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Objective: This study aimed to describe and compare the proportion of patients classified as an emergency department (ED) mental health presentation under different definitions, including the Australian Institute of Health and Welfare (AIHW) definition. Methods: This retrospective cohort study enrolled all patients that presented to the EDs of a multi-centre Victorian health service between 1 January 2020 and 30 June 2023. Varying definitions of a mental health presentation were applied to each ED attendance, applying the current AIHW definition (using selected diagnosis codes), broader diagnosis-based coding, the presenting complaint recorded at triage and whether the patient was seen by or referred to the emergency psychiatric service (EPS). The proportion of all ED presentations meeting each definition and any overlap between definitions were calculated. The agreement between each definition and the AIHW definition was evaluated using Kappa's coefficient. Results: There were 813,078 presentations to ED of which 34,248 (4.2%) met the AIHW definition for a mental health presentation. Throughout the study, 45,376 (5.6%) patients were seen and/or referred to EPS, and 36,160 (4.4%) patients were allocated a mental health presenting complaint by triage staff. There was moderate interrater agreement between these definitions, with a kappa statistic (95% confidence interval) between the AIHW definition and a mental health presenting complaint recorded at triage of 0.58 (0.58–0.59) and between the AIHW definition and review by EPS of 0.58 (0.57–0.58). Conclusions: The AIHW definition is a conservative measure of ED mental health presentations and may underestimate emergency psychiatry workload in Australian EDs. What is known about this topic? It is unknown whether the Australian Institute of Health and Welfare (AIHW) definition of an emergency department (ED) mental health presentation definition accurately reflects ED mental health workload. What does this paper add? The AIHW definition appears to underestimate the clinical workload related to ED mental health presentations. There is moderate agreement between the AIHW definition and mental health presentations classified according to complaint recorded at triage, or whether the patient is reviewed by psychiatry services. What are the implications for practitioners? Accurate measurement of emergency psychiatry workload should not rely on the AIHW definition alone. [ABSTRACT FROM AUTHOR]

Aim: Partnered Pharmacist Medication Charting (PPMC) in patients admitted under general medical units has been shown to reduce medication errors. The aim of this study is to evaluate the impact of the PPMC model on medication errors in patients admitted under cancer units in Victorian hospitals. Methods: A prospective cohort study comparing cohorts before and after the introduction of PPMC was conducted. This included a 2-month pre-intervention phase and 3-month intervention phase. PPMC was implemented during the intervention phase as new model of care that enabled credentialed pharmacists to chart all admission medications, including pre-admission or new medications and cancer therapies, in collaboration with the admitting medical officer. The proportion of medication charts with at least one error was the primary outcome measure. Results: Seven health services across Victoria were included in the study. The majority of health services were using paper-based prescribing systems for oncology. Of the 547 patients who received standard medical medication charting, 331 (60.5%) had at least one medication error identified compared to 18 out of 416 patients (4.3%) using the PPMC model (p < 0.001). The median (interquartile range) inpatient length of stay was 5 (2.9–10.6) days in pre-intervention and 4.9 (2.9–11) days in intervention (p = 0.88). In the intervention arm, 42 patients had cancer therapy charted by a pharmacist with no errors. Conclusions: PPMC was successfully scaled into cancer units as a collaborative medication safety strategy. The model was associated with significantly lower rates of medication errors, including cancer therapies. PPMC should be adopted more widely in cancer units in Australia. [ABSTRACT FROM AUTHOR]

Aim: To provide an updated description of the rates, trends, and predictors of mortality of individuals with cerebral palsy (CP), born in the Australian state of Victoria between 1970 and 2012. Method: Data were extracted for 4807 individuals (2091 females; 2716 males). The probability of survival to 30th June 2017 was calculated using the Kaplan–Meier method. Mortality rates were calculated per 1000 person‐years using age strata and compared with population mortality rates to produce mortality ratios. Cox proportional hazards regression was used to calculate hazard ratios for selected demographic and clinical characteristics and to estimate the effect of birth epoch on 15‐year survival. Results: There were 666 recorded deaths. Compared to the general population, mortality was higher for all persons with CP and highest for children aged 1 to 15 years (45–62 times). We observed 35% improvement in the probability of survival to 15 years for births in the 2000s relative to the 1970s (hazard ratio 0.65, 95% confidence interval [CI] 0.49, 0.86), but only 4% improvement for the subgroup with complex CP (hazard ratio 0.96, 95% CI 0.69, 1.33). Interpretation: The observed improvements in survival for those born in the 2000s is likely related predominantly to a proportional reduction in complex CP within the cohort. What this paper adds: Length of survival improved for Australians with cerebral palsy (CP) born this millennium.Improved survival was mainly because of a proportional reduction in complex CP.A small improvement in length of survival was seen for children with complex CP. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) can involve patterns of physical, sexual and emotional abuse. Women typically experience physical IPV in combination with emotional IPV, while emotional IPV is often experienced in the absence of other types of IPV. There is very little known about women's experiences of these different types of IPV over time. The primary aim of this paper is to describe patterns in women's individual experiences of physical and/or emotional IPV across the first 10 years of motherhood. Data were drawn from a prospective pregnancy cohort of 1507 first-time mothers in Melbourne, Australia. Emotional, physical, and combined physical and emotional IPV were reported in the first, fourth and tenth year of motherhood using the Composite Abuse Scale. The overall prevalence of each type of IPV remained consistent across the three time-points, with emotional IPV alone being the most prevalent. There was substantial variability in women's experiences of IPV over time and there was no common progression from one type of IPV to another. Women were more likely to report IPV at more than one time-point if they experienced combined physical and emotional IPV, while for women who reported emotional or physical IPV alone this was more likely to be at a single time-point. A number of socio-demographic characteristics in early pregnancy were associated with a higher risk of reporting IPV at all three time-points, including being unemployed (RRR = 3.6; 95% CI: 2.1, 6.2) and being aged 18–24 years (RRR = 3.1; 95% CI: 1.8, 5.4). Knowledge of the variability and persistence of IPV in the first 10 years of motherhood, and factors associated with these experiences, can help tailor effective health and social service responses. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the institutionalization of value-based healthcare (VBHC) in the public healthcare system in the state of Victoria, Australia. Design/methodology/approach: The empirical part of this paper is based on a content analysis of 34 policy and industry-commissioned reports that have guided the development of health-care strategy in Victoria from 1988 to 2020. Findings: This study sheds light on how VBHC in Victoria has been institutionalized over time, through three key phases (centralization, transitioning and digitalization), how the conceptualization of best value has changed in each phase and the implications each phase has presented for other actors in the health-care system. Practical implications: This study highlights the key opportunities and challenges for organizational actors that emerge when a health-care system transitions toward VBHC, and derives implications for vendors, health-care procurement, policymakers and governmental agencies. Originality/value: This study develops a longitudinal analysis that describes the evolution and institutionalization of a VBHC approach in a complex societal system over three decades and highlights the key implications for other organizational stakeholders. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to estimate the public hospital costs associated with primary liver cancer (PLC) in the first and second years following the cancer diagnosis. Methods: This study linked administrative datasets of patients diagnosed with PLC in Victoria, Australia, from January 2008 to December 2015. The health system perspective was adopted to estimate the direct healthcare costs associated with PLC, based on inpatient and emergency costs. Costs were estimated for the first 12 months and 12–24 months after the PLC diagnosis and expressed in 2017 Australian dollars (A$). The cost estimated was then extrapolated nationally. The linear mixed model with a Box–Cox transformation of the costs was used to explore the relationship between costs and patients' sociodemographic and clinical characteristics. Results: For the first 12 months, the total and annual per-patient cost was A$211.4 million and A$63 664, respectively. Costs for the subsequent year were A$49.7 million and A$46 751, respectively. Regarding the cost extrapolation to Australia, the total cost was A$137 million for the first 12 months after notification and A$42.6 million for the period from 12 to 24 months. Higher costs per episode of care were mostly associated with older age, hepatocellular carcinoma type of PLC, metropolitan hospitals, and Asian birth region. Conclusion: This study showed the public hospital admission and emergency costs associated with PLC and the substantial economic burden this cancer has placed on the Australian health system. What is known about the topic? There are limited data on the economic burden of primary liver cancer in Australia. What does this paper add? This study showed the cost in the second year after cancer diagnosis was substantially lower than that of the first year. Higher costs per episode of care were mostly associated with older age, metropolitan hospitals, and Asian birth region. What are the implications for practitioners? Results from this study can be used as a baseline for comparison with other initiatives to mitigate cancer risk factors or inputs for future economic evaluations of cancer surveillance. [ABSTRACT FROM AUTHOR]

