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Objective To examine urban-rural differences and individual risk factors for a late stage of breast cancer at diagnosis in Australian women. Design Individual-level longitudinal data were linked with cancer registry data from New South Wales (New South Wales Cancer Registry linked by the Centre for Health Record Linkage (CHeReL)), Queensland (Queensland Cancer Registry) and Victoria (The Cancer Council Victoria). Setting Participants were drawn from the Australian Longitudinal Study on Women's Health 1946-1951 cohort (n = 13 715). Participants The sample included 195 women identified from the linked cancer registry data with a breast cancer diagnosis. Interventions Rural or urban residence was measured using Accessibility/Remoteness Index of Australia Plus (ARIA+). Individual characteristics and socio-demographic variables examined included survey year, menopausal status, country of birth, education and marital status. Main outcome measures A late stage of breast cancer at diagnosis was defined based on the TNM Classification of Malignant Tumours. Results A late stage of breast cancer diagnosis was observed in 36% of women residing in urban areas and 40% of women residing in rural areas. After adjusting for individual characteristics, we found that obesity was the strongest risk factor for a late stage of breast cancer at diagnosis. Conclusions Given that women are becoming increasingly obese, and that the rate of obesity is higher in the Australian rural population, this paper provides further evidence for targeting interventions for obesity, particularly in rural Australia, as a public health priority. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This paper examined whether or not: (a) care-giver 'alcohol abuse' is associated with recurrent child maltreatment; (b) other 'risk factors' affect this relationship; and (c) which of alcohol abuse or other drug abuse plays a stronger role. It also examined (d) how children and families where alcohol-related child abuse was identified were managed by child protection services (CPS) in Victoria, Australia. Design, setting and participants Using anonymized data from Victorian CPS, repeat cases were examined involving 29 455 children identified between 2001 and 2005. Measurements Carer alcohol abuse, other drug abuse, mental ill-health, carer experience of abuse as a child, child age and gender, family type, socio-economic variables and level of child protection service intervention as recorded in the CPS electronic database were examined as risk factors for recurrence, using bivariate and multivariate techniques. Findings Almost one-quarter of children in CPS experienced a recurrent incident of child maltreatment in a 5-year period. Where carer alcohol abuse was identified children were significantly more likely to experience multiple incidents compared with children where this was not identified ( P < 0.001), as were children where other family risk factors (including markers of socio-economic disadvantage) were identified. The majority of children whose carers were identified with alcohol abuse experienced either repeat incidents or interventions (84%), although almost three-quarters of these children were managed without resort to the most serious outcome, involving court orders. Conclusions Alcohol and drug abuse in carers are important risk-factors for recurrent child maltreatment after accounting for other known risk factors; the increased risk appears to be similar between alcohol and drug abuse. [ABSTRACT FROM AUTHOR]

Background/aim: Demand for occupational therapy graduates able to work in complex and diverse workplaces is increasing. The threshold concepts framework has emerged as one pathway to assist in the development of work‐ready graduates. A previous Australian study identified 10 threshold concepts for occupational therapy; the aim of this study was to explore the acquisition of these. Method: A mixed‐methods study using observational, cross sectional design and a triangulation design convergence model was undertaken. A survey using Likert scales and open response questions was developed by the authors. Seventy‐three surveys were completed by 13 first and 20 final year Victorian occupational therapy students. Twenty recent graduates and 20 experienced clinicians from across Australia also participated. Seven first and 10 final year occupational therapy students, 10 recent graduates and 10 experienced clinicians also took part in in‐depth interviews. Likert scales were used by participants to rate confidence that they had acquired the threshold concepts, they also answered open‐response questions (via survey or interview) asking them to provide examples of how they would use threshold concepts in practice. Results: Fourth year students were statistically significantly less confident than experienced clinicians for the threshold concepts Understanding the models and theories of occupational therapy and Applying clinical reasoning (P < 0.05). When whole group data were analysed, participants were most confident for Occupation and Client centred practice (P < 0.05). These results resonated with the qualitative findings which demonstrated a shift from surface to deep knowledge with increased experience. Fourth year students reported responses that suggested some threshold concepts were still in development, while experienced clinicians used a web of threshold concepts. Conclusion: This exploratory study provides provisional data to suggest that students appear to still be acquiring some threshold concepts at graduation and experienced clinicians make use of a web of threshold concepts in their clinical practice. [ABSTRACT FROM AUTHOR]

