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Background Pregnant women have been identified as high users of complementary and alternative medicine (CAM). However, no research to date has provided a detailed analysis of the prevalence and determinants of CAM consumption amongst pregnant women. Aim To examine the prevalence and determinants of CAM use by pregnant women, utilising a national representative sample. Methods The study sample was obtained via the Australian Longitudinal Study on Women's Health. This paper is based on a sub-study of 1,835 pregnant women, administered in 2010. The women answered questions about CAM use, demographics, pregnancy-related health concerns and health service utilisation. Results Complementary and alternative medicine use was found to be high with 48.1% ( n = 623) of pregnant women consulting a CAM practitioner and 52.0% ( n = 842) of women using CAM products (excluding vitamins and minerals) during pregnancy. CAM practitioner visits were more likely for selected pregnancy-related health concerns, namely back pain or back ache, neck pain and labour preparation. Women were less likely to consult a CAM practitioner if they suffered with headaches/migraines. Employment was also found to be predictive of pregnant women's visits to a CAM practitioner. Significant health history and demographic predictors of CAM product use were tiredness and fatigue, embarking on preparation for labour and having a university education. Conclusion Most pregnant women are utilising CAM products and/or services as part of their maternity care and obstetricians, general practitioners and midwives need to enquire with women in their care about possible CAM use to help promote safe, effective coordinated maternity care. [ABSTRACT FROM AUTHOR]

Objective This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Methods The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models. Results Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon. Conclusions The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems. [ABSTRACT FROM AUTHOR]

Aim: This study attempts to identify any association between length of exposure to urban environmental risk and non-infectious chronic disease in a group of Australian residents who lived in the same location for at least 20 years. Methods: Using Australian survey data, we selected 1256 participants who were 45 years and older and had lived in the same location for at least 20 years. We used logistic regression and survival analysis to identify factors associated with the presence of non-infectious chronic disease at baseline and after 7 years. Results: Results show that increasing age, living in an urban area and living in an area with a lower socioeconomic status increase the odds of having a long-term health condition. Conclusion: This study provides empirical evidence that older long-term Australian urban residents are more likely to have a non-infectious chronic disease, which may be associated with environmental exposure, than those living in rural locations. [ABSTRACT FROM AUTHOR]

Aims To investigate the prevalence of awareness of the online illicit drug marketplace Silk Road ( SR), consumption of drugs purchased from SR and reasons for use and non-use of SR. Design and setting Global Drug Survey: purposive sample collected in late 2012. Participants The base sample ( n = 9470) reported recent drug purchase and resided in the United Kingdom ( n = 4315, median age 24, 76% male), Australia ( n = 2761, median age 32, 76% male) or the United States ( n = 2394, median age 21, 80% male). Measurements Online questionnaire. Findings A total of 65% of US, 53% of Australian and 40% of UK respondents had heard of SR; 18% of US, 10% of UK and 7% of Australian respondents had consumed drugs purchased through SR. Across the three countries, 3,4-methylenedioxy-N-methylamphetamine (MDMA) was the most commonly purchased drug (53-60%), followed by cannabis (34-51%), lysergic acid diethylamide (LSD) (29-45%) and the 2C family (16%-27%). The most common reasons for purchasing from SR were wider range (75-89%), better quality (72-77%), greater convenience (67-69%) and the use of vendor rating systems (60-65%). The most common reasons for avoiding SR purchase were adequate drug access (63-68%) and fear of being caught (41-53%). Logistic regressions found that, compared with people from the UK, Australians [odds ratio ( OR) = 3.37; 95% confidence interval ( CI) = 2.29, 4.97) and Americans (OR = 1.46; 95% CI = 1.10, 1.94) were more likely to use SR due to lower prices; and to avoid SR purchase due to fear of being caught ( Australia: OR = 1.65; 95% CI = 1.39, 1.96; USA: OR = 1.62; 95% CI = 1.37, 1.92). Conclusions While reasons for Silk Road use accord with broader online commerce trends (range, quality, convenience, ratings), its appeal to drug purchasers is moderated by country-specific deterrents and market characteristics. [ABSTRACT FROM AUTHOR]

Context Medical school curricula remain one of the key levers in increasing the future supply of rural doctors. Data from Australia and overseas have suggested exposure to rural practice via rural placements during basic medical training is positively associated with graduates becoming rural doctors. However, previous studies have suffered from serious methodological limitations. Objectives This study sought to determine whether rural clinical placements are associated with a higher proportion of graduating students planning rural careers and to explore associations with timing, duration and location of placements. Methods Data were obtained from the Medical Schools Outcomes Database and Longitudinal Tracking Project, which is a longitudinal study with a high response rate that prospectively collects data, including practice location intention, from all Australian medical schools. Using logistic regression analysis, the association between placements and rural career intention was assessed, controlling for a number of demographic and contextual variables. Results The association between rural/remote placements later in the programme and rural practice intention was strongly positive whether viewed as simple occurrence or as duration, in contrast to later urban placements, which were strongly negative. A longer duration of placement enhanced the associations reported. Non-metropolitan medical schools were also associated with higher odds of intention to take up rural practice. However, the association with rural placements was overshadowed by the strong positive associations with rural background of students and their stated intention to become a rural doctor at the start of their studies. Conclusions Exposure to rural practice during basic medical training, and the location and curriculum focus of a medical school are confirmed as factors that are positively associated with students' intention to become rural doctors after graduation. However, rural origin and the early intentions at the start of their medical training are better predictors of expressed intention to take up rural practice than rural clinical placements. [ABSTRACT FROM AUTHOR]

Aims To assess the level of evidence-based drug prescribing for acute coronary syndrome ( ACS) at discharge from Western Australian ( WA) hospitals and determine predictors of such prescribing in Aboriginal and non- Aboriginal patients. Methods All Aboriginal (2002-2004) and a random sample of non-Aboriginal (2003) hospital admissions with a principal diagnosis of ACS were extracted from the WA Hospital Morbidity Data Collection of WA Data Linkage System. Clinical information, history of co-morbidities and drugs were collected from medical notes by trained data collectors. Evidence-based prescribing ( EBP) was defined as prescribing of aspirin, statin and beta-blocker or angiotensin-converting enzyme inhibitor/angiotensin II antagonist. Results Records for 1717 ACS patients discharged alive from hospitals were reviewed. The majority of patients (71%) had EBP, and there was no significant difference between Aboriginal and non- Aboriginal patients (70% vs 71%, P = 0.36). Conversely, a significantly higher proportion of Aboriginal patients had none of the drugs prescribed compared with non- Aboriginal patients (11% vs 7%, P < 0.01). EBP for ACS was independently associated with male sex (odds ratio ( OR) 1.63, 95% confidence interval ( CI) 1.26−2.11), previous admission for ACS ( OR 1.83, 95% CI 1.39-2.42) and diabetes ( OR 1.36, 95% CI 1.04-1.79). However, ACS patients living in regional and remote areas, attending district or private hospitals, or with a history of chronic obstructive pulmonary disease were significantly less likely to have ACS drugs prescribed at discharge. Conclusions Opportunity exists to improve prescribing of recommended drugs for ACS patients at discharge from WA hospitals in both Aboriginal and non- Aboriginal patients. Attention regarding pharmaceutical management post- ACS is particularly required for patients from rural and remote areas, and those attending district and private hospitals. [ABSTRACT FROM AUTHOR]

