Search

Introduction: Multimorbidity is common among people living with HIV (PLWH), with numerous cross‐sectional studies demonstrating associations with older age and past immunosuppression. Little is known about the progression of multimorbidity, particularly in the setting of long‐term access to antiretrovirals. This study aims to determine factors predictive of change in multimorbidity in PLWH. Methods: People living with HIV who attended a regional HIV service were recruited to a consented observational cohort between September 2016 and March 2020. Demographic data, laboratory results and a Cumulative Illness Rating Scale (CIRS) were collected at enrolment and first clinical review of every subsequent year. Change in CIRS score was calculated from enrolment to February 2021. Associations with change were determined through univariate and multivariate linear regression. Results: Of 253 people, median age was 58.9 [interquartile range (IQR): 51.9–64.4] years, 91.3% were male, and HIV was diagnosed a median of 22.16 years (IQR: 12.1–30.9) beforehand. Length of time in the study was a median of 134 weeks (IQR: 89.0–179.0), in which a mean CIRS score change of 1.21 (SD 2.60) was observed. Being older (p < 0.001) and having a higher body mass index (p = 0.008) and diabetes (p = 0.014) were associated with an increased likelihood of worsening multimorbidity. PLWH with a higher level of multimorbidity at baseline were less likely to worsen over time (p < 0.001). Conclusion: As diabetes and weight predict worsening multimorbidity, routine diabetes screening, body mass index measurement, and multimorbidity status awareness are recommended. [ABSTRACT FROM AUTHOR]

Background: Neonatal hypoxic ischaemic encephalopathy (HIE) is the most common cause of encephalopathy in the neonatal period and carries a high risk of mortality and long‐term morbidity. Aim: The aim of this study was to investigate key antecedents of moderate and severe HIE in a large contemporary birth cohort. Methods: A retrospective cohort study of births meeting criteria was conducted between 2016 and 2020 at the Mater Mothers' Hospital, Brisbane, Australia. This is a quaternary perinatal centre and Australia's largest maternity hospital. Univariate and multivariate Firth logistic regression were used to account for imbalanced frequency classes between non‐HIE and HIE groups. Maternal variables and intrapartum factors were investigated for associations with neonatal moderate and severe HIE. Results: Overall, 133 of 46 041 (0.29%) infants were diagnosed with HIE: 77 (0.17%) with mild HIE and 56 (0.12%) with moderate/severe HIE. Nulliparity, type 1 diabetes mellitus and maternal intensive care unit admission were associated with increased odds of moderate/severe HIE. Intrapartum risk factors included emergency caesarean birth, emergency caesarean for non‐reassuring fetal status or failure to process, intrapartum haemorrhage and an intrapartum sentinel event (shoulder dystocia, cord prolapse, uterine rupture and placental abruption). Neonatal risk factors included male sex, late preterm gestation (35+0–36+6 weeks), Apgar score less than four at 5 min, severe respiratory distress requiring ventilatory support and severe acidosis at birth. Conclusions: This cohort study identified a series of potentially modifiable maternal and obstetric risk factors for HIE. Risk factors for HIE do not appear to have changed significantly with evolution in modern obstetric care. [ABSTRACT FROM AUTHOR]

Background: Previous findings from research investigating the role of antenatal nutrition in preventing postpartum depression (PPD) are inconsistent. Our primary aim was to investigate the association between pregnancy diet quality and PPD. Our secondary aim was to investigate associations between (a) diet quality and depression during pregnancy and (b) depression during pregnancy and PPD. Methods: This analysis represents data from 73 women participating in the Microbiome Understanding in Maternity Study (MUMS) cohort in Sydney, Australia, which followed women from Trimester 1 of pregnancy to 1‐year postpartum (PP). Participants' diet quality was assessed using the Australian Eating Survey at Trimester 1 and 3 to calculate diet quality, known as the Australian Recommended Food Score (lower diet quality defined as score <39; higher diet quality ≥39). Depression was assessed using the Edinburgh Depression Scale at Trimesters 1, 2, 3 and 6 weeks PP (defined as score ≥11). Results: Depression scores during pregnancy were significantly associated with depression score 6 weeks PP (Trimester 1: r = 0.66, Trimester 2: r = 0.69, Trimester 3: r = 0.67; all p < 0.001). Diet quality during pregnancy was not significantly correlated with 6‐week PPD score. In unadjusted analysis, diet quality during pregnancy was not associated with pregnancy depression scores. When adjusted for age, parity and Trimester 1 body mass index, Trimester 1 physical activity levels and gestational weight gain, higher Trimester 3 diet quality was associated with reduced Trimester 3 depression only. Conclusions: Depression scores during pregnancy were positively associated with PPD, highlighting the importance of screening for depression during pregnancy and postnatally. Larger longitudinal prospective studies may elucidate the association between diet quality and PPD. Highlights: Depression during pregnancy was associated with postpartum depression score, highlighting the importance of adhering to routine screening guidelines throughout the perinatal period.Although diet is clearly important for the health of both the mother and the developing foetus during pregnancy, our analysis of data from the Microbiome Understanding in Maternity Study (MUMS) cohort did not find any associations between diet quality and depression. [ABSTRACT FROM AUTHOR]