Objective: Hospital utilisation research is important in pursuing cost-saving healthcare models. Tonsillectomy is one of the most common paediatric surgeries and the most frequent reason for paediatric hospital readmission. This study aimed to report the government-funded costs of paediatric tonsillectomy in the state of Victoria, Australia, extrapolate costs across Australia, and identify the cost determinants. Methods: A population-based longitudinal study was conducted with a bottom-up costing approach using linked datasets containing all paediatric tonsillectomy and tonsillectomy with adenoidectomy surgeries performed in the state of Victoria between 2010 and 2015. Results: The total average annual cost of tonsillectomy hospitalisation in Victoria was A$21 937 155 with a median admission cost of A$2224 (interquartile range (IQR) 1826–2560). Inflation-adjusted annual tonsillectomy costs increased during 2010–2015 (P < 0.001), not explained by the rising number of surgeries. Hospital readmissions resulted in a total average annual cost of A$1 427 716, with each readmission costing approximately A$2411 (IQR 1936–2732). The most common reason for readmission was haemorrhage, which was associated with the highest total cost. The estimated total annual expenditure of both tonsillectomy and resulting readmissions across Australia was A$126 705 989. Surgical cost in the upper quartile was associated with younger age, male sex, lower socioeconomic status, surgery for reasons other than infection alone, overnight vs day case surgery, public hospitals and metropolitan hospitals. Surgery for obstructed breathing during sleep had the strongest association to high surgical cost. Conclusions: This study highlights the cost of paediatric tonsillectomy and associated hospital readmissions. The study findings will inform healthcare reform and serve as a basis for strategies to optimise patient outcomes while reducing both postoperative complications and costs. What this known about the topic? Tonsillectomy is one of the most common surgeries in childhood and the most frequent reason for paediatric unplanned hospital readmissions. There is growing interest in cost containment and a value-based model of funding. What does this paper add? This is the first study to investigate the economic effect of paediatric tonsillectomy at a national level worldwide. The estimated national annual cost of tonsillectomy was A$126 705 989 and rising. What are the implications for practitioners? These findings will inform healthcare reform that aims to contain costs while optimising patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: There continue to be disparate health outcomes for people who are Aboriginal and Torres Strait Islander. The aim of the present study was to measure whether there were any differences in in-patient experiences between Aboriginal and Torres Strait Islander people and those without an Aboriginal or Torres Strait Islander background. Methods: Random samples of people were invited to complete a survey following admission at the hospitals at Peninsula Health, Victoria, Australia. This survey was based on the Victorian Patient Satisfaction Monitor. Open-ended questions were also asked to gauge perspectives on how the services could better meet needs of Aboriginal and Torres Strait Islander patients. Results: A total of 154 responses was obtained. There were differences between the two groups of participants in the following variables: respect of privacy, representation of culture, assistance with meals and access to a culturally specific worker if needed. This was reflected in thematic analysis, with three main themes identified: (1) interactions with staff; (2) the challenging environment; and (3) not just about me, but my family too. Conclusion: There were systemic differences in in-patient experiences. Healthcare services have a responsibility to make systemic changes to improve the health care of all Australians by understanding and reforming how services can be appropriately delivered. What is known about the topic?: There is a disparity in health outcomes between Aboriginal and Torres Strait Islander Australians and those who do not identify as Aboriginal and/or Torres Strait Islander. In addition, Aboriginal and Torres Strait Islanders have different interactions within healthcare services. Many rural health services have models that aim to deliver culturally appropriate services, but it is unknown whether the same challenges apply for this group of Australians within metropolitan health services. What does this paper add?: This paper identifies the structural supports that are required to help close the gap in health care provision inequality. Many of the key issues identified are not people but system based. Healthcare administrators should consider the factors identified and address these at a whole-of-service level. What are the implications for practitioners?: Many practitioners are aware of the challenges of providing culturally appropriate services. This research raises awareness of how traditional healthcare is not a one size fits all and flexibility is required to improve health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: This paper compares consequences of cannabis use initiated after high school with those of cannabis initiation in adolescence, with estimates of the proportion of adverse consequences accounted for by adult‐onset and adolescent‐onset cannabis users. Methods: A state‐representative sample in Victoria, Australia (n = 1792) participated in a 10‐wave longitudinal study and was followed from age 15 to 35 years. Exposure variable: Patterns of cannabis use across 20 years. Outcomes at age 35: Alcohol use, smoking, illicit drug use, relationship status, financial hardship, depression, anxiety and employment status. Results: Substantially more participants (13.6%) initiated regular use after high school (young‐adult onset) than in adolescence (7.7%, adolescent onset). By the mid‐30s, both young‐adult and adolescent‐onset regular users were more likely than minimal/non‐users (63.5%) to have used other illicit drugs (odds ratio [OR] > 20.4), be a high‐risk alcohol drinker (OR > 3.7), smoked daily (OR > 7.2) and less likely to be in relationships (OR < 0.4). As the prevalence of the young‐adult‐onset group was nearly double of the adolescent‐onset group, it accounted for a higher proportion of adverse consequences than the adolescent‐onset group. Discussion and Conclusions: Cannabis users who began regular use in their teens had poorer later life outcomes than non‐using peers. The larger group who began regular cannabis use after leaving high school accounted for most cannabis‐related harms in adulthood. Given the legalisation of cannabis use in an increasing number of jurisdictions, we should increasingly expect harms from cannabis use to lie in those commencing use in young adulthood. [ABSTRACT FROM AUTHOR]

The Life-Patterns project is a panel-cohort longitudinal study following the life trajectories of 1,908 young people who left school in Victoria in 1991. The project attempts to obtain nuanced pictures of young people's lives in three ways: using a reflexive longitudinal study design, with opportunities for participant feedback and influence on future questionnaire design; using a mix of large-numbers surveying with smaller-numbers in-depth interviewing; and by building ongoing relationships with participants through regular feedback reports on the findings and the impact of the research. The paper uses the example of this project to explore the challenge of participatory approaches to large-numbers longitudinal research. [ABSTRACT FROM AUTHOR]

Background: Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women's satisfaction with care across the maternity continuum.Methods: Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating.Results: Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88% in the caseload group and 74% in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95% CI 2.79, 4.03), intrapartum care (OR 2.14; 95% CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95% CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95% CI 2.64, 3.85).Conclusion: For women at low risk of medical complications, caseload midwifery increases women's satisfaction with antenatal, intrapartum and postpartum care.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN012607000073404 (registration complete 23rd January 2007). [ABSTRACT FROM AUTHOR]

Objective: HealthPathways (HPW) is an international web-based information portal that provides health practitioners with guidelines and referral pathways to specialists and services. The present study explored usage of HPW by general practitioners (GPs) in the Barwon region, south-west Victoria, and any benefits and barriers to its use. Methods: Approximately 421 GPs provide services in 86 clinics across the Barwon region, south-west Victoria and Barwon Health is the public health service providing acute, subacute, residential aged care and community health services to approximately 350 000 people. The present study was a mixed-methods analysis of all GPs in the region, who were invited to complete a survey in two waves (2014 and 2016) and participate in focus groups. Data were survey/questionnaire (fixed response and free text options, analysed with descriptive statistics and content analysis), and focus groups (interview and facilitated group discussion, analysed using the principles of thematic analysis). Results: Most GPs surveyed used HPW and usage increased over time from 2014 to 2016 (67% vs 77% respectively). Junior GPs used HPW more often than the more experienced practitioners. GPs reported that HPW was easy to access and navigate, improved their knowledge of local services, improved their confidence, changed their clinical management and saved them time. Main barriers to use of HPW were: GPs did not think to look at HPW, or simply did not know about it. Conclusions: HPW has the potential to improve patient management and health outcomes, and use of HPW is increasing over time. What is known about the topic?: Initiatives such as HPW are viewed positively by clinicians and have the potential to address challenges at the primary–secondary care interface, specifically, referral to secondary specialists. What does this paper add?: Proof of concept that the ongoing availability of localised HPW for common clinical conditions improves GP usage of HPW and has increased access to HPW as the first source of clinical information. Benefits and barriers to use have been identified. What are the implications for practitioners?: HPW improves knowledge of local services and provides GPs with easy access to referral pathways. [ABSTRACT FROM AUTHOR]

