linked to catchment conditions (flow) are essential for adequate simulation of EC dynamics during flow events. [ABSTRACT FROM AUTHOR]

This paper examines the reflections of a cohort of Australian children who lived through the 2020–21 COVID‐19 pandemic and experienced being in 'lockdown'; a state of largely being confined to the home for long periods daily. We report how children reflect on their experiences and illustrate how reflections draw on similar topics focused on localised child concerns regarding health, education, family, digital engagement, mealtimes and food. Further, we argue for the importance of including children's own voices of lived experience in reports regarding life during the pandemic since these perspectives may differ from those reported by adults on children's behalf. [ABSTRACT FROM AUTHOR]

A biochemical diagnosis of subclinical hypothyroidism (SCH) is defined by an elevated serum thyroid‐stimulating hormone (TSH) with a normal serum free thyroxine (FT4). This paper discusses SCH in the Australian population, the impact of SCH on health‐related quality of life (HRQoL), and the evidence for thyroid hormone therapy as well as exercise therapy to improve HRQoL in SCH. The prevalence of SCH in Australia is approximately 4–5% and is higher in females and the elderly. Current evidence suggests thyroid hormone therapy is not associated with an improvement in HRQoL. However, there does appear to be a subgroup of those with SCH that experience an impairment in HRQoL who may potentially benefit from treatment. Because the majority of research to date has been done in elderly, largely asymptomatic individuals, this may not be representative of the entire SCH population. In addition, alternative treatments, such as exercise therapy, have not been well explored in the literature, despite exercise therapy's effects on HRQoL in other populations. Further research is required to define clearly which individuals with SCH are likely to experience an impaired HRQoL, as well as explore the effects of thyroid hormone therapy and exercise therapy in these individuals. [ABSTRACT FROM AUTHOR]

Summary: We examine the relationships between electoral socio‐demographic characteristics and two‐party preferences in the six Australian federal elections held between 2001 and 2016. Socio‐demographic information is derived from the Australian Census which occurs every 5 years. Since a census is not directly available for each election, an imputation method is employed to estimate census data for the electorates at the time of each election. This accounts for both spatial and temporal changes in electoral characteristics between censuses. To capture any spatial heterogeneity, a spatial error model is estimated for each election, which incorporates a spatially structured random effect vector. Over time, the impact of most socio‐demographic characteristics that affect electoral two‐party preference do not vary, with age distribution, industry of work, incomes, household mobility and relationships having strong effects in each of the six elections. Education and unemployment are among those that have varying effects. All data featured in this study have been contributed to the eechidnaR package (available on CRAN). This paper models all Australian federal elections from 2001‐2016 to examine the socio‐demographic drivers of electorates' two‐party preferred vote. [ABSTRACT FROM AUTHOR]

Physical activity (PA) during childhood and adolescence is important for the accrual of maximal peak bone mass. The precise dose that benefits bone remains unclear as methods commonly used to analyze PA data are unsuitable for measuring bone‐relevant PA. Using improved accelerometry methods, this study identified the amount and intensity of PA most strongly associated with bone outcomes in 11–12‐year‐olds. Participants (n = 770; 382 boys) underwent tibial peripheral quantitative computed tomography to assess trabecular and cortical density, endosteal and periosteal circumference and polar stress‐strain index. Seven‐day wrist‐worn raw acceleration data averaged over 1‐s epochs was used to estimate time accumulated above incremental PA intensities (50 milli‐gravitational unit (mg) increments from 200 to 3000 mg). Associations between time spent above each 50 mg increment and bone outcomes were assessed using multiple linear regression, adjusted for age, sex, height, weight, maturity, socioeconomic position, muscle cross‐sectional area and PA below the intensity of interest. There was a gradual increase in mean R2 change across all bone‐related outcomes as the intensity increased in 50 mg increments from >200 to >700 mg. All outcomes became significant at >700 mg (R2 change = 0.6%–1.3% and p = 0.001–0.02). Any further increases in intensity led to a reduction in mean R2 change and associations became non‐significant for all outcomes >1500 mg. Using more appropriate accelerometry methods (1‐s epochs; no a priori application of traditional cut‐points) enabled us to identify that ∼10 min/day of PA >700 mg (equivalent to running ∼10 km/h) was positively associated with pQCT‐derived measures of bone density, geometry and strength in 11–12‐year‐olds. Highlights: Accelerometry methods that are commonly used to assess free‐living, bone‐relevant physical activity (PA) are not well suited to measuring bone‐specific characteristics of PA (short bursts of high‐impact activity).Processing raw acceleration data using much shorter epochs (1‐s) and using incremental 50 mg intensity thresholds (rather than traditional, broad intensity thresholds) enabled a bone‐specific, beneficial intensity to be identified.The methods outlined provide a means for more precisely assessing free‐living bone‐relevant PA and permit the transparent and reproducible analysis of raw accelerometry data, which will enhance our ability to quantify dose‐response associations in the future. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Hysterectomy is a common gynecological procedure, particularly in middle and high income countries. The aim of this paper was to describe and examine hysterectomy trends in Australia from 2000-2001 to 2013-2014.Material and Methods: For women aged 25 years and over, data on the number of hysterectomies performed in Australia annually were sourced from the National Hospital and Morbidity Database. Age-specific and age-standardized hysterectomy rates per 10 000 women were estimated with adjustment for hysterectomy prevalence in the population. Using joinpoint regression analysis, we estimated the average annual percentage change over the whole study period (2000-2014) and the annual percentage change for each identified trend line segment.Results: A total of 431 162 hysterectomy procedures were performed between 2000-2001 and 2013-2014; an annual average of 30 797 procedures (for women aged 25+ years). The age-standardized hysterectomy rate, adjusted for underlying hysterectomy prevalence, decreased significantly over the whole study period [average annual percentage change -2.8%; 95% confidence interval (CI) -3.5%, -2.2%]. The trend was not linear with one joinpoint detected in 2008-2009. Between 2000-2001 and 2008-2009 there was a significant decrease in incidence (annual percentage change -4.4%; 95% CI -5.2%, -3.7%); from 2008-2009 to 2013-2014 the decrease was minimal and not significantly different from zero (annual percentage change -0.1%; 95% CI -1.7%, 1.5%). A similar change in trend was seen in all age groups.Conclusions: Hysterectomy rates in Australian women aged 25 years and over have declined in the first decade of the 21st century. However, in the last 5 years, rates appear to have stabilized. [ABSTRACT FROM AUTHOR]

This paper investigates the use of sample reweighting, in a behavioural tax microsimulation model, to examine the implications for government taxes and expenditure of population ageing in Australia. First, a calibration approach to sample reweighting is described, producing new weights that achieve specified population totals for selected variables. Second, the performance of the Australian Bureau of Statistics’ (ABS) weights provided with the 2000–2001 Survey of Income and Housing Cost (SIHC) was examined and it was found that reweighting does not improve the simulation outcomes for the 2001 situation, so the original ABS weights were retained for 2001. Third, the implications of changes in the age distribution of the population were examined, based on population projections to 2050. A ‘pure’ change in the age distribution was examined by keeping the aggregate population size fixed and changing only the relative frequencies in different age-gender groups. Finally, the effects of a policy change to benefit taper rates in Australia were compared for 2001 and 2050 population weights. It is suggested that this type of exercise provides an insight into the implications for government income tax revenue and social security expenditure of changes in the population, indicating likely pressures for policy changes. [ABSTRACT FROM AUTHOR]