Objectives To investigate patterns of Australian GP procedural activity and associations with: geographical remoteness and population size, hours worked in hospitals and in total; and, availability for on-call, Design and participants National annual panel survey (Medicine in Australia: Balancing Employment and Life) of Australian GPs, 2011-2013. Main outcome measures Self-reported geographical work location, hours worked in different settings, and on-call availability per usual week, were analysed against GP procedural activity in anaesthetics, obstetrics, surgery or emergency medicine. Results Analysis of 9301 survey responses from 4638 individual GPs revealed significantly increased odds of GP procedural activity in anaesthetics, obstetrics or emergency medicine as geographical remoteness increased and community population size decreased, albeit with plateauing of the effect-size from medium-sized (population 5000-15 000) rural communities. After adjusting for confounders, procedural GPs work more hospital and more total hours each week than non-procedural GPs. In 2011 this equated to GPs practising anaesthetics, obstetrics, surgery, and emergency medicine providing 8% (95% CI 0, 16), 13% (95% CI 8, 19), 8% (95% CI 2, 15) and 18% (95% CI 13, 23) more total hours each week, respectively. The extra hours are attributable to longer hours worked in hospital settings, with no reduction in private consultation hours. Procedural GPs also carry a significantly higher burden of on-call. Conclusions The longer working hours and higher on-call demands experienced by rural and remote procedural GPs demand improved solutions, such as changes to service delivery models, so that long-term procedural GP careers are increasingly attractive to current and aspiring rural GPs. [ABSTRACT FROM AUTHOR]

Live streaming of child sexual abuse (CSA) involves the procurement and viewing of sexual abuse of children across the internet in real time, in exchange for money. These offenses leave little tangible evidence of the offense beyond a financial transaction, and metadata relating to the live-streaming session. This research analyzed the demographic, criminal history, and financial transaction characteristics of 209 individuals who live streamed child sexual abuse. A machine learning clustering technique was implemented to consider whether there were sub-groups present among these offenders, and in particular the prevalence of contact sexual offending among any detected sub-groups. Findings revealed that offenders tend to engage in live streaming around the same age, before making regular transactions with facilitators at brief intervals, with the majority of offenders featuring limited criminal history. This analysis identified a notable sub-group of live-streaming offenders that also engaged in contact sexual offending. This is the first study to empirically demonstrate an intersection between live streaming of CSA, and contact sexual offenses against children and adults. This research highlighted the importance of financial transactions data in detecting, and disrupting this crime type. Further, the identification of an intersection between live-streaming CSA offenders, and contact sexual offenders suggests that these individuals may pose a risk to both local and international communities. [ABSTRACT FROM AUTHOR]

Objective : To describe trends, age, and sex-specific patterns of population hospital admissions with a diagnosis of craniosynostosis (CS) in Australia. Data Source : Population data for hospital separations (in-patient) from public and private hospitals (July 1996-June 2018) were obtained from the publicly available Australian Institute of Health and Welfare (AIHW) National Hospital Morbidity Database. Main outcome measures : The outcome variables were hospital separation rates (HSR) (number of hospital separations divided by the estimated resident population [ERP] per year) and average length of stay (aLOS) (patient days divided by the number of hospital separations) with a diagnosis of CS. Trends in HSR and aLOS adjusted for age, sex, and type of CS were investigated by negative binomial regression presented as annual percent change (APC). Results : In 8057 admissions identified, we observed no significant change in the annual trend for HSR for the 22-year period. However, a marginal annual decrease of 1.6% (95% CI: -0.7, -2.4) in the aLOS was identified for the same time period. HSR were higher for males, infants, and single suture synostosis. aLOS was 3.8 days (95% CI: 3.8, 3.9) per visit, longer for syndromic conditions. Conclusion : There was a minor reduction in the average length of hospital stay for CS over the 22-year period potentially indicative of improved care. Population-level information on hospitalisations for rare craniofacial conditions can inform research, clinical, and surgical practice. [ABSTRACT FROM AUTHOR]