Objective To determine if the financial costs of teaching GP registrars differs between rural and urban practices. Design Cost-benefit analysis of teaching activities in private GP for GP vocational training. Data were obtained from a survey of general practitioners in South Australia and Western Australia. Setting and participants General practitioners and practices teaching in association with the Adelaide to Outback General Practice Training Program or the Western Australian General Practice Training. Main outcome measures Net financial effect per week per practice. Results At all the training levels, rural practices experienced a financial loss for teaching GP registrars, while urban practices made a small financial gain. The differences in net benefit between rural and urban teaching practices was significant at the GPT2/ PRRT2 (−$515 per week 95% CI −$1578, −$266) and GPT3/ PRRT3 training levels (−$396 per week, 95% CI (−$2568, −$175). The variables contributing greatest to the difference were the higher infrastructure costs for a rural practice and higher income to the practice from the GP registrars in urban practices. Conclusion There were significant differences in the financial costs and benefits for a teaching rural practice compared with an urban teaching practice. With infrastructure costs which include accommodation, being a key contributor to the difference found, it might be time to review the level of incentives paid to practices in this area. If not addressed, this cost difference might be a disincentive for rural practices to participate in teaching. [ABSTRACT FROM AUTHOR]

Background The management of the occiput posterior ( OP) position has been controversial for many years. Manual rotation can be performed by midwives and could reduce cesarean sections and instrumental births. We aimed to determine current midwifery views, knowledge, and practice of manual rotation. Method A de-identified, self-reported questionnaire was e-mailed to all Australian College of Midwives full members ( n = 3,997). Results Of 3,182 surveyed, 57 percent (1,817) responded, of whom 51 percent (920) were currently practicing midwifery. Seventy-seven percent of midwives thought that manual rotation at full dilatation was a valid intervention. Sixty-four percent stated the procedure was acceptable before instrumental delivery, but 30 percent were unsure. Most practicing midwives (93%) had heard of manual rotation, but only 18 percent had performed one in the last year. Midwives would support the routine performance of manual rotation for OP position if it reduced operative births from 68 to 50 percent and would support manual rotation for occiput transverse ( OT) position if it reduced operative births from 39 to 25 percent. Conclusion This study indicates that manual rotation is considered acceptable by most midwives in Australia, yet is only performed by a minority. Midwives would be willing to perform prophylactic manual rotation if it was known to facilitate normal vaginal births suggesting a scope to introduce this procedure into widespread clinical practice. [ABSTRACT FROM AUTHOR]

Background Language impairment (LI) in the preschool years is known to vary over time. Stability in the diagnosis of LI may be influenced by children's individual variability, the measurement error of commonly used assessment instruments and the cut-points used to define impairment. Aims To investigate the agreement between two different age-based versions of a language assessment instrument and the stability of the classification of LI using the two measures over a 12-month period. Methods & Procedures A total of 945 participants completed the Clinical Evaluation of Language Fundamentals (CELF-Preschool 2 or 4th Edn) at 4 and 5 years of age. Agreement and stability were analysed using Bland-Altman plots, correlation and odds ratios. Sensitivity and specificity were calculated for two thresholds of the CELF-P2 using the diagnostic category on the child's subsequent CELF-4. Outcomes & Results For all CELF scores, mean differences for the cohort between 4 and 5 years were within 1.5 scale score units. In contrast, at the individual level variability was found across the range of scores and was of a greater magnitude than previously reported. Stability in LI classification was low, with 36% of 5-year-olds with LI (defined as a standard score below -1.25) classified as typical at 4 years, even though odds ratios calculated from classifications at the two time points suggested that 4-year-olds with LI had 23 times greater odds than their typical peers to receive a diagnosis of LI at 5 years. The CELF-P2 did not demonstrate adequate levels of diagnostic accuracy for LI at 5 years: sensitivity of 64% and specificity of 92.9%. Conclusions Substantial variability across the entire range of possible CELF scores was observed in this community cohort between the ages of 4 and 5 years. The stability of LI classification was lower than that reported in previous research conducted primarily on smaller clinical cohorts. The current study's results suggest that the variability observed in developmental language pathways is the result of a combination of limitations in measurement instruments, individual children's abilities and the arbitrary nature of the boundaries defining LI. [ABSTRACT FROM AUTHOR]

Emergency department mental health triage is a complex clinical task for which the evidence base is minimal. Research in the past decade has consistently identified issues associated with the accuracy and consistency of mental health triage assessment. In this study, we investigated the predictive validity of the clinical descriptors in the Victorian Emergency Department Mental Health Triage Tool. Using a naturalistic, retrospective study design, an audit of the emergency department triage database was undertaken on 12 months of continuous data for all mental health presentations ( n = 1718). The main outcome measure was urgency categorization. The study findings indicate that triage nurses can accurately identify the urgency of mental health presentations using defined clinical criteria. A significant finding was that patients with acute psychotic symptoms were more likely to be triaged as high urgency (code 2); however, the Australasian Triage Scale, in use in all Australian and many international emergency departments, provides no mental health-specific descriptors in high-urgency categories (1 and 2). [ABSTRACT FROM AUTHOR]

Background There are minimal data involving predictors of success of external cephalic version (ECV) in an Australian healthcare setting. Aims To determine the predictors of successful ECV as well as the success rate of ECV and the mode of, and presentation at, delivery for women undergoing ECV for breech presentation from 36-weeks gestation. Methods A prospective review was carried out on all women who had undergone ECV from 36-weeks gestation at the Mater Mothers Hospital over an 8-year period from 2001 to 2008. Data were collected prospectively and were collated in conjunction with database review, chart review and telephonic patient interviews. Results A total of 355 women underwent ECV for breech presentation. The overall success rate was 66% (57% for nulliparous, 76% for multiparous). A woman who underwent ECV had a 46% chance of a vaginal birth. If the ECV was successful, she had a 70% chance of vaginal birth. From bivariate analysis, parity, amniotic fluid index (AFI) and estimated fetal weight (EFW) were determined to be possible predictors of success of ECV and were included in the logistic regression modelling. In the regression analysis, multiparity increased the odds of successful ECV by 2.18. For every one unit increase in AFI, the odds of successful ECV increased by 1.18. Conclusions Multiparity and amniotic fluid volume as assessed by AFI were the significant predictors of immediate success of ECV. Conversely, lower AFI and nulliparity are factors that are likely to reduce the likelihood of successful ECV. [ABSTRACT FROM AUTHOR]