Although the adverse health consequences of zinc deficiency are becoming increasingly well known internationally, few studies have investigated zinc status in Australia and New Zealand. The aim of this review was to identify which population groups, if any, in Australia and New Zealand are likely to be at risk of zinc deficiency. A literature review was conducted to identify papers on zinc status in Australasia using electronic databases (MEDLINE, BIOSIS Previews, CINAHL, EMBASE, Web of Knowledge, ProQuest and Cochrane Library). Government databases and reference lists from peer-reviewed journal articles were also accessed. Thirty-one Australasian studies that measured dietary zinc intake and/or serum zinc were identified. Many were based on a small number of self-selected subjects, and did not use the recommended procedures for evaluating the prevalence of inadequate zinc intakes and low serum zinc concentrations. Existing data suggest that at-risk groups in Australasia are toddlers, adolescents (especially those of Pacific and Aboriginal ethnicities), institutionalised elderly and possibly people with diabetes. Data on the zinc status of selected population groups in Australasia are limited. Randomised controlled zinc supplementation trials that include the recommended indicators and other clinical outcomes are needed to confirm the existence of zinc-related health outcomes among the at-risk groups identified. [ABSTRACT FROM AUTHOR]

Background and Aims: To determine the incidence of inflammatory bowel disease (IBD) in the Mackay‐Isaac‐Whitsunday region in Northern Queensland (−21.14° S) and to allow a comparison with Southern Australian and New Zealand data (Geelong, Australia −38.14° S; Tasmania −41.43° S and −42.88° S (Launceston and Hobart) and Canterbury, New Zealand −43.46 °S). Design: A prospective observational community population‐based IBD study was conducted between 1 June 2017 and 31 May 2018. Outcome measures: Primary includes the crude annual incidence rate of IBD, Crohn's disease (CD), ulcerative colitis (UC) and inflammatory bowel disease‐unclassified (IBDU), while secondary includes disease phenotype and behaviour. Results: Fifty‐six new cases of IBD were identified. Twenty‐three were CD, 30 were UC and 3 were IBDU. The crude annual incidence rate per 100 000 for IBD, CD, UC and IBDU were 32.2 (95% confidence interval (CI): 24.78–41.84), 13.23 (95% CI: 8.79–19.90), 17.25 (95% CI: 12.06–24.67) and 1.73 (95% CI: 0.56–5.35). When directly age‐standardised to the World Health Organisation Standard Population Distribution, the overall CD, UC and IBDU incidence were 13.19, 17.34 and 1.85 per 100 000, with an overall age‐standardised IBD incidence of 32.38. Conclusions: This is the first study to define the incidence of IBD in a Northern Australian cohort and to allow a comparison between North and Southern Australia. The IBD crude is the highest reported in Australia. Like others, we found a high and low incidence of upper gastrointestinal Crohn's disease and complicated disease at diagnosis respectively, likely reflective of the increased availability and early uptake of endoscopic procedures. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol's harm to others (AHTO) has become a key driver of national and international alcohol policy. This study aimed to produce a contemporary, comprehensive estimate of the correlates and harms from others' drinking in 2021 in Australia. Design, setting, participants and measurements: Across Australia, 2574 adults (1380 women; 1172 men) were sampled via two cross‐sectional survey modes: a random‐digit dial mobile phone sample of 1000 people and 1574 people from the Life in Australia™ panel survey. In 2021 participants were asked about harms they had experienced from the drinking of family, friends, co‐workers and the public in the past year. Applying combined sample weights from each mode, bivariable and adjusted multivariable logistic regressions were used to analyse differences in rates of AHTO by participant gender, age, residence in rural or metropolitan regions, country of birth, education and employment. Findings: In 2021, 23.6% reported being negatively affected by strangers' drinking and 21.3% by the drinking of someone they knew, with 34.3% reporting being negatively affected a lot or a little by either; 42.4% of respondents reported specific harms from strangers' drinking. Thus, 48.1% of respondents reported any harm (negative effects or specific harms) from others' drinking. Women, younger people, Australian‐born and heavier episodic drinkers reported significantly higher rates of AHTO compared with other respondents. Smaller percentages (7.5%) of participants reported being harmed substantially by others' drinking, including by people they knew (5.8%) or strangers (2.3%). Stratified analyses showed that heavier drinking, furloughed, younger men who were born overseas in English‐speaking countries were affected by others' drinking, whereas women were affected regardless of these factors (apart from age). Conclusions: More than one‐third of Australian adults appear to have been negatively affected by others' drinking in 2021, with women, younger people and heavier drinkers at greater risk. Substantial harm appears to be more likely to arise from the drinking of people Australians know than from strangers' drinking. [ABSTRACT FROM AUTHOR]

Introduction: Multimorbidity is common among people living with HIV (PLWH), with numerous cross‐sectional studies demonstrating associations with older age and past immunosuppression. Little is known about the progression of multimorbidity, particularly in the setting of long‐term access to antiretrovirals. This study aims to determine factors predictive of change in multimorbidity in PLWH. Methods: People living with HIV who attended a regional HIV service were recruited to a consented observational cohort between September 2016 and March 2020. Demographic data, laboratory results and a Cumulative Illness Rating Scale (CIRS) were collected at enrolment and first clinical review of every subsequent year. Change in CIRS score was calculated from enrolment to February 2021. Associations with change were determined through univariate and multivariate linear regression. Results: Of 253 people, median age was 58.9 [interquartile range (IQR): 51.9–64.4] years, 91.3% were male, and HIV was diagnosed a median of 22.16 years (IQR: 12.1–30.9) beforehand. Length of time in the study was a median of 134 weeks (IQR: 89.0–179.0), in which a mean CIRS score change of 1.21 (SD 2.60) was observed. Being older (p < 0.001) and having a higher body mass index (p = 0.008) and diabetes (p = 0.014) were associated with an increased likelihood of worsening multimorbidity. PLWH with a higher level of multimorbidity at baseline were less likely to worsen over time (p < 0.001). Conclusion: As diabetes and weight predict worsening multimorbidity, routine diabetes screening, body mass index measurement, and multimorbidity status awareness are recommended. [ABSTRACT FROM AUTHOR]

Background: Previous findings from research investigating the role of antenatal nutrition in preventing postpartum depression (PPD) are inconsistent. Our primary aim was to investigate the association between pregnancy diet quality and PPD. Our secondary aim was to investigate associations between (a) diet quality and depression during pregnancy and (b) depression during pregnancy and PPD. Methods: This analysis represents data from 73 women participating in the Microbiome Understanding in Maternity Study (MUMS) cohort in Sydney, Australia, which followed women from Trimester 1 of pregnancy to 1‐year postpartum (PP). Participants' diet quality was assessed using the Australian Eating Survey at Trimester 1 and 3 to calculate diet quality, known as the Australian Recommended Food Score (lower diet quality defined as score <39; higher diet quality ≥39). Depression was assessed using the Edinburgh Depression Scale at Trimesters 1, 2, 3 and 6 weeks PP (defined as score ≥11). Results: Depression scores during pregnancy were significantly associated with depression score 6 weeks PP (Trimester 1: r = 0.66, Trimester 2: r = 0.69, Trimester 3: r = 0.67; all p < 0.001). Diet quality during pregnancy was not significantly correlated with 6‐week PPD score. In unadjusted analysis, diet quality during pregnancy was not associated with pregnancy depression scores. When adjusted for age, parity and Trimester 1 body mass index, Trimester 1 physical activity levels and gestational weight gain, higher Trimester 3 diet quality was associated with reduced Trimester 3 depression only. Conclusions: Depression scores during pregnancy were positively associated with PPD, highlighting the importance of screening for depression during pregnancy and postnatally. Larger longitudinal prospective studies may elucidate the association between diet quality and PPD. Highlights: Depression during pregnancy was associated with postpartum depression score, highlighting the importance of adhering to routine screening guidelines throughout the perinatal period.Although diet is clearly important for the health of both the mother and the developing foetus during pregnancy, our analysis of data from the Microbiome Understanding in Maternity Study (MUMS) cohort did not find any associations between diet quality and depression. [ABSTRACT FROM AUTHOR]

