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Objective Despite increases in Commonwealth funded general practice (GP) Registrar training positions, workforce trends continue to show geographical maldistribution. This study aimed to identify Registrar attributes which describe a cohort choosing to work in rural practice. Design Cross-sectional self-report questionnaire for socio-demographics, prior training, current training pathway, measures of personality and resilience. Participants and Setting GP Registrars ( N = 452) training in either the general or rural pathways of three Registered Training Providers in three states, or training through the Australian College of Rural and Remote Medicine's independent pathway. Main outcome measure Ordinal logistic regression tested the impact of key variables on the likelihood that Registrars would settle in rural practice. Univariate analysis explored differences between groups and effects of variables. Results A significantly increased interest in rural practice was to found to exist among registrars who were male, identified themselves as being rural, had a partner who identified as being rural, were enrolled in a rural training pathway and had high levels of Cooperativeness. Conclusion We present a discriminating model combining socio-demographics, prior training and personality variables which challenges Australia to rethink Registrar attributes when training for rural general practice. With significant changes about to occur to GP training in Australia, this paper highlights the need for a more holistic approach which considers personal attributes such as Cooperativeness, rural identity and provision of geographically focused rural training pipelines to encourage Registrars to bond to individual rural communities and further develop their personal connectedness to country life and rural medical practice. [ABSTRACT FROM AUTHOR]

Introduction: Baby Boomers are working and living longer than their pre-war counterparts, and are more likely to live in high density urban housing. This paper examines the relationship between housing type, working status and location of residence on health status in Baby Boomers. Methods: We investigated location of residence and housing type in 1009 participants of the Ageing Baby Boomers in Australia (ABBA) Study to identify any predictors of, or correlations between, these variables and health status. Results: Current workers were less likely to report depression than retirees. We found a significantly higher rate of diabetes, obesity and hypertension in retirees than in current workers however rates of obesity, diabetes and hypertension were higher than predicted in current workers. Conclusion: The rates of chronic disease are higher than previous estimates and provide evidence to inform health promotion programs designed to increase physical activity and improve eating habits in baby boomers. [ABSTRACT FROM AUTHOR]

Aim: To examine the associations between self‐efficacy, resilience and healthy ageing among older people who have an acute hospital admission. Design: A cross‐sectional study. Method s : Survey and medical record data were collected from older people on discharge from hospital. The survey measured self‐efficacy with the 6‐item General Self‐Efficacy scale (GSE‐6), resilience with the Brief Resilience Scale (BRS), and healthy ageing with the Selfie Ageing Index (SAI). Medical record data included potential confounders: co‐morbidities, frailty items, previous falls and previous admission in the last 28 days. Multi‐linear regression and Spearman's rank correlation coefficient were used to examine the independent associations between self‐efficacy, resilience and healthy ageing. Results: Responses were received from 143 older people (mean age 79). After adjusting for potential confounders, co‐morbidities (ß = ‐0.08, p = 0.001) remained negatively associated with healthy ageing, while self‐efficacy (ß = 0.03, p = 0.005) and resilience (ß = 0.05, p < 0.001) remained positively associated with healthy ageing (R2 = 0.243). Positive correlations were found between self‐efficacy (ρ = 0.33, p < 0.01), resilience (ρ = 0.38, p < 0.001) and healthy ageing. Positive correlations were also found between self‐efficacy and resilience (ρ = 0.38, p < 0.01). Those with lower self‐efficacy and resilience were more likely to report reduced activities of daily living, mobility, physical activity and mood. Conclusion: Findings indicate that while the number of co‐morbidities have negative consequences for healthy ageing among older people who are hospitalised, the promotion of self‐efficacy and resilience can potentially contribute to healthy ageing within the physical and psychological domains. Implications for Patient Care: Nurses can promote self‐efficacy, which can potentially increase resilience and help to improve self‐management of chronic conditions, functional ability in daily activities, mobility and physical activity and reduce both anxiety and depressive symptoms. Patient Contribution: Participant feedback throughout the data collection process assisted in the evaluation of study methods and data interpretation. This included processes such as assessing selected tools and clarifying the meanings of healthy ageing factors. [ABSTRACT FROM AUTHOR]