Objective: This study explored use and perceived barriers to the use of post‐operative video‐link telehealth among a sample of Australian surgeons shortly before the COVID‐19 pandemic. Methods: During 2019–2020, a survey was mailed to RACS or RANZCOG Fellows. Design: Cross‐sectional survey. Setting and Participants: A total of 907 surgeons practising in Australia completed the survey. Main Outcome Measures: The study‐specific survey assessed telehealth use in the last 3 months and the perceived barriers and enablers to the use of post‐operative teleconsultations, across the domains: quality of care; convenience and efficiency; legal/regulatory issues; financial issues and technological issues. Results: Twenty‐five percent of eligible surgeons returned the survey, with n = 763 pre‐pandemic responses included in analyses. Approximately one‐quarter (26%) of surgeons had used telehealth post‐operatively with patients in the last 3 months. The most frequently endorsed barriers to use related to quality of care: 'I cannot undertake a patient examination' and 'I cannot provide the same level of care as during an in‐person consultation'; and convenience and efficiency: 'Teleconsultations are more difficult to arrange'. Surgeons who had recently used telehealth were less likely to endorse most barriers. Younger age, awareness of Medicare telehealth reimbursement and working in neurosurgery, urology, paediatric surgery and plastic and reconstructive surgery (compared to general surgery) were associated with recent telehealth use by surgeons. Conclusions: Some surgeons' perceived barriers to telehealth pre‐COVID may be overcome by COVID‐19‐related telehealth uptake and familiarisation. However, many barriers will need to be addressed to ensure that telehealth adoption is sustained beyond the pandemic. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to examine age, period and birth cohort trends in the prevalence of any alcohol‐related risky behaviour and to compare these trends between men and women. Design and setting: We used an age–period–cohort analysis of repeated cross‐sectional survey data from the Australian National Drug Strategy Household Survey from 2001 to 2016. Participants: Participants were 121 281 people aged 14–80 years who reported consuming alcohol in the past 12 months. Measurements: Any risky behaviour undertaken while under the influence of alcohol in the past 12 months (e.g. operating a motor vehicle) was measured: male or female. Findings Controlling for age and cohort, cubic spline models showed that any alcohol‐related risky behaviour declined with time among participants who consumed alcohol [2016 versus 2007 rate ratio (RR) = 0.80, 95% confidence interval (CI) = 0.76–0.84]. Risky behaviour peaked in the 1954 birth cohort (1954 versus 1971 RR = 1.42, 95% CI = 1.30–1.55) and then steadily declined with more recent birth cohorts (2002 versus 1971 RR = 0.32, 95% CI = 0.27–0.39). Risky behaviour peaked at age 21 years, followed by steady decline and stabilization at approximately age 70 years. Males were overall twice as likely as females to report alcohol‐related risky behaviour (RR = 2.10, 95% CI = 1.84–2.39), but this effect was smaller in cohorts born after 1980 [1980 prevalence rate ratios (PRR) = 2.09, 95% CI = 1.81–2.43; 2002 PRR = 1.31, 95% CI = 1.03–1.68]. Conclusions: Alcohol‐related risky behaviour in Australia has declined generally since 2001, with rates for recent cohorts having the sharpest decline. Risky behaviour remains most prevalent in young adults, and the male–female gap in risky behaviour is closing for more recent birth cohorts. These trends are consistent with alcohol consumption trends observed in Australia and world‐wide. [ABSTRACT FROM AUTHOR]

Gay, bisexual, and other men who have sex with men (GBM) have developed community norms for regular HIV/STI testing. We investigated factors associated with self-reported COVID-19 testing in response to reported COVID-19 cases and public health restrictions. Participants responded to weekly cohort surveys between 10th May 2021 and 27th September 2021. We used the Andersen-Gill extensions to the Cox proportional hazards model for multivariable survival data to predict factors influencing COVID-19 testing. Mean age of the 942 study participants was 45.6 years (SD: 13.9). In multivariable analysis, GBM were more likely to report testing during periods of high COVID-19 caseload in their state of residence; if they were younger; university educated; close contact of someone with COVID-19; or reported coping with COVID-19 poorly. COVID-19 testing was higher among men who: were more socially engaged with other GBM; had a higher proportion of friends willing to vaccinate against COVID-19; and were willing to contact sexual partners for contact tracing. Social connection with other gay men was associated with COVID-19 testing, similar to what has been observed throughout the HIV epidemic, making community networks a potential focus for the promotion of COVID-19 safe practices. [ABSTRACT FROM AUTHOR]

