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Objective: Living in regional/rural areas can impact outcomes for people with head and neck cancer (HNC). Using a comprehensive state‐wide dataset, the impact of remoteness on key service parameters and outcomes for people with HNC was examined. Methods: Retrospective quantitative analysis of routinely collected data held within the Queensland Oncology Repository. Design: Quantitative methods (descriptive statistics, multivariable logistic regression and geospatial analysis). Setting: All people diagnosed with HNC in Queensland, Australia. Participants: The impact of remoteness was examined in 1991 people (1171 metropolitan, 485 inner‐regional, 335 rural) with HNC cancer diagnosed between 2013 and 2015. Main Outcome Measures: This paper reports key demographics and tumour characteristics (age, gender, socioeconomic status, First Nations status, co‐morbidities, primary tumour site and staging), service use/uptake (treatment rates, attendance at multidisciplinary team review and timing to treatment) and post‐acute outcomes (readmission rates, causes of readmission and 2‐year survival). In addition to this, the distribution of people with HNC across QLD, distances travelled and patterns of readmission were also analysed. Results: Regression analysis revealed remoteness significantly (p < 0.001) impacted access to MDT review, receiving treatment, and time to treatment commencement, but not readmission or 2‐year survival. Reasons for readmission did not differ by remoteness, with dysphagia, nutritional inadequacies, gastrointestinal disorders and fluid imbalance indicated in the majority of readmissions. Rural people were significantly (p < 0.0001) more likely to travel to care and to readmit to a different facility than provided primary treatment. Conclusions: This study provides new insights into the health care disparities for people with HNC residing in regional/rural areas. [ABSTRACT FROM AUTHOR]

Objective To examine the association between residential remoteness and stage of cancer at diagnosis, treatment uptake, and survival within the Australian Indigenous population. Design Systematic review and matched retrospective cohort study. Setting Australia. Participants Systematic review: published papers that included a comparison of cancer stage at diagnosis, treatment uptake, mortality and/or survival for Indigenous people across remoteness categories were identified (n = 181). Fifteen papers (13 studies) were included in the review. Original analyses: new analyses were conducted using data from the Queensland Indigenous Cancer Study (QICS) comparing cancer stage at diagnosis, treatment uptake, and survival for Indigenous cancer patients living in rural/remote areas (n = 627, 66%) and urban areas (n = 329, 34%). Main Outcome Measures Systematic review: Papers were included if there were related to stage of disease at diagnosis, treatment, mortality and survival of cancer. Restrictions were not placed on the outcome measures reported (e.g. standardised mortality ratios versus crude mortality rates). Original analyses: Odds ratios (OR, 95%CI) were used to compare stage of disease and treatment uptake between the two remoteness groups. Treatment uptake (treated/not treated) was analysed using logistic regression analysis. Survival was analysed using Cox proportional hazards regression. The final multivariate models included stage of cancer at diagnosis and area-level socioeconomic status (SEIFA). Results Existing evidence of variation in cancer outcomes for Indigenous people in remote compared with metropolitan areas is limited. While no previous studies have reported on differences in cancer stage and treatment uptake by remoteness within the Indigenous population, the available evidence suggests Indigenous cancer patients are less likely to survive their cancer the further they live from urban centres. New analysis of QICS data indicates that Indigenous cancer patients in rural/remote Queensland were less likely to be diagnosed with localised disease and less likely to receive treatment for their cancer compared to their urban counterparts. Conclusion More research is needed to fully understand geographic differentials in cancer outcomes within the Indigenous population. Knowing how geographical location interacts with Indigenous status can help to identify ways of improving cancer outcomes for Indigenous Australians. [ABSTRACT FROM AUTHOR]

Objective This paper describes the sociodemographic and health-related characteristics of people with chronic disease attending an interprofessional student-assisted clinic in regional Queensland. Design A retrospective review of data collected during the first 10 months of operation of the clinic was conducted. Setting, participants and outcome measures Data was collected on up to 378 patients during an intake appointment at the Capricornia Allied Health Partnership ( CAHP) community-based clinic and compared with normative reference groups where available. Sociodemographic characteristics included age, gender and education level; health-related characteristics included body mass index and hospitalisations in the previous 12 months; and risk factors included prescribed medications, smoking status and general practitioner-diagnosed medical conditions. Results Patients attending the CAHP clinic had a mean number of chronic conditions of 4.9 ± 2.1 per patient, and 97% of patients had multimorbidities. A high level of socioeconomic disadvantage was found in comparison with normative comparison groups based on employment, highest level of schooling completed and the index of social disadvantage. Patients predominantly lived in inner regional areas (76.7%). The most common diagnoses of patients attending the clinic for the first time were hypertension, osteoarthritis, high cholesterol, diabetes and chronic back pain. Conclusions The CAHP clinic offers a unique student-assisted service model for interprofessional management of patients who are socioeconomically disadvantaged, have multimorbid chronic disease and live in regional areas. The description of baseline data in this paper is important to refine clinic services, to guide other chronic disease clinics and to inform future research study designs. [ABSTRACT FROM AUTHOR]

Parental substance misuse has a pervasive impact on family functioning, parenting, and, ultimately, child wellbeing and development. Subsequently, linkages with informal and formal support networks are crucial for ameliorating risk. To facilitate engagement with these families prior to identification in child protection systems, it is vital to understand the factors inhibiting and promoting engagement with informal and formal support. This paper examines how different factors influence informal and formal help‐seeking by alcohol‐misusing parents with regard to parenting and family concerns. Parents reporting alcohol problems in a clinical range (n = 322) were drawn from a representative parent sample (n = 1991). Alcohol‐misusing parents reported low help‐seeking for parenting‐focused support services. The findings particularly highlight the role of age, education, socioeconomic status, ethnicity, parenting stress, empowerment and trust in support services for predicting parents' help‐seeking. 'Examines how different factors influence informal and formal help‐seeking by alcohol‐misusing parents with regard to parenting and family concerns' Key Practitioner Messages: The role of practitioners working in family welfare and child protection services in identifying and facilitating support for alcohol-misusing families is described.Parenting‐focused support services need to be promoted, especially for vulnerable parent populations.Education of service providers along with the wider community is required to foster and increase trust and support uptake before alcohol-misusing families become involved with statutory systems. [ABSTRACT FROM AUTHOR]

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

Aim This study aimed to demonstrate how supervisors and students use their time during the three domains of nutrition and dietetic clinical placement and to what extent patient-care and non-patient activities change during placement compared with pre- and post-placement. Methods A cohort survey design was used with students from two Queensland universities, and their supervisors in 2010. Participants recorded their time use in either a paper-based or an electronic survey. Supervisors' and students' time use was calculated as independent daily means according to time-use categories reported over the length of the placement. Mean daily number of occasions of service, length of occasions of service, project activities and other time use in minutes was reported as productivity output indicators and the data imputed. A linear mixed modelling approach was used to describe the relationship between the stage of placement and time use in minutes. Results Combined students' (n = 21) and supervisors' (n = 29) time use as occasions of service or length of occasions of service in patient-care activities were significantly different pre, during and post placement. On project-based placements in food-service management and community public health nutrition, supervisors' project activity time significantly decreased during placements with students undertaking more time in project activities. Conclusions This study showed students do not reduce occasions of service in patient care, and they enhance project activities in food service and community public health nutrition while on placement. A larger study is required to confirm these results. [ABSTRACT FROM AUTHOR]