Background Early identification of Autism Spectrum Disorder (ASD) is currently limited by the absence of reliable biological markers for the disorder, as well as the reliability of screening and assessment tools for children aged between 6 and 18 months. Ongoing research has demonstrated the importance of early social communication skills in differentiating children later diagnosed with ASD from their typically developing (TD) peers, but researchers have not yet investigated whether these differences can be detected using community-ascertained systematic observation data as early as 12 months. Aims To investigate whether differences in early social communication skills can be detected at 12 months of age, comparing children later diagnosed with ASD, and TD peers; and to determine whether differences remain when groupings are based on age of subsequent ASD diagnosis. Methods & Procedures From a prospective community-ascertained sample, we collected data on children in early life, then conducted retrospective analyses for those children who were later diagnosed with ASD by the age of 7 years, compared with matched TD peers. We analysed standardized observational data of early communication skills, collected using the Communication and Symbolic Behavior Scales-Developmental Profile (CSBS-DP) Behavior Sample, when participants were 12 months of age. Outcomes & Results Children in the ASD group exhibited significantly lower social communication skills than the TD group, including on the Total score and Social and Symbolic Composite scores of the CSBS-DP Behavior Sample. Differences on the Total score and Social Composite were also detected for both early and late ASD diagnosis groups when compared with the TD group. Conclusions & Implications These findings give further support for the importance of social communication in assessing children at risk of ASD as early as 12 months of age. Future research could evaluate the sensitivity and specificity of direct observation of these early communication skills as diagnostic indicators for ASD at 12 months, and investigate whether it is possible to distinguish between ASD and other high-risk groups (e.g. developmental delay) at this age. [ABSTRACT FROM AUTHOR]

Background Current molar hypomineralisation ( MH) indices do not guide clinicians in management of affected dentitions, and treatment is based on individual judgment. Aim The aims of this study were to describe characteristics of MH and molar incisor hypomineralisation ( MIH) and trial the new Molar Hypomineralisation Severity Index ( MHSI). Design First permanent molars ( FPMs) and permanent incisors ( PIs) in 283 affected children were examined for hypomineralisation characteristics [defect colour, location, post-eruptive breakdown ( PEB); restorations placed/replaced/atypical; sensitivity]. The MHSI scores were compared with treatment received (152 children). Results Mean ( SD) affected teeth/dentition were as follows: FPMs: 3.2 (1.0) and PIs: 1.6 (1.6). Affected FPMs showed no arch or quadrant predilection; maxillary central PIs were affected particularly. As affected FPMs/dentition increased, MIH diagnoses also increased ( P = 0.009). Among FPMs, defects most prevalent were brown (47%) and cuspal (74%); 67% showed PEB. Before study entry, 43% of FPMs had restorations placed/replaced. Among PIs, white defects were common (65%) on smooth surfaces; sensitivity was rare. Affected FPMs received more restorations and extractions than unaffected FPMs ( P = 0.0001). As MHSI scores increased, FPM treatments/dentition increased (number, invasiveness). All characteristics were significant in predicting treatment (logistic regression model). Conclusions A spectrum from MH to MIH occurred. The MHSI characteristics were predictive of the treatment of affected FPMs and can guide management. [ABSTRACT FROM AUTHOR]