Some women who breastfeed will experience complex ongoing difficulties, such as breastfeeding aversion response (BAR). This recently named breastfeeding challenge is defined as feelings of aversion while breastfeeding for the entire time that the child is latched. This study provides the first prevalence data for the experience of BAR in Australian breastfeeding women. A national online survey investigated the breastfeeding experience of Australian women including data on (1) participant demographics, (2) breastfeeding experience with up to four children, (3) breastfeeding challenges and prevalence of BAR, and (4) the value of available breastfeeding support. This study found that of the Australian breastfeeding women who participated (n = 5511), just over one in five self‐identified as having experienced a BAR (n = 1227, 22.6%). Most reported experiencing some breastfeeding challenges, with only 4.5% (n = 247) having had no breastfeeding complications. Importantly, despite these difficulties, 86.9% of the total women in this study rated their overall breastfeeding experience as good (n = 2052, 37.6%), or very good (n = 2690, 49.3%), and 82.5% of those who experience BAR as good (n = 471, 38.7%) or very good (n = 533, 43.8%). BAR reporting was decreased in higher education and income groups. Women who are breastfeeding for the first time are more likely to encounter difficulties with breastfeeding such as BAR. Complications with breastfeeding are pervasive, but women who can overcome breastfeeding issues often report a positive overall breastfeeding experience. Key messages: This national survey of 5511 breastfeeding women in Australia found that one in five reported having experienced a breastfeeding aversion response.There is limited evidence to guide stakeholders in supporting women who experience complex breastfeeding challenges such as breastfeeding aversion responses.Breastfeeding challenges are common for those who breastfeed however women who are supported to manage breastfeeding aversion response report a positive overall breastfeeding experience. [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]

Fruit and vegetable (F&V) consumption is associated with a reduced risk of developing obesity and chronic diseases: however, only one in twenty Australian adults consume F&Vs at the recommended two servings of fruit and five servings of vegetables per day. What and how much people eat is influenced by their social and physical environments. Supermarkets are a key setting influencing food purchases, and as such, they can shape consumption patterns of F&Vs. Implementing effective strategies to increase F&V intake is crucial. The objective of this research was to test if shopper purchasing behaviour can be modified to purchase more F&Vs using social norm nudge messages (prompts) placed in shopping trolleys. Placards giving the message that the majority of shoppers purchased F&Vs at each shop were placed in shopping trolleys. Applying an intervention research design, 30 out of ~100 trolleys were fitted with the placards and shopper purchases were measured by collecting receipts to measure the quantity (kg), total and F&V spending (Australian dollars) for intervention versus control trolleys. We also conducted a short intercept survey that was administered independently from the research study day. Shoppers who selected trolleys with the social norm nudge placards (n = 109) purchased 1.25 kg more F&Vs (Intervention: mean = 5.45 kg, SD = 4.23 kg, 95% CI 4.65 kg, 6.26 kg vs. Control: mean 4.19 kg, SD = 3.75 kg, 95% CI 3.48 kg, 4.90 kg, p = 0.020, Cohen's d = 0.32) and spent an extra $9.10 more on F&Vs compared to shoppers in the control group (n = 109; Intervention: mean = $36.20, SD = $26.30, 95% CI = $31.24, $41.26 vs. Control: mean $27.10, SD = $24.00, 95% CI = $22.50, $31.67, p = 0.008, Cohen's d = 0.36). The social norm nudge placard shows promise in modifying shoppers' purchases to buy more F&Vs. Larger studies are required to elucidate and confirm these findings over the longer term. [ABSTRACT FROM AUTHOR]

Background: The safety of waterbirth is contested because of the lack of evidence from randomized trials and conflicting results. This research assessed the feasibility of a prospective study of waterbirth (trial or cohort). Methods: We conducted a prospective cohort study at an Australian maternity hospital. Eligible women with uncomplicated pregnancies at 36 weeks of gestation were recruited and surveyed about their willingness for randomization. The primary midwife assessed waterbirth eligibility and intention on admission in labor, and onset of second stage. Primary outcomes measured feasibility. Intention‐to‐treat analysis, and per‐protocol analysis, compared clinical outcomes of women and their babies who intended waterbirth and nonwaterbirth at onset of second stage. Results: 1260 participants were recruited; 15% (n = 188) agreed to randomization in a future trial. 550 women were analyzed by intention‐to‐treat analysis: 351 (waterbirth) and 199 (nonwaterbirth). In per‐protocol analysis, 14% (n = 48) were excluded. Women in the waterbirth group were less likely to have amniotomy and more likely to have water immersion and physiological third stage. There were no differences in other measures of maternal morbidity. There were no significant differences between groups for serious neonatal morbidity; four cord avulsions occurred in the waterbirth group with none in the landbirth group. An RCT would need approximately 6000 women to be approached at onset of second stage. Conclusions: A randomized trial of waterbirth compared with nonwaterbirth, powered to detect a difference in serious neonatal morbidity, is unlikely to be feasible. A powered prospective study with intention‐to‐treat analysis at onset of second stage is feasible. [ABSTRACT FROM AUTHOR]

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

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]