Aims To determine comorbidity patterns in treatment-seeking substance use disorder ( SUD) patients with and without adult attention deficit hyperactivity disorder ( ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse. Design Data were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence ( IASP) study. Setting Forty-seven centres of SUD treatment in 10 countries. Participants A total of 1205 treatment-seeking SUD patients. Measurements Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners' Adult ADHD Diagnostic Interview for DSM-IV ( CAADID), the presence of antisocial personality disorder ( ASPD), major depression ( MD) and (hypo)manic episode ( HME) was assessed with the Mini International Neuropsychiatric Interview- Plus ( MINI Plus), and the presence of borderline personality disorder ( BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II ( SCID II). Findings The prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio ( OR) = 2.8, 95% confidence interval ( CI) = 1.8-4.2], BPD ( OR = 7.0, 95% CI = 3.1-15.6 for alcohol; OR = 3.4, 95% CI = 1.8-6.4 for drugs), MD in patients with alcohol as primary substance of abuse ( OR = 4.1, 95% CI = 2.1-7.8) and HME ( OR = 4.3, 95% CI = 2.1-8.7) were all more prevalent in ADHD+ compared with ADHD− patients ( P < 0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype ( P < 0.01), increased HME and ASPD in the hyperactive/impulsive ( P < 0.01) and combined subtypes ( P < 0.001) and increased BPD in all subtypes ( P < 0.001) compared with SUD patients without ADHD. Seventy-five per cent of ADHD patients had at least one additional comorbid disorder compared with 37% of SUD patients without ADHD. Conclusions Treatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders. [ABSTRACT FROM AUTHOR]

Background The most recent Global Burden of Disease Study ( GBD 2010) is the first to include attention-deficit/hyperactivity disorder ( ADHD) and conduct disorder ( CD) for burden quantification. We present the epidemiological profiles of ADHD and CD across three time periods for 21 world regions. Methods A systematic review of global epidemiology was conducted for each disorder (based on a literature search of the Medline, PsycInfo and EMBASE databases). A Bayesian metaregression tool was used to derive prevalence estimates by age and sex in three time periods (1990, 2005 and 2010) for 21 world regions including those with little or no data. Prior expert knowledge and covariates were applied to each model to adjust suboptimal data. Final prevalence output for ADHD were adjusted to reflect an equivalent value if studies had measured point prevalence using multiple informants while final prevalence output for CD were adjusted to reflect a value equivalent to CD only. Results Prevalence was pooled for males and females aged 5-19 years with no difference found in global prevalence between the three time periods. Male prevalence of ADHD in 2010 was 2.2% (2.0-2.3) while female prevalence was 0.7% (0.6-0.7). Male prevalence of CD in 2010 was 3.6% (3.3-4.0) while female prevalence was 1.5% (1.4-1.7). ADHD and CD were estimated to be present worldwide with ADHD prevalence showing some regional variation while CD prevalence remained relatively consistent worldwide. Conclusions We present the first prevalence estimates of both ADHD and CD globally and for all world regions. Data were sparse with large parts of the world having no estimates of either disorder. Epidemiological studies are urgently needed in certain parts of the world. Our findings directly informed burden quantification for GBD 2010. As mental disorders gained increased recognition after the first GBD study in 1990, the inclusion of ADHD and CD in GBD 2010 ensures their importance will be recognized alongside other childhood disorders. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to quantify the sensitivity and specificity of three-point compression ultrasonography for diagnosing proximal lower extremity deep venous thrombosis when performed by Australian consultant emergency physicians with limited specific training. Secondary aims included quantifying rapidity, technical adequacy, predictability of equivocal results and relationships between emergency physician experience and proficiency. Methods: This prospective diagnostic study enrolled a convenience sample of adult patients presenting to a major ED with suspected lower extremity deep venous thrombosis. The index test was abbreviated compression ultrasonography examining three points: common femoral, proximal great saphenous and popliteal veins. Emergency physicians received specific training. The reference test was full-leg duplex ultrasonography in the Radiology Department. Results: A total of 15 emergency physicians participated, enrolling 178 subjects. Sensitivity of the index test was 77.8% (95% confidence interval: 54.8-91.0%), specificity was 91.4% (95% confidence interval: 84.9%-95.3%) and accuracy was 89.6% (95% confidence interval: 83.1-94.2%). Median duration of the index test was 10 min 34 s (interquartile range: 6 min 31 s) and ED diagnosis occurred significantly before Radiology Department diagnosis. The only statistically significant relationship between emergency physician experience and proficiency related to rapidity, which increased from the 36th scan. Equivocal index tests occurred in 9.2% of examinations and emergency physicians predicted equivocal assessments with specificity of 86.1% (95% confidence interval: 78.8-91.1%). Conclusions: Abbreviated ultrasonography performed by emergency physicians for proximal lower extremity deep venous thrombosis could be valuable. However, more precise estimates for sensitivity and greater understanding of relationships between emergency physician experience and proficiency are required. [ABSTRACT FROM AUTHOR]

Background People with intellectual disability ( ID) in the general population and people in prison experience unrecognised medical conditions and inadequate disease prevention. Among prisoners, those with an ID may be particularly disadvantaged. The aim of this study was to identify demographic, health and health-related characteristics of adult prisoners who screened positive for ID. Methods Cross-sectional data were collected via face-to-face administration of a structured questionnaire in seven prisons in Queensland, Australia, between 2008 and 2010. Participants were adult prisoners within 6 weeks of release from custody. We identified ID using a pragmatic screening tool. Prisoners who scored <85 on the Hayes Ability Screening Index and either (a) reported having attended a special school or (b) reported having been diagnosed with an ID were considered to have screened positive for ID. We compared the characteristics of participants who screened positive and negative for ID using univariable and multivariable logistic regression. Results Screening positive for ID was associated with younger age, identifying as Indigenous and lower educational achievement. Prisoners who screened positive for ID were more likely to have been diagnosed with medical conditions such as heart disease (odds ratio; 95% confidence interval = 2.1; 1.0-4.2) and hearing problems (2.2; 1.3-3.7), after adjustment for age, sex, education level and Indigenous status. Screen-positive prisoners were less likely to have received preventive care interventions such as testing for hepatitis A infection (0.4; 0.2-0.6), and immunisation for tuberculosis (0.4; 0.2-0.8). Prisoners with possible ID were more likely to be obese (1.7; 1.1-2.7). Conclusions Adult prisoners who screen positive for ID have worse health outcomes than their non-disabled peers. An improved understanding of physical health characteristics prior to release can direct treatment and support pathways out of the criminal justice system and inform transitional planning of health services for this profoundly disadvantaged group. [ABSTRACT FROM AUTHOR]