Introduction: The WHO estimates the incidence of iron deficiency anaemia in Australia is 25%. However there is considerable variation during pregnancy and in regional areas. Objective: The aim of this investigation is to quantify the incidence of iron deficiency anaemia during pregnancy within Far North Queensland. Design: This is a single‐centre retrospective cohort study. Cairns Hospital is the main referral centre for complex maternity care in Far North Queensland with an estimated population of 280‐000, which includes many people from rural and remote communities and a high proportion who identify as Aboriginal or Torres Strait Islander. This study included all births at the Cairns Hospital in 2018, a total of 2190 deliveries. Findings: The study randomly sampled 551 mothers from the cohort, and the incidence of iron deficiency anaemia was 34.9%. 48.7% of women who identified as Aboriginal or Torres Strait Islander within the region were anaemic. This was significantly higher than an incidence of 28.9% for the rest of the population. Other risk factors include booking appointment after 28‐weeks, Asian ethnicity and age less than 25‐years. A BMI greater than 35 was protective Discussion: This study will inform antenatal care providers within the region and improve obstetric outcomes by increasing awareness. Identifying risk factors will also facilitate prompt treatment and improve maternity care for vulnerable patient groups. On a broader level, the study provides new data to inform population health estimates both nationally and internationally. Conclusion: The incidence of iron deficiency anaemia during pregnancy in Far North Queensland is significantly higher than previous estimates. [ABSTRACT FROM AUTHOR]

Background: Preventative strategies for preterm birth are lacking. Recent evidence proposed COVID‐19 lockdowns may have contributed to changes in preterm birth. Aims: To determine the prevalence of preterm birth and birth outcomes during and after the COVID‐19 lockdown at the Sunshine Coast University Hospital and the overall state of Queensland, Australia. Methods: Retrospective cohort analysis of all births in Queensland including the Sunshine Coast University Hospital, during two epochs, April 1–May 31, 2020 (lockdown) and June 1–July 31, 2020 (post‐lockdown), compared to antecedent calendar‐matched periods in 2018–2019. Prevalence of preterm birth, stillbirth, and late terminations were examined. Results: There were 64 989 births in Queensland from April to July 2018–2020. At the Sunshine Coast University Hospital, there was a significantly higher chance of birth at term during both lockdown (odds ratio (OR) 1.81, 95% CI 1.17, 2.79; P = 0.007) and post‐lockdown (OR 2.01, 95% CI 1.27, 3.18; P = 0.003). At the same centre, prevalence of preterm birth was 5.5% (30/547) during lockdown, compared to 9.1% (100/1095) in previous years, a 40.0% relative reduction (P = 0.016). At this centre during lockdown, emergency caesareans concurrently decreased (P < 0.01) and instrumental vaginal births increased (P < 0.01). In Queensland overall, there was a nonsignificant decrease in the prevalence of preterm birth during lockdown. Conclusions: There is a link between lockdown and a reduction in the prevalence of preterm birth on the Sunshine Coast. The cause is speculative at present, although increased influenza vaccination rates, decreased transmission of infections, and improved air quality may have been favourable in reducing preterm birth. Further research is needed to determine a causal link. [ABSTRACT FROM AUTHOR]

Objective(s): The objective of the study was to validate a clinical aid to guide the assessment and management of a patient's listed beta‐lactam antibiotic allergy for use in rural areas of Australia. Design: Rural generalists, pharmacists and junior doctors completed an online assessment of eight patient case studies using the tool. Setting: The study was conducted in the Southern Downs, QLD. Participants: Twenty‐seven rural generalists, nine pharmacists and eight junior doctors. Main outcome measures: The sensitivity of the selected allergy phenotype and management option for each case study was calculated by profession and overall. Hazardous responses were reported by management category and profession. Results: The sensitivity overall for phenotype selection was 82.4% (95% CI, 78.0–86.2) and for management 88.1% (95% CI, 84.2–91.2). The sensitivity for phenotype selection was lower for junior doctors than other professions 73.4% (95% CI, 60.9–83.7), but did not reach statistical significance (p = 0.08). A total of 10/308 responses for management recommended the least restrictive option of direct delabelling or oral challenge, where the correct answer was skin prick testing or referral to an allergist. Conclusion(s): With further education the tool could be a key component of increased antimicrobial stewardship in rural areas in Australia. [ABSTRACT FROM AUTHOR]

Hospital‐acquired skin tear prevalence is under‐reported; thus, the aim of this study was to analyse skin tear point prevalence and characteristics in a tertiary acute care hospital in Queensland, Australia, over a 10‐year period. All consenting adult inpatients received a full skin inspection and skin tear category, site, cause, treatment, and whether it was documented as hospital‐ or community‐acquired were recorded. Eleven prevalence audits were analysed with a total sample of 3626 patients. An overall pooled prevalence of 8.9% (95% confidence interval [CI] 7.5‐10.4) with an associated hospital‐acquired pooled prevalence of 5.5% (95% CI 4.5‐6.7) was found. In total, 616 skin tears were reported, of which 374 (60.7%) were hospital‐acquired. Over a third of patients (38.7%) had multiple skin tears and most patients (84.8%) with at least one skin tear were aged ≥70 years. The largest proportion of skin tears (40.1%) was those with no skin flap. Of those documented, most were caused by falls or collisions, suggesting combined skin tear and falls prevention strategies may be effective. Over a decade, there was a downward trend in hospital‐acquired skin tear, which is encouraging. Skin tear prevalence is recommended as a measure of care quality with an emphasis on good quality documentation. [ABSTRACT FROM AUTHOR]

Background: Immediate postpartum long‐acting reversible contraception (LARC) has been shown to reduce unintended pregnancy but uptake of this type of contraception in Australia is low compared to European counterparts. Aims: To assess self‐reported continuation rates, complications and satisfaction in patients having immediate postpartum hormonal intrauterine device (IUD) inserted at caesarean section (CS) or after vaginal birth (VB). Materials and methods: Retrospective cohort study of all patients with immediate postpartum hormonal IUD insertion over three years at a tertiary maternity service. Primary outcomes were patient satisfaction, continuation and expulsion rates. Secondary outcomes were reason for discontinuation, patient‐reported complications, attendance for postpartum check with a general practitioner (GP) and rate of unplanned pregnancy. Simple descriptive statistics were used to analyse the data. Results: One hundred and ninety‐three women had a hormonal IUD inserted and 143 consented to involvement (CS n = 79; VB n = 64). Six and 12 months continuation rates for CS were 60.8% and 54.4%, and VB were 46.9% and 39.1%. The most common reasons for removal were: pain (34.5%), heavy or irregular bleeding (25.9%) and partial expulsion (24.1%). Expulsion was more likely after VB (34.1%) than CS (10.1%), (odds ratio 2.72; 95% CI 1.07–6.90; P = 0.036). There were 60.8% of women post‐CS and 56.3% of women post‐VB who were satisfied with their decision to have immediate postpartum insertion and most women attended routine postpartum follow‐up with their GP (89.5%). Conclusion: Immediate postpartum hormonal IUD insertion in this cohort is associated with higher rates of expulsion and lower satisfaction rates compared to those documented in the literature for delayed postpartum insertion cohorts. [ABSTRACT FROM AUTHOR]