Research collaboration is promoted by governments and research funders, but if the relative prevalence and merits of collaboration vary internationally then different national and disciplinary strategies may be needed to promote it. This study compares the team size and field normalized citation impact of research across all 27 Scopus broad fields in the 10 countries with the most journal articles indexed in Scopus 2008–2012. The results show that team size varies substantially by discipline and country, with Japan (4.2) having two‐thirds more authors per article than the United Kingdom (2.5). Solo authorship is rare in China (4%) but common in the United Kingdom (27%). While increasing team size associates with higher citation impact in almost all countries and fields, this association is much weaker in China than elsewhere. There are also field differences in the association between citation impact and collaboration. For example, larger team sizes in the Business, Management & Accounting category do not seem to associate with greater research impact, and for China and India, solo authorship associates with higher citation impact in this field. Overall, there are substantial international and field differences in the extent to which researchers collaborate and the extent to which collaboration associates with higher citation impact. [ABSTRACT FROM AUTHOR]

The impact of university rankings has driven scholars to increase productivity, and expanding collaboration has dramatically changed the publishing patterns in the academic publication system. The aim of this study was to develop a scholar classification scheme from publication patterns in academic science. Classification schemes are ways of describing groups that display different clusters of behaviors, approaches, or perspectives, and useful in the development of typologies. In this research, sample data are selected from three representative universities, considered a leading university, a middle‐tier university, and a noncomprehensive university. A final set of 11,427 effective scholars and their 284,128 journal publication records were used to develop the classification scheme via cluster analysis. The results identify six types of scholars, labeled as: singleton (8%), small‐team low performer (16%), small‐team high performer (17%), big‐team strategist (22%), free‐style follower (21%), and life‐time warrior (17%). These six scholar types demonstrate different approaches to publishing that can be used to understand both individual and research team performance across different institutional settings. Additionally, possible future work was identified that uses the scholar classification scheme to define the behavior for agents in an agent‐based model to simulate the strategic‐behavior‐driven academic publication system. [ABSTRACT FROM AUTHOR]

Background: The measurement and interpretation of patient experience is a distinct dimension of health care quality. The Midwives @ New Group practice Options (M@NGO) randomized control trial of caseload midwifery compared with standard care among women regardless of risk reported both clinical and cost benefits. This study reports participants' perceptions of the quality of antenatal care within caseload midwifery, compared with standard care for women of any risk within that trial. Methods: A trial conducted at two Australian tertiary hospitals randomly assigned participants (1:1) to caseload midwifery or standard care regardless of risk. Women were sent an 89‐question survey at 6 weeks postpartum that included 12 questions relating to pregnancy care. Ten survey questions (including 7‐point Likert scales) were analyzed by intention to treat and illustrated by participant quotes from two free‐text open‐response items. Results: From the 1748 women recruited to the trial, 58% (n = 1017) completed the 6‐week survey. Of those allocated to caseload midwifery, 66% (n = 573) responded, compared with 51% (n = 444) of those allocated to standard care. The survey found women allocated to caseload midwifery perceived a higher level of quality care across every antenatal measure. Notably, those women with identified risk factors reported higher levels of emotional support (aOR 2.52 [95% CI 1.87‐3.39]), quality care (2.94 [2.28‐3.79]), and feeling actively involved in decision‐making (3.21 [2.35‐4.37]). Conclusions: Results from the study show that in addition to the benefits to clinical care and cost demonstrated in the M@NGO trial, caseload midwifery outperforms standard care in perceived quality of pregnancy care regardless of risk. [ABSTRACT FROM AUTHOR]

Abstract: Background: Language outcomes for children with cochlear implants (CIs) vary widely, even for those implanted before 2 years of age. Identifying the main influencing factors that account for some of the variability is important in order to provide information to guide appropriate clinical and intervention services for young children with CIs. However, there is limited research focusing on the predictors of early vocabulary development for children implanted in infancy. Aims: To identify significant predictors of vocabulary (12–15 months post‐implant) for a sample of 33 children with CIs, the majority implanted between 6 and 10 months of age, drawing on predictors of vocabulary reported for children with normal hearing. Of particular interest was the impact of pre‐implant development and use of gestures. Methods & Procedures: Children with severe to profound hearing loss, and no other known disabilities, were recruited from CI clinics in Australia before receiving their CIs. Subscales from the Bayley Scales‐III (receptive and expressive communication, gross and fine motor, and cognition) were used to assess their development at that time. Using the Macarthur–Bates Communicative Development Inventory (Words and Gestures) we documented the children's (1) use of gestures at six data‐collection times 3 months apart; and (2) vocabulary at the last three time points. Time since implant and time to consistent use of the CIs were also included as potential predictors. Data were analysed using generalized linear models, assuming a negative binomial response with a log‐link function. Stepwise variables selection was followed to retain a smaller number of the covariates. Outcomes & Results: A year after implantation, the significant predictors identified for vocabulary were pre‐implant receptive communication and early gesture use. Together with fine motor and cognitive skills, these two variables were also significant predictors of vocabulary 3 months later. With maternal education entered into the models, higher vocabulary scores were significantly associated with higher maternal education 12 months post‐implantation, but not 15 months. Conclusions & Implications: Pre‐implant abilities are important in explaining some variability in the early vocabulary of infants with CIs, together with their use of early gestures post‐implantation. That is, having a non‐verbal means to express a concept can assist in their development of oral vocabulary. Identifying strategies to help develop fine motor skills for infants with CIs, and encouraging their use of gestures to communicate their needs/intentions, are likely to be of benefit. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: The purpose of this study was to determine whether there was an association between dietary patterns and children's academic performance. METHODS: This cross‐sectional study involved 315 children aged 9‐11 years from 26 schools in Australia. Academic performance was measured in 4 domains (reading, writing, numeracy, and language—subdomains: spelling, grammarm and punctuation) using the National Assessment Program in Literacy and Numeracy (NAPLAN). A self‐reported child questionnaire collected dietary intake data. “Core” (healthy) and “noncore” (unhealthy) dietary patterns were derived using principal components analysis. RESULTS: The noncore pattern was associated with lower NAPLAN scores across all academic domains (mean: −12.6, 95% CI: −18.7 to −6.4, r2 = .073, p < .001) except writing, while the core foods pattern was not associated with NAPLAN scores across all domains. When the noncore model was adjusted for sociodemographic covariates (child body mass index, ethnicity, sex, parental education, household income, marital status, mother's employment hours, and number of siblings), the association was attenuated but remained statistically significant (NAPLAN summary score: −8.5, 95% CI −15.0 to −1.9, r2 = .123, p = .011). CONCLUSIONS: Academic performance was deleteriously associated with a nutrient‐poor, energy‐dense diet, yet not associated with a nutritious diet. [ABSTRACT FROM AUTHOR]