Aims This study examined how family, peer and school factors are related to different trajectories of adolescent alcohol use at key developmental periods. Design Latent class growth analysis was used to identify trajectories based on five waves of data (from grade 6, age 12 to grade 11, age 17), with predictors at grades 5, 7 and 9 included as covariates. Setting Adolescents completed surveys during school hours. Participants A total of 808 students in Victoria, Australia. Measurements Alcohol use trajectories were based on self-reports of 30-day frequency of alcohol use. Predictors included sibling alcohol use, attachment to parents, parental supervision, parental attitudes favourable to adolescent alcohol use, peer alcohol use and school commitment. Findings A total of 8.2% showed steep escalation in alcohol use. Relative to non-users, steep escalators were predicted by age-specific effects for low school commitment at grade 7 ( P = 0.031) and parental attitudes at grade 5 ( P = 0.003), and age-generalized effects for sibling alcohol use ( Ps = 0.001, 0.012, 0.033 at grades 5, 7 and 9, respectively) and peer alcohol use ( Ps = 0.041, < 0.001, < 0.001 at grades 5, 7 and 9, respectively). Poor parental supervision was associated with steep escalators at grade 9 ( P < 0.001) but not the other grades. Attachment to parents was unrelated to alcohol trajectories. Conclusions Parental disapproval of alcohol use before transition to high school, low school commitment at transition to high school, and sibling and peer alcohol use during adolescence are associated with a higher risk of steep escalations in alcohol use. [ABSTRACT FROM AUTHOR]

Background Chlamydia trachomatis is the most common reportable infection in Australia. Since 2006, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists ( RANZCOG) have recommended chlamydia screening in pregnant women aged <25 years. Aims To assess clinical uptake and policy integration of the 2006 RANZCOG recommendation on chlamydia testing in pregnant women aged <25 years. Methods A mixed method approach was used involving a literature review, a survey of obstetricians and gynaecologists, and survey of hospital managers from April 2010 to May 2010. Results Of the 1644 participating RANZCOG Fellows, Trainees, and Diplomates, 21.2% reported universal screening for pregnant women <25 years (25% of primary care clinicians, 23% of those working in the public hospital sector, 16% of those working in both public and private hospitals, and 13% of those in private hospitals or private practice). There was a strong association between members who agreed with the guideline and offering universal screening to pregnant women aged <25 years (adjusted odds ratio = 17.1, 95% CI: 6.0-49.2, P < 0.01). Of the 143 participating hospital managers who completed the hospital policy questionnaire; 20% reported that their hospital had a formal screening guideline. There were two national and four state/local policy documents recommending chlamydia screening in pregnancy. Conclusions This study shows low uptake of chlamydia screening of young pregnant women by RANZCOG Fellows, Trainees, and Diplomates involved in antenatal care and highlights the need for national clinical leadership regarding screening for chlamydia among pregnant women aged <25 years. [ABSTRACT FROM AUTHOR]

Objective The study aimed to determine factors related to ICU mortality in critically ill patients transferred by Adult Retrieval Victoria ( ARV) medical staff. Patients who died in ICU after interhospital transfer were compared against those who survived. Methods This was a retrospective cohort study of ARV cases between 1 January 2009 and 30 June 2010. Retrieval data were linked with data from the ANZICS CORE APD ( Australia and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database). Victoria Data Linkage ( VDL) performed linkage of data. Data included demographic and clinical data obtained during transfer and clinical data recorded in ICU. Results Of the 601 cases transferred by ARV during the study period, 549 cases were eligible for linkage to 25 543 ANZICS APD case records for the same period. VDL matched 460 of these cases (83.8%). Mortality rate in the matched sample was 13.9%. Variables associated with mortality were: advanced age (odds ratios [ OR] 1.02, 95% confidence interval [ CI] 1.00-1.04, P = 0.02), principal referral problem cardiac ( OR 1.84, 95% CI 1.02-3.32, P = 0.04), lower mean arterial blood pressure ( OR 0.97, 95% CI 0.95-0.99, P = 0.005) and tachycardia ( OR 1.02, 95% CI 1.00-1.03, P = 0.008) on arrival at destination hospital. Conclusions Advanced age, lower mean arterial blood pressure and tachycardia towards the completion of transfer were associated with increased ICU mortality in this population. Clinicians should be aware of the additional risk for cardiac patients. [ABSTRACT FROM AUTHOR]

The study is based on an innovative demonstration project which trialled the implementation of the Finnish 'workability' framework and research measures. It aimed, firstly, to test the applicability of the Workability Index ( WAI) to the Australian residential aged care workforce, focusing on personal care assistants ( PCAs), and secondly, to assess the effectiveness of actions aimed at improving workability. The facility manager implemented multidimensional 'actions' according to the workability framework. The Workability Survey ( WAS) and WAI and intervention instruments were administered ( n = 64). Completed responses to 'pre' and 'post' instruments formed matched pairs ( n = 15). WAI scores increased significantly, by 3 points on average, after all 'actions' were implemented. The only significant 'action' was increasing the number of PCAs in high care. Workability provides a useful research workforce development instrument measuring interactions between aged care workers and organisational demands and the outcomes of 'actions'. [ABSTRACT FROM AUTHOR]

Aims This study aimed to compare emotion perception and social inference in opioid maintenance patients with abstinent ex-users and non-heroin-using controls, and determine whether any deficits in could be accounted for by cognitive deficits and/or risk factors for brain damage. Design Case-control. Setting Sydney, Australia. Participants A total of 125 maintenance patients ( MAIN), 50 abstinent opiate users ( ABST) and 50 matched controls ( CON). Measurements The Awareness of Social Inference Test ( TASIT) was used to measure emotion perception and social inference. Measures were also taken of executive function, working memory, information processing speed, verbal/non-verbal learning and psychological distress. Findings After adjusting for age, sex, pre-morbid IQ and psychological distress, the MAIN group was impaired relative to CON (β = −0.19, P < 0.05) and ABST (β = −0.19, P < 0.05) on emotion perception and relative to CON (β = −0.25, P < 0.001) and ABST (β = −0.24, P < 0.01) on social inference. In neither case did the CON and ABST groups differ. For both emotion perception ( P < 0.001) and social inference ( P < 0.001), pre-morbid IQ was a significant independent predictor. Cognitive function was a major predictor of poor emotion perception (β = −0.44, P < 0.001) and social inference (β = −0.48, P < 0.001). Poor emotion recognition was also predicted by number of heroin overdoses (β = −0.14, P < 0.05). Neither time in treatment or type of maintenance medication (methadone or buprenorphine) were related to performance. Conclusions People in opioid maintenance treatment may have an impaired capacity for emotion perception and ability to make inferences about social situations. [ABSTRACT FROM AUTHOR]