Background: A significant barrier to the access of safe abortion is the lack of trained abortion providers. Recent studies show that with appropriate education, nurses and midwives can provide abortions as safely as medical practitioners. Aims: To examine the attitudes and practices of registered midwives (RMs) and sexual health nurses (SHNs) in Queensland toward abortion. Materials and Methods: A cross‐sectional mixed‐methods questionnaire was distributed to RMs and SHNs from the Queensland Nursing and Midwifery Union. Data were described and analysed both quantitatively and qualitatively. Results: There was a 20% response rate (n = 624) to the survey from the overall study population. There were 53.5% who reported they would support the provision of abortion in any situation at all; 7.4% held views based on religion or conscience that would make them completely opposed to abortion. There were 92.9% who felt that education surrounding abortion should be part of the core curriculum for midwifery and/or nursing students in Australia. The qualitative responses demonstrated a variety of views and suggestions regarding the practice of abortion. Conclusions: There was a wide variation in views toward induced abortion from RMs and SHNs in Queensland. While a proportion of respondents opposed abortion in most circumstances, a significant group was in support of abortion in any situation and felt involvement in initiating and/or performing abortion would be within the scope of RMs and SHNs. [ABSTRACT FROM AUTHOR]

Objective: To determine whether after‐hours presentation to EDs is associated with differences in 7‐day and 30‐day mortality. The influence of patient case‐mix and workforce staffing differences are also explored. Methods: We conducted a retrospective observational study of 3.7 million ED episodes across 30 public hospitals in Queensland, Australia during May 2013–September 2015 using routinely collected hospital data linked to hospital staffing data and the death registry. Episodes were categorised as within/after‐hours using time of presentation. Staffing was derived from payroll records and explored by defining 11 staffing ratios. Results: Weekend presentation was slightly more associated (7‐day mortality odds ratio 1.05, 95% confidence interval [CI] 1.01–1.10) or no more associated (30‐day mortality odds ratio 1.01, 95% CI 0.98–1.03) with death than weekday presentation. When weeknights are included in the 'after‐hours' period, odds ratios are smaller, so that after‐hours presentation is no more associated (7‐day mortality odds ratio 1.03, 95% CI 0.99–1.08) or less associated (30‐day mortality odds ratio 0.95, 95% CI 0.93–0.97) with death. No significant after‐hours patient case‐mix differences were observed between weekday and weekend presentations for 7‐day mortality. In other combinations of outcome and after‐hours definition, some differences (especially measures relating to severity of presenting condition) were found. Staffing ratios were not strongly associated with any within/after‐hours differences in ED mortality. Conclusions: After‐hours presentation on the weekend to an ED is associated with higher 7‐day mortality even after controlling for case‐mix. [ABSTRACT FROM AUTHOR]

Background: Multiple micronutrient supplement use in the Australian pregnant population is rising, despite little evidence of benefit in low‐risk women. While some supplement recommendations are grounded in high‐quality evidence, others warrant further investigation. This highlights a research gap regarding appropriate use of supplements during pregnancy in the Australian population. Aims: To describe micronutrient supplement use during pregnancy in the context of current evidence and national recommendations in a population of south‐east Queensland women. Material and Methods: A cross‐sectional observational design was used to examine data gathered from pregnant women aged 16–44 years residing in south‐east Queensland, Australia. Women were recruited to the study between 23 May 2016 and 30 September 2017. Results: Pregnancy multivitamin use was declared by 42% of the cohort, with 26.8% declaring multivitamins in combination with individual micronutrients and 9.8% declaring specific micronutrient supplement use. Nulliparous women were more likely to declare use of supplements than their multiparous peers (adjusted odds ratio (aOR) 1.938, 95% CI 1.053–3.571, P = 0.034); smoking (aOR 2.717, 95% CI 1.011–7.302, P = 0.047) and low socio‐economic status were associated with no supplement use (aOR 2.451, 95% CI 1.010–5.949, P = 0.048). Conclusions: Current recommendations regarding micronutrient supplements throughout pregnancy are based on varying degrees of evidence, resulting in supplement advice of poor cohesion and consistency. Adherence to micronutrient supplement recommendations in the peri‐conception period in this population was poor; second and third trimester supplement use was high. Contemporary empirical research is required to determine what constitutes appropriate supplementation in high‐income regions and the populations they will benefit most. [ABSTRACT FROM AUTHOR]

Aims: Early childhood anaemia, usually attributed to iron deficiency, is associated with persistent detrimental effects on child development. This study investigates the association of anaemia between age six and 23 months with indicators of childhood development at school‐age among children of remote Aboriginal and Torres Strait Islander communities of Far North Queensland. Methods: The triennial Australian Early Development Census (AEDC) encompasses five domains of early childhood development—physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school‐based), communication skills and general knowledge. AEDC 2012 and 2015 assessments were linked with health information for children and their mothers from remote Aboriginal and Torres Strait Islander communities of Far North Queensland. Results: AEDC assessments were available for 250 children who had measurements of haemoglobin recorded at age 6 to 23 months. More children who had had early childhood anaemia (n = 66/143, 46.2%, [37.9%, 54.4%]) were developmentally vulnerable on two or more domains compared to those who had not been anaemic (n = 25/107, 23.4% [15.2%, 31.5%], P <.001). Multivariable analysis confirmed that early childhood anaemia more than doubled the risk of developmental vulnerability (OR 2.2 [1.1, 4.3] P =.020) at school age. Conclusions: Early childhood anaemia is a risk factor for developmental vulnerability at school‐age in this setting. Interventions combining nutrition promotion and multi‐micronutrient food fortification, are effective in prevention of early childhood anaemia. Such interventions could also improve early childhood development and subsequent educational achievement. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine dietary intake and decision‐making in a cohort of pregnant South‐East Queensland women to determine compliance with dietary guidelines and the relationships between dietary intake, decision‐making and birth outcomes. Methods: Pregnant women attending maternity services at participating hospitals reported food frequency and motivations using the Maternal Outcomes and Nutrition Tool, a novel digital instrument. Birth outcomes were sourced from hospital records. A cross‐sectional cohort design was used to examine the data. Results: Analysis demonstrated suboptimal intake of core food groups; meat and alternatives (median [IQR]) (2.6 [2.0‐3.4] serves/day) and grains (3.1 [2.1‐4.1]) fell below recommendations; fruit (3.8 [2.5‐5.3]) and discretionary foods (3.1 [2.1‐4.4]) exceeded them. Hypertensive disorders demonstrated a negative linear relationship with vegetable intake (P =.017). Cultural diversity was significantly associated with decreased birthweight (P =.022) but increased intake of meat and alternatives (3.1 vs 2.6, P <.001) compared to Caucasian women; median intake of meat and alternatives was lower in women who reported smoking in the examined time frame. Smokers were less likely to declare health motives for food selection than non‐smokers; smoking and health were inversely associated with increasing maternal age. Food choice was primarily sensory‐driven. Conclusions: This cohort demonstrated poor adherence to dietary guidelines. Culturally and linguistically diverse women and smokers exhibit dietary behaviours which may contribute to suboptimal birth outcomes; targeted nutrition counselling may improve outcomes in these women. These findings highlight the need for transdisciplinary maternity care and provide a foundation for further research aimed at optimising nutrition‐related birth outcomes in at‐risk groups. [ABSTRACT FROM AUTHOR]