Abstract: Stable, long‐term foster care homes are critical to ensuring a safe and nurturing childhood for many children worldwide. Greater foster carer satisfaction is associated with increased carer retention and is therefore critical in securing such stable homes for children. The purpose of this study is to determine which factors associated with foster care agencies contribute to higher levels of foster carer satisfaction. Results from a longitudinal study of 137 foster carers indicate that perceived adequacy of agency support, preplacement training, money to cover placement expenses, and a good match between the carer and the child are predictive of higher foster carer satisfaction. A mediation model further points to the provision of preplacement training as key to ensuring higher levels of satisfaction. Results offer new insights into factors related to foster carer retention and provide guidance to foster care agencies about actions that they can take to maximize the retention of foster carers. [ABSTRACT FROM AUTHOR]

Abstract: Background: As allied health professions change over time to keep up with and reflect a rapidly changing society, it is quite possible that the people attracted to the profession may also change. If this is the case, then knowing this could be critical for future workforce marketing, training and planning. Aims: The aim was to investigate whether the personality of students entering a speech‐language pathology (SLP) program had changed over time and whether there were generational differences in personality. Methods & Procedures: The study used the Big Five personality inventory to consider whether there were differences in the personality in speech–language pathology (SLP) students enrolled in the same regional university in Australia in 2005 and 2016. Outcomes & Results: The results showed there were significant differences between the two groups on the Agreeableness and Extroversion scales. The students who were more Conscientious were also more Confident in their ability to perform as an SLP. Generational differences across the two cohorts were also considered. Conclusions & Implications: SLP is a dynamic profession that is reflected through an evolving scope of practice, increasing utilization of technology and specialization. As careers evolve it is logical that the people attracted to those careers may also shift; as demonstrated here via changes in the personality of SLP students. Understanding the personality of current SLP students and future Generation Z students may assist universities to identify specific skills and experiences students need to be successful in the workforce. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to profile students undertaking placements at University Departments of Rural Health (UDRHs) and investigate factors affecting students' satisfaction and intention to enter rural practice. Design: Cross‐sectional survey comprising 21 core questions used by all UDRHs. Setting: Eleven UDRHs across Australia that support students' placements in regional, rural and remote locations. Participants: Medical, nursing and allied health students who participated in UDRH placements between July 2014 and November 2015 and completed the questionnaire. Main outcome measures: Key dependent variables were placement satisfaction and rural practice intention. Descriptive variables were age, gender, Aboriginal or Torres Strait Islander (ATSI) background, location of placement, healthcare discipline, year of study and type and length of placement. Results: A total of 3328 students responded. The sample was predominantly female (79%), the mean age was 26.0 years and 1.8% identified as ATSI. Most placements (69%) were >2 but ≤12 weeks, 80% were in Modified Monash 3, 4 or 5 geographical locations. Public hospitals and community health made up 63% of placements. Students satisfied with their placement had 2.33 higher odds of rural practice intention. Those satisfied with Indigenous cultural training, workplace supervision, access to education resources and accommodation had higher odds of overall satisfaction and post‐placement rural practice intention. Conclusions: The majority of students were highly satisfied with their placement and the support provided by rural clinicians and the UDRHs. UDRHs are well placed to provide health professional students with highly satisfactory placements that foster rural practice intention. [ABSTRACT FROM AUTHOR]