Aims To test the population impact of offering automated smoking cessation interventions via the internet and/or by mobile phone. Design Pragmatic randomized controlled trial with five conditions: offer of (i) minimal intervention control; (ii) QuitCoach personalized tailored internet-delivered advice program; (iii) on Q, an interactive automated text-messaging program; (iv) an integration of both QuitCoach and on Q; and (v) a choice of either alone or the combined program. Setting Australia, via a mix of internet and telephone contacts. Participants A total of 3530 smokers or recent quitters recruited from those interested in quitting, and seeking self-help resources ( n = 1335) or cold-contacted from internet panels ( n = 2195). Measurements The primary outcome was self-report of 6 months sustained abstinence at 7 months post-recruitment. Findings Only 42.5% of those offered one of the interventions took it up to a minimal level. The intervention groups combined had a non-significantly higher 6-month sustained abstinence rate than the control [odds ratio ( OR) = 1.48; 95% confidence interval (CI): 0.98-2.24] (missing cases treated as smokers), with no differences between the interventions. Among those who used an intervention, there was a significant overall increase in abstinence ( OR = 1.95; CI: 1.04-3.67), but not clearly so when analysing only cases with reported outcomes. Success rates were greater among those recruited after seeking information compared to those cold-contacted. Conclusions Smokers interested in quitting who were assigned randomly to an offer of either the QuitCoach internet-based support program and/or the interactive automated text-messaging program had non-significantly greater odds of quitting for at least 6 months than those randomized to an offer of a simple information website. [ABSTRACT FROM AUTHOR]

Background Myelodysplastic syndrome ( MDS), a haematological disorder of the elderly, has been formally classified as a neoplastic disease for 10 years. Aims Our aim was to collate national cancer registry incidence data to describe the epidemiology of MDS in New Zealand. Methods The New Zealand Cancer Registry has now reported five complete years of incidence data, the last three of which were used for analysis. For the years 2005-2007, age-sex specific and age-standardised MDS incidence rates from New Zealand were compared with those from Australia. Age-standardised incidence rates were calculated by the direct standardisation method and standardised rate ratios were compared at the 5, 1 and 0.1% levels. Results Diagnoses of MDS represented 1.3% of total cancer registrations in New Zealand and 1.0% in Australia. In both New Zealand and Australia, 86-87% of MDS cases were diagnosed in individuals ≥60 years of age, the incidence increased significantly with age, and males had a significantly higher age-standardised incidence rate ( P < 0.001) than females. The incidence rate for New Zealand males was significantly higher ( P < 0.001) than Australian males. In both New Zealand males and females, the age-standardised incidence rate of MDS was significantly higher ( P < 0.05) than most other haematological neoplasms. Conclusions In New Zealand and Australia, MDS is a common haematological neoplasm. The marked difference between male and female incidence rates, especially with advancing age, may provide insights into the causes of this disease. [ABSTRACT FROM AUTHOR]

Aims To evaluate the impact of community-based drug treatment on methamphetamine use using inverse probability of treatment-weighted ( IPTW) estimators to derive treatment effects. Design A longitudinal prospective cohort study with follow-ups at 3 months, 1 year and 3 years. Treatment effects were derived by comparing groups at follow-up. IPTW estimators were used to adjust for pre-treatment differences between groups. Setting Sydney and Brisbane, Australia. Participants Participants were methamphetamine users entering community-based detoxification ( n = 112) or residential rehabilitation ( n = 248) services and a quasi-control group of methamphetamine users ( n = 101) recruited from the community. Measurements Frequency of methamphetamine use between interviews (no use, less than weekly, 1-2 days per week, 3+ days per week), continuous abstinence from methamphetamine use, past month methamphetamine use and methamphetamine dependence. Findings Detoxification did not reduce methamphetamine use at any follow-up relative to the quasi-control group. Relative to quasi-control and detoxification groups combined, residential rehabilitation produced large reductions in the frequency of methamphetamine use at 3 months [odds ratio ( OR) = 0.23, 95% confidence interval ( CI) 0.15-0.36, P < 0.001), with a marked attenuation of this effect at 1 year ( OR 0.62, 95% CI 0.40-0.97, P = 0.038) and 3 years ( OR = 0.71, 95% CI 0.42-1.19, P = 0.189). The greatest impact was for abstinence: for every 100 residential rehabilitation clients there was a gain of 33 being continuously abstinent at 3 months, with this falling to 14 at 1 year and 6 at 3 years. Conclusions Community-based residential rehabilitation may produce a time-limited decrease in methamphetamine use, while detoxification alone does not appear to do so. [ABSTRACT FROM AUTHOR]

Background Discrimination in women's health care, particularly perinatal care, has received minimal attention. The aim of this study is to describe women's experience of discrimination in different models of maternity care and to examine the relationship between maternal social characteristics and perceived discrimination in perinatal care. Methods A population-based postal survey was mailed 6 months postpartum to all women who gave birth in two Australian states in September and October 2007. Perceived discrimination was assessed using a five-item measure designed to elicit information about experiences of unequal treatment by health professionals. Results A total of 4,366 eligible women completed the survey. Women attending public models of maternity care were significantly more likely to report perceived discrimination compared with women attending a private obstetrician (30.7% vs 19.7%, OR 1.79, 95% CI 1.5-2.1). Compared with women reporting no stressful life events or social health issues in pregnancy, those reporting three or more stressful life events or social health issues had a twofold increase in adjusted odds of perceived discrimination (41.1% vs 20.4%, adj OR 2.27, 95% CI 1.8-2.8). Young women (< 25 yr) and women who were smoking in pregnancy were also at increased risk of experiencing perceived discrimination. Conclusions Discrimination is an unexplored factor in how women experience perinatal care. Developing approaches to perinatal care that incorporate the capacity to respond to the needs of vulnerable women and families requires far-reaching changes to the organization and provision of care. ( BIRTH 39:3 September 2012) [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This study seeks to establish the prevalence alcohol-related harms to children (ARHC) that occur because of others' drinking in the general population and examine how this varies by who was reported to have harmed the child and socio-demographic factors. Design and setting A randomly selected cross-sectional national population telephone survey undertaken in 2008 in Australia. Participants A total of 1142 adult respondents who indicated they lived with or had a parental/carer role for children. Measurements Questions included whether children had been negatively affected in any way, left unsupervised or in an unsafe situation, verbally abused, physically hurt or exposed to serious family violence because of others' drinking in the past year. Findings Twenty-two per cent of respondents reported children had been affected because of another's drinking in the past year; 3% reported substantial harm. Respondents most commonly reported that children were verbally abused because of others' drinking (9%). Participants in single-carer households were more likely to report ARHC than participants in households with two carers, and participants who drank weekly were more likely to report ARHC than those who did not drink. Conclusions Almost a quarter of those with a caring role for children in Australia reported that a child or children with whom they lived or for whom they were responsible have been affected adversely by others' alcohol consumption in the past year. The problem extends across the social spectrum, but children in single-parent homes may be at higher risk. [ABSTRACT FROM AUTHOR]