Background: Neonatal hypoxic ischaemic encephalopathy (HIE) is the most common cause of encephalopathy in the neonatal period and carries a high risk of mortality and long‐term morbidity. Aim: The aim of this study was to investigate key antecedents of moderate and severe HIE in a large contemporary birth cohort. Methods: A retrospective cohort study of births meeting criteria was conducted between 2016 and 2020 at the Mater Mothers' Hospital, Brisbane, Australia. This is a quaternary perinatal centre and Australia's largest maternity hospital. Univariate and multivariate Firth logistic regression were used to account for imbalanced frequency classes between non‐HIE and HIE groups. Maternal variables and intrapartum factors were investigated for associations with neonatal moderate and severe HIE. Results: Overall, 133 of 46 041 (0.29%) infants were diagnosed with HIE: 77 (0.17%) with mild HIE and 56 (0.12%) with moderate/severe HIE. Nulliparity, type 1 diabetes mellitus and maternal intensive care unit admission were associated with increased odds of moderate/severe HIE. Intrapartum risk factors included emergency caesarean birth, emergency caesarean for non‐reassuring fetal status or failure to process, intrapartum haemorrhage and an intrapartum sentinel event (shoulder dystocia, cord prolapse, uterine rupture and placental abruption). Neonatal risk factors included male sex, late preterm gestation (35+0–36+6 weeks), Apgar score less than four at 5 min, severe respiratory distress requiring ventilatory support and severe acidosis at birth. Conclusions: This cohort study identified a series of potentially modifiable maternal and obstetric risk factors for HIE. Risk factors for HIE do not appear to have changed significantly with evolution in modern obstetric care. [ABSTRACT FROM AUTHOR]

Objective: This study explored use and perceived barriers to the use of post‐operative video‐link telehealth among a sample of Australian surgeons shortly before the COVID‐19 pandemic. Methods: During 2019–2020, a survey was mailed to RACS or RANZCOG Fellows. Design: Cross‐sectional survey. Setting and Participants: A total of 907 surgeons practising in Australia completed the survey. Main Outcome Measures: The study‐specific survey assessed telehealth use in the last 3 months and the perceived barriers and enablers to the use of post‐operative teleconsultations, across the domains: quality of care; convenience and efficiency; legal/regulatory issues; financial issues and technological issues. Results: Twenty‐five percent of eligible surgeons returned the survey, with n = 763 pre‐pandemic responses included in analyses. Approximately one‐quarter (26%) of surgeons had used telehealth post‐operatively with patients in the last 3 months. The most frequently endorsed barriers to use related to quality of care: 'I cannot undertake a patient examination' and 'I cannot provide the same level of care as during an in‐person consultation'; and convenience and efficiency: 'Teleconsultations are more difficult to arrange'. Surgeons who had recently used telehealth were less likely to endorse most barriers. Younger age, awareness of Medicare telehealth reimbursement and working in neurosurgery, urology, paediatric surgery and plastic and reconstructive surgery (compared to general surgery) were associated with recent telehealth use by surgeons. Conclusions: Some surgeons' perceived barriers to telehealth pre‐COVID may be overcome by COVID‐19‐related telehealth uptake and familiarisation. However, many barriers will need to be addressed to ensure that telehealth adoption is sustained beyond the pandemic. [ABSTRACT FROM AUTHOR]

Objectives To investigate patterns of Australian GP procedural activity and associations with: geographical remoteness and population size, hours worked in hospitals and in total; and, availability for on-call, Design and participants National annual panel survey (Medicine in Australia: Balancing Employment and Life) of Australian GPs, 2011-2013. Main outcome measures Self-reported geographical work location, hours worked in different settings, and on-call availability per usual week, were analysed against GP procedural activity in anaesthetics, obstetrics, surgery or emergency medicine. Results Analysis of 9301 survey responses from 4638 individual GPs revealed significantly increased odds of GP procedural activity in anaesthetics, obstetrics or emergency medicine as geographical remoteness increased and community population size decreased, albeit with plateauing of the effect-size from medium-sized (population 5000-15 000) rural communities. After adjusting for confounders, procedural GPs work more hospital and more total hours each week than non-procedural GPs. In 2011 this equated to GPs practising anaesthetics, obstetrics, surgery, and emergency medicine providing 8% (95% CI 0, 16), 13% (95% CI 8, 19), 8% (95% CI 2, 15) and 18% (95% CI 13, 23) more total hours each week, respectively. The extra hours are attributable to longer hours worked in hospital settings, with no reduction in private consultation hours. Procedural GPs also carry a significantly higher burden of on-call. Conclusions The longer working hours and higher on-call demands experienced by rural and remote procedural GPs demand improved solutions, such as changes to service delivery models, so that long-term procedural GP careers are increasingly attractive to current and aspiring rural GPs. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to examine age, period and birth cohort trends in the prevalence of any alcohol‐related risky behaviour and to compare these trends between men and women. Design and setting: We used an age–period–cohort analysis of repeated cross‐sectional survey data from the Australian National Drug Strategy Household Survey from 2001 to 2016. Participants: Participants were 121 281 people aged 14–80 years who reported consuming alcohol in the past 12 months. Measurements: Any risky behaviour undertaken while under the influence of alcohol in the past 12 months (e.g. operating a motor vehicle) was measured: male or female. Findings Controlling for age and cohort, cubic spline models showed that any alcohol‐related risky behaviour declined with time among participants who consumed alcohol [2016 versus 2007 rate ratio (RR) = 0.80, 95% confidence interval (CI) = 0.76–0.84]. Risky behaviour peaked in the 1954 birth cohort (1954 versus 1971 RR = 1.42, 95% CI = 1.30–1.55) and then steadily declined with more recent birth cohorts (2002 versus 1971 RR = 0.32, 95% CI = 0.27–0.39). Risky behaviour peaked at age 21 years, followed by steady decline and stabilization at approximately age 70 years. Males were overall twice as likely as females to report alcohol‐related risky behaviour (RR = 2.10, 95% CI = 1.84–2.39), but this effect was smaller in cohorts born after 1980 [1980 prevalence rate ratios (PRR) = 2.09, 95% CI = 1.81–2.43; 2002 PRR = 1.31, 95% CI = 1.03–1.68]. Conclusions: Alcohol‐related risky behaviour in Australia has declined generally since 2001, with rates for recent cohorts having the sharpest decline. Risky behaviour remains most prevalent in young adults, and the male–female gap in risky behaviour is closing for more recent birth cohorts. These trends are consistent with alcohol consumption trends observed in Australia and world‐wide. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the incidence, characteristics and in‐hospital mortality of non‐ventilator‐associated hospital‐acquired pneumonia (NV‐HAP) in a regional (Modified Monash Model 2) Australian hospital. Methods: All cases with NV‐HAP were obtained from the Business Analysis and Decision Support (BADS) Unit between 1st January 2013 and 31st December 2018. Medical records were reviewed, and data pertaining to incidence, characteristics (age and gender), length of stay, co‐morbidities (measured using the Charlson Comorbidity Index) and in‐hospital mortality were extracted. Incidence rate was calculated as a proportion of NV‐HAP cases per 1000 bed‐days. Design: A retrospective study design was used to review all cases of NV‐HAP between 1 January 2013 and 31 December 2018 at a single regional Australian hospital. Using the Modified Monash Model (MMM), our regional setting is classified as a regional centre (MMM‐2). Setting: Rockhampton Hospital, Australia. Participants: Patient cases. Main outcome measures: Incidence rate, Incidence proportion, mortality. Results: A total of 501 cases were identified with an incidence rate of 0.98 cases per 1000 bed‐days over the study period 2013–2018. Cases with NV‐HAP had a median age of 78.2 years (interquartile range 18.8), a median length of stay of 13.0 days (interquartile range 12.0) and a median Charlson Comorbidity Index score of 3.0 out of 39 (interquartile range 3.0), and a greater proportion was male (n = 297, 57%). The in‐hospital mortality rate for NV‐HAP cases was 18.9%. Conclusion: This study revealed an overall incidence rate of 0.98 cases per 1000 bed‐days from 2013 to 2018 in a regional Australian hospital. In addition, this study provided the descriptive characteristics for patients with NV‐HAP at our regional hospital. [ABSTRACT FROM AUTHOR]