BACKGROUND: Accurate measurement of adherence to prescribed exercise programs is essential. Diaries and self-report rating scales are commonly used, yet little evidence exists to demonstrate their validity and reliability OBJECTIVES: To examine the concurrent validity of adherence to home strengthening exercises measured by (1) exercise diaries and (2) a self-report rating scale, compared to adherence measured using an accelerometer concealed in an ankle cuff weight. Test-retest reliability of the self-report rating scale was also assessed. METHODS: In this clinical measurement study 54 adults aged 45 years or older with self-reported chronic knee pain were prescribed a home quadriceps-strengthening program. Over 12 weeks, participants completed paper exercise diaries and, at appointments every 2 weeks, rated their adherence on an 11-point numeric rating scale. A triaxial accelerometer was concealed in the ankle cuff weight used for exercises. Self-reported adherence rating scale data over each 2-week period were analyzed using descriptive statistics, the Wilcoxon signed-rank test, and a Bland-Altman plot to assess agreement, Spearman correlations for validity and intraclass correlation coefficients for test-retest reliability RESULTS: Exercise adherence was significantly overestimated in diaries during the 12 weeks (diary median, 220 exercises; accelerometer, 176; P<.001) and was moderately correlated with accelerometer data (r = 0.52; 95% confidence interval: 0.25, 0.69). A Bland-Altman plot indicated large between-participant variability in agreement between these measures. Self-reported adherence showed poor to fair correlations with accelerometer data (mean r = 0.23-0.39), and less than acceptable reliability (intraclass correlation coefficient = 0.79; lower 1-sided 95% confidence limit, 0.68). CONCLUSION: Exercise diaries showed questionable validity and variable levels of agreement compared with accelerometer-measured exercise completion. A self-reported adherence rating scale had limited validity and less than acceptable test-retest reliability. [ABSTRACT FROM AUTHOR]

Consumer-directed care (CDC) is increasingly widespread among aged care service options in Organisation for Economic Co-operation and Development (OECD) countries. However, the evidence base regarding the programmatic and contextual factors that affect the outcome of CDC interventions is surprisingly small. This paper reports on a self-directed care approach for older Australians with complex care needs. A multimethods longitudinal comparative cohort study was employed comprising 4 survey tools and 56 semi-structured interviews. Participation rates were around 20%. A total of 185 (98 in the intervention and 87 in the control group) older people and carers were recruited at baseline. Eleven months later, 109 participants (59 in the intervention and 50 in the control group) completed the repeat measure. Attrition rates were around 40%. Data collection occurred between July 2010 and April 2012. The data suggest that intervention group participants were likely to be more satisfied with the way they were treated (P = 0.013), their care options (P = 0.014), the 'say' they had in their care (P < 0.001), the information they received regarding their care (P = 0.012), what they were achieving in life (P = 0.031), that the services changed their view on what could be achieved in life (P = 0.020) and with their standard of living (P = 0.008). The evaluation suggests that while only a very small segment of older people is interested in a voucher or cash option, a substantially larger group would like to have greater say over and more direct access to their care, without, however, assuming administrative and financial responsibilities. The paper concludes that a stepped capacity-building approach to CDC may improve the acceptability of CDC to older people and generate synergies that improve older people's care outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aims of this paper were to report on the global psychosocial functioning of 5-year-old DHH children and examine the risk and protective factors that predict outcomes. Design: A cross-sectional analysis of data collected from a prospective, population-based longitudinal study. Study sample: Parents/caregivers of 356 children completed questionnaires on psychosocial development (CDI, SDQ), functional communication (PEACH) and demographic information. Children completed standardized assessments of non-verbal cognitive ability (WNV) and language (PLS-4). Results: On average, global psychosocial functioning was within the range of typically developing children; however, variability was high and 12% of children had scores that were more than 2 SDs below the norm. Non-verbal cognitive ability, presence of additional disabilities, language and functional communication significantly predicted outcomes. In contrast, type of hearing device, severity of hearing loss and age at intervention did not. Conclusion: The global psychosocial functioning of this cohort of 5-year-old DHH children fell within the range of typically developing children. The findings suggest that spoken language ability and functional communication skills are vital for healthy psychosocial development. [ABSTRACT FROM AUTHOR]

Drawing on data from a prospective pregnancy cohort (N = 1,507), this study examines the relationship between exposure to physical and emotional intimate partner violence (IPV) across the first 10 years of motherhood and women's mental and physical health. A measure of IPV (Composite Abuse Scale) was included at 1, 4, and 10 years postpartum. Past year and prior experiences of IPV were associated with mental and physical health issues at 10 years, both for mothers who had experienced combined IPV and emotional IPV alone. Awareness of the health issues associated with different types of IPV can assist in tailoring responses for women who experience IPV. [ABSTRACT FROM AUTHOR]

This paper reports on preliminary findings of a novel program piloted in 2010 to address rural mental health workforce shortages. The program involved exposing allied health and nursing students from rural backgrounds studying in Melbourne to mental health service employment opportunities in Gippsland.A longitudinal study is underway to evaluate the effect and outcomes of the program and includes surveying participants' interest in rural mental health work through an online questionnaire immediately prior to and following the program; and surveying career decisions at 6 months and yearly intervals. Paired sample t-tests were used to analyse participants' level of interest in rural work (pre-event 4.67 (1.50); post-event 5.93 (0.96); P = 0.001), career in a rural setting (pre-event 4.67 (1.63); post-event 5.67 (1.23); P = 0.006), mental health work (pre-event 4.73 (1.39); post-event 6.07 (0.80); P < 0.000) and rural mental health career (pre-event 4.73 (1.33); post-event 5.80 (1.21); P = 0.002). These findings indicate a significant increase from pre- to post-event and are supported by strong effect sizes suggesting that the program had a significant effect on participant interest in rural mental health work. Longer-term evaluation will determine whether the program influences participant career decisions and thereby addressing mental health workforce shortages in Gippsland. [ABSTRACT FROM AUTHOR]

Aims: To present the results of a region-wide evaluation of Baby Makes 3, a brief relationship education program for first time parents implemented in the maternal and child health setting. Background: The program is designed to utilise the 'teachable moment' provided by the birth of the first child, and strengthen the couple relationship, promoting gender equity and preventing intimate partner violence. The literature contains only a few similar examples, none of which have been implemented on a region-wide scale in a rural context. Participants: First time parents in the Great South Coast Region of Victoria, irrespective of whether they had participated in Baby Makes 3, group facilitators, and other stakeholders involved in the program across the region including maternal and child health nurses. Methods: Interviews were conducted with parents, group facilitators and other stakeholders. Routinely collected surveys completed by parents and group facilitators were also analysed. Data was collected throughout the period April 2013 to August 2015. Findings: Fewer than one-third of new parents in the region participated in Baby Makes 3. Parents, group facilitators and other stakeholders all made suggestions as to how program reach could be improved. These included the need to take account of key components of rural life including farm work and not clashing with sporting activities. Nevertheless, for those who participated, the program was judged highly effective according to both parents and staff. Additionally, parents valued the social interaction generated by the program as an outcome in itself, connected to the value of the program in normalising the challenges they were facing as new parents. Minimal negative effects were identified. Discussion: Transition to parenthood is a time when many parents are open to exploring gender roles and expectations within their relationships, especially in a context in which the challenges of parenting are normalised. However, the implementation of such a program which has been designed in an urban context may require modifications when delivered in a rural area. Conclusion: Parenting programs are just as necessary in rural as in urban contexts. Furthermore, modifying the program to commence prior to the birth of a child further work may improve program reach. What is already known about this topic? * The birth of the first child, has been found in urban settings, to be a time when parents are open to brief interventions which lead to improved awareness, communication skills, attitudes and behaviours supportive of gender equity and a strengthened couple relationship. What this paper adds: * Programs which promote gender equity and respectful relationships are beneficial to new parents in rural areas, but effective implementation requires taking into account the characteristics of local communities. [ABSTRACT FROM AUTHOR]