Purpose: Socioecological factors are understudied in relation to trauma patients' outcomes. This study investigated the association of neighborhood socioeconomic disadvantage (SED) and remoteness of residence on acute length of hospital stay days (ALSD) and inpatient mortality. Methods: A retrospective cohort study was conducted on adults hospitalized for major trauma in a Level 1 trauma center in southeast Queensland from 2014 to 2017. Neighborhood SED and remoteness indices were linked to individual patient variables. Step‐wise multivariable negative binomial regression and proportional hazards regression analyses were undertaken, adjusting for injury and patient factors. Outcomes were ALSD and inpatient mortality. Findings: We analyzed 1,025 patients. Statistically significant increased hazard of inpatient mortality was found for older age (HR 3.53, 95% CI: 1.77‐7.11), injury severity (HR 5.27, 95% CI: 2.78‐10.02), remoteness of injury location (HR 1.75, 95% CI: 1.06‐2.09), and mechanisms related to intentional self‐harm or assault (HR 2.72, 95% CI: 1.48‐5.03,). Excess mortality risk was apparent for rural patients sustaining less severe injuries (HR 4.20, 95% CI: 1.35‐13.10). Increased risk for longer ALSD was evident for older age (RR 1.35, 95% CI: 1.07‐1.71), head injury (RR 1.39, 95% CI: 1.19‐1.62), extremity injuries (RR 1.82, 95% CI: 1.55‐2.14), and higher injury severity scores (ISS) (RR 1.51, 95%: CI: 1.29‐1.76). Conclusions: Severely injured rural trauma patients are more likely to be socioeconomically disadvantaged and sustain injuries predisposing them to worse hospital outcomes. Further research is needed to understand more about care pathways and factors influencing the severity, mechanism and clinical consequences of rural‐based traumatic injuries. [ABSTRACT FROM AUTHOR]

Objective: To describe patient presentation characteristics and outcomes for people aged 16–18 years pre, during and post a planned youth mass gathering event (MGE): 'Schoolies week' on the Gold Coast, Queensland, Australia. Methods: This was a retrospective observational study, including patient presentations by all young adults requiring care in the ED or in‐event health services (EHS) over a 21‐day period in 2014. Data analysis included descriptive and inferential statistics. Results: A total of 1029 patient presentations were made by people aged 16–18 years to the ED and EHS over the 21‐day study period (139 pre, 695 during [275 in ED, 420 in EHS], 195 post Schoolies week). Some ED patient characteristics and outcomes varied between the pre, during and post Schoolies periods, such as patients age (P < 0.001), usual place of residence (P < 0.001) and not waiting for treatment (P = 0.015). Of the 24 375 registered MGE attendees, 420 (1.72% [95% confidence interval 1.57–1.89], 17.2/1000) presented for in‐event care. Most patients were allocated an Australasian Triage Scale category of 4 (n = 162, 65.6%), with toxicology related presentations (n = 169, 44.9%). Transportation to hospital was undertaken for seven MGE attendees (0.03% [95% confidence interval 0.01–0.06], 0.3/1000). Conclusions: Establishment of an in‐event model of care for 1 week during Schoolies served as an effective hospital avoidance strategy for a planned youth MGE. Such in‐event models of care may be considered for other similar future MGE. [ABSTRACT FROM AUTHOR]

Aims: To compare long‐term trends in wastewater data with other indicators of stimulant use in three locations and to test the reliability of estimates based on 1 week of sampling. Design: Comparison of trends in quantities ('loads') of stimulants or their metabolites in wastewater with trends in other indicators of stimulant use (e.g. treatment, police, population survey data). Setting and Participants: Populations in Oslo (Norway), South‐East Queensland (Australia) and Eindhoven (the Netherlands). Measurements: Wastewater data were modelled for MDMA (3,4‐methyl​enedioxy​methamphetamine), benzoylecgonine (a metabolite of cocaine), amphetamine and methamphetamine in Oslo; benzoylecgonine in Eindhoven; and methamphetamine in South‐East Queensland. Choice of stimulants modelled in each region was primarily determined by availability of useable data. Findings: In Oslo, wastewater data, driving under the influence of drugs statistics and seizure data all suggested increasing MDMA use between 2009 and 2017. In South‐East Queensland, there was an estimated 31.1% [95% confidence interval (CI) = 29.4–32.9%] annual increase in daily loads of methamphetamine in wastewater between 2009 and 2016, compared with a 14.1% (95% CI = 10.9–17.3%) annual increase in seizures. Some of the increase in wastewater can be explained by increased purity. In Eindhoven, there was no evidence of a change in cocaine consumption from wastewater, but a reduction was observed in numbers in treatment for cocaine use from 2012 to 2017. In approximately half the cases examined in Oslo, credible intervals around estimates of annual average loads from a regression model versus estimates based on a single week of sampling did not overlap. Conclusions: Long‐term trends in loads of stimulants in wastewater appear to be broadly consistent with trends in other indicators of stimulant use in three locations. Wastewater data should be interpreted alongside epidemiological indicators and purity data. One week of wastewater sampling may not be sufficient for valid inference about drug consumption. [ABSTRACT FROM AUTHOR]

Both hip fractures and vitamin D (25‐hydroxyvitamin D (25‐OHD)) deficiency are more common in winter in regions with temperate climates, but few data exist for a sub‐tropical climate. In a South East Queensland tertiary hospital over a 7‐year period, there were significantly more hip fractures in winter than the other three seasons (analysis of variance P = 0.003), with associated higher frequency of 25‐OHD deficiency – 42.5% in winter compared to 28.5% in summer, odds ratio 1.86 (95% confidence interval 1.35–2.56), P = 0.0001. Seasonality of hip fracture and 25‐OHD deficiency occurs even in a sub‐tropical climate. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is associated with significant perinatal morbidity and mortality. The fetal fibronectin test (fFN) is used to manage women presenting with threatened preterm labour (TPTL). Aim: To evaluate the use of fFN in women presenting with TPTL with regard to hospital admission, tertiary hospital transfer and use of tocolytics and steroids in our hospital, against recommended guidelines. The ability of fFN <10 ng/mL, 10–49 ng/mL, 50–199 ng/mL and >200 ng/mL to predict outcome was also examined. Material and Methods: This was a single‐centre retrospective study from January 2015 to June 2017. All women who presented to Ipswich hospital, a level two facility for births at >32 weeks of gestation, between 23 and 346 weeks of gestation with TPTL and who had fFN tests were included in the study. Results: Fetal fibronectin <50 ng/mL had a negative predictive value of 93.5% (95% CI 86.5–97.1). Despite this assurance, one in four presentations resulted in hospital admission and nearly one in ten in steroids and tocolysis administration. Birth <34 weeks was 0% for fFN <10 and 2% for women with fFN levels <200 ng/mL compared to nearly 30% for levels >200 ng/mL. Conclusion: There is noncompliance with use of fFN to its full potential. This small study also provides support for the use of a 200 ng/mL cut‐off fFN level for birth <34 weeks. This would avoid the need to transfer to a tertiary facility many women who present with TPTL. [ABSTRACT FROM AUTHOR]

Wound management in Australia suffers from a lack of adequate coordination and communication between sectors that impacts patient outcomes and costs. Wound Innovations is a specialist service comprising of a transdisciplinary team that aims to streamline and improve patient care and outcomes. We compared patient experiences and outcomes prior to accessing this specialist service, and the 3 months following their enrolment at the clinic. Information on patient experiences, wound history, and outcomes was collected through interviews and a review of medical records for the 12 months prior to enrolment at the clinic. Wound progress, quality of life (QoL) outcomes, and service use were tracked during the 3‐month prospective phase. A sample of 29 participants was recruited. 40% healed completely by 3 months, with the average time to healing being 8 weeks. The average QoL score at baseline was 0.69 (from a score of 1, being best health imaginable). At 3 months, the average QoL score increased significantly to 0.84 (P≤0.001). On average, participants attended the clinic 4.6 times. The average decrease in wound size was 85.4% (95% CI [75.7%, 95%]). Accessing wound care treatment at a specialist, multidisciplinary wound clinic leads to an increase in QoL and access to consistent evidence‐based practices. [ABSTRACT FROM AUTHOR]