Background Preterm birth continues to be a major cause of infant morbidity and mortality worldwide, but advances have recently been made in its prediction and prevention. A short cervix (<25 mm) in the second trimester on transvaginal ultrasound scan and fetal fibronectin are important predictive tests. For over ten years, the Preterm Labour Clinic at the Royal Women's Hospital, Melbourne, Australia has provided care for women at high risk of preterm birth, including those with a previous preterm birth, previous cervical surgery, uterine malformation or incidental finding of short cervix at routine ultrasound. The purpose of this study was to review this clinic's outcomes for the first decade. Methods This was a retrospective cohort study of all referrals to the Preterm Labour Clinic during the period 2004-2013 inclusive. Seven hundred and fifty-six cases met the study inclusion criteria of appropriate risk factor, singleton pregnancy, surveillance undertaken and outcome data available. Results The preterm birth rate (<37 weeks) was 21.4%. The rate of preterm birth by year decreased significantly when adjusted for risk ( P = 0.002). A short cervix was diagnosed in 32% of the sample, and positively correlated with lower gestational age at delivery. Fetal fibronectin and serum alkaline phosphatase were independent predictors of preterm birth <34 weeks and <37 weeks. Conclusion The adjusted preterm birth rate at the Royal Women's Hospital's Preterm Labour Clinic has decreased significantly over the decade studied. Positive fetal fibronectin at 26 weeks and elevated serum alkaline phosphatase are independent predictors of preterm birth. [ABSTRACT FROM AUTHOR]

Background and Objective Triclosan/copolymer toothpaste is effective in controlling plaque and gingivitis and in slowing the progression of periodontitis. This study describes its influence on microbiological and clinical outcomes, over a 5-year period, in patients with established cardiovascular disease ( CVD). Material and Methods Four-hundred and thirty-eight patients were recruited from the Cardiovascular Unit at The Prince Charles Hospital, Brisbane, Australia, and randomized to triclosan or placebo groups. Six sites per tooth were examined annually for probing pocket depth and loss of attachment. These outcomes were analysed, using generalized linear modelling, in 381 patients who had measurements from consecutive examinations. Concurrent load of the periodontal pathogens Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Tannerella forsythia and Porphyromonas gingivalis was determined, using quantitative real-time PCR, in 437 patients with baseline plaque samples. Group comparisons were expressed as geometric means. The chi-square test was used to test for differences between the two groups of patients with regard to the proportion of patients with different numbers of bacterial species. Results There was no difference in general health or periodontal status between the groups at baseline. There was a significant reduction in the number of interproximal sites showing loss of attachment between examinations, by 21% on average ( p < 0.01), in the triclosan group compared with the placebo group. The prevalence of patients with F. nucleatum and A. actinomycetemcomitans was high and remained relatively constant throughout the 5 years of the study. In contrast, the prevalence of T. forsythia and P. gingivalis showed more variability; however, there was no significant difference between the groups, at any time point, in the prevalence of any organism. A significant difference in the geometric means for P. gingivalis ( p = 0.01) was seen at years 1 and 4, and for F. nucleatum ( p = 0.01) and in the total bacterial load ( p = 0.03) at year 2; however, these differences were not statistically significant following a Bonferroni correction for multiple comparisons. There was no difference between the groups in the geometric means for each organism at year 5. Conclusion Within the limitations of the study, these data suggest that the use of triclosan/copolymer toothpaste significantly slowed the progression of periodontitis in patients with CVD but that it had little influence on key subgingival periodontopathic bacteria in these patients over the 5 years of the study. [ABSTRACT FROM AUTHOR]