Background: Possessing a strong cultural identity has been shown to protect against mental health symptoms and buffer distress prompted by discrimination. However, no research to date has explored the protective influences of cultural identity and cultural engagement on violent offending. This paper investigates the relationships between cultural identity/engagement and violent recidivism for a cohort of Australian Indigenous people in custody.Methods: A total of 122 adults from 11 prisons in the state of Victoria completed a semi-structured interview comprising cultural identification and cultural engagement material in custody. All official police charges for violent offences were obtained for participants who were released from custody into the community over a period of 2 years.Results: No meaningful relationship between cultural identity and violent recidivism was identified. However a significant association between cultural engagement and violent recidivism was obtained. Further analyses demonstrated that this relationship was significant only for participants with a strong Indigenous cultural identity. Participants with higher levels of cultural engagement took longer to violently re-offend although this association did not reach significance.Conclusions: For Australian Indigenous people in custody, 'cultural engagement' was significantly associated with non-recidivism. The observed protective impact of cultural engagement is a novel finding in a correctional context. Whereas identity alone did not buffer recidivism directly, it may have had an indirect influence given its relationship with cultural engagement. The findings of the study emphasize the importance of culture for Indigenous people in custody and a greater need for correctional institutions to accommodate Indigenous cultural considerations. [ABSTRACT FROM AUTHOR]

The year 2014 marked the abolition of the Baby Bonus and its replacement with a substantially reduced parenting payment. While often criticised as "middle-class welfare," or publicly denounced due to its purported misuse by disadvantaged mothers, this paper argues that the Baby Bonus provided valuable financial assistance to families experiencing high financial stress. To investigate young women's experience of receiving the Baby Bonus, 19 semistructured interviews were conducted with young mothers in Melbourne who had recently had babies. Many were experiencing financial stress and this payment provided much needed financial support for the basic costs arising from having a baby. Several mothers perceived work as a luxury that was out of reach due to high childcare costs relative to their earning capacity and therefore saw Paid Parental Leave as a further privilege unavailable to them. Our results suggest that while the concerns of policymakers to achieve the best use of scarce resources are critical, it should also be acknowledged that the policy change may have serious implications for many young mothers and may exacerbate disadvantage, and young mothers' sense of alienation, ultimately leading to greater inequalities. [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]

Objective. My Therapy is an allied health guided, co-designed rehabilitation self-management program for residents of aged care facilities. This study aimed to determine the feasibility of implementing My Therapy in a residential aged care setting. Methods. This observational study was conducted on a 30-bed wing, within a 90-bed metropolitan residential aged care facility, attached to a public health service, in Victoria, Australia. Staff and resident data were collected prospectively over 6 weeks (staff focus groups, patient surveys, and audits) to evaluate the feasibility domains of acceptability, reach and demand, practicality, integration, limited efficacy testing and adaptations. Results. Twenty-six residents and five allied health staff (physiotherapy and occupational therapy) participated. My Therapy was acceptable to residents (survey) and staff (focus groups). Via initial My Therapy discussions between the resident and the therapists, to determine goals and resident preferences, My Therapy reached 26 residents (n = 26/26, 100% program reach), with 15 residents subsequently receiving a rehabilitation program (n = 15/26, 58% program demand). The remaining 11 residents did not participate due to resident preference or safety issues (n = 11/26, 42%). Collecting physical function outcome measures for limited efficacy testing was practical, and the cost of My Therapy was AUD$6 per resident per day, suggesting financial integration may be possible. Several adaptations were required, due to limited allied health staff, complex resident goal setting and program co-design. Conclusion. My Therapy has the potential to improve the rehabilitation reach of allied health services in residential aged care. While introducing this low-cost intervention is feasible, adaptations were required for successful implementation. [ABSTRACT FROM AUTHOR]

Objectives: Chinese medicine is a complex domain of theoretical and practical approaches that is being increasingly put under the research spotlight. The "Chinese Medicine in Australia"research project attempted to capture the clinical features of practitioners of Chinese medicine. Participants and Interventions: The project involved a national survey of Chinese medicine professional association members and registered practitioners in the state of Victoria, Australia (n = 655; response rate, 42%-55%) completed in 2012-2013. Design: The content and face validated survey was developed using new and previous workforce survey questions. Results: This paper reports on the workforce and practice characteristics of the survey respondents. Chinese medicine practitioners are highly educated, come from diverse backgrounds, and have chosen to practice predominantly in sole or multipractitioner private practice settings. An interest in the philosophy of Chinese medicine and previous experiences contributed to practitioners' decisions to study and practice Chinese medicine. Incorporating a variety of techniques, practitioners describe themselves as practicing predominantly Chinese acupuncture and herbal medicine. Conclusions: The results from this survey contribute to the understanding of the nature and description of Chinese medicine practice in Australia. [ABSTRACT FROM AUTHOR]

Objective This paper aims to describe cancer survival and examine association between survival and socio-demographic characteristics across Barwon South- Western region ( BSWR) in Victoria, Australia. Design This study is based on the retrospective cohort database of patients accessing oncology services across BSWR. Setting Six rural and three urban hospital settings across the BSWR. Participants The participants were patients who were diagnosed with cancer in 2009. Main outcome measures Overall survival (OS) of participants was the main outcome measure. Results Total of 1778 eligible patients had four-year OS for all cancers combined of 59.7% (95% CI, 57.4-62.0). Improved OS was observed for patients in the upper socio-economic tertile (64.2%; 95% CI, 60.9-67.5) compared to the middle (59.3%; 95% CI, 55.5-63.1) and lowest tertiles (49.6%; 95% CI, 44.2-54.9) ( P < 0.01). On multivariate analyses, higher socio-economic status remained a significant predictor of OS adjusting for gender, remoteness and age ( HR [hazard ratio] 0.81; 95% CI 0.74-0.89; P < 0.01). Remoteness was significantly associated with improved OS after adjusting for age, gender and socio-economic status ( HR 0.86; 95% CI, 0.77-0.97; P = 0.01). Older age ≥70 years compared to <70 years conferred inferior OS ( HR 3.08; 95% CI, 2.64-3.59; P < 0.01). Conclusions Our study confirmed improved survival outcomes for patients of higher socio-economic status and younger age. Future research to explain the unexpected survival benefit in patients who lived in more remote areas should examine factors including the correlation between geographical residence and eventual treatment facility as well as compare the BSWR care model to other regions' approaches. [ABSTRACT FROM AUTHOR]

Rates of gambling and gambling-related harm fluctuate over time, influenced by availability, adaptation and demographic change, among other things. Assessing change is compromised by methodological variation. The main aim of this paper is to assess change in gambling participation and problems in adult Victorians over a 5-year period. Data are from the Victorian Gambling Study (VGS) 2008-2012 (n = 15,000) and the 2003 Victorian Longitudinal Attitudes Survey (n = 8479). An additional aim was to determine the impact of methodological differences on prevalence estimates. Despite gambling availability increasing and more activities being included participation rates declined substantially. Decreases occurred across almost all demographic groups and gambling activities. When adjustments were made for methodological differences there were no significant changes in problem, moderate risk and low risk gambling. Males and people with lower education had higher rates in both surveys. In the latter survey, two groups that experienced large participation reductions, namely young adults and metropolitan residents, emerged as additional groups with higher rates of problem and moderate-risk gambling. Further research is required to discover why overall rates of harm may have plateaued when participation continues to fall and why some groups with reduced participation experience increased harm. The findings suggest that availability and total consumption models are over-simplistic. They further suggest that to be effective prevention programmes will need to extend beyond gambling availability to include interventions directed towards individuals at risk and wider environmental determinants of vulnerability and harm. Additionally this study found that restricting administration of the problem gambling measure to subsets of gamblers generate significantly lower prevalence estimates, implying that many previous surveys under-portray gambling-related harm and that without appropriate adjustment for methodological variation findings cannot be validly compared across studies. [ABSTRACT FROM AUTHOR]