Background: Early childhood caries (ECC) remains one of the most prevalent childhood diseases in Australia, disproportionately affecting disadvantaged populations. Aim: To investigate the ECC experience including risk factors, incidence of caries, pain and infection as well as relapse rates of caries and secondary dental general anaesthesia (GA). Design: A retrospective cohort study included dental records of children with ECC, aged <72 months at an Australian public dental hospital paediatric dentistry department from 2013 to 2015 (n = 102). Dental caries, pain, infection, referral patterns, demographic and caries risk factor data were recorded for 24 months. Descriptive statistics were used for patient characteristics and clinical data, and Kaplan–Meier curves and parametric exponential survival models for time‐to‐event series. Results: The study population demonstrated higher‐than‐national average dmft and disease progression at baseline. Major risk factors for the development of caries, pain and infection were daily consumption of sweetened beverages, poor oral hygiene, residing in lower socio‐economic areas, older age and being male. Rates of caries relapse and new referral for secondary treatment under general anaesthesia were relatively high. Conclusion: A high degree of ECC progression and recurrence in this population indicates a need for a more comprehensive approach to ECC addressing multilevel root causes and systemic risk factors. [ABSTRACT FROM AUTHOR]

Nitrous oxide is commonly used in Australia for labour analgesia. Its use in labour is potentially associated with aerosol generation. During the first wave of the COVID‐19 pandemic of 2020, nitrous oxide was suspended on many birthing units to reduce the risk of transmission. We aimed to determine the impact of withholding nitrous oxide for labour analgesia, during the COVID‐19 pandemic, on epidural rates, opioid analgesia use, and maternal and neonatal outcomes. Withholding nitrous oxide for labour analgesia did not alter epidural rates but did significantly increase opioid analgesia use. Caesarean section rates, post‐partum blood loss and neonatal APGAR scores did not change. [ABSTRACT FROM AUTHOR]

Objectives: To compare minimal trauma hip fractures (MTHF) between older Indigenous and non‐Indigenous Australians. Methods: Epidemiological study of retrospective New South Wales hospitalisation data (2005–2016) for MTHF among Indigenous and non‐Indigenous Australians over 40 years of age. Results: Estimated age‐standardised rates of MTHF were lower among Indigenous Australians than non‐Indigenous Australians (142.2 vs. 161.7 per 100,000) with a direct standardised rate ratio of 0.887 (95%CI 0.78–0.99, p = 0.031). However, for both male and female Indigenous Australians, MTHF occur at a younger age than in non‐Indigenous Australians (age 40–74: 52% vs. 19%, p < 0.001). Proportions of MTHF are higher among women and were almost double among rural Indigenous Australians compared with rural non‐Indigenous Australians (59% vs. 31%, p < 0.001). Conclusions: New South Wales Hospitalisation data showed that estimated age‐standardised rates of MTHF appear lower among Indigenous Australians than in non‐Indigenous Australians but also occur at a younger age for Indigenous people. MTHF are more common among rural Indigenous Australians and women. [ABSTRACT FROM AUTHOR]

Aim: Australian children consume 35% of energy from discretionary food and beverages which increases their risk of non‐communicable diseases like type 2 diabetes. Despite this concerning statistic, broad analysis of the profile of discretionary food intake has not been fully undertaken. This study asks: what is the discretionary food and beverage intake profile, contribution to nutrient intakes, and associations with demographic and health characteristics? Methods: Cross‐sectional data from the 2011–12 National Nutrition and Physical Activity Survey (n = 2812, 2–18 years) were used to profile discretionary food consumption. Dietary intake was assessed by 24‐h recall. General linear models tested the difference in respondent characteristics by age group, sex, and quartiles of discretionary food energy contribution. Results: Ninety‐nine percent of respondents consumed discretionary foods, 74% exceeded the maximum discretionary food recommended serves. Among 10 eating occasions available to select: snack, dinner, lunch and morning tea appeared to contribute 76% of discretionary food energy, with snack and dinner contributing 24% each. Age and frequency of discretionary food consumption were positively associated with energy intake from discretionary foods (p < 0.001); while sex, socio‐economic status, physical activity and body composition had no association. High discretionary food consumers chose specific discretionary food items in a large quantity (1.0–3.5‐serves/discretionary food) compared to low discretionary food consumers (0.4–1.4‐serves/discretionary food). Conclusions: Nearly all Australian children and adolescents consumed discretionary food daily. No demographic or anthropometric characteristics beyond increasing age were associated with higher discretionary food. Targeted public health policy and community interventions are required to focus on addressing the largest contributors to discretionary food intake in terms of equivalent serve sizes, popularity, and eating occasion. [ABSTRACT FROM AUTHOR]

Background: To better understand the potential role of social media (SM) as a self‐management tool for individuals with endometriosis and to assess its current use by endometriosis patients. Aims: The primary outcome was use of SM for health in patients with endometriosis. Secondary outcomes included preferred SM platforms for health information sharing and factors that influenced use, positive and negative experiences and reported impacts on health. Materials and Methods: A single‐centre, cross‐sectional study performed within benign gynaecology units at a tertiary hospital in Melbourne, Australia. One hundred patients with a confirmed diagnosis of endometriosis participated. Individuals did not have to be users of SM. Data were collected through an electronic third‐party survey tool (SurveyMonkey®). Analysis methods included descriptive statistical analysis, frequency counts, as well as cross‐tabulation to examine statistical association between variables. Free‐text responses were qualitatively analysed using deductive‐inductive semantic thematic analysis. Results: Social media was used for health by 76% of patients with endometriosis in this study. SM users were younger, had pelvic pain for more than six months and reported higher rates of psychosocial impact and symptoms from endometriosis. Respondents reported overall positive impacts on psychological, social and cognitive health outcomes (76%) from SM use. Conclusion: In our cohort, a high number of people with endometriosis are using SM for health. These individuals are more likely to suffer both physical and psychosocial impacts from endometriosis. Hospitals and health organisations may consider support of the endometriosis community through SM. [ABSTRACT FROM AUTHOR]

Objective: The Australian COVID‐19 Frontline Healthcare Workers study examined the prevalence and severity of mental health symptoms during the second wave of the COVID‐19 pandemic. This substudy examined the differences in psychological well‐being between rural and metropolitan health care workers (HCWs). Design: A nationwide survey conducted between August and October 2020. Setting and Participants: Australian HCWs were recruited through multiple strategies. Main outcome measures: Demographics, mental health outcomes (anxiety, depression, post‐traumatic stress disorder [PTSD] and burnout). Results: Complete responses were included from 7846 participants, with 1473 (18.8%) in regional or remote ('rural') areas and 81.2% in metropolitan areas. Rural participants were older, more likely to work in allied health, nursing or in health administration, and had worked longer in their profession than metropolitan participants. Levels of resilience were similar (p = 0.132), but there was significantly higher prevalence of pre‐COVID‐19 pandemic mental illness in the rural workforce (p < 0.001). There were high levels of current mental health issues: moderate–severe PTSD (rural 38.0%; metropolitan 41.0% p = 0.031); high depersonalisation (rural 18.1%; metropolitan 20.7% p = 0.047); and high emotional exhaustion (rural 46.5%; metropolitan 43.3% p = 0.002). Among rural participants, mental health symptoms were associated with younger age, worry about being blamed if they contracted COVID‐19, fear of transmitting COVID‐19 to their family, experiencing worsening relationships and working in primary care or allied health. Conclusion: Despite having low COVID‐19 case numbers in rural Australian health services compared with metropolitan counterparts over the course of 2020, there were widespread mental health impacts on the workforce. Rural health services need specific and flexible training, education, work policies and practices that support psychological well‐being now in preparedness for ongoing or future crises. [ABSTRACT FROM AUTHOR]