This study investigated the influence of cardiac intervention and physical capacity of individuals attending an Australian outpatient cardiac rehabilitation program on the initial exercise prescription. A total of 85 patients commencing outpatient cardiac rehabilitation at a major metropolitan hospital had their physical capacity assessed by an incremental shuttle walk test, and the initial aerobic exercise intensity and resistance training load prescribed were recorded. Physical capacity was lower in surgical patients than nonsurgical patients. While physical capacity was higher in younger compared with older surgical patients, there was no difference between younger and older nonsurgical patients. The initial exercise intensity did not differ between surgical and nonsurgical patients. This study highlights the importance of preprogram exercise testing to enable exercise prescription to be individualized according to actual physical capacity, rather than symptoms, comorbidities and age, in order to maximize the benefit of cardiac rehabilitation. [ABSTRACT FROM AUTHOR]

Older people prefer to remain living in their own home for as long as possible; however, many require support to do so through health and other care services provided in the home. This study aimed to explore the trends in usage of a home-based care service by older people in metropolitan Melbourne and factors associated with unplanned hospitalisations. This longitudinal study analysed episodes of home-based care for people aged ≥65 years between 2006 and 2015. An episode of care was defined as the period of time during which the home care services were provided to the client. Care episodes culminated in a planned discharge from the service or an unplanned hospitalisation. Descriptive statistics and multivariable logistic regression were utilised to investigate the characteristics associated with unplanned hospitalisations. Utilisation of home-based care services over the 10-year period showed an increasing rate of use by people aged ≥85 years and a reduced usage rate by females aged 70–84 years and males 75–79 years old. Of 170,001 episodes of care, 43,608 (25.7%) resulted in an unplanned hospitalisation. Home-based care delivered to people aged ≥85 years showed an increasing rate of episodes ending in an unplanned transfer to the hospital. Between 2006 and 2015, individuals aged 85–89 years displayed a rate increase of 18.7% in episodes ending in an unplanned hospitalisation; for those aged ≥90 years, the rate rise was 43.6%. Factors associated with an unplanned hospitalisation included advancing age, male gender, living alone, cognitive dysfunction, and the complexity of medical issues. Health policy has focussed on providing services to enable older people to remain in their own home. The increasing rate of unplanned hospitalisations for community-dwellers aged ≥85 years suggests more support is required to enable ageing in place. [ABSTRACT FROM AUTHOR]

Objective. To investigate age differences in treatment and survival from acute lymphoblastic (ALL) and acute myeloid leukemia (AML). Methods. 1053 ALL/566 AML patients diagnosed in 2003–2015 on the New South Wales Cancer Registry were included. Treatment within 12 months from diagnosis was assessed using linked registry, hospital, and health-insurance data. Differences by age at diagnosis in treatment and survival were investigated using socio-demographically adjusted regression analyses, with adolescents and young adults (AYA, 15–24 years) as the reference category. Results. Children were less likely than AYA to start ALL treatment >3 days from diagnosis (adjusted odds ratio (aOR 0.39, 95% CI 0.27–0.57)) and to have multiple treatment types (aOR 0.22, 95% CI 0.14–0.34). For AML, aOR of treatment start >3 days was 0.16 (95% CI 0.09–0.29) for children compared with AYA, with no age differences in treatment types. Five-year disease-specific survival for ALL was 84%. Children were less likely than AYA to die from ALL (adjusted subhazard ratio (aSHR 0.32, 95% CI 0.22–0.50)). For AML, the corresponding survival was 73% without an age difference. Children having multiple treatment types for ALL had an increased risk of mortality at aSHR 2.67 (95% CI 1.53–4.67), but not adults at 1.26 (95% CI 0.67–2.47) (interaction p = 0.017). Time from diagnosis to initial treatment start and initial treatment type were not associated with mortality outcomes after adjusting for socio-demographic variables. Conclusion. Children with ALL had better survival. ALL Mortality were negatively associated with multiple treatment types. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the incidence, characteristics and in‐hospital mortality of non‐ventilator‐associated hospital‐acquired pneumonia (NV‐HAP) in a regional (Modified Monash Model 2) Australian hospital. Methods: All cases with NV‐HAP were obtained from the Business Analysis and Decision Support (BADS) Unit between 1st January 2013 and 31st December 2018. Medical records were reviewed, and data pertaining to incidence, characteristics (age and gender), length of stay, co‐morbidities (measured using the Charlson Comorbidity Index) and in‐hospital mortality were extracted. Incidence rate was calculated as a proportion of NV‐HAP cases per 1000 bed‐days. Design: A retrospective study design was used to review all cases of NV‐HAP between 1 January 2013 and 31 December 2018 at a single regional Australian hospital. Using the Modified Monash Model (MMM), our regional setting is classified as a regional centre (MMM‐2). Setting: Rockhampton Hospital, Australia. Participants: Patient cases. Main outcome measures: Incidence rate, Incidence proportion, mortality. Results: A total of 501 cases were identified with an incidence rate of 0.98 cases per 1000 bed‐days over the study period 2013–2018. Cases with NV‐HAP had a median age of 78.2 years (interquartile range 18.8), a median length of stay of 13.0 days (interquartile range 12.0) and a median Charlson Comorbidity Index score of 3.0 out of 39 (interquartile range 3.0), and a greater proportion was male (n = 297, 57%). The in‐hospital mortality rate for NV‐HAP cases was 18.9%. Conclusion: This study revealed an overall incidence rate of 0.98 cases per 1000 bed‐days from 2013 to 2018 in a regional Australian hospital. In addition, this study provided the descriptive characteristics for patients with NV‐HAP at our regional hospital. [ABSTRACT FROM AUTHOR]