Background: Mastitis is an acute, debilitating condition that occurs in approximately 20 % of breastfeeding women who experience a red, painful breast with fever. This paper describes the factors correlated with mastitis and investigates the presence of Staphylococcus aureus in women who participated in the CASTLE (Candida and Staphylococcus Transmission: Longitudinal Evaluation) study. The CASTLE study was a prospective cohort study which recruited nulliparous women in late pregnancy in two maternity hospitals in Melbourne, Australia in 2009-2011. Methods: Women completed questionnaires at recruitment and six time-points in the first eight weeks postpartum. Postpartum questionnaires asked about incidences of mastitis, nipple damage, milk supply, expressing practices and breastfeeding problems. Nasal and nipple swabs were collected from mothers and babies, as well as breast milk samples. All samples were cultured for S. aureus. "Time at risk" of mastitis was defined as days between birth and first occurrence of mastitis (for women who developed mastitis) and days between birth and the last study time-point (for women who did not develop mastitis). Risk factors for incidence of mastitis occurring during the time at risk (Incident Rate Ratios [IRR]) were investigated using a discrete version of the multivariable proportional hazards regression model. Results: Twenty percent (70/346) of participants developed mastitis. Women had an increased risk of developing mastitis if they reported nipple damage (IRR 2.17, 95 % CI 1.21, 3.91), over-supply of breast milk (IRR 2.60, 95 % CI 1.58, 4.29), nipple shield use (IRR 2.93, 95 % CI 1.72, 5.01) or expressing several times a day (IRR 1.64, 95 % CI 1.01, 2.68). The presence of S. aureus on the nipple (IRR 1.72, 95 % CI 1.04, 2.85) or in milk (IRR 1.78, 95 % CI 1.08, 2.92) also increased the risk of developing mastitis. Conclusions: Nipple damage, over-supply of breast milk, use of nipple shields and the presence of S. aureus on the nipple or in breast milk increased the mastitis risk in our prospective cohort study sample. Reducing nipple damage may help reduce maternal breast infections. [ABSTRACT FROM AUTHOR]

In the disaster literature, psycho-social recovery is conceptualised typically as the alleviation of traumatic stress, with the alleviation of disaster-related grief as a less prominent part of this. Yet, incorporating grief understandings into recovery conceptualisations post disaster is important. This paper explores these conceptualisations by analysing participants' bereavement experiences following the Black Saturday bushfires. It draws on data from Beyond Bushfires, a mixed-methods study (n = 1,016) in which survey and interview data relating to individual loss and recovery experiences were examined. The loss through death of friends and community members was found to be predictive of poorer mental health outcomes, although prolonged grief outcomes were rare. The sense of relationships as being 'like family' was identified by interviewees as an important dimension of their particular communities, as was coping with multiple deaths and the hierarchy of grief that emerged, and the stress of notifying others of these deaths. The implications of these impacts are considered for social work research and practice. [ABSTRACT FROM AUTHOR]

Purpose – Women with mental illness, substance-dependence or dual diagnosis are at increased risk of losing care of their children which leads to poorer outcomes for mothers. The purpose of this paper is to explore the service response to substance-dependent mothers, many of whom had a dual diagnosis, and reports outcomes for their infants from the perinatal period to the end of each infant's first year. Design/methodology/approach – This was a longitudinal case study of 20 women substance-dependent women and their associated care. Semi-structured interviews were held with mothers recruited from a specialist alcohol and other drug obstetric service at infant age six weeks, six and 12 months. Structured interviews were also held with counsellors from the obstetric service at infant age six weeks. Child protection (CP) workers were interviewed at infant age six weeks, six and 12 months regarding mothers involved with the service. Findings – By 12-month follow-up, CP services had been involved with 14 mothers and eight had lost the legal care of their infant. Mothers who retained legal care were more likely to have addressed their drug use and less likely to be in a domestically violent relationship. Domestic violence, homelessness and maternal recidivism to crime tipped the scales in favour of protection of the infant through removal from maternal care, essentially leaving mothers with minimal support for reunification and reduced incentive for treatment. Research limitations/implications – Reliance on mothers’ self-reports was a limitation of the study. The small sample size restricts generalisability of findings. Practical implications – Key workers should engage women (and their partners) during the perinatal period to provide support, advocacy and case-management to enable substance-dependent mothers to safely parent. Originality/value – This is one of few studies to report long-term outcomes for mother/infant dyads when substance-dependence and/or mental health are present that allows women to speak for themselves. The prospective design provides a contemporaneous account of events as they unfolded in situ. [ABSTRACT FROM AUTHOR]

This paper describes how a complex meal provision system in an acute hospital setting supports clinical decision-making in dysphagia management at the ward level. The aim was to reduce the number of incorrect texture modified diet and/or fluids delivered to patients with dysphagia. A process map of the meal provision system at The Austin Hospital was revised and an auditing tool created for the purposes of this study. This auditing tool comprised nine key parameters in the meal provision process for texture modified diet/fluids. An audit was conducted across eleven acute wards over three breakfast, lunch and dinner meals over four non-consecutive days. Following analysis of the audit, focus groups were held with seven speech pathologists, four nurse unit managers and the food services coordinators. Audit results, barriers to achieving higher accuracy across auditing parameters and areas for intervention were discussed in these groups. Intervention was three-fold: targeting safe swallowing bed-signs, and supervision of the plating line and in the re-therm trolley room. Three and a half months after the first audit and implementation of the interventions, a subsequent audit was conducted on six acute wards over two breakfast and lunch meals on two consecutive days. Overall reductions in the number of delivered meals of incorrect texture were noted between the initial audit and the subsequent audit results. [ABSTRACT FROM AUTHOR]

Background This paper explores how group home staff in Victoria, Australia, responded to residents with an intellectual disability (ID) as residents developed age-related health conditions. Method The analysis was based on a longitudinal study that followed 17 ageing group home residents over a 3-year period. Eighty-three interviews were conducted with 30 group home staff in 17 group homes. Dimensional analysis, a variant of grounded theory, guided data collection and analysis. Results Findings revealed that the organisations all had systems in place to address health issues. However, the results also suggest an inability of staff to differentiate between significant health conditions and normal age-related changes, thus contributing to delays in care for serious medical conditions. Conclusions Lack of knowledge about normal ageing and an absence of organisational policies influence timeliness of diagnosis and treatment for people with ID. Group home staff could be more effective advocates for older residents, leading to improvements in health outcomes, if they had basic knowledge about normal ageing and symptoms of common age-related illnesses and if group home agencies provided clearer guidance to their staff. The study has implications for staff education and organisational policy development for group homes. [ABSTRACT FROM AUTHOR]

Background: As frontline healthcare workers, there is a growing expectation that nurses should be able to respond to disclosures of family violence. However, the profession and hospital systems have been slow to respond with clear skills, knowledge and confidence deficits identified in existing research. There is limited research which has robustly evaluated the effectiveness of in‐depth, multifaceted training on readiness to respond among nurses. Aim: To longitudinally evaluate the effectiveness of an in‐depth family violence training intervention on confidence, knowledge and clinical skills of nurses working in a large tertiary adult hospital. Design: Single‐centre, longitudinal intervention study. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross‐sectional guidelines were used. Methods: One hundred and ten nursing clinicians participated in this study to complete a comprehensive evidence‐based model of healthcare workers response for assisting patients experiencing family violence. A mixed methods survey was used to assess change in knowledge, confidence and clinical skills among participants. Outcome assessment was electronically undertaken at baseline, 6–9 months and 12–15 months following intervention. Results: Statistically significant improvement was seen in self‐reported knowledge, confidence and frequency of screening for family violence. Relative to baseline estimates, these improvements were identified 6–9 months and 12–15 months following intervention; albeit with consideration to the visually observed trend of skill reversion at follow‐up. Quantitative findings were paralleled by qualitatively identified improvements in the recognition of the intersectional nature of violence, need for patient collaboration in screening and depth in considerations around how family violence is screened for. Conclusions: Findings provide tentative support for the utility of a multidimensional training approach to improving nurses' readiness to respond to disclosures of family violence. Relevance to clinical practice: This study provides preliminary support for multidimensional, evidence‐based training to effectively improve nurses' confidence, knowledge and clinical skills required for responding to family violence. Reporting Method: The study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (SQUIRE) Statement: guidelines for reporting observational studies (see Table S1). Patient Contribution: Patients were involved in the initial design of the survey tool. This involvement came through the Allied Health Consumer panel and included input on the design and question wording of the survey items. [ABSTRACT FROM AUTHOR]