Background The Assistance to Participate Scale ( APS) was designed to measure the primary carer's estimate of the amount of assistance that their school-aged child with a disability requires to participate in play and leisure activities. Previous research suggests that the 8-item APS has good internal consistency. The construct validity of the scale is supported by strong correlations with instruments measuring similar constructs and discrimination between groups of children with developmental disability, based on extent of need for caregiver assistance. Aim The aim of this current study was to undertake further evaluation of the psychometric properties of the APS using Rasch analysis. Method Rasch analysis was conducted using the RUMM2030 program to assess the APS items in terms of their overall fit to the Rasch model, individual item fit, response format, targeting and dimensionality. Results Rasch analysis showed good fit to the model, with no misfitting items and good internal consistency ( PSI = 0.85). There was no differential item functioning across mothers' age, education level or child's age. Dimensionality testing supported the combination of all items to create a total score. Most items showed disordered thresholds, suggesting some inconsistencies in the way respondents used the response scale options. Conclusions The APS has been subjected to substantial psychometric testing during development and evaluation, revealing a sound, brief and easy-to-use scale. The APS has a number of potential clinical and research uses measuring the amount of additional assistance that children require from their primary care giver to participate in play activities. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to develop the evidence-based Healthy Ageing Quiz (HAQ). Methods: Phase 1 activities (focus groups with 33 older adults, literature review and discussion with an advisory panel) informed the development of a draft HAQ. Phase 2 involved assessing the quiz's psychometric properties and collecting respondent feedback. Results: Phase 1 provided broad topics for formulating quiz questions. In Phase 2, 297 and 122 respondents returned a quiz for validity and reliability testing respectively (over 70% response rate). The HAQ was found to be both valid (r =−0.7 to 0.6) and reliable (r = 0.8). Conclusions: The development of the HAQ was guided by the literature and input from older people and experts in healthy ageing. The quiz showed good psychometric properties and was acceptable to respondents. It allows older adults and people approaching old age to evaluate their current lifestyle in order to maximise their chances of ageing well. [ABSTRACT FROM AUTHOR]

Objective To examine health literacy in a rural community by measuring the understanding of the preventable nature of six major health conditions. Design Cross-sectional population survey. Setting New housing areas of Strathfieldsaye, Victoria. Participants A total of 197 adults aged 18 years or older. Main outcome measures Perceived preventability of skin cancer, lung cancer, cervical cancer, high blood pressure, heart attack and diabetes. Results Skin cancer was the only condition which most people perceived as being all or mostly preventable (50.3%). Lung cancer was perceived to be all or mostly preventable by 35.5% of respondents, high blood pressure by 34.0%, cervical cancer by 27.4%, diabetes by 25.4% and heart attack by only 14.7%. Conclusions This study shows that there is a lack of understanding of the preventability of these health conditions. Efforts need to be directed towards improving the public's knowledge of disease prevention and to ensure that health promotion programs reach populations with the most need. [ABSTRACT FROM AUTHOR]

Aims Debate continues about whether the association between cannabis use in adolescence and common mental disorders is causal. Most reports have focused on associations in adolescence, with few studies extending into adulthood. We examine the association from adolescence until the age of 29 years in a representative prospective cohort of young Australians. Design Nine-wave, 15-year representative longitudinal cohort study, with six waves of data collection in adolescence (mean age 14.9-17.4 years) and three in young adulthood (mean age 20.7, 24.1 and 29.1 years). Participants Participants were a cohort of 1943 recruited in secondary school and surveyed at each wave when possible from mid-teen age to their late 20s. Setting Victoria, Australia. Measurements Psychiatric morbidity was assessed with the Revised Clinical Interview Schedule ( CIS-R) at each adolescent wave, and as Composite International Diagnostic Interview ( CIDI)-defined ICD-10 major depressive episode and anxiety disorder at 29 years. Frequency of cannabis use was measured in the past 6 months in adolescence. Cannabis use frequency in the last year and DSM- IV cannabis dependence were assessed at 29 years. Cross-sectional and prospective associations of these outcomes with cannabis use and dependence were estimated as odds ratios (OR), using multivariable logistic regression models, with the outcomes of interest, major depressive episode ( MDE) and anxiety disorder ( AD) at 29 years. Findings There were no consistent associations between adolescent cannabis use and depression at age 29 years. Daily cannabis use was associated with anxiety disorder at 29 years [adjusted OR 2.5, 95% confidence interval ( CI):< 1.2-5.2], as was cannabis dependence (adjusted OR 2.2, 95% CI: 1.1-4.4). Among weekly+ adolescent cannabis users, those who continued to use cannabis use daily at 29 years remained at significantly increased odds of anxiety disorder (adjusted OR 3.2, 95% CI: 1.1-9.2). Conclusions Regular (particularly daily) adolescent cannabis use is associated consistently with anxiety, but not depressive disorder, in adolescence and late young adulthood, even among regular users who then cease using the drug. It is possible that early cannabis exposure causes enduring mental health risks in the general cannabis-using adolescent population. [ABSTRACT FROM AUTHOR]