Objective: Negative attitudes towards ageing have been associated with poor mental well‐being, and protective factors are not well‐understood. This study examined the relationship between ageing attitudes and symptoms of anxiety and depression, and the potential moderating effect of age, and buffering effects of social support, physical activity and education. Methods: This study used a subsample of 482 adults aged 50+ years from a mail questionnaire study in Brisbane, Australia. Data were analysed using linear regression. Results: People with more positive ageing attitudes reported fewer symptoms of anxiety and depression, with no moderating effect of age. There was a significant interaction between ageing attitudes and education on depression, and a similar trend for anxiety. Conclusions: This study confirmed the adverse impacts of negative ageing attitudes on mental health and indicated that those with low education may be most vulnerable. This has implications for future research and targeting interventions for mental health promotion. [ABSTRACT FROM AUTHOR]

Objective: To explore rural motor vehicle collision (MVC) fatalities by trends over time, mode of transport, age, state, sex, and Aboriginal and Torres Strait Islander status. Design: A retrospective total population‐based time series was conducted using the Australian Bureau of Statistics (ABS) death registration data. Setting: All statistical local area (SLA) within Australia from 2006 to 2017. Participants: Australian residents whose deaths were registered with the ABS between 01 January 2006 and 31 December 2017 where the underlying cause of death was related to unintentional transport accidents. Main outcome measures: Fatality rates were determined using population data collected from the 2006, 2011 and 2016 census. Trends over time by rurality were analysed by financial year. Rates of transport deaths by vehicle type were determined by rurality. Risk ratios were calculated to compare demographic groups based on sex, Aboriginal and Torres Strait Islander status and age. A 3‐year scorecard was organised by state and rurality using 99.7% confidence intervals. Results: Motor vehicle collision fatalities increase with increasing remoteness. Females, children from 0 to 14 years, pedestrians, and Aboriginal and Torres Strait Islander peoples are at a significantly higher risk of fatal MVCs than their respective metropolitan counterparts. The 3‐year scorecard indicates that road fatality rates in the NT, WA, and all rural and remote areas required immediate attention and targeted action. Conclusions: There is a need for investment in MVC fatality prevention in rural Australia from inner regional to remote areas in order to meet the road safety targets established by the National Road Safety Strategy. [ABSTRACT FROM AUTHOR]

Background: Results have been varied regarding the effect of donor age on the outcome of unrelated donor haemopoietic cell transplantation (HCT). Aims: To determine the influence of donor age on adult unrelated donor HCT outcome in Australia. Methods: Patients were included in the study if they were aged 16 years or above and underwent first allogeneic unrelated donor HCT in Australia for the indications of acute lymphoblastic leukaemia (ALL), acute myelogenous leukaemia (AML), chronic myelogenous leukaemia (CML) or myelodysplastic syndromes (MDS) between the years of 2001 and 2014 inclusive. The main outcome measure was overall survival (OS), which was tested against independent variables using univariate Kaplan–Meier methods and multivariate Cox regression. Results: A total of 1158 unrelated donor HCT were represented in the data. Cumulative incidences of engraftment, transplant related mortality (TRM), acute graft‐versus‐host disease (GvHD), chronic GvHD and relapse were not significantly affected by donor age. OS probability at 5 years post‐transplant was 48.3%. In multivariate analysis of OS, year of transplant 2001–2007, recipient age 40 years or greater, poor risk disease, human leukocyte antigen (HLA) match less than 6/6 and poor performance status at transplant (Karnofsky scale) were independently significant adverse OS risk factors. Donor age was not a significant risk factor for OS in univariate or multivariate analysis. Conclusions: The conclusion from this study was that donor age (up to 59 years) did not influence post‐transplant outcome among adult unrelated donor HCT performed in Australia for haematologic malignancies. [ABSTRACT FROM AUTHOR]

Background: In 2009, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) published College Statement C-Gyn 25: 'Prophylactic oophorectomy at the time of hysterectomy for benign gynaecological disease, which recommended that caution should be exercised in performing bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy for benign disease in women younger than 65 years of age.' Aims: The aims of the study were to assess current practice with regard to prophylactic oophorectomy in this setting and to assess knowledge about the College Statement. We also sought to review the evidence behind the Statement. Method: An anonymous email survey of all consultant gynaecologists and gynaecology registrars in Sydney West Area Health Service (SWAHS) was conducted. Results: The response rate was 52%. The survey found that there was an increasing tendency to remove ovaries with increasing patient age, and over 60% of gynaecologists would routinely recommend removal of ovaries during a hysterectomy for benign disease in a 60 year old woman. The survey also revealed a lack of knowledge as to the existence or content of the College Statement. A review of the literature found that evidence suggesting benefit in retention of ovaries in postmenopausal women has been extrapolated from a modelling study, observational studies or from data on premenopausal oophorectomy. Conclusion: A survey of gynaecologists revealed that few currently appear to adhere to the College Statement regarding prophylactic oophorectomy at the time of hysterectomy for benign disease. High quality evidence regarding either harm or benefit following retention of ovaries after menopause is lacking. Nevertheless, dialogue between clinicians and patients on this topic is important. [ABSTRACT FROM AUTHOR]

Aim: Water is critical for human survival, yet water intake equations may not reflect contemporary populations. This research aims to determine the total water intake of a representative Australian population, per kilogram of body weight (mL/kg) and stratified by age and sex. Methods: A secondary analysis of the 2011 to 2013 National Nutrition and Physical Activity Survey (n = 10 146) was conducted. Dietary intake from food and beverages was assessed by a 24‐hour recall, with respondent's weight objectively measured. Data were descriptively analysed, with multiple linear regressions used to identify the impact of demographic and physiologic factors on total water intake (mL/kg). Results: The median (interquartile range) daily total water intake per kilogram of body weight for children (2‐8 years), adolescents (9‐18 years) and adults (19+ years) were 77.1 (57.4‐100) mL/kg, 40.4 (29.3‐53.4) mL/kg and 35.5 mL/kg (26.1‐47.8), respectively. Increasing height and waist circumference were associated with reduced total water intake, with a change of −1.03 mL/kg (−1.43, −0.618) [coefficient (95% confidence interval)] in children for height and −0.448 mL/kg (−0.484, −0.412) in adults for waist circumference. Similarly, seasonality decreased intake, with greatest reductions in winter [adolescents: −4.11 mL/kg (−6.83, −1.40)]. In comparison, being male, living in rural areas and having a physical occupation were associated with greater intake, by 1.73 mL/kg (0.347, 3.10), 4.74 mL/kg (3.47, 6.00) and 2.82 (trade workers: 1.08, 4.59) in adults, respectively. Conclusions: Total water intake (mL/kg) decreased with age in both sexes. The results highlight possibilities to incorporate other factors into water intake equations to improve their accuracy. [ABSTRACT FROM AUTHOR]

Background/Objectives: Frailty is common in people with heart failure (HF) and associated with poorer outcomes. The aim of this study was to describe the characteristics, exercise participation, and outcomes of frail and not‐frail participants enrolled in a randomized trial of exercise training (ET) within a cardiac rehabilitation (CR) program. Design Secondary analysis of EJECTION‐HF randomized trial (ACTRN12608000263392). Setting: Five HF‐specific CR programs in Queensland, Australia. Participants: Adults recently hospitalized with HF. Intervention: All participated in CR including home exercise prescription and monitoring; half were randomized to center‐based ET. Measurements A frailty index (FI) was constructed at randomization and 6‐month follow‐up. Outcomes included ET attendance, change in 6‐min walk distance (6MWD), improved FI (>0.09 units) at 6 months, achieving physical activity (PA) guidelines at 6 months, and 12 month all‐cause death or readmission. Results: The FI was measured in 256 participants at randomization: 110 (43%) were not‐frail (FI 0.2 or less), 119 (46%) were frail (FI >0.2 to 0.39), and 27 (11%) were very frail (FI ≥0.4). Frailty was more common with older age, female gender, decompensated HF, worse HF symptoms, and preserved ejection fraction. ET attendance did not differ by frailty group. Participants who were more frail had lower 6WMD at enrollment, but similar improvement over 6 months. Mean FI improved by 0.03 units at 6 months (95% CI 0.02–0.04, p < 0.001). Participants who were more frail had significantly greater improvements in FI compared with not‐frail participants and were often able to achieve PA guidelines, both in intervention and control groups. Neither baseline frailty nor intervention was significantly associated with 12‐month death or readmission. Conclusion: Frail people with HF participating in CR that includes home and/or center‐based ET often achieve PA guidelines, and some may have meaningful reductions in frailty. See related editorial by Pandey et al. [ABSTRACT FROM AUTHOR]