Aims: The safety of preventive asthma medicines during pregnancy has already been established. The aim of this study was to assess asthma management by women during pregnancy. Methods: Pregnant women attending the out-patient clinics of an Australian maternity hospital completed a questionnaire about their asthma medication use and symptoms. Parameters associated with changes in asthma medicine use are presented as odds ratio with a 95% confidence level. P-values <0.05 indicated statistical significance. Results: Participants ( n = 102) self-reported worsening of their asthma symptoms during pregnancy compared with the pre-pregnancy period, both during the day ( P = 0.003) and night ( P = 0.044). The number of participants whose asthma was treated by a medical professional decreased from 81 (79.4%) before pregnancy to 67 (65.7%) during pregnancy ( P = 0.008). The use of regular asthma medicines (preventers and symptom controllers alone or in combination) decreased during pregnancy ( P < 0.001 and P = 0.012, respectively), while the use of intermittent therapies (relievers) increased ( P = 0.004) during pregnancy. Being treated by a medical professional during pregnancy ( P = 0.033), a history of asthma medicine use before pregnancy ( P = 0.015) and younger age of first asthma diagnosis ( P = 0.046) were associated with the use of asthma medicines during pregnancy. Conclusions: Despite worsening of asthma symptoms, many pregnant women do not take regular preventive asthma medicines. Ongoing assessment of asthma control during pregnancy, medication review and adjustments in therapy by health professionals might facilitate asthma management. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim To determine whether declines in the prevalence of cannabis use in Australia have been accompanied by changes in age of onset of cannabis use. Design A retrospective cohort study. To account for right censoring error we contrasted the mean age of onset for comparable age groups across the four surveys conducted from 1998 to 2007. Kaplan-Meier failure graphs were used to describe how the cumulative risk of first use of cannabis varied across birth cohorts born from 1947 to 1993. Setting Australian data collected in the nationally representative, triennial, National Drug Strategy Household Surveys (NDSHS) Participants A total of 88 268 Australian household residents aged 14 years and older. Measurements Life-time use of cannabis and age of first use. Findings For respondents under the age of 20 years, mean age of first use of cannabis has increased from 14.6 years in 1998 to 15.2 years in 2007. Conclusions The decline in cannabis use prevalence that has occurred since 1998 in Australia has been accompanied by an increase in age of first use among those aged under 20 years. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This study aimed to examine the associations between reported exposure to anti-smoking warnings at the point-of-sale (POS) and smokers' interest in quitting and their subsequent quit attempts by comparing reactions in Australia where warnings are prominent to smokers in other countries. Design A prospective multi-country cohort design was employed. Setting Australia, Canada, the United Kingdom and the United States. Participants A total of 21 613 adult smokers who completed at least one of the seven waves (2002-08) of the International Tobacco Control Four Country Survey were included in the analysis. Measurements Reported exposure to POS anti-smoking warnings and smokers' interest in quitting at the same wave and quit attempts over the following year. Findings Compared to smokers in Canada, the United Kingdom and the United States, Australian smokers reported higher levels of awareness of POS anti-smoking warnings, and this difference was consistent over the study period. Over waves in Australia (but not in the other three countries) there was a significantly positive association between reported exposure to POS anti-smoking warnings and interest in quitting [adjusted odds ratio = 1.139, 95% confidence interval (CI) 1.039-1.249, P < 0.01] and prospective quit attempts (adjusted odds ratio = 1.216, 95% CI 1.114-1.327, P < 0.001) when controlling for demographics, smoking characteristics, overall salience of anti-smoking information and awareness of anti-smoking material from channels other than POS. Conclusions Point-of-sale health warnings about tobacco are more prominent in Australia than the United Kingdom, the United States or Canada and appear to act as a prompt to quitting. [ABSTRACT FROM AUTHOR]

Objective: Evidence indicates that medical graduates with a rural background are more likely to become rural doctors than those with an urban background (the rural background effect (RBE)). Exactly why this is so has rarely been studied. This study sought to identify the role of social, environmental and economic factors in addition to isolation characterising rural environments that either explain or modify the association between rural background and becoming a rural doctorrural practice intention. Design and setting: Secondary analysis of linked databases from the Medical Schools Outcomes Database (MSOD), Australian Bureau of Statistics and other government sources. Participants: Seven thousand four hundred twenty-two commencing medical students who took part in the MSOD survey and for whom external data could be linked. Results: No social, environmental or economic factor studied or isolation significantly contributed to explaining the RBE, although there is some evidence that areas of more attractive climate strengthen the RBE. However, even when the RBE is at its weakest, it remains a strong, positive predictor of attraction to rural practice. Conclusion: Why the RBE occurs remains unexplained. Evidence was found of a reduced RBE under certain climatic conditions and personal circumstances, but further work is required to better understand why rural background is so strongly related with rural medical intention and practice. [ABSTRACT FROM AUTHOR]

Background: Infants, toddlers and preschoolers are the highest risk group for burn injury. However, to date this population has been largely neglected. This study examined the prevalence, onset, comorbidity and recovery patterns of posttrauma reactions in young children with burns. Methods: Parents of 130 unintentionally burned children (1-6 years) participated in the study. The Diagnostic Infant Preschool Assessment was conducted with parents at 1 and 6 months postinjury. Results: The majority of children were resilient. However, 35% were diagnosed with at least one psychological disorder, there was a high rate of comorbidity with posttraumatic stress disorder, and 8% of children did not experience recovery in distress levels over the course of 6 months. Conclusions: These outcomes are likely to have serious repercussions for a young child's medical and psychosocial recovery as well as their normal developmental trajectories. It is recommended that screening, prevention and early intervention resources are incorporated into paediatric health care settings to optimise children's psychological adjustment following burn injury. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim To evaluate the relationship between change in cannabis use and changed cognitive performance over 8 years. Design We used survey methodology with a cohort design. Setting and participants An Australian community sample aged 20-24 years at baseline. Measures We assessed cognitive performance with the California Verbal Learning Test (CVLT) (immediate and delayed), Spot-the-Word test (STW), Symbol Digit Modality test (SDMT) and Digit Backwards (DB). Groups of cannabis users were defined from self-reports across three waves as: 'never' ( n= 420) 'remain light' ( n= 71), 'former light' ( n= 231), 'remain heavy' ( n= 60), 'former heavy' ( n= 60) and 'always former' (since start of study) ( n= 657). Planned contrasts within mixed model repeated-measures analysis of variance was used for longitudinal analysis with an adjusted alpha of 0.01. Findings Data were obtained from 2404 participants with 1978 (82.3%) completing wave 3. At baseline there were significant differences between cannabis groups on CVLT (immediate and delayed) and SDMT. However, after controlling for education, gender, gender × group and gender × wave, there were no significant between-group differences and only CVLT immediate recall reached adjusted statistically significant longitudinal change associated with changed cannabis use (group × wave P= 0.007). Specifically, former heavy users improved their performance relative to remaining heavy users (estimated marginal means: former heavy 6.1-7.5: remain heavy 6.4-6.6). Conclusions Cessation of cannabis use appears to be associated with an improvement in capacity for recall of information that has just been learned. No other measures of cognitive performance were related to cannabis after controlling for confounds. [ABSTRACT FROM AUTHOR]