International Journal of Paediatric Dentistry 2013; 23: 2-12 Background. Hypomineralised enamel is a prevalent, congenital defect vulnerable to deteriorate post-eruptively particularly in the presence of an unfavourable oral environment. Aims. To assess the influence of salivary characteristics on the clinical presentation of hypomineralisation lesions diagnosed in first permanent and second primary molars and to evaluate caries severity in relation to the defect's clinical presentation. Design. Recruitment consisted of 445 seven- to nine-year-old participants, of whom 152 were diagnosed as having molar hypomineralisation (MH); the remaining unaffected subjects ( N = 293) were considered their controls for saliva analysis. Dental caries status was assessed in 300 subjects of saliva sub-sample, equally divided as MH-affected and non-affected children. The International Caries Detection and Assessment System was used for caries detection. Salivary flow rates, viscosity, pH, and buffering capacity were determined. Results. Molar hypomineralisation-affected children have significantly higher mean caries scores compared to the non-affected group. Dentinal carious lesions were ten times more frequent in teeth with post-eruptive breakdown (PEB) than with teeth with opacities only. Low salivary flow rates (LSFR), moderately viscous saliva, and low pH were significantly more common in the affected group. LSFR and moderate and highly acidic saliva were more likely associated with PEB. Conclusion. Demarcated hypomineralised enamel is a dynamic defect highly influenced by individual characteristics of the oral environment. [ABSTRACT FROM AUTHOR]

Objective To quantify late-pregnancy weight gain in women with and without gestational diabetes mellitus ( GDM) and to determine factors associated with gestational weight gain. Study design A prospective clinical audit of 212 women (115 GDM and 97 non- GDM) who were weighed at each antenatal visit from 24-32 weeks gestation until delivery. Women received routine antenatal clinical care. For women with GDM, this included a 2-h lifestyle counselling session, capillary blood glucose testing and frequent clinical review. Results Women with GDM gained less weight than nondiabetic women ( GDM: 1.18 kg (1.6%) [range, 3.8-7.1 kg]; non- GDM: 4.0 kg (4.8%) [range, 0.7-18.5 kg]; P < 0.0001). Weight gain was influenced by body mass index and country of birth. Women with GDM showed reduced weight gain at weeks 1-4 postrecruitment, relative to weeks 4-8 (0.04 kg/week vs 0.45 kg/week; P < 0.0001). Nondiabetic women gained weight at a constant rate. GDM status was the only independent predictor of postrecruitment weight gain. Conclusions Application of a model of care for GDM (lifestyle advice and regular clinical review, in addition to home glucose monitoring) may reduce weight gain in women with GDM. The potential for applying a modified version of this model to all women in pregnancy warrants further study. [ABSTRACT FROM AUTHOR]