Background and Aims: Past research has found that young smokers are more likely to make quit attempts; however, there are conflicting findings regarding age and quit success. This study examined the degree to which smoker age is related to making quit attempts and quit success. Design Ten waves of the International Tobacco Control Policy Cohort survey (ITC‐4C) collected between 2002 and 2014, with nine wave‐to‐wave transitions with predictors at the first wave predicting quit attempts and success by the next wave. Setting: Canada, the United States, the United Kingdom and Australia. Participants: Data from 15 874 smokers categorized into four age groups at baseline (18–24, 25–39, 40–54 and 55+ years). Measurements Age, quit attempts and success (defined as ≥ 30 days abstinence confirmed, if possible, on a third wave for recent attempts). Findings Older smokers were more likely to smoke daily (χ2 = 1557.86, r = 0.136, P < 0.001) than younger smokers. Daily smokers were less likely to report quit attempts (38.1 versus 58.2%) and to achieve 30 days of abstinence (22.9 versus 34.3%) than non‐daily smokers. Older daily smokers were less likely to make quit attempts [0.61, confidence interval (CI) = 0.54–0.70, P < 0.001], even after controlling for indicators of nicotine dependence, country, sex, education, income, relationship status and household composition, than younger smokers. Younger smokers (< 25) were more likely to succeed for at least 30 days of abstinence, but only when compared with those aged 40–54 (OR = 0.83, 95% CI = 0.68–0.99). However, when controlling for heaviness of smoking the age effect disappeared. Significant interactions with age were found between age and intention when predicting quit attempts, and age and heaviness of smoking when predicting quit success. Conclusions: An international cohort study indicates that young smokers are more likely to attempt to quit and appear to have similar levels of success in abstaining from smoking compared with older smokers when controlling for dependence. Quit success in all ages is most predicted by lower levels of nicotine dependence. [ABSTRACT FROM AUTHOR]

Background and aim: The effect of the COVID‐19 pandemic on alcohol consumption is currently unclear. This study aimed to provide early estimates of how stress and demographics will interact with shifts in harmful alcohol consumption from before the COVID‐19 outbreak to 2 months into social distancing. Design Cross‐sectional convenience sample. Setting: Australia. Participants: A total of 1684 Australians aged 18–65 years who drink at least monthly. Measurements Items from the Alcohol Use Disorders Identification Test (AUDIT) and the stress subscale of the Depression Anxiety and Stress Scale (DASS). Findings Overall, harmful drinking decreased during social distancing measures in our sample [2019 score = 8.2, 95% confidence interval (CI) = 7.9–8.4; during the pandemic = 7.3, 95% CI = 7.1–7.6]. Younger drinkers, particularly young women, decreased their consumption the most, but there was a small increase in consumption in middle‐aged women. Drinkers experiencing high levels of stress also reported a relatively higher shift in harmful consumption compared with those with low levels of stress (β = 0.65, P = 0.003), despite reporting a small decrease overall. Conclusions: The closure of licensed premises and social distancing measures in Australia in response to the COVID‐19 outbreak appear to have reduced harmful alcohol consumption in younger drinkers, particularly young women. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether perceived opinions of primary care are associated with student career preferences after graduation among a rural clinical school cohort and whether the preferred location of practice moderates these relationships. Design: Cross‐sectional study using data from the national Federation of Rural Australian Medical Educators survey. Participants/Setting: Medical students across 18 Australian universities who completed a clinical year in a rural setting in 2019. Main outcome measure(s): Career preference in primary care after graduation. Results: The survey was completed by 624 students (response rate = 69.9%). A preference for primary care was reported by 35.5% (95% CI: 29.4‐42.0) of students and was more likely among those age 30+ years, with a rural background, or preferring to practise rurally after graduation. Students reported that primary care was more commonly respected by medical academics (66.8%) than peers (24.0%) or junior/hospital doctors (24.0%). In adjusted analysis, none of the perceived opinions were associated with student career preferences. However, among students aiming to work in small rural locations, a career in primary care was associated with more frequent reports that peers had poor opinions of primary care (P =.004). Conclusion: Rural clinical school students perceive negative opinions of primary care, particularly among peers and junior/hospital doctors. Students aiming to work in small towns after graduation are more likely to report negative opinions among their peers, suggesting they may be more attuned to negative attitudes. This points to the need for a community of practice of like‐minded peers and clinicians to preserve the career interest of these students. [ABSTRACT FROM AUTHOR]

Background: When aiming to develop dietary messaging to achieve reductions in added sugar intakes, it is necessary to identify key food contributors. Food contributors are not expected to remain static over time. Therefore, the present study aimed to compare the total added sugars (AS) intake and related food sources for adult respondents of two Australian national consumption surveys. Methods: Repeated 24‐h recall data from the 1995 National Nutrition Survey (1995NNS, n = 10 851) and the 2011–12 National Nutrition and Physical Activity Survey (2012NNPAS, n = 9341) was used to estimate AS consumption. Food group sources of AS were examined per consumer and per capita and the food group predictors of energy provided by AS were determined. Results: A significant difference in total AS intake was identified by age and gender between the surveys (all P < 0.001). Increased variability in food group contributions per consumer was also identified. Nine of the top 20 food groups from the 1995NNS differed (P < 0.001) in their contribution to AS in 2012NNPAS per consumer. Fewer changes were apparent at the population level, with >40% AS coming from only three food groups. Age‐stratified analyses showed that the 'sugar, honeys and syrups' and the 'sweetened beverages' food groups were the top contributors between the surveys up to the age group of 70 years. 'Sugar, honey and syrups', 'chocolate and chocolate‐based confectionery,' and 'other confectionery' (all, P < 0.001) were significant predictors of AS intake (1995NNS, r2 = 0.755; 2012NNPAS r2 = 0.740). Conclusions: At a population level, food group contributions to AS intakes for Australian adults have not changed substantially over time, yet notable shifts in AS can be seen when targeting only the consumers of these food sources. 'Cake type desserts' appear to be increasingly consumed though 'sweetened beverages' remain a major contributor to AS intakes warranting targeted public health strategies. [ABSTRACT FROM AUTHOR]

Objective: To explore reasons for the gap between the perception that high home ownership provides a strong pillar of funding for aged care accommodation and the actuality of half of those in residential care having this cost met by the Accommodation Supplement. Methods: Review of data from Australian Bureau of Statistics and administrative sources, and recent research studies. Results: Trends in payment methods show continuing reliance on the Accommodation Supplement. Reasons are found in patterns of home ownership at older ages, changes in tenure and living arrangements over the age range, and increasing use of the exchange value of housing assets. Policy tensions arise between protecting access for low means residents and requiring those who are able to pay to do so. Conclusions: The housing assets pillar at advanced ages is not as strong as early in retirement and makes it increasingly unreliable as a source of funding. [ABSTRACT FROM AUTHOR]