Aim Spot-tests of urine pH are claimed to be an accessible biomarker of net acid excretion ( NAE), and as such, they may be able to determine changes in an individual's intake of acid- or base-forming foods. To test this hypothesis, we aimed to determine if spot-tests of urine pH could index NAE and relay the consumption of a fruit and vegetable (F&V) concentrate whilst determining this concentrate's capacity to modulate NAE. Methods In a double blind, placebo-controlled, cross-over trial, healthy adults (n = 13) were allocated by simple randomisation to receive a F&V concentrate or placebo for three days each, with diet standardised throughout. Measurements of 24-hour NAE, 24-hour urine pH and spot-tests of urine pH were taken throughout the study. Results The 24-hour urine pH predicted 24-hour NAE ( P = <0.0001). However, spot-tested urine pH displayed prediction intervals too wide to infer 24-hour NAE and inconsistent ability to reflect concentrate ingestion, despite 24-hour NAE and 24-hour urine pH decreasing (−25.8 mEq, 95% CI −44.3 to −7.4, P = 0.01, d = 0.94) and increasing (+0.51, 95% CI 0.25-0.79, P = 0.002, d = 1.3), respectively, following supplementation. Conclusions Spot-tests of urine pH are not a valid dietary biomarker of daily NAE and were unable to reliably track changes, despite a F&V concentrate clearly modulating the daily rate of NAE. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study was to describe demographic and clinical characteristics including features that were consistent with subarachnoid hemorrhage ( SAH), use of diagnostic tests, emergency department ( ED) discharge diagnoses, and disposition of adult patients presenting with an acute headache to EDs statewide across Queensland, Australia. In addition, potential variations in the presentation and diagnostic workup between principal-referral and city-regional hospitals were examined. Methods A prospective cross-sectional study was conducted over 4 weeks in September 2014. All patients ≥ 18 years presenting to one of 29 public and five private hospital EDs across the state with an acute headache were included. The headache had to be the principal presenting complaint and nontraumatic. The 34 study sites attend to about 90% of all ED presentations statewide. The treating doctor collected clinical information at the time of the ED visit including the characteristics of the headache and investigations performed. A study coordinator retrieved results of investigations, ED discharge diagnoses, and disposition from state databases. Variations in presentation, investigations, and diagnosis between city-regional and principal-referral hospitals were examined. Results There were 847 headache presentations. Median (range) age was 39 (18-92) years, 62% were female, and 31% arrived by ambulance. Headache peaked instantly in 18% and ≤ 1 hour in 44%. It was 'worst ever' in 37%, 10/10 in severity in 23%, and associated with physical activity in 7.4%. Glasgow Coma Scale score was < 15 in 4.1%. Neck stiffness was noted on examination in 4.8%. Neurologic deficit persisting in the ED was found in 6.5%. A computed tomography ( CT) head scan was performed in 38% (318/841, 95% CI = 35% to 41%) and an lumbar puncture in 4.7% (39/832, 95% CI = 3.4% to 6.3%). There were 18 SAH, six intraparenchymal hemorrhages, one subdural hematoma, one newly diagnosed brain metastasis, and two bacterial meningitis. Migraine was diagnosed in 23% and 'primary headache not further specified' in 45%. CT head scans were more likely to be performed in principal-referral hospitals (41%) compared to city-regional hospitals (33%). The headache in patients presenting to the latter was less likely to be instantly peaking or associated with activity, but was no less severe in intensity and was more frequently accompanied by nausea and vomiting. Their diagnosis was more likely to be a benign primary headache. Variations in CT scanning could thus be due to differences in the case mix. The median (interquartile range) ED length of stay was 3.1 (2.2 to 4.5) hours. Patients was discharged from the ED or admitted to the ED short-stay unit prior to discharge in 57 and 23% of cases, respectively. Conclusions The majority of patients had a benign diagnosis, with intracranial hemorrhage and bacterial meningitis accounting for only 3% of the diagnoses. There are variations in the proportion of patients receiving CT head scans between city-regional and principal-referral hospitals. As 38% of headache presentations overall underwent CT scanning, there is scope to rationalize diagnostic testing to rule out life-threatening conditions. [ABSTRACT FROM AUTHOR]

Aim This study aimed to determine factors associated with the implementation by employers of the practice of offering reduced working hours for workers nearing retirement. Methods Data came from a survey of 2000 employers of more than 50 employees each (30% response rate). Results A minority (33%) of employers offered reduced working hours to older workers nearing retirement. Factors associated with offering reduced working hours were: expecting workforce ageing to cause a loss of staff to retirement; being a large employer; being a public/not-for-profit sector employer; not experiencing difficulties recruiting labourers; having a larger proportion of workers aged over 50; experiencing national competition for labour; not experiencing difficulties recruiting machinery operators/drivers; not expecting workforce ageing to increase workplace injuries; and experiencing difficulties with the quality of candidates. Conclusion A minority of employers were found to offer reduced working hours to those nearing retirement. Factors associated with their propensity to do so included industry sector, size of employer, concerns about labour supply and the effects of workforce ageing. [ABSTRACT FROM AUTHOR]

Aims This study aimed to investigate: (i) whether attitudes and beliefs about driving predict older adults' driving self-regulation, and how much variance in self-regulation can be explained by these factors; and (ii) if driving confidence is controlled, whether attitudes and beliefs remain significant independent predictors of driving self-regulation. Method The present study examined the psychosocial factors that underlie driving self-regulation in 277 older adults within Australia. Participants completed standardised questionnaires about their driving, attitudes, belief and use of driving self-regulation. Results Driving confidence, affective and instrumental attitude, and perceived behavioural control were all significant predictors of driving self-regulation. The combination of these factors accounted for 56% of the variance in driving self-regulation. Conclusion Driving self-regulation is a complex behaviour influenced by a wide range of psychosocial factors. Improved understanding of these factors could inform strategies to improve older driver safety and influence the advice that people receive. [ABSTRACT FROM AUTHOR]

People who experience homelessness face many challenges and disadvantages that negatively impact health and well-being and form barriers to achieving stable housing. Further, people who are homeless often have limited social connections and support. Building on previous research that has shown the beneficial effect of group identification on health and well-being, the current study explores the relationship between two social identity processes - multiple group memberships and service identification - and well-being and positive housing outcomes. Measures were collected from 76 participants while they were residing in a homeless accommodation service ( T1) and again 2-4 weeks after leaving the service (or 3 months after T1 if participants had not left the service). Mediation analyses revealed that multiple group memberships and service identification at T1 independently predicted well-being at T2 indirectly, via social support. Further, both social identity processes also indirectly predicted housing outcomes via social support. The implications of these findings are twofold. First, while belonging to multiple social groups may provide a pathway to gaining social support and well-being, group belonging may not necessarily be beneficial to achieve stable housing. Second, fostering identification with homeless services may be particularly important as a source of support that contributes to well-being. [ABSTRACT FROM AUTHOR]

Objectives One out of 50 injury-related presentations to an ED is a transport-related cycling injury. Detailed information about the most frequent mechanism of cycling injuries, sustained injuries and patterns are under-reported. The objective of this research was to examine the pattern of injuries sustained by cyclists at a level 1 trauma centre. Methods A retrospective review of data of injured cyclists admitted and treated at a level 1 trauma centre between 2011 and 2012 evaluated demographic data, mechanism of injury, injury pattern, economic costs and outcome. Results Data of 261 patients (mean age of 39 years) were reviewed, of which 88% was male patients with an average age of 38 years. Non-collision cycling injuries were reported in 55% of cases followed by collisions with other motor vehicles in 25.6% of cases. The mean injury severity score (ISS) was 9, but an ISS ≥ 12 was documented in 24%. Predominantly upper limb injuries (24.8%) were found, followed by injuries to the head and lower limb (each with 16.8%). Traumatic brain and chest injuries were equally seen in 8%. The overall length of stay was 4 days, and survival rate was 98%. Conclusion This current data review reveals that non-collision traffic crashes accounted for the majority of injuries in cyclists treated in this facility, and the upper limb has replaced the head as the most injured body part. With a growing number of cyclists, this information contributes to considerations to improve road safety and trauma management. [ABSTRACT FROM AUTHOR]