Background As the proportions of older women giving birth increase, there is a growing body of evidence on the increased risks of poorer maternal and perinatal outcomes for this group. However, the associations are not completely understood. This study aimed to establish the prevalence of selected maternal morbidities and examine whether advanced maternal age is associated with a higher risk of morbidity for women giving birth in Victoria. Method Data on all births over 20 weeks- gestation for 2005 and 2006 were obtained from the Victorian Perinatal Data Collection. Unadjusted and adjusted analyses were undertaken using logistic regression to examine and quantify the association between advanced maternal age (35 years and older) and selected obstetric morbidities and complications. Results There was evidence of an association between older maternal age and selected morbidities and complications. Older nulliparous women were at highest odds of gestational diabetes (Adj OR, 1.83; 95% CI, 1.67-2.02), placenta praevia (Adj OR, 2.02; 95% CI, 1.68-2.44), multiple birth (Adj OR, 1.80; 95% CI, 1.58-2.06) and caesarean delivery (Adj OR, 1.93; 95% CI, 1.84-2.02). Older multiparous women were at highest odds of gestational diabetes (Adj OR, 2.01; 95% CI, 1.88-2.15) and placenta praevia (Adj OR, 2.11; 95% CI, 1.83-2.44). Conclusions Older women giving birth in Victoria are at an increased risk of a range of obstetric morbidities. Delayed childbearing for an increasing number of women has societal and public health ramifications and will potentially place greater demand on healthcare services. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To assess the association between access to off-premises alcohol outlets and harmful alcohol consumption. Design, setting and participants Multi-level study of 2334 adults aged 18-75 years from 49 census collector districts (the smallest spatial unit in Australia at the time of survey) in metropolitan Melbourne. Measurements Alcohol outlet density was defined as the number of outlets within a 1-km road network of respondents' homes and proximity was the shortest road network distance to the closest outlet from their home. Using multi-level logistic regression we estimated the association between outlet density and proximity and four measures of harmful alcohol consumption: drinking at levels associated with short-term harm at least weekly and monthly; drinking at levels associated with long-term harm and frequency of consumption. Findings Density of alcohol outlets was associated with increased risk of drinking alcohol at levels associated with harm. The strongest association was for short-term harm at least weekly [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.04-1.16]. When density was fitted as a categorical variable, the highest risk of drinking at levels associated with short-term harm was when there were eight or more outlets (short-term harm weekly: OR 2.36, 95% CI 1.22-4.54 and short-term harm monthly: OR 1.80, 95% CI 1.07-3.04). We found no evidence to support an association between proximity and harmful alcohol consumption. Conclusions The number of off-premises alcohol outlets in a locality is associated with the level of harmful alcohol consumption in that area. Reducing the number of off-premises alcohol outlets could reduce levels of harmful alcohol consumption. [ABSTRACT FROM AUTHOR]

Purpose: There are inconsistent research findings regarding the impact of rurality on adolescent alcohol, tobacco, and illicit substance use. Therefore, the current study reports on the effect of rurality on alcohol, tobacco, and illicit drug use among adolescents in 2 state representative samples in 2 countries, Washington State (WA) in the United States and Victoria (VIC) in Australia. Participants: The International Youth Development Study (IYDS) recruited representative samples of students from Grade 7 (aged 12 to 13 years) and Grade 9 (aged 14 to 15) in both states. A total of 3,729 students responded to questions about alcohol, tobacco, cannabis, and other illicit substance use ( nVIC= 1,852; nWA= 1,877). In each state, males and females were equally represented and ages ranged from 12 to 15 years. Methods: Data were analyzed to compare lifetime and current (past 30 days) substance use for students located in census areas classified as urban, large or small town, and rural. Findings were adjusted for school clustering and weighted to compare prevalence at median age 14 years. Findings: Rates of lifetime and current alcohol, tobacco, and cannabis use were significantly higher in rural compared to urban students in both states (odds ratio for current substance use = 1.31). Conclusions: In both Washington State and Victoria, early adolescent rural students use substances more frequently than their urban counterparts. Future studies should examine factors that place rural adolescents at risk for alcohol, tobacco, and illicit drug use. [ABSTRACT FROM AUTHOR]