Purpose: The present study examines differences in the characteristics and recidivism risk of young people reported to police for family violence (FV) with a history of prior offending (generalists) and those only known to police for using FV (family-only). Method: A population-based cohort of youth aged 10–24 years (N = 5014) who were reported to police for using FV over a four-month period in 2019 was examined and FV-related risk and need data extracted, with a six-month follow-up period for further police-reported FV. All data was extracted from police databases. Logistic regression with odds ratios as a measure of effect size were used to compare generalist and family-only cohorts. Cox proportional hazards were used to assess time to FV recidivism among the two cohorts, and to assess whether diversity of prior offending was associated with risk of FV recidivism among generalist youth. Results: Generalists were more likely than family-only youth to be recorded as using FV in a high severity FV incident, be abusive across multiple relationships, and breach court orders. Generalists experienced a greater level of need and were more likely to engage in FV recidivism, and do so more quickly, than family-only youth. Diversity of prior offending among generalists was positively associated with risk of FV recidivism. Conclusion: Compared to family-only youth, generalists represent a higher risk cohort with a greater level of need. History of prior offending among young people may be a simple and efficacious means of prioritising higher risk youth who use FV. [ABSTRACT FROM AUTHOR]

Background: Typically a large amount of information is collected during healthcare research and this information needs to be organised in a way that will make it manageable and to facilitate clear reporting. The Chiropractic Observation and Analysis STudy (COAST) was a cross sectional observational study that described the clinical practices of chiropractors in Victoria, Australia. To code chiropractic encounters COAST used the International Classification of Primary Care (ICPC-2) with the PLUS general practice clinical terminology to code chiropractic encounters. This paper describes the process by which a chiropractic-profession specific terminology was developed for use in research by expanding the current ICPC-2 PLUS system. Methods: The coder referred to the ICPC-2 PLUS system when coding chiropractor recorded encounter details (reasons for encounter, diagnoses/problems and processes of care). The coder used rules and conventions supplied by the Family Medicine Research Unit at the University of Sydney, the developers of the PLUS system. New chiropractic specific terms and codes were created when a relevant term was not available in ICPC-2 PLUS. Results: Information was collected from 52 chiropractors who documented 4,464 chiropractor-patient encounters. During the study, 6,225 reasons for encounter and 6,491 diagnoses/problems were documented, coded and analysed; 169 new chiropractic specific terms were added to the ICPC-2 PLUS terminology list. Most new terms were allocated to diagnoses/problems, with reasons for encounter generally well covered in the original ICPC 2 PLUS terminology: 3,074 of the 6,491 (47%) diagnoses/problems and 274 of the 6,225 (4%) reasons for encounter recorded during encounters were coded to a new term. Twenty nine new terms (17%) represented chiropractic processes of care. Conclusion: While existing ICPC-2 PLUS terminology could not fully represent chiropractic practice, adding terms specific to chiropractic enabled coding of a large number of chiropractic encounters at the desired level. Further, the new system attempted to record the diversity among chiropractic encounters while enabling generalisation for reporting where required. COAST is ongoing, and as such, any further encounters received from chiropractors will enable addition and refinement of ICPC-2 PLUS (Chiro). More research is needed into the diagnosis/problem descriptions used by chiropractors. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to investigate the change in the relationship between play, language and social skills of children aged 5-8 years pre and post participation in the "Learn to Play" program. The Learn to Play program is a child led play based intervention aimed at developing self-initiated pretend play skills in children. Methods: All 19 participants attended a specialist school, with 10 of the 19 children having a diagnosis of autism. The play, language and social skills of the children were assessed at baseline and at follow up. Children were assessed using the Child-Initiated Pretend Play Assessment, the Preschool Language Scale and the Penn Interactive Peer Play Scale. Follow up data collection occurred after the children had been participating in the Learn to Play program for 1 hour twice a week for 6 months. Results: After 6 months in the program, typical indicators of play accounted for an increase of 47.3% in shared variance with social interaction and an increase of 36% in shared variance for social connection. For language, object substitution ability accounted for 50% of the shared variance, which was an increase of 27% from baseline. Conclusion: The "Learn to Play" program was associated with increases in children's language and social skills over a 6-month period within a special school setting, indicating the Learn to Play program is an effective intervention for children with developmental disabilities. This paper presents an example of how the Learn to Play program can be adapted into a classroom setting. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to describe the implementation of a depression screening and referral tool in two cardiac wards of a major metropolitan public hospital. The tool consisted of two sections: (1) screening for depression risk (Cardiac Depression Scale-5) and (2) consequential referral actions. Background. Prior research has shown that depression in patients with heart disease is associated with significantly impaired quality of life, decreased medication adherence, increased morbidity and increased use of healthcare services. Design. A prospective in-patient study design. Method. A consecutive sample of 202 patients admitted to either the cardiac medical ( n = 145) or surgical ( n = 57) wards of a major Melbourne metropolitan hospital were recruited into the study over an 18-week period. Results. Just over half (54%) of the patients were identified as 'at risk' of depression. Of these, 19% were assessed as moderate risk and 35% high risk. Of those patients, 91% had the risk score documented in their medical history, 90% had engaged in discussions with clinicians regarding their risk score, 85% had their risk score communicated formally to the medical team and 25% were formally referred for appropriate follow-up - significantly more than prior to implementation of the screening and referral tool. Conclusions. By providing a formalised mechanism for detecting depression, documented screening and referral rates improved for those with comorbid depression and heart disease affording an opportunity for early intervention. These findings support a move towards integrated approaches to screening of depression to become standard practice in the acute cardiac setting. Relevance to clinical practice. Such mechanisms also have the potential to initiate the development of new models of care that acknowledge the complexity of comorbid depression and heart disease and provide pathways from speciality to primary care which integrate the physical and psychosocial domains inclusive of screening, referral, systematic monitoring and streamlined behavioural and physical care. [ABSTRACT FROM AUTHOR]

The existence and provision of emergency relief remains one of the more contentious aspects of poverty relief in Australia. This is largely due to a fundamental difference of opinion within government and the welfare sector about how to best tackle the financial hardship being experienced by people in need. Some contend that emergency relief should be expanded and better funded by the Commonwealth, whereas others believe it should be discontinued altogether and replaced by more generous social welfare payments. This debate continues unresolved for a number of reasons, including a lack of reliable and comprehensive data on who uses emergency relief in Australia and why. This paper reports on a State-wide investigation undertaken of emergency relief use in Victoria between 2007 and 2008. It has found that existing social welfare recipients—especially those on the disability support pension, parenting payment, and Newstart allowance—are the main users of emergency relief, who are living in households headed by a single adult, and forced to rent housing in the private sector. A disaggregation of the findings over both time and spatial regions of Victoria suggests that the level of need is not uniform. Several recommendations are offered to address the financial hardship that some people living in differing parts of Victoria face on an ongoing basis. [ABSTRACT FROM PUBLISHER]

To support self-management, health professionals need to adopt a client-centred approach and learn to deliver evidence-based behaviour change interventions. This paper reports on the evaluation of 1- and 2-day training programs developed to improve health professionals' capacity to support chronic disease self-management (CDSM). he 321 participants attended one of eighteen supporting CDSM courses held in urban and rural settings. Participants included nurses, allied health professionals, Aboriginal health workers and general practitioners. Data were collected at three time points: before participation; immediately after the training; and, for a sub-sample of 37 participants, 2 months after the training. Results revealed a significant and sustained increase in CDSM self-efficacy following training regardless of participants' gender, age or qualifications. A thematic analysis of the responses concerning intended practice revealed four main areas of intended practice change, namely: use behavioural strategies; improve communication with clients; adopt a client-centred approach; and improve goal setting. The number of practice changes at 2 months reported by a sub-sample of participants ranged from 1 to 20 with a mean of 14 (s.d. = 4). The three most common areas of practice change point to the adoption by health professionals of a collaborative approach with chronic disease patients. Lack of staff trained in CDSM was seen as a major barrier to practice change, with lack of support and finance also named as barriers to practice change. Participants identified that increased training, support and awareness of the principles of supporting CDSM would help to overcome barriers to practice change. These results indicate a readiness among health professionals to adopt a more collaborative approach given the skills and the tools to put this approach into practice. [ABSTRACT FROM AUTHOR]