Aim The co-occurrence of mental health and substance use disorders adds complexity to already-significant health burdens. This study tests whether mental health disorders group differently across substance use disorder types and compares associations of early factors with the development of differing comorbidities. Design Consecutive antenatal clinic attendees were recruited to the longitudinal Mater-University of Queensland Study of Pregnancy (MUSP). Mother/offspring dyads were followed over 21 years. Setting Mater-Misericordiae Public Hospital, Brisbane, Australia. Participants MUSP offspring with maternal baseline information ( n = 7223), offspring behaviour data at 14 ( n = 4815) and psychiatric diagnoses at 21 ( n = 2575). Measurements The Composite International Diagnostic Interview yielded life-time diagnoses of mental health (MH) and substance use (SU) disorders for offspring, then latent class modelling predicted membership of polydisorder groups. We fitted the resulting estimates in multinomial logistic regression models, adjusting for maternal smoking, drinking and mental health, adolescent drinking, smoking and behaviour and mother-child closeness. Findings Fit indices [Bayesian information criterion (BIC) = 12 415; Akaike information criterion (AIC) = 12 234] from LCA supported a four-class solution: low disorder (73.6%), MH/low SU disorder (10.6%), alcohol/cannabis/low MH disorder (12.2%) and poly SU/moderate MH disorder (3.5%). Adolescent drinking predicted poly SU/MH disorders [odds ratio (OR) = 3.34, 95% confidence interval (CI) = 1.42-7.84], while externalizing predicted membership of both SU disorder groups (ORalcohol/cannabis = 2.04, 95% CI = 1.11-3.75; ORpolysubstance = 2.65, 95% CI = 1.1-6.08). Maternal smoking during pregnancy predicted MH (OR = 1.53, 95% CI = 1.06-2.23) and alcohol/cannabis-use disorders (OR = 1.73; 95% CI = 1.22-2.45). Low maternal warmth predicted mental health disorders only (OR = 2.21, 95% CI = 1.32-3.71). Conclusions Mental health disorders are more likely in young adults with polysubstance use disorders than those with alcohol/cannabis use disorders. Predictors of comorbid mental health/polysubstance use disorders differ from those for alcohol/cannabis use disorders, and are detectable during adolescence. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assess the test–retest reliability, relative validity and responsiveness to change of a 20‐item fat and fibre behaviour questionnaire (FFBQ) compared with a semi‐quantitative food frequency questionnaire (FFQ). Methods: Four hundred thirty‐four primary care patients with type 2 diabetes and/or hypertension were randomised to lifestyle intervention or usual care. Data (FFBQ and FFQ) were collected at baseline and 4 months follow‐up. A subset of usual care participants (n = 27) completed the FFBQ 2 weeks after baseline. FFQ‐measured nutrients included total and saturated fat (percentage of energy; energy‐adjusted grams) and fibre (crude grams; energy‐adjusted grams). The FFBQ was scored as a total, fat and fibre index. Test–retest reliability was assessed by intra‐class correlations (ICCs); relative validity by Pearson's correlations between the FFBQ and FFQ; and responsiveness (mean change in intervention group divided by SD of usual care group change). Results: Test–retest ICCs (95% CI) were 0.87 (0.62, 0.95) for total index, 0.87 (0.69, 0.95) for fat index and 0.89 (0.69, 0.95) for fibre index. Pearson's correlations for fat index ranged from −0.50 to −0.54, and for fibre index from 0.42 to 0.56. Total index had correlations of 0.5–0.6 (or −0.5 to −0.6) with all FFQ‐measured nutrients except crude fibre. The fat index showed similar responsiveness compared with FFQ‐measured fat intake while the fibre index was significantly more responsive than FFQ‐measured fibre. Conclusions: The FFBQ may provide a suitable alternative or adjunct to FFQs for use in intervention trials in adults with chronic diseases, because of its ability to detect changes in dietary behaviours. [ABSTRACT FROM AUTHOR]

Background Dental caries is a multifactorial condition, prevention of which requires comprehensive understanding of both contextual and compositional determinants and their population impact. Aims To investigate contextual and compositional factors associated with the prevalence of dental caries in children and to estimate the population impact of those factors. Methods Children in one Australian state were selected through stratified random sampling selection in 2010-2011. Oral epidemiological examinations provided individual-level outcomes: prevalence of dental caries in the primary (among 5- to 8-year-olds) and permanent dentitions (9- to 14-year-olds). Socioeconomic status, oral health behaviours and practices and dietary patterns were explanatory factors at the individual-level, school-level and area-level fluoridation status. Three-level multilevel multivariable models were sequentially specified for the prevalence of dental caries to estimate prevalence ratios (PR) associated with explanatory factors, adjusting for covariates and between- and within-group variances. Population attributable fraction (PAF) was estimated as the population impact of the statistically significant explanatory factors. Results Data from 2214 5- to 8-year-olds and 3186 9- to 14-year-olds from 207 schools in 16 areas were analysed. The prevalence of dental caries in the primary and the permanent dentitions was 47.1% (43.9-50.4) and 38.8% (36.1-41.6), respectively. The highest prevalence of dental caries was observed in the nonfluoridated areas. In bivariate associations, factors at three levels were associated with prevalence of dental caries. In the full models, children in the nonfluoridated areas had significantly higher prevalence of dental caries [PR for the primary: 1.29 (1.11-1.50); PR for the permanent 1.49 (1.01-2.21)] compared with children in fluoridated areas, controlling for other factors. PAF estimates indicated that lack of water fluoridation attributed to 21% and 31% of primary and permanent dental caries, respectively in this child population. Conclusion A multitude of factors had significant population impact on the prevalence of dental caries in children. Water fluoridation has a significant population impact on dental caries experience in this child population. [ABSTRACT FROM AUTHOR]

Background Gut hormones change with weight loss in adults but are not well studied in obese youth. Objective The primary aim was to evaluate how gut hormones and subjective appetite measure change with dietary weight loss in obese adolescents. Methods Participants were a subset of those taking part in the 'Eat Smart Study'. They were aged 10-17 years with body mass index ( BMI) > 90th centile and were randomized to one of three groups: wait-listed control, structured reduced carbohydrate or structured low-fat dietary intervention for 12 weeks. Outcomes were fasting glucose, insulin, leptin, adiponectin, total amylin, acylated ghrelin, active glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide ( GIP), pancreatic polypeptide ( PP) and total peptide tyrosine-tyrosine. Pre- and postprandial subjective sensations of appetite were assessed using visual analogue scales. Results Of 87 'Eat Smart' participants, 74 participated in this sub-study. The mean (standard deviation) BMI z-score was 2.1 (0.4) in the intervention groups at week 12 compared with 2.2 (0.4) in the control group. Fasting insulin ( P = 0.05) and leptin ( P = 0.03) levels decreased, while adiponectin levels increased ( P = 0.05) in the intervention groups compared with control. The intervention groups were not significantly different from each other. A decrease in BMI z-score at week 12 was associated with decreased fasting insulin ( P < 0.001), homeostatic model of assessment-insulin resistance ( P < 0.001), leptin ( P < 0.001), total amylin ( P = 0.03), GIP ( P = 0.01), PP ( P = 0.02) and increased adiponectin ( P < 0.001). There was no significant difference in appetite sensations. Conclusions Modest weight loss in obese adolescents leads to changes in some adipokines and gut hormones that may favour weight regain. [ABSTRACT FROM AUTHOR]