Background: Central venous access devices (CVAD) are commonly employed in the management of cancer patients. While having several benefits they are associated with significant risks. Aim: To review the incidence and risk factors for catheter‐related thrombosis (CRT) in cancer patients with a CVAD. Methods: We performed a prospective observational cohort study of adult patients with cancer requiring a CVAD between 1 January 2004 and 29 June 2016. The rate of, and risk factors for the development of, symptomatic CRT were evaluated. Results: A total of 4920 central lines was inserted into 3130 patients. The incidence of CRT was 3.6%. CRT developed a median of 12 days following line insertion. Peripherally inserted central catheters (PICC) were associated with the highest rates of CRT (hazards ratio (HR) 22.2, 95% confidence interval (CI) 2.9–170.6). Older age groups developed CRT at lower rates (HR 0.57; 95% CI 0.39–0.84 for age 50–61 years, and HR 0.63; 95% CI 0.45–0.89 for age >61 years) compared to age <50 years. Increased CRT was seen in patients with prior CRT (HR 1.81; 95% CI 1.19–2.77). There was a trend to more CRT events with a Khorana tumour score of 1 compared to those with a score of 0 (HR 1.37, 95% CI 1.00–1.88). Hodgkin lymphoma, germ cell and oesophagus cancers had the highest CRT rates. Side of insertion was not associated with thrombosis risk (HR 0.77; 95% CI 0.57–1.05; P = 0.10). Conclusions: Age <50 years, PICC lines and prior CRT were associated with highest CRT rate. Cancer subtype and insertion side were not predictive of thrombosis. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Urinary tract infection (UTI) is a common presentation to general practitioners (GPs). There is increasing antimicrobial resistance in urinary pathogens in many healthcare systems. Adherence to principles of antimicrobial stewardship is important to combat this problem. Our aim was to describe the prevalence of presentations of clinically diagnosed new UTI to early‐career GPs, to describe management choices made, and to identify associations of prescribing antibiotics at the index consultation for UTI. Method: This is a cross‐sectional analysis of the Registrar Clinical Encounters in Training cohort study. Early‐career GPs from five Australian states (urban to very remote practices) collected data on 60 consecutive patient encounters during each of three 6‐month training terms. Proportions of problems being new UTIs, antibiotics prescribed, urine microscopy and culture ordered were calculated. Univariate and multivariable logistic regressions established associations of patient, registrar, and practice factors with prescribing antibiotics for a new UTI. Results: One thousand three hundred thirty‐three early‐career GPs diagnosed 2850 new UTIs from 189 736 consultations (1.5%; 95% CI, 1.4‐1.6). Antibiotics were prescribed at 86% (95% CI, 84.7‐87.2) of these index consultations. Antibiotic choice followed Australian therapeutic guideline recommendations. Urine microscopy and culture were requested at the index consultation less than recommended by guidelines in men, 69.2% (95% CI, 62.6‐75.1), and children, 80.8% (95% CI, 76.4‐84.6). Adults were significantly more likely to be treated with antibiotics at the index consultation than children under 16. Conclusions: A new UTI is a common presentation to Australian early‐career GPs. There is general adherence to guidelines for antibiotic choice in UTIs. Further research is needed, however, to understand some decisions made when managing UTI in children and men. This may reflect diagnostic uncertainty with consequent attention to antibiotic stewardship by deferring antibiotic prescription. [ABSTRACT FROM AUTHOR]

Background: Seasonal influenza and pertussis cause significant morbidity and mortality among expectant mothers and infants. Vaccination during the antenatal period is an important public health intervention, minimising rates of maternal, neonatal and infant infection. Aims: The primary aim of this project was to establish the rates of antenatal vaccine uptake. Secondly, the study aimed to determine socio‐demographic factors significant to vaccine uptake. Thirdly, the project aimed to produce a thematic analysis of the factors affecting vaccination uptake during pregnancy. Materials and Methods: A cross‐sectional observational study was conducted among women attending a large maternity hospital, in the western suburbs of Melbourne, for perinatal care. Data were collected via self‐completed questionnaires after delivery. Data from the questionnaires were entered into an electronic database, and STATA was used to undertake correlation analysis. Results: Over a 12‐month period 1678 women completed questionnaires and 1305 were eligible for further analysis. The uptake of influenza vaccine was 48.3%, pertussis vaccine uptake was higher, at 82.9%. Uptake of influenza and pertussis vaccines strongly correlated with recommendations from healthcare providers (odds ratios 29.7 and 63.8 respectively). Maternal country of birth, age and parity were significant predictors of vaccine uptake. In thematic analysis, healthcare provider recommendation and the perceived risk of the disease were factors resulting in vaccination. Conclusion: This study determined the rate of antenatal vaccine uptake and significant socio‐demographic determinants affecting uptake at a large maternity hospital in metropolitan Melbourne. Ensuring healthcare providers recommend vaccination is likely to improve coverage. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence and context of disability exclusion reported by people with disability, with and without communication and mobility problems. Methods: The 2015 Survey of Disability Ageing and Carers was used to measure the prevalence of reported exclusion. Tests of proportions were used to examine differences in prevalence rates. Proportional Venn diagrams were used to examine the intersection of measures of exclusion. Results: Approximately 53% of those with a communication or mobility difficulty reported at least one measure of exclusion. Among this group, 7% reported an instance of discrimination, 44% reported avoidance, and 29% reported an accessibility problem. The levels of discrimination and avoidance for those without communication or mobility difficulties were approximately half this level (16% avoidance and 3% discrimination). Avoidance and discrimination reduced with age, but accessibility was age‐invariant. Exclusion measures intersected and occurred in a variety of contexts. Conclusion: Despite protections provided in Australian law, disability exclusion persists and is high among those with communication and mobility difficulties. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence, context and types of discrimination reported by older Australians (aged 55 years and over) and associations between outcomes (trust, self‐efficacy and life satisfaction) and exposure to discrimination. Methods: The 2014 General Social Survey was used to measure discrimination. Multivariable logistic regression was used to examine associations between levels of trust, self‐efficacy and life satisfaction and exposure to discrimination. Results: A sizeable minority of older Australians with a disability reported discrimination (15%), with higher exposure for those with more severe or multiple disabilities. In addition to disability, age and nationality, race or ethnic group were cited as reasons for discrimination. Discrimination was reported across a variety of contexts, including everyday social interactions. Lower levels of trust, self‐efficacy and life satisfaction were associated with exposure to disability discrimination. Conclusions: Focusing on disability discrimination alone underestimates the level of exposure to discrimination. Discrimination may reinforce social exclusion by reducing trust and self‐efficacy in familial and community contexts. [ABSTRACT FROM AUTHOR]

Issue Addressed: Problematic alcohol consumption (PAC) affects one-third of homeless Australians, and it is expected that the rates will increase as the population ages. However, current policy does not recognise the importance of this problem. The aim of this narrative review was to examine the social determinants and other risk factors contributing to PAC in homeless Australians, the barriers to receiving help and possible solutions for the Australian context.Methods: PubMed and PsycINFO databases and Australian government websites were examined for the keywords "alcohol" and "homeless," and pertinent articles were selected for inclusion and for citation tracking of further relevant articles.Results: The causes of PAC in homeless Australians are multifactorial, and multidirectional, and include risk factors such as low socio-economic status, mental illness and having experienced trauma. There is significant stigma associated with both homelessness and PAC, which further isolates this group. Current policies to address PAC in the homeless are inadequate; however, there are a range of possible programs to reduce PAC in this group, and international harm reduction strategies have also shown success in improving outcomes for this group.Conclusion: There are numerous social risk factors that influence the development of PAC in the homeless. The introduction of harm reduction strategies, programs to enhance motivation and personal skills, as well as better mental health treatment, would all fill important gaps in services for homeless Australians with PAC. SO WHAT?: Health professionals can be advised that there are many social determinants that influence PAC in homeless Australians. There are important structural barriers to providing this marginalised group with the services they require; however, there is scope for the introduction of new programs, including harm reduction strategies, to meet the fundamental needs of this group. [ABSTRACT FROM AUTHOR]