Background: High rates of conduct difficulties have been reported among children with borderline intellectual disabilities or intellectual disabilities. Little is known about predictors of the persistence of conduct difficulties in the pre-adolescent period in this high-risk group. Methods: Secondary analysis of data from the first three waves of the Longitudinal Study of Australian Children. Results: The prevalence of conduct difficulties at age 4/5 years among children with cognitive delay was independently associated with: living in an income poor household; living in a more deprived neighbourhood; having co-morbid emotional difficulties; having poorer pro-social behaviours; poorer maternal health; greater exposure to angry/harsh parenting; and greater exposure to more inconsistent parenting. The persistence of conduct difficulties at ages 6/7 years and 8/9 years was independently associated with: male child gender; living in material hardship; child expressive communication difficulties; living in a single parent headed household; and greater exposure to angry/harsh and inconsistent parenting. When compared to their more intellectually able peers, children with borderline or intellectual disability were significantly more likely to exhibit persistent conduct difficulties, but only when exposed to multiple environmental risks. These results were consistent across different thresholds for measuring conduct difficulties and different thresholds for measuring cognitive delay. Conclusions: The persistence and high levels of conduct difficulties among this high risk group appears to be associated with a combination of increased risk of exposure to environmental adversity and decreased resilience when so exposed. [ABSTRACT FROM AUTHOR]

The belief in the gender invariance of many traits is a view that dominates much of psychology. In social psychology, this position is clearly represented by social dominance theory and the construct of social dominance orientation (SDO) where it is argued that, all else being equal, men will be higher in SDO than women. In other domains, though, these assumptions are being questioned, and researchers are arguing for a gender similarities hypothesis. The argument is that men and women are more similar than different, and where there are effects for gender, these are small. In this investigation, men and women are compared under similar cultural (Study 1), ideological, (Study 2) and status (Study 3) contexts to examine whether, all else being equal, men really are higher in SDO than women. In an additional study (Study 4), a meta-analysis is conducted aggregating the effect sizes of the previous studies. Results demonstrated either no effect for gender or an interaction between gender and the relevant social context and only a small effect size of gender-findings that disconfirm the ceteris paribus assumption of social dominance theory. In conclusion, the implications of the findings for understanding gender effects in social psychology are discussed. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Women with a history of hypertensive disorders of pregnancy (HDP) are known to be at increased risk of subsequent hypertension and cardiovascular disease. Aims: In this study, we aimed to assess whether the long-term follow-up, diagnosis and treatment of hypertension in these women is adequate. Methods: Prospective study of 2112 women who were part of a Birth Cohort Study - The Mater University of Queensland Study of Pregnancy, who received antenatal care at a major public hospital in Brisbane between 1981 and 1983 and were followed up at 21 years. Results: Of the 191 women who had HDP, 62 (32.46%) were hypertensive (29 adequately treated, 33 inadequately identified or managed). Of the 1921 women without HDP, 280 (14.58%) were hypertensive (113 adequately treated, 167 inadequately identified or managed). Women with HDP were at higher risk of hypertension (OR 4.09, 95% CI 2.76, 6.07). Women with a history of HDP were more likely to have hypertension that was inadequately identified or managed (OR 3.56, 95% CI 2.06, 5.97). Conclusion: Women with HDP are at increased risk of undiagnosed or undertreated hypertension. Attention needs to be given to appropriate follow-up of women who have a pregnancy complicated by hypertensive disorders. [ABSTRACT FROM AUTHOR]

Background: Most women use medications at some stage in their pregnancy. Medication nonadherence during pregnancy could be detrimental to both mother and fetus. Aims: To study the extent and nature of the use of prescribed medications during pregnancy and factors associated with medication nonadherence. Methods: All women ≥18 years presenting for their 36th week antenatal visit at the pregnancy clinic of a maternity hospital were invited to complete an anonymous questionnaire that contained 61 items, including the Morisky scale. Factors associated with nonadherence were identified in univariate analysis; factors with P < 0.1 were further analysed in a binary logistic regression model. Results: The participants ( n = 819) had a mean age of 30.8 ± 5.3 years. Most participants were born in Australia, lived with a partner, had university education, were nulliparous, carried one fetus and were nonsmokers. Of these participants, 322 (39.3%) reported a chronic health condition during pregnancy, the most common being asthma (104; 12.7%). Two hundred and seventeen (26.5%) were using prescribed medications, which included anti-anaemics (68; 8.3%), medicines for chronic airway conditions (64; 7.8%), vitamins and minerals (59; 7.2%) and anti-diabetics (43; 5.2%). Nonadherence was reported by 107 (59.1%) participants, mainly because of forgetting (79; 43.6%). Factors associated with nonadherence were having asthma (OR 0.26 (95% CI 0.095 - 0.72), P = 0.009) and using nonprescription dietary minerals (0.30 (0.10 - 0.87), P = 0.027). Conclusions: Adherence to prescribed medicines during pregnancy is alarmingly low. Health professionals should be more proactive in promoting adherence and assisting women avoid potential fetal harm because of nonadherence. [ABSTRACT FROM AUTHOR]

BSTRACT [ABSTRACT FROM AUTHOR]

Objective: To compare the all‐cause and specific‐cause death rates of Australian male farmers and farm managers aged 25–74 years, with other Australian men. Methods: Data were extracted from the Australian Bureau of Statistics Death Registration Collection covering the calendar years of 1999–2002. Denominator data for male farmers and farm managers were drawn from the 2001 Australian Population Census. Direct age‐standardized death rates were calculated and compared with the general Australian male population. Results: The 4025 male farmers or farm managers who died in this period represented 3.35% of all male deaths in the 25–74 year age range. The all‐cause death rate for farmers and farm managers (730/100 000) was 33% higher than that of the Australian male population of the same age (549/100 000) (standardized mortality ratio (SMR) = 1.33). Causes of death related to neoplasms (SMR = 1.37), circulatory disease (SMR = 1.40) and all external causes (SMR = 1.37), were all statistically higher than the comparison population. Within these groupings, ischaemic heart disease (SMR = 1.39), other circulatory disease (SMR = 1.42), prostate cancer (SMR = 2.40), lymphohaematopoietic cancer (SMR = 1.80) and transport injuries (SMR = 2.06), were all significantly higher. Conclusion: These data indicate that Australian male farmers and farm managers are a disadvantaged group in terms of health status. The elevated rates of all‐cause and specific‐cause mortality compared with the Australian comparison population, illustrate both the need and scope for further investigation of these issues. [ABSTRACT FROM AUTHOR]