Background Research has identified associations between serum 25( OH) D and a range of clinical outcomes in chronic kidney disease and wider populations. The present study aimed to investigate vitamin D deficiency/insufficiency in dialysis patients and the relationship with vitamin D intake and sun exposure. Methods A cross-sectional study was used. Participants included 30 peritoneal dialysis (PD) (43.3% male; 56.87 ± 16.16 years) and 26 haemodialysis (HD) (80.8% male; 63.58 ± 15.09 years) patients attending a department of renal medicine. Explanatory variables were usual vitamin D intake from diet/supplements ( IU day−1) and sun exposure (min day−1). Vitamin D intake, sun exposure and ethnic background were assessed by questionnaire. Weight, malnutrition status and routine biochemistry were also assessed. Data were collected during usual department visits. The main outcome measure was serum 25( OH) D (n m). Results Prevalence of inadequate/insufficient vitamin D intake differed between dialysis modality, with 31% and 43% found to be insufficient (<50 n m) and 4% and 33% found to be deficient (<25 n m) in HD and PD patients, respectively ( P < 0.001). In HD patients, there was a correlation between diet and supplemental vitamin D intake and 25( OH)D (ρ = 0.84, P < 0.001) and average sun exposure and 25( OH)D (ρ = 0.50, P < 0.02). There were no associations in PD patients. The results remained significant for vitamin D intake after multiple regression, adjusting for age, gender and sun exposure. Conclusions The results highlight a strong association between vitamin D intake and 25( OH)D in HD but not PD patients, with implications for replacement recommendations. The findings indicate that, even in a sunny climate, many dialysis patients are vitamin D deficient, highlighting the need for exploration of determinants and consequences. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the impact of More Learning for Interns in Emergency ( MoLIE) on clinical documentation in the ED of a large regional hospital. Methods MoLIE was implemented at The Townsville Hospital ( TTH) in 2010, and has since provided ED interns with structured off-floor teaching and a dedicated clinical supervisor. A pre- and post-intervention study was conducted using retrospective medical record review methodology. Charts were selected by identifying all TTH ED patients seen by interns in the period 2008-2011. Two hundred pre-intervention records (2008-2009) and 200 post-intervention records (2010-2011) were reviewed. These were randomly selected following an initial screen by an ED staff specialist. The quality of clinical documentation for five common ED presentations (asthma, chest pain, lacerations, abdominal pain and upper limb fractures) was assessed. For each presentation, documentation quality was scored out of 10 using predefined criteria. An improvement of two or more was thought to be clinically significant. Mean scores for each group were compared using a Student's t-test for independent samples. Results Mean documentation scores (and 95% confidence intervals) were 5.55 (5.17-5.93) in 2008, 5.42 (4.98-5.86) in 2009, 6.37 (5.99-6.75) in 2010 and 6.08 (5.71-6.45) in 2011. There was a statistically but not clinically significant improvement in scores pre- and post-intervention ( P ≤ 0.001). Conclusion The introduction of MoLIE was associated with a small but statistically significant improvement in documentation, despite an 80% increase in intern placements. These results suggest that structured training programmes have potential to improve intern performance while simultaneously enhancing training capacity. The impact on quality of care requires further evaluation. [ABSTRACT FROM AUTHOR]

Aims To compare the incidence, timing and risk factors for substance-related death between Indigenous and non-Indigenous ex-prisoners in Queensland, Australia. Design Retrospective cohort study. Setting All adult prisons in the state of Queensland, Australia, linked to deaths registered in Australia. Participants/cases We obtained records for all adults released from prison in Queensland, Australia from 1 January 1994 to 31 December 2007. Among this cohort of 42 015 individuals we observed 82 315 releases from prison and 2158 deaths in the community by the end of 2007, of which 661 were substance-related deaths. Measurements Incarceration data were obtained from Queensland Corrective Services and linked probabilistically with deaths recorded in the Australian National Death Index. Findings In the first year after release, Indigenous ex-prisoners were more likely to die from alcohol-related causes [hazard ratio ( HR) = 1.9, 95% confidence interval ( CI) = 1.1-3.1)] but less likely to die of drug-related causes ( HR = 0.34, 95% CI = 0.21-0.53) than were non-Indigenous ex-prisoners. Among non-Indigenous prisoners only, the risk of substance-related death was significantly higher in the first 4 weeks [relative risk ( RR) = 5.1, 95% CI = 3.7-6.9] when compared with the risk after 1 year post-release. Most evaluated risk factors for substance-related death were similar for Indigenous and non-Indigenous ex-prisoners; however, the hazard of death increased with age more for Indigenous ex-prisoners ( HR = 1.7 per decade of age, 95% CI = 1.4-2.1) than for non-Indigenous ex-prisoners ( HR = 1.3, 95% CI = 1.2-1.4). Conclusions In Australia, patterns of substance-related death in ex-prisoners differ markedly according to Indigenous status. Efforts to prevent substance-related deaths in ex-prisoners should consider heterogeneity in the target population and tailor responses accordingly. [ABSTRACT FROM AUTHOR]

Despite the availability of a wide range of contraceptive options in Australia, rates of unintended pregnancy remain high. A survey of tertiary students in Far North Queensland in regard to their knowledge of contraceptive methods and services revealed significant deficiencies, suggesting that existing sex education and contraceptive advice services need improving if unplanned pregnancy rates are to be reduced in this population. [ABSTRACT FROM AUTHOR]

Background The economic costs of maternal obesity and underweight have not been described. We aim to assess the effect of maternal underweight and obesity on hospital utilisation and hospital costs. Methods Data from the Queensland Perinatal Data Collection and Queensland Hospital Admitted Patient Data Collection were analysed for 2008. The sample included 37,912 Queensland resident mothers with a singleton pregnancy who gave birth in a public facility. Outcome measures were hospital length of stay ( LOS) and hospital costs accrued during the birth admission and during pre- and postnatal admissions within 90 days of the birth admission. Results There were 1,581 (4.2%) underweight, 17,175 (45.3%) normal weight, 10,155 (26.8%) overweight and 9,001 (23.7%) obese women. Maternal obesity was associated with significantly longer stays although effect sizes were modest (≤0.5 days) and specific to women who delivered vaginally. LOS was significantly higher among babies born to underweight mothers when compared to those born to normal weight women. Maternal obesity was associated with a total increase of $5 million in mothers' hospital costs when compared to those amongst normal weight women; the corresponding figure for underweight mothers was $385,734. The total hospital costs for babies born to underweight women were $1.6 million higher than those born to mothers in the normal weight category. Maternal obesity was not associated with an increase in babies' hospital costs. Conclusions Maternal obesity contributed to an increase in mothers' hospital LOS and hospitalisation costs. Maternal underweight contributed to an increase in babies' hospital costs. [ABSTRACT FROM AUTHOR]