Objective: Primarily to determine mid‐term functional outcome for patients with distal radius fracture (DRF) and to compare this between operative and conservatively managed patients. Secondarily to examine for differences in age, gender and number of instability factors between management groups. Methods: Eligible patients (age 18 years or more, closed DRF managed to completion of care within Monash Health), presenting between 1 January and 31 December 2016. Completion of the patient‐rated wrist evaluation (PRWE) questionnaire was sought at 6–12 months post‐injury. Management was noted (operative or conservative). Age, sex and number of defined instability factors present (dorsal angulation >20°, intra‐articular fracture, associated ulna fracture, dorsal comminution, radial shortening >2 mm) are reported and compared between management groups. Results: Of 369 eligible patients, 199 (54%) completed a PRWE. Median age was 60 years (interquartile range [IQR] 45–71), 150 (75%) were women, median number of instability factors present was 2 (IQR 1–4) and 45 (23%) underwent operative management. Difference in PRWE scores between operative and conservatively managed patients was not significant (20 [IQR 7–36] vs 16 [IQR 5–35]). Differences in age and gender between management groups were not significant. Significantly more in the operative group had presence of four or more instability factors (44% [95% confidence interval 30–60] vs 20% [14–27]). Conclusion: The mid‐term median PRWE score was 18 (IQR 5–36). This was not significantly different between operative and conservatively managed patients. Operation was more likely when four or more instability factors were present. [ABSTRACT FROM AUTHOR]

There is widespread recognition that workplace stress can have profound negative impacts on nurses' well‐being and practice. Resilience is a process of positive adaptation to stress and adversity. This study aimed to describe mental health nurses' most challenging workplace stressors, and their psychological well‐being, workplace resilience, and level of caring behaviours, explore the relationships between these factors, and describe differences in workplace resilience for sociodemographic characteristics. In a descriptive correlational study using convenience sampling, data were collected from N = 498 nurses working in mental health roles or settings in Victoria Australia via an online cross‐sectional survey. Key findings included weak to strong (r = 0.301 to r = 0.750) positive relationships between workplace resilience with psychological well‐being across all stressor categories (consumer/carer; colleague; organizational role; and organizational service). Psychological well‐being was moderately high, but lower for nurses indicating consumer/carer‐related stressors as their most stressful challenge. There were weak to moderate (r = 0.306 to r = 0.549) positive relationships between workplace resilience and psychological well‐being, and no relationship between resilience and caring behaviours. Workplace resilience was lower (P < 0.05) for less experienced nurses compared with those with >5 years' experience, and lower for younger nurses compared with those aged ≥40 years. To improve their resilience and prevent psychological distress, there is prime opportunity to support nursing students with well‐being and resilience‐building strategies during their undergraduate education, and to support new graduates with similar programmes when they enter the workforce. [ABSTRACT FROM AUTHOR]

Background: While research in high‐income countries (HICs) has established high costs associated with alcohol's harm to others (AHTO) in the workplace, scant attention has been paid to AHTO in the workplace in lower‐ or middle‐income countries (LMICs). Aim: To compare estimates and predictors of alcohol's impacts upon coworkers among workers in 12 countries. Methods: Cross‐sectional surveys from 9,693 men and 8,606 women employed in Switzerland, Australia, the United States, Ireland, New Zealand, Chile, Nigeria, Lao PDR, Thailand, Vietnam, India, and Sri Lanka. Five questions were asked about harms in the past year because of coworkers' drinking: Had they (i) covered for another worker; (ii) worked extra hours; (iii) been involved in an accident or close call; or had their (iv) own productivity been reduced; or (v) ability to do their job been affected? Logistic regression and meta‐analyses were estimated with 1 or more harms (vs. none) as the dependent variable, adjusting for age, sex, rurality of location, and the respondent worker's own drinking. Results: Between 1% (New Zealand) and 16% (Thailand) of workers reported that they had been adversely affected by a coworker's drinking in the previous year (with most countries in the 6 to 13% range). Smaller percentages (<1% to 12%) reported being in an accident or close call due to others' drinking. Employed men were more likely to report harm from coworkers' drinking than employed women in all countries apart from the United States, New Zealand, and Vietnam, and own drinking pattern was associated with increased harm in 5 countries. Harms were distributed fairly equally across age and geographic regions. Harm from coworkers' drinking was less prevalent among men in HICs compared with LMICs. Conclusions: Workforce impairment because of drinking extends beyond the drinker in a range of countries and impacts productivity and economic development, particularly affecting men in LMICs. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the global incidence of ameloblastoma and to provide a profile of ameloblastoma patients. Material and Methods: A systematic review and meta‐analysis was conducted. Searches were performed in PubMed, EMBASE, SCOPUS, and Web of Science for articles published from 1969 to 2018 for the global incidence and from 1995 to 2018 for the profile of ameloblastoma patients. Results: Seven studies on the incidence rate of ameloblastoma were included in the meta‐analysis. These studies only covered Europe, Africa, and Australia. The pooled incidence rate was 0.92 per million person‐years (95% CI: 0.57–1.49), with significant heterogeneity between studies. Forty‐two articles provided profile data of 6,446 ameloblastoma patients. Mean age was 34 years and the peak age incidence in the third decade of life. In Europe and North America, ameloblastoma mostly occurred at an older age when compared to Africa and South America. A slight male preference (53%) was found, and the mandible appeared to be the preferred site. The most common type of ameloblastoma was multicystic. The histopathologic patterns were mostly follicular and plexiform. Conclusions: This is the first study assessing the global incidence of ameloblastoma. The pooled incidence rate was determined to be 0.92 per million person‐years. [ABSTRACT FROM AUTHOR]

Objective To identify risk factors for thunderstorm asthma (TA) in subjects ≥15 years of age from information available in routine clinical records. Methods: Retrospective and hospital‐based case–control study of various clinical factors in all TA cases (n = 53) who presented to a single‐site ED in November 2016 (TA16) and in a control group of patients (n = 156) who presented to the same ED with asthma during the pollen season over eight non‐TA years. Bivariate analysis and multivariable logistic regression modelling was performed to calculate the odds of TA asthma in the presence of potential risk factors. Results: A logistic regression model revealed that the odds of TA were lower for age (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.95–0.99), higher for Asian country of birth (OR 4.09, 95% CI 1.40–11.95) and higher for oral beta‐blocker use (OR 6.43, 95% CI 1.58–26.33) compared to controls. No difference was found between TA16 cases and controls for allergies (to medication, grass pollen, animal), hayfever, smoking, oral non‐steroidal anti‐inflammatory drugs, or aspirin. Newly diagnosed asthma was higher in TA16 cases versus controls (32.1% vs 12.2%, P = 0.001). Conclusions: Oral beta‐blocker medications, younger age and Asian‐born heritage are risk factors for TA. Further study is required to explore the potential association between beta‐blockers and TA. [ABSTRACT FROM AUTHOR]

Objective: Students from regional and remote backgrounds are more likely to stay and work in regional and remote locations. Health students transition and retention at university impacts the retainment of a competent rural health workforce. This study aimed to examine the perceptions of allied health students as they reflected upon their first six weeks at university and identified strategies which enhanced these experiences. Design: A cross‐sectional study. Surveys were administered to students who then completed a reflection exercise. Data were analysed using Pearson correlation coefficient and chi‐squares. Setting: An Australian regional university. Participants: First year occupational therapy, physiotherapy and speech pathology students. Main outcome measures: Factors influencing the first 6 weeks at university. Results: One hundred and forty‐three students participated. Homesickness was the major challenge in transitioning to university life. Subthemes identified were adjusting to being away from home, adjusting to university culture and the mature‐aged student. Specific issues included a lack of familiarity with university campuses and services, being unprepared for the workload and confusion while learning new skills. Conclusion: Orientation week activities assist students transition into university and age‐appropriate and family‐friendly activities should be considered for mature‐age students. All students were found to benefit from support to address economic pressures and skill development focusing on coping with university workload. The development of regional university policy including these strategies is likely to enhance student success. [ABSTRACT FROM AUTHOR]