Background: The Beers criteria are used to identify potentially inappropriate medications (PIMs) in the elderly. Few studies have examined the Beers criteria in elderly hospitalised patients in Australia. Aim: To identify the prevalence of PIM use in elderly patients admitted to an Australian hospital using the 2003 Beers criteria. Method: A prospective cross-sectional study of 100 elderly inpatients was undertaken using the Beers criteria to identify and compare PIM on admission and discharge. Logistic regression analysis examined the risk factors for PIM use. Results: 42% of patients had at least one PIM on admission compared to 39% at discharge. The most common PIMs were amitriptyline, senna, amiodarone and benzodiazepines (nitrazepam and diazepam). Excluding senna, the prevalence decreased to 36% at admission and 24% at discharge. At admission (including and excluding senna), PIM was not significantly associated with age, gender, living arrangements, number of comorbidities and number of medications. At discharge, PIM (including senna) was significantly associated with age (OR 1.1; 95%CI 1.02-1.3; p = 0.02), female gender (OR 3.6; 95%CI 1.3-10; p = 0.01) and number of medications (OR 1.2; 95%CI 1.0-1.3; p = 0.02). When senna was excluded PIM at discharge was only significantly higher in female patients (OR 5.4; 95%CI 1.7-16.9; p = 0.004). Conclusion: The Beers criteria detected a high prevalence of PIM use in elderly hospitalised patients. [ABSTRACT FROM AUTHOR]

Previous research suggests that alcohol use during pregnancy and breastfeeding has a negative impact on birth and neonatal outcomes. No threshold for this effect has been determined. The aim of this study is to determine the prevalence and correlates of alcohol use in pregnancy and lactation in a large representative sample of Australian women. Data were used from a large representative sample of Australian women drawn from the 2007 National Drug Strategy Household Survey. A complex sampling framework was used to elicit prevalence estimates for alcohol use during pregnancy and lactation. A logistic regression analysis was used to determine the psychosocial characteristics associated with alcohol use during the perinatal period. Alcohol use was reported by 29 percent of women who were pregnant in the past 12 months. In addition, 43 percent of women who were breastfeeding in the past 12 months reported alcohol use, whereas 36 percent of women who were both pregnant and breastfeeding in the past 12 months reported alcohol use. Most women (95%) reported a reduction in the quantity of their alcohol use while pregnant or breastfeeding. Older age was significantly associated with alcohol use in pregnancy, and also with alcohol use while breastfeeding (after controlling for other psychosocial characteristics). Higher educational attainment, and breastfeeding for more weeks in the past 12 months were significantly associated with alcohol use while breastfeeding, after controlling for confounding psychosocial factors. More research is needed to ease uncertainty about 'safe' levels of alcohol use during pregnancy and while breastfeeding. A high proportion of the sample reported alcohol use during pregnancy or lactation, despite uniform international government guidelines recommending that no alcohol should be consumed during the prenatal and postnatal periods. These results indicate that public health education campaigns about the risks of alcohol during these periods are needed. (BIRTH 38:1 March 2011) [ABSTRACT FROM AUTHOR]

Background: Much is known about severe maternal morbidity during pregnancy, but there has been little attention paid to the impact of pregnancy itself on women's general health and well-being. Aim: To investigate women's general health and well-being in early pregnancy and examine the relationship between maternal age and women's physical and mental health. Method: Cross-sectional analysis of baseline data from a multicentre, prospective nulliparous pregnancy cohort study. The baseline questionnaire included the SF-36 health status measure and individual items assessing a range of common maternal health issues. Results: A total of 1507 eligible women returned baseline questionnaires in early pregnancy (mean gestation 15 weeks, range 6-24 weeks) ranging from 18 to 49 years of age (mean age 30.1 years). Study participants reported significantly poorer health compared with age and gender-standardised population means on all SF-36 scales except general health. Two-thirds of women (68%) reported three or more health issues, the most common being exhaustion (87%), nausea (64%), back pain (46%), constipation (44%) and severe headaches/migraines (30%). Younger women (18-24 years) had significantly lower SF-36 scores (poorer self perceived health) compared with women ≥35 ( P ≤ 0.03). After adjusting for socio-demographic factors, maternal age remained significantly positively associated with women's mental and physical component scores. Younger women reported significantly more health issues than women ≥35 (4.39 and 3.27, mean difference = 1.12, 95% CI 0.75-1.79, P < 0.001). Conclusions: Common pregnancy symptoms have a marked impact on women's physical and mental health in early pregnancy, with the greatest impact apparent for younger women. [ABSTRACT FROM AUTHOR]

Background: With human papilloma virus (HPV) vaccines now approved for women up to 45 years of age, gynaecologists in Australia will be approached increasingly for advice on whether to have the HPV vaccine. Aim: We seek to establish the attitudes of gynaecologists to HPV vaccination when advising women in various age groups. Methods: Fellows, members and trainees of Royal Australian and New Zealand College of Obstetricians and Gynaecologists were approached in early 2009 to complete an Australian Society for Colposcopy and Cervical Pathology survey, which they could return by post or internet on-line. There were 836 (49.0%) responses, with 35.6% of responders using 'Tuna' on-line. Results: 836 RANZCOG fellows, members and trainees responded to the survey. The gender of responders are 261 (43%) females and 470 (56%) males. Of the responders, 391 (46.8%) usually initiated discussion regarding the role of HPV vaccination with their patients. More than 93% encourage when recommending the HPV vaccines for female responders aged 12-26 years. This proportion decreased to 66% for women aged 27-45 years, with 15% strongly encouraging vaccination for this age group. The attitudes to HPV vaccination for the different age groups of females were similar for trainees, fellows and members, as well as for gender and age groups of the responders. However, those with lower level of knowledge are less likely to encourage HPV vaccination in all vaccination age groups and the association is statistically significant after adjusting for role, gender and age. Conclusions: The results show a strong support from gynaecologists in Australia for HPV vaccination. [ABSTRACT FROM AUTHOR]

Objective: Identify the most important factors associated with choosing rural medical practice. Design: Cross-sectional design using a web survey to collect quantitative and qualitative data. Participants: One hundred and ninety junior doctors - 91 interns, 99 PGY2. Main outcome measures: Choice of practice location (urban/rural), reason for choosing location, enticement to a rural location. Results: Twenty-seven per cent of junior doctors preferred a rural practice location. Preference to practice in a rural area was associated with medical placement bonding schemes, rural background, rural placement experience and being older. High levels of professional expectations and prestige were associated with a preference for an urban location. The most important reasons for choosing a practice location included consideration of partner, family and friends (35.3%), preference for a location (20.5%), lifestyle goals (19.5%) and career opportunities, specialty requirements and infrastructure (17.9%). Those who preferred an urban compared with a rural location gave more importance to factors concerning partner, family and friends. The factors that would entice a doctor to a rural location included partner and family considerations (27.0%), professional support (20.3%), and career opportunities, specialty requirements and infrastructure (16.3%). Women gave more importance to partner and family factors than men. Conclusions: Our findings support the continuation of policies that are known to encourage choice of rural practice, but highlight the need for additional strategies that consider the personal and professional needs of this generation of doctors. [ABSTRACT FROM AUTHOR]