Aim To investigate characteristics associated with screening positive for depressive symptoms among older adults accessing low-vision rehabilitation and eye-care services and to determine client acceptability of depression screening using the Patient Health Questionnaire-2 ( PHQ-2) in these settings. Methods One-hundred and twenty-four older adults (mean = 77.02 years, SD = 9.12) attending low-vision rehabilitation and eye-care services across Australia were screened for depression and invited to complete a telephone-administered questionnaire to determine characteristics associated with depressive symptoms and client acceptability of screening in these settings. Results Thirty-seven per cent ( n = 46/124) of participants screened positive for depressive symptoms, and the majority considered the new depression screening method to be a 'good idea' in vision services (85%). Severe vision loss ( <6/60 in the better eye) was associated with an increased odds of screening positive for depressive symptoms (odds ratio 2.37; 95% confidence interval 1.08-6.70) even after adjusting for potential confounders. Participants who screened positive had a preference for 'talking' therapy or a combination of medication and 'talking therapy' delivered within their own home (73%) or via telephone (67%). Conclusion The PHQ-2 appears to be an acceptable method for depression screening in eye-care settings among older adults. Targeted interventions that incorporate home-based or telephone delivered therapy sessions may improve outcomes for depression in this group. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective While previous studies have shown a link between cigarette smoking and disordered eating (DE), it is less clear whether this association can be explained by attempts to control weight and/or temperament. This study had two aims: to examine weight/shape and DE symptomatology associated with weight control-related smoking and disordered eating; second, to investigate whether temperament-based factors explain the association between compensatory smoking and weight and shape-related characteristics, and disordered eating symptoms. Method Female twins ( N = 1,002) from the Australian Twin Registry, aged 28-39 years, were assessed by interview yielding lifetime diagnostic information of disordered eating and use of cigarette smoking for weight control. Self-report measures of temperament were available. Results Women who had never smoked (50.6%, n = 495) or had smoked for reasons other than weight and shape control (42.5%, n = 415) were generally not differentiated with respect to indicators of disordered eating. Women who smoked for reasons primarily associated with weight and shape control (6.9%, n = 67) had significantly higher levels of disordered eating than non-smokers identified as being higher levels of purging (OR = 4.55, 95% CI = 2.41-8.59) and fasting (OR = 9.32, 94% CI = 4.43-19.90) but not objective binge episodes (OR = 1.69, 95% CI = 0.71-3.99). Of those women diagnosed with lifetime eating disorders, weight-control smokers had higher levels of purging (OR = 4.22, 95% CI = 1.13-15.80) than those who did not. There were no differences in temperament. Discussion Results support co-occurrence of smoking for weight control and purging in both community and clinical groups, and indicate this association is related to weight control and not temperament. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:708-714) [ABSTRACT FROM AUTHOR]

Background/Aims We aimed to assess differences in patient management, and outcomes, of Australian and New Zealand patients admitted with a suspected or confirmed acute coronary syndrome ( ACS). Methods We used comprehensive data from the binational Australia and New Zealand ACS ' SNAPSHOT' audit, acquired on individual patients admitted between 00.00 h on 14 May 2012 to 24.00 h on 27 May 2012. Results There were 4387 patient admissions, 3381 (77%) in Australia and 1006 (23%) in New Zealand; Australian patients were slightly younger (67 vs 69 years, P = 0.0044). Of the 2356 patients with confirmed ACS, Australian patients were at a lower cardiovascular risk with a lower median Global Registry Acute Coronary Events score (147 vs 154 P = 0.0008), but as likely to receive an invasive coronary angiogram (58% vs 54%, P = 0.082), or revascularisation with percutaneous coronary intervention (32% vs 31%, P = 0.92) or coronary artery bypass graft surgery (7.0% vs 5.6%, P = 0.32). Of the 1937 non-segment elevation myocardial infarction/unstable angina pectoris ( NSTEMI/ UAP) patients, Australian patients had a shorter time to angiography (46 h vs 67 h, P < 0.0001). However, at discharge, Australian NSTEMI/ UAP survivors were less likely to receive aspirin (84% vs 89%, P = 0.0079, a second anti-platelet agent (57% vs 63%, P = 0.050) or a beta blocker (67% vs 77%, P = 0.0002). In-hospital death rates were not different (2.7% vs 3.2%, P = 0.55) between Australia and New Zealand. Conclusions Overall more similarities were seen, than differences, in the management of suspected or confirmed ACS patients between Australia and New Zealand. However, in several management areas, both countries could improve the service delivery to this high-risk patient group. [ABSTRACT FROM AUTHOR]

Objective To determine trainee perspectives of the utility of a trainee research project ( TRP) or the coursework pathway ( CP) in completing the Trainee Research Requirement of the ACEM. Methods A survey based on the ACEM learning objectives for research was sent to all trainees and Fellows who had completed or intending to complete the Trainee Research Requirement between 2010 and 2012. Participants were asked to rate the value of the TRP or CP on a scale of 1 to 10 (1 = 'not useful' and 10 = 'invaluable'). In addition, open-ended questions were asked for qualitative assessment. Results Survey response was 142/621 (23%). Most participants had undertaken the CP (113/142, 79%). Median scores were better for the CP compared with the TRP, and when results were dichotomised to scores of 1-5 as being not useful and 6-10 as being useful, a significantly higher proportion of participants rated the CP as being useful across all learning objectives ( P ≤ 0.01). There was a bimodal distribution of scores for TRPs, with a minority of trainees reporting a very poor TRP experience. Cost was the most commonly cited negative aspect of the CP, whereas the TRP was perceived as time consuming and being difficult to attain. Conclusions More ACEM trainees are undertaking the CP compared with a TRP. The CP was associated with better self-reported fulfilment of the ACEM learning objectives for research. There is scope for the ACEM to improve the experience of trainees wishing to undertake their own research projects. [ABSTRACT FROM AUTHOR]