Abstract: For young people with refugee backgrounds, establishing a sense of belonging to their family and community, and to their country of resettlement is essential for wellbeing. This paper describes the psychosocial factors associated with subjective health and wellbeing outcomes among a cohort of 97 refugee youth (aged 11–19) during their first three years in Melbourne, Australia. The findings reported here are drawn from the Good Starts Study, a longitudinal investigation of settlement and wellbeing among refugee youth conducted between 2004 and 2008. The overall aim of Good Starts was to identify the psychosocial factors that assist youth with refugee backgrounds in making a good start in their new country. A particular focus was on key transitions: from pre-arrival to Australia, from the language school to mainstream school, and from mainstream school to higher education or to the workforce. Good Starts used a mix of both method and theory from anthropology and social epidemiology. Using standardized measures of wellbeing and generalised estimating equations to model the predictors of wellbeing over time, this paper reports that key factors strongly associated with wellbeing outcomes are those that can be described as indicators of belonging – the most important being subjective social status in the broader Australian community, perceived discrimination and bullying. We argue that settlement specific policies and programs can ultimately be effective if embedded within a broader socially inclusive society – one that offers real opportunities for youth with refugee backgrounds to flourish. [ABSTRACT FROM AUTHOR]

Respiratory distress is a common presentation attended by paramedics. Chest auscultation has been shown to have low accuracy for diagnosing respiratory complaints, and this can lead to inaccurate patient assessment and potentially poor patient outcomes. Conversely, lung ultrasound is a relatively simple exam allowing for rapid differentiation of respiratory complaints with comparable accuracy to more advanced imaging modalities. Evidence suggests that lung ultrasound is easy to learn and apply and could be ideal for assessment of respiratory illness by paramedics. This study aimed to explore the utility of out-of-hospital lung ultrasound performed by intensive care paramedics (ICP) for patients with medical causes of respiratory distress, and explore whether the use of lung ultrasound affects the ICP's clinical impression or management. This was a prospective observational pilot study. After a training program, a sample of ICPs working in metropolitan and regional Victoria, Australia used ultrasound to assess adult patients with respiratory distress and/or dyspnea. ICPs used a handheld point-of-care ultrasound device to scan respiratory patients using a modified protocol, and completed a worksheet with their scan findings. The scans were then reviewed by a subject matter expert for quality and agreement. Ninety-five patients were enrolled over the study period. The average image quality score was 2.68/5, and 56% of scans were of interpretable quality. Interrater agreement (between the ICPs and the subject matter expert) was reported using Cohen's kappa. Moderate overall agreement (0.44) was shown, with the highest reliability reported in A-profile and B-profile (0.49 and 0.57). In 42% of cases performance of the scan affected paramedic clinical impression and/or management. ICPs can perform lung ultrasound with moderate accuracy for some respiratory conditions, and the scans may affect clinical impression and management. Future research should focus on enhanced education, expert feedback, and clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: The novel coronavirus (COVID-19) pandemic is disproportionately impacting the health of people with disability. Resilience has remained an important health promoting characteristic during periods of social distancing restrictions. Factors promoting resilience for people with disability under the context of the pandemic remains poorly understood. Studies have yet to investigate evidence-based factors that promote resilience over multiple periods of restrictions for people with disability. Methods: A longitudinal study developed via a collaborative partnership between peer-support workers with lived experience of spinal cord injury (SCI) and university researchers was undertaken to fill knowledge gaps around factors promoting resilience for people with SCI during two periods of stringent social distancing restrictions within Victoria, Australia. Over 12-months, participants with SCI completed two surveys, towards the end of two lockdown periods. Evidence-based factors associated with resilience were measured. The Impact on Participation and Autonomy Questionnaire, the International SCI Quality of Life scale, and the 10-item Conor Davidson Resilience Scale, respectively measured autonomy and participation limitations, life satisfaction and psychological health, and resilience. A structural equation modelling (SEM) approach established factors directly and indirectly associated with resilience. Results: A model with excellent fit was produced. During two extended lockdowns over the 12-month period, increased family role limitations and favourable psychological health were respectively, negatively (Lockdown 1 [n = 127]: β = -.251, p <.01, Lockdown 2: β = -.400, p <.01) and positively (Lockdown 1: β =.601, p <.01, Lockdown 2 [n = 65]: β =.430, p <.01) associated with resilience. Indirect negative associations between resilience and increased outdoor autonomy limitations (Lockdown 1: β = -.195, p <.01, Lockdown 2: β = -.255, p <.01) and social life limitations (Lockdown 1: β = -.217, p <.01, Lockdown 2: β = -.142, p <.05) existed, and these relationships were moderated by psychological health. Conclusions: Psychological health, and participation and autonomy are determinants of resilience during periods of crisis. Health and social care providers and public health departments should prioritise programs promoting these domains, to counter the negative impact of social distancing. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationship between structural characteristics of Australian residential aged care facilities (RACFs) and breaches of the aged care quality standards. Methods: Facility‐level analysis of audits, sanctions and non‐compliance notices of all accredited Australian RACFs between 2015/16 and 2018/19. Structural factors of interest included RACF size, remoteness, ownership type and jurisdiction. Two government data sources were joined. Each outcome was analysed to calculate time trends, unadjusted rates and relative risks. Results: Non‐compliance notices were imposed on 369 RACFs (13%) and 83 sanctions on 75 RACFs (3%). Compared with New South Wales (NSW), non‐compliance notices were less likely in Victoria, Queensland and the Northern Territory (NT), more likely in South Australia (SA), and comparable in Western Australia (WA), Tasmania and the Australian Capital Territory (ACT). RACFs with more than 100 beds and RACFs located in remote and outer regional areas (vs. major cities) also increased the likelihood of non‐compliance notices. Compared with NSW, sanctions were less likely in Victoria, Queensland, NT and WA and comparable in SA, Tasmania and ACT. Additionally, the likelihood of sanctions was higher for RACFs with more than 40 beds. For both non‐compliance notices and sanctions, no significant relationship was found with RACF ownership type. Conclusions: We partially confirmed other Australian findings about the relationship between RACF structural characteristics and regulatory sanctions and reported new findings about non‐compliance notices. Routine and standardised public reporting of RACF performance is needed to build trust that Australia's latest aged care reforms have led to sustained quality improvements. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association between player wellness and injury in elite junior Australian football players over 1 competitive season. Methods: Prospective cohort study. Elite junior Australian football players (N = 196, average age = 17.7 y, range = 16–18 y) were recruited in the under-18 state league competition in Victoria, Australia. They recorded their wellness (sleep, fatigue, soreness, stress, and mood) according to a 5-point Likert scale 3 times weekly, with injuries (missed match/training session) entered into an online sport-injury surveillance system. A logistic generalized estimating equation was used to examine the association (expressed as odds ratio [OR]) between wellness and injury (yes/no). Results: Soreness was associated with injury at each time point across the week, with the strongest association evident for soreness reported 6 d postmatch (OR = 1.30; 95% confidence interval [CI], 1.17–1.44; P <.001). Stress and injury were associated with injury for average stress values across the week, as well as specifically on day 1 postmatch (OR = 1.10; 95% CI, 1.01–1.21; P =.038). Mood reported in the middle of the week (3 d postmatch) was associated with injury (OR = 0.87; 95% CI, 0.78–0.97; P =.014), as was fatigue (OR = 1.10; 95% CI, 1.00–1.22; P =.044). Conclusions: This study demonstrates key associations between wellness and injury in elite junior Australian football, specifically soreness, stress, fatigue, and mood. Monitoring strategies help identify injury-risk profiles, which can help decision makers (coaches or medical staff) intervene when relevant to reduce injury risk. [ABSTRACT FROM AUTHOR]

Barrett's oesophagus (BE) is the precursor of oesophageal adenocarcinoma, which has become the most common type of oesophageal cancer in many Western populations. Existing evidence on diet and risk of BE predominantly comes from case–control studies, which are subject to recall bias in measurement of diet. We aimed to investigate the potential effect of diet, including macronutrients, carotenoids, food groups, specific food items, beverages and dietary scores, on risk of BE in over 20 000 participants of the Melbourne Collaborative Cohort Study. Diet at baseline (1990–1994) was measured using a food frequency questionnaire. The outcome was BE diagnosed between baseline and follow-up (2007–2010). Logistic regression models were used to estimate OR and 95 % CI for diet in relation to risk of BE. Intakes of leafy vegetables and fruit were inversely associated with risk of BE (highest v. lowest quartile: OR = 0·59; CI: 0·38, 0·94; P -trend = 0·02 and OR = 0·58; CI: 0·37, 0·93; P -trend = 0·02 respectively), as were dietary fibre and carotenoids. Stronger associations were observed for food than the nutrients found in them. Positive associations were observed for discretionary food (OR = 1·54; CI: 0·97, 2·44; P -trend = 0·04) and total fat intake (OR per 10 g/d = 1·11; CI: 1·00, 1·23), the association for fat was less robust in sensitivity analyses. No association was observed for meat, protein, dairy products or diet scores. Diet is a potential modifiable risk factor for BE. Public health and clinical guidelines that incorporate dietary recommendations could contribute to reduction in risk of BE and, thereby, oesophageal adenocarcinoma. [ABSTRACT FROM AUTHOR]