Objective To determine the frequency and nature of intern underperformance as documented on in-training assessment forms. Methods A retrospective review of intern assessment forms from a 2 year period (2009-2010) was conducted at a tertiary referral hospital in Brisbane, Queensland. The frequency of interns assessed as 'requiring substantial assistance' and/or 'requires further development' on mid- or end-of-term assessment forms was determined. Forms were analysed by the clinical rotation, time of year and domain(s) of clinical practice in which underperformance was documented. Results During 2009 and 2010 the overall documented incidence of intern underperformance was 2.4% (95% CI 1.5-3.9%). Clinical rotation in emergency medicine detected significantly more underperformance compared with other rotations ( P < 0.01). Interns predominantly had difficulty with 'clinical judgment and decision-making skills', 'time management skills' and 'teamwork and colleagues' (62.5%, 55% and 32.5% of underperforming assessments, respectively). Time of the year did not affect frequency of underperformance. A proportion of 13.4% (95% CI 9.2-19.0%) of interns working at the institution over the study period received at least one assessment in which underperformance was documented. Seventy-six per cent of those interns who had underperformance identified by mid-term assessment successfully completed the term following remediation. Conclusion The prevalence of underperformance among interns is low, although higher than previously suggested. Emergency medicine detects relatively more interns in difficulty than other rotations. [ABSTRACT FROM AUTHOR]

Background/aim: Driving cessation has been recognised as affecting the health and wellbeing of older people. Further exploration of the impact of driving status on time use, role participation and life satisfaction was required. Methods: A cross-sectional survey of 234 older people (current drivers, retired drivers and people who have never driven) was employed. Time use in the previous week, role participation and life satisfaction were measured and compared between the groups, while controlling for sociodemographic variables (health status, activities of daily living and instrumental activities of daily living status, gender, age and living situation). Results: When compared to current drivers, retired drivers had significantly lower life satisfaction (P = 0.01), fewer present roles (P < 0.0001) and were less likely to participate in volunteer (P = 0.005) and family member roles (P = 0.009). Retired drivers spent less time on social leisure (P = 0.002) and away from home (P = 0.0001), and more time in solitary leisure (P = 0.0001). Comparing the participation of retired drivers with those who had never driven indicated that retired drivers spent significantly less time in volunteer work ( P = 0.009). Conclusions: The findings indicate that older non-drivers may require support for participation and wellbeing. [ABSTRACT FROM AUTHOR]

Aim: To identify the level of uptake of occupational therapists' home environmental audit recommendations by older community dwellers and the factors that contribute to adherence. Methods: Design and setting: Cohort nested within an RCT that compared two models of care for fall prevention located in Brisbane, Australia. Participants: Community-dwelling older people >60 at risk of falls (n = 80). Interventions: An environmental audit and recommendations by an occupational therapist. Results: Of the recommendations made, 55% were completed by 6 months. Increasing number of comorbidities was a significant predictor of adherence with recommendations. Recommendations requiring external providers were more likely to be completed than those relying on the client or family member. Conclusion: Occupational therapists need to consider a wide range of intrinsic and extrinsic factors, which may contribute to adherence with home modifications. [ABSTRACT FROM AUTHOR]

Aim: To examine the psychometric properties of a novel anxiety rating scale, the Geriatric Anxiety Inventory (GAI) in Parkinson's disease (PD). Method: The predictive validity of the GAI was tested against the presence of any DSM-IV anxiety disorders in 58 PD patients using receiver operating curve analysis. The concurrent validity of this scale was also studied against the state half of the Spielberger State Trait Anxiety Inventory (STAI). The internal consistency and test-retest reliability of the GAI were also examined. Results: The GAI displayed good concurrent validity against the STAI and the DSM-IV. It also showed good internal consistency and test-retest reliability. Conclusions: This study suggested that the GAI is an appropriate scale to use in non-demented PD patients. [ABSTRACT FROM AUTHOR]

Objective: The administration of i.v. fluids to children is common in hospital. There are risks associated with fluid therapy, especially iatrogenic hyponatraemia. The objective of this study was to assess the workplace practices and knowledge of tertiary hospital doctors regarding paediatric i.v. fluid prescription. Methods: This is a prospective, questionnaire-based observational study conducted at a 570-bed teaching hospital in June 2009. A convenience sample of doctors ( n= 150), representing all levels of experience and all specialties that regularly prescribe paediatric i.v. fluids, were invited to participate. The main outcome measures consisted of demographical data and the ability to correctly prescribe paediatric fluids measured as 'fluid calculation', 'fluid choice' and 'total' percentage scores based on a percentage score of correctly answered questions using eight clinical scenarios. Results: One hundred and six (71%) doctors returned a completed questionnaire. The great majority of respondents had a method for calculating a fluid bolus and maintenance rates (91% and 97%, respectively). Scenarios involving infants, especially where an increased risk of antidiuretic hormone secretion was possible, were answered poorly. Senior doctors performed better than junior doctors. ED and paediatric doctors performed better than those in other specialities. Conclusions: Most doctors in this Australian tertiary hospital have a correct method for prescribing bolus and maintenance fluid rates. However, the potential for adverse events from i.v. fluid prescription remains. Further education in this area for junior doctors, introduction of standardized guidelines for fluid use and restriction of available fluid choice may reduce the risk of iatrogenic hyponatraemia in children. [ABSTRACT FROM AUTHOR]

Objective: Short-term isolation might occur during pandemic disease or natural disasters. We sought to measure preparedness for short-term isolation in an Australian state during pandemic (H1N1) 2009. Methods: Data were collected as part of the Queensland Social Survey (QSS) 2009. Two questions related to preparedness for 3 days of isolation were incorporated into QSS 2009. Associations between demographic variables and preparedness were analysed using χ2, with P < 0.05 considered statistically significant. Results: Most respondents (93.6%; confidence interval [CI] 92.2-94.9%) would have enough food to last 3 days, but only 53.6% (CI 50.9-56.4%) would have sufficient food and potable water if isolated for 3 days with an interruption in utility services. Subpopulations that were less likely to have sufficient food and potable water reserves for 3 days' isolation without utility services included single people, households with children under 18 years of age, people living in South-East Queensland or urban areas, those with higher levels of education and people employed in health or community service occupations. Conclusions: The majority of Queensland's population consider themselves to have sufficient food supplies to cope with isolation for a period of 3 days. Far fewer would have sufficient reserves if they were isolated for a similar period with an interruption in utility services. The lower level of preparedness among health and community service workers has implications for maintaining the continuity of health services. [ABSTRACT FROM AUTHOR]

Prenatal maternal stress can adversely affect birth outcomes, likely reflecting effects of maternal stress hormones on fetal development. Maternal stress might also induce behavioural changes, such as dietary change, that might influence fetal development. Few studies have documented relationships between stress and dietary change in pregnancy. We analysed stress and dietary change among 222 pregnant women exposed to the 2011 Queensland Floods. We assessed women's objective hardship, subjective distress and cognitive appraisal of the disaster; changes in their diets and their associations with infants' gestational age, weight, length and head circumference at birth, head circumference to birth length ratio (HC/BL) and ponderal index. Greater objective hardship was correlated with more negative dietary change, skipped meals and skipped multivitamins. There were no direct effects of stress or dietary change on birth outcomes. However, we observed an interactive effect of dietary change and exposure timing on head circumference for gestational age (HC for GA) ( p = 0.010) and a similar trend for HC/BL ( p = 0.064). HC for GA and HC/BL were larger among children whose mothers experienced negative changes to their diet in early pregnancy compared with later pregnancy, consistent with a 'head-sparing' response with early gestation exposure. Further analyses indicated that dietary change mediates the relationship between objective hardship because of the floods and these outcomes. This is the first report of relationships among an independent stressor, dietary change and birth outcomes. It highlights another possible mechanism in the relationship between prenatal maternal stress and child development that could guide future research and interventions. [ABSTRACT FROM AUTHOR]