Aim Many older people lead sedentary lives. National Health Survey physical activity prevalence data provide limited coverage of the 'old old' ( ≥75 years). Method The Dynamic Analyses to Optimise Ageing ( DYNOPTA) project's dataset provided physical activity data for 13 420 participants. Physical activity (walking, moderate- and vigorous-intensity activities in the previous week) was measured. Data were weighted and prevalence was calculated. Results The frequency of walking in DYNOPTA was similar to that in the national sample. Walking remained relatively stable until a decline among persons aged 80 years and over; moderate and vigorous activity declined in all but a minority of persons aged 70 years and over. Although DYNOPTA participants reported more physical activity than those in the contemporary national survey, the rates of sedentary behaviour were high. Conclusion We require more information about the 'oldest old' (85 + years). There is great scope for increasing physical activity, even walking, among older people. [ABSTRACT FROM AUTHOR]

Purpose Medical schools worldwide have developed rural primary care immersive experiences to nurture students' interest in future rural careers and address workforce shortages. Few studies have looked at the students who participate in these programs. This study explores personality traits in US and Australian students who undertake rural-focused medical training. Methods A cross-sectional cohort design used the Temperament and Character Inventory to identify levels of the 7 basic dimensions of personality. Data were collected in successive cohorts over 2007-2011. Multivariate analysis compared trait levels between groups and by demographic variables. Findings The majority of the 302 students (US-167; Australia-135) were female, aged 20-29 years and single. A greater proportion of US students reported being partnered, living longest in a small rural/remote community and having a rural background. Significant differences between groups were detected in several traits but effect sizes were small. The personality pattern of the combined sample indicates students with a mature and stable personality high in Self-Directedness, Persistence, and Cooperativeness. Rural background and marital status enhanced this pattern. Conclusions Despite coming from different educational and societal backgrounds, similar personality patterns are evident in US and Australian students who pursue rural medical education. Data provide support for a pattern of traits associated with a rural background and its predictive influence on interest in rural practice. Considering the international expansion of rural longitudinal integrated clerkships, understanding student attributes may assist in identifying strategies to enhance the rural workforce that are relevant across cultures and continents. [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]

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]

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]

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]

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]

Objectives To describe perceptions of medical students and emergency doctors towards careers in emergency medicine ( EM), and to identify influences on career choice. Methods A prospective, cross-sectional questionnaire study was performed in three EDs. The instrument used Likert-type items addressing: factors important in the choice of a career, factors offered by a career in EM, and opinions of EM. EM consultants and registrars and a cohort of final-year medical students participated. Results Overall, 22 consultants, 30 registrars and 164 students completed the questionnaire (77.1% overall response). Student interest in an EM career increased from 10/161 (6.2% [95% CI 3.0-11.1%]) before, to 26/137 (19.0% [95% CI 12.8-26.6%]) after an EM attachment ( P = 0.0014). The highest proportion of students chose work-life balance as being an important factor for career choice (143/163 students, 87.7% [95% CI 81.2-92.6%]). Compared with consultants and registrars, students had negative perceptions about lifestyle factors that EM offered, as well as about the future of the specialty, job security and workplace stress. Some students also preferred careers with opportunities for research, subspecialty practice, and better pay and conditions, yet perceived EM as not offering these factors. Students considered EM as an acute, procedural, public hospital specialty, with diverse patient problems and minimal continuity of care. Smaller proportions of students considered these factors important for career choice. Conclusion Increasing the attractiveness of a career in EM requires changing student perceptions of lifestyle and satisfaction benefits, access to EM subspecialties, increasing ED research, information about job security, and improved work conditions. [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]

Medical Education 2012 Context Education in simulated learning environments (SLEs) has grown rapidly across health care professions, yet no substantive randomised controlled trial (RCT) has investigated whether SLEs can, in part, substitute for traditional clinical education. Methods Participants were physiotherapy students (RCT 1, n = 192; RCT 2, n = 178) from six Australian universities undertaking clinical education in an ambulatory care setting with patients with musculoskeletal disorders. A simulated learning programme was developed as a replica for clinical education in musculoskeletal practice to replace 1 week of a 4-week clinical education placement. Two SLE models were designed. Model 1 provided 1 week in the SLE, followed by 3 weeks in clinical immersion; Model 2 offered training in the SLE in parallel with clinical immersion during the first 2 weeks of the 4-week placement. Two single-blind, multicentre RCTs (RCT 1, Model 1; RCT 2, Model 2) were conducted using a non-inferiority design to determine if the clinical competencies of students part-educated in SLEs would be any worse than those of students educated fully in traditional clinical immersion. The RCTs were conducted simultaneously, but independently. Within each RCT, students were stratified on academic score and randomised to either the SLE group or the control ('Traditional') group, which undertook 4 weeks of traditional clinical immersion. The primary outcome measure was a blinded assessment of student competency conducted over two clinical examinations at week 4 using the Assessment of Physiotherapy Practice (APP) tool. Results Students' achievement of clinical competencies was no worse in the SLE groups than in the Traditional groups in either RCT (Margin [Δ ] ≥ 0.4 difference on APP score; RCT 1: 95% CI − 0.07 to 0.17; RCT 2: 95% CI − 0.11 to 0.16). Conclusions These RCTs provide evidence that clinical education in an SLE can in part (25%) replace clinical time with real patients without compromising students' attainment of the professional competencies required to practise. [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 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]