Objective: To explore and describe strategies to enhance the implementation of an organisational clinical supervision framework and subsequently inform the development of a model of implementation of clinical supervision for allied health professionals in a regional health care setting. Setting: A large regional health service in Victoria, providing hospital, rehabilitation, community, mental health and aged care services. Participants: Allied health managers employed at the health service were members of an action research group. Design This longitudinal study used an action research approach. The action research group informed the repeated cycles of planning, action and reflection. Data from recorded action research meetings were analysed using content analysis. Results: The action research group met 11 times over a 5‐year period informing four action research cycles. Six main themes relating to factors that enhanced the quality of clinical supervision emerged from the analysis of the action research group data: purpose and value of clinical supervision; clinical supervision characteristics; differences between disciplines; framework development; training and support and implementation of clinical supervision. Conclusion: The findings from this comprehensive longitudinal study provide evidence‐based approaches to the implementation of allied health clinical supervision. The action research approach used ensures that the strategies described are realistic and sustainable. A model has been developed to inform the implementation of clinical supervision for allied health. [ABSTRACT FROM AUTHOR]

Objective: Perinatal emotional well‐being is more than the presence or absence of depressive and anxiety disorders; it encompasses a wide range of factors that contribute to emotional well‐being. This study compares perinatal well‐being between women living in metropolitan and rural regions. Design: Prospective, longitudinal cohort. Participants/setting: Eight hundred and six women from Victoria and Western Australia recruited before 20 weeks of pregnancy and followed up to 12 months postpartum. Main outcome measures: Rurality was assessed using the Modified Monash Model (MM Model) with 578 in metropolitan cities MM1, 185 in regional and large rural towns MM2‐MM3 and 43 in rural to remote MM4‐MM7. The Structured Clinical Interview for DSM‐IV (SCID‐IV) was administered at recruitment to assess depression, and symptoms of depression and anxiety were measured using the Edinburgh Post‐natal Depression Scale and the State and Trait Anxiety Scale, respectively. Other measures included stressful events, diet, exercise, partner support, parenting and sleep. Results: The prevalence of depressive disorders did not differ across rurality. There was also no difference in breastfeeding cessation, exercise, sleep or partner support. Women living in rural communities and who also had depression reported significantly higher parenting stress than metropolitan women and lower access to parenting activities. Conclusions: Our study suggests while many of the challenges of the perinatal period were shared between women in all areas, there were important differences in parenting stress and access to activities. Furthermore, these findings suggest that guidelines and interventions designed for perinatal mental health should consider rurality. [ABSTRACT FROM AUTHOR]

Background: Virtual communication has become common practice during the coronavirus disease 2019 (COVID‐19) pandemic because of visitation restrictions. Aims: The authors aimed to evaluate overall family satisfaction with the intensive care unit (FS‐ICU) care involving virtual communication strategies during the COVID‐19 pandemic period. Methods: In this prospective multicentre study involving three metropolitan hospitals in Melbourne, Australia, the next of kin (NOK) of all eligible ICU patients between 1 July 2020 and 31 October 2020 were requested to complete an adapted version of the FS‐ICU 24‐questionnaire. Group comparisons were analysed and calculated for family satisfaction scores: ICU/care (satisfaction with care), FS‐ICU/dm (satisfaction with information/decision‐making) and FS‐ICU/total (overall satisfaction with the ICU). The essential predictors that influence family satisfaction were identified using quantitative and qualitative analyses. Results: Seventy‐three of the 227 patients' NOK who initially agreed completed the FS‐ICU questionnaire (response rate 32.2%). The mean FS‐ICU/total was 63.9 (standard deviation [SD], 30.8). The mean score for satisfaction with FS‐ICU/dm was lower than the FS‐ICU/care (62.1 [SD, 30.3) vs 65.4 (SD, 31.4); P < 0.001]. There was no difference in mean FS‐ICU/total scores between survivors (n = 65; 89%) and non‐survivors (n = 8, 11%). Higher patient Acute Physiology and Chronic Health Evaluation III score, female NOK and the patient dying in the ICU were independent predictors for FS‐ICU/total score, while a telephone call at least once a day by an ICU doctor was related to family satisfaction for FS‐ICU/dm. Conclusions: There was low overall family satisfaction with ICU care and virtual communication strategies adopted during the COVID‐19 pandemic. Efforts should be targeted for improving factors with virtual communication that cause low family satisfaction during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

This study examined associations between school sector (Government, Catholic or Independent) and depressive symptomology over the secondary school years. Six waves of data collected annually from a representative Australian sample were examined. Multilevel piecewise linear and logistic regression controlling for a variety of demographic variables and protective factors was undertaken. In all sectors, depressive symptomology decreased between 10 and 13 years of age, but significantly increased for girls at age 13. Adolescents in Catholic schools reported significantly fewer symptoms of depression compared to those in Government and Independent schools. Adolescents in Catholic schools were less likely to report clinical levels of depressed mood compared to adolescents in Government schools. [ABSTRACT FROM AUTHOR]

Background: A precipitous decline in health status among people recently released from prison is common. In Victoria, Australia, opioid agonist treatment (OAT) in the community involves frequent contact with primary care, potentially facilitating broader use of primary healthcare services. Among a cohort of men who injected drugs regularly pre-imprisonment, we estimated differences in rates of primary healthcare use and medication dispensation between people who did and did not receive OAT post-release. Methods: Data came from the Prison and Transition Health Cohort Study. Three-month post-release follow-up interviews were linked with primary care and medication dispensation records. Generalised linear models were fit with one exposure (OAT: none/partial/complete) for 13 outcomes relating to primary healthcare use, pathology testing, and medication dispensation, adjusted for other covariates. Coefficients were reported as adjusted incidence rate ratios (AIRR). Results: Analyses included 255 participants. Compared to no OAT use, both partial and complete OAT use were associated with increased rates of standard (AIRR: 3.02, 95%CI: 1.88–4.86; AIRR: 3.66, 95%CI: 2.57–5.23), extended (AIRR: 2.56, 95%CI: 1.41–4.67; AIRR: 2.55, 95%CI: 1.60–4.07) and mental health-related (AIRR: 2.71, 95%CI: 1.42–5.20; AIRR: 2.27, 95%CI: 1.33–3.87) general practitioner (GP) consultations, total medication (AIRR: 1.88, 95%CI: 1.19–2.98; AIRR: 2.40, 95%CI: 1.71–3.37), benzodiazepine (AIRR: 4.99, 95%CI: 2.81–8.85; AIRR: 8.30, 95%CI: 5.28–13.04) and gabapentinoid (AIRR: 6.78, 95%CI: 3.34–13.77; AIRR: 4.34, 95%CI: 2.37–7.94) dispensations, respectively. Partial OAT use was also associated with increased after-hours GP consultations (AIRR: 4.61, 95%CI: 2.24–9.48) and complete OAT use? with increased pathology utilisation (e.g. haematological, chemical, microbiological or immunological tissue/sample testing; AIRR: 2.30, 95%CI: 1.52–3.48). Conclusion: We observed higher rates of primary healthcare use and medication dispensation among people who reported partial and complete OAT use post-release. Findings suggest that access to OAT post-release may have a collateral benefit in supporting broader health service utilisation, underscoring the importance of retention in OAT after release from prison. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has had a profound psychological impact on our frontline healthcare workers. Throughout the entire second COVID-19 wave at one major tertiary hospital in Melbourne Australia, longitudinal qualitative data between perioperative staff members, and analyses of intrapersonal changes were reported. Inductive analysis of three open-ended questions generated four major themes: Organisational Response to the Pandemic, Psychological Impact, Changes in Feelings of Support Over Time and Suggestions for Changes. Understanding the challenges, perception and suggestions from this longitudinal study allows us to provide a range of support services and interventions to minimise the long-term negative psychological impact and be better prepared should another similar situation arises again. [ABSTRACT FROM AUTHOR]