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: 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]

Objective: Absence or hypoplasia of the nasal bone is commonly reported in Down syndrome fetuses. We define normal ranges and the 2.5th centile for fetal nasal bone length (NBL) in a multiethnic Australian population at 18-20 weeks of gestation. Methods: A prospective cohort study of women attending for a routine anomaly scan. Ethnicity of the patient and their partner was recorded, and the nasal bone was measured three times. Two methods of nasal bone assessment were used to define normal ranges: a single (first) measurement and the mean value of three measurements. Mixed-effects regression models were employed to account for interoperator differences treating sonographers as random effects. Nonparametric methods were used to define the 2.5th centile for gestational age. Results: A total of 1199 women were included with a mean gestational age 19.1 (SD 0.4; range 18-20) weeks. There is significant linear relationship between NBL and gestational age ( P < 0.001). The mean of three nasal bone measurements had a smaller standard deviation than single nasal bone measurements. Nonparametric assessment was used to define the 2.5th centile, which is 4.4 mm at 18 weeks and 5.0 mm at 20 weeks of gestation. Conclusions: This study provides a reference range for fetal NBL at 18-20 weeks of gestation in an unselected multiethnic Australian population. Whilst NBL increases linearly from 18 to 20 weeks, the data are not normally distributed and nonparametric techniques are required to define the 2.5th centile. The mixed-effects model also accounts for variation in sonographer measurements. [ABSTRACT FROM AUTHOR]

To evaluate the proposed revisions to the DSM-IV alcohol use disorder criteria using epidemiological data. Data came from the 1997 Australian National Survey of Mental Health and Well-Being. The sample consisted of 10 641 participants aged 18 years and over. Alcohol use disorders were assessed using a revised version of the CIDI version 2.0. Alcohol use disorders were assessed in all respondents who indicated that they had used alcohol more than 12 times in the previous 12 months ( n = 7746). The proposed introduction of a single alcohol use disorder was supported by confirmatory factor analysis (CFA). DSM-5 criteria were all indicators of a single underlying disorder. Under DSM-5, the prevalence of alcohol use disorders would increase by 61.7% when compared with those diagnosed under DSM-IV. When investigating the most appropriate diagnostic threshold, the 3+ threshold maximized agreement between DSM-IV and DSM-5 diagnoses, and produced similar prevalence estimates to those yielded by DSM-IV. Item response theory (IRT) analyses supported the removal of the legal criterion while provided equivocal results for the craving criterion. Under the proposed DSM-IV revisions for alcohol use disorders, estimates of the prevalence in the general population would increase substantially. Whereas evidence supports some of the revisions such as a single underlying disorder, others such as the 2+ threshold for diagnosis of alcohol use disorder and the inclusion of a 'craving' criterion may be problematic. [ABSTRACT FROM AUTHOR]

Time series analysis has seen limited application in the biomedical Literature. The utility of conventional and advanced time series estimators was explored for intensive care unit (ICU) outcome series. Monthly mean time series, 1993-2006, for hospital mortality, severity-of-illness score (APACHE III), ventilation fraction and patient type (medical and surgical), were generated from the Australia and New Zealand Intensive Care Society adult patient database. Analyses encompassed geographical seasonal mortality patterns, series structural time changes, mortality series volatility using autoregressive moving average and Generalized Autoregressive Conditional Heteroscedasticity models in which predicted variances are updated adaptively, and bivariate and multivariate (vector error correction models) cointegrating relationships between series. The mortality series exhibited marked seasonality, declining mortality trend and substantial autocorrelation beyond 24 lags. Mortality increased in winter months (July-August); the medical series featured annual cycling, whereas the surgical demonstrated long and short (3-4 months) cycling. Series structural breaks were apparent in January 1995 and December 2002. The covariance stationary first-differenced mortality series was consistent with a seasonal autoregressive moving average process; the observed conditional-variance volatility (1993-1995) and residual Autoregressive Conditional Heteroscedasticity effects entailed a Generalized Autoregressive Conditional Heteroscedasticity model, preferred by information criterion and mean model forecast performance. Bivariate cointegration, indicating long-term equilibrium relationships, was established between mortality and severity-of-illness scores at the database level and for categories of ICUs. Multivariate cointegration was demonstrated for {log APACHE III score, log ICU length of stay, ICU mortality and ventilation fraction}. A system approach to understanding series time-dependence may be established using conventional and advanced econometric time series estimators. [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]