Individuals have multiple intersecting identities, unique perspectives, and experiences which provide opportunities for new ways to interact, support inclusion and equity, and address the Sustainable Development Goals (SDGs). This commentary explores the diversity of the speech-language pathology workforce in Australia. A survey of Australian speech-language pathologists (SLPs; n = 1,638) distributed in November and December 2021 explored personal characteristics and experiences of the workforce. Almost 30% of SLPs who responded reported having experiences or perspectives that were relevant to service users and a quarter described other lived experiences, which included disability, cultural and linguistic background, mental health, caring responsibilities, neurodiversity, and being LGBTQI+. This commentary affirms the value of diversity among allied health professions to enrich practice with individuals and communities. By understanding the diversity of the speech-language pathology workforce and perspectives of historically marginalised or invisible groups, the profession can introduce strategies to more meaningfully engage and support people with diverse backgrounds and perspectives in the workforce and enhance service equity and accessibility for people with communication and swallowing disabilities. This commentary focusses on SDG 3, SDG 4, SDG 8, SDG 10. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to explore healthcare managers' perceptions about older nurses' and midwives' and their contribution to the workplace. Design: A qualitative descriptive methodology. Method: Twenty healthcare managers working in Australia participated in semi‐structured interviews. Data were collected between April 2019 and April 2021. Interviews were recorded, transcribed and then analysed using thematic analysis. Results: All healthcare managers said older nurses and midwives contributed to the workplace through their experience and knowledge. Managers viewed them as a different type of worker and while there were some positive aspects to this, it was mostly negative. Although managers identified a broad age range for the older nurses or midwives, there was a common perception that if they were no longer able to perform their duties, they should leave the workforce. Conclusion: Healthcare managers' perceptions towards older nurses and midwives are mostly negative, and their understanding of older workers' contribution is contradictory and poor. These negative views co‐exist with the lack of agreement on who is the older worker, which explain the reluctance of healthcare organizations to invest in their older workforce. Future research is needed to better understand the unique contribution of older nurses and midwives in healthcare and how they can be supported at work. Impact The global ageing population will result in a rise in complex age‐related health issues and will require an experienced and knowledgeable workforce. Given the greater experience of older nurses and midwives they are an important part of the health workforce. Yet managers' perception of the contribution by older nurses and midwives were often negative. The findings of this study highlight the need for organizational change so that the contribution of older nurses and midwives is recognized and supported by managers. [ABSTRACT FROM AUTHOR]

Background: Exclusive breastfeeding to six months of age is a major global public health priority. Several characteristics are known to be associated with early cessation of breastfeeding, however, limited evidence exists regarding whether women's reported reasons for cessation are associated with maternal, pregnancy and infant characteristics. The aims of this study were to: i) describe women's reported intention to breastfeed and their subsequent breastfeeding practices; ii) describe women's reported reasons for breastfeeding cessation prior to the infant being five months of age; and iii) examine associations between these factors and maternal, pregnancy and infant characteristics. Methods: Telephone and online surveys were conducted between October 2019 and April 2020 with 536 women who had given birth in the previous eight to 21 weeks at four public maternity services in Australia. Results: The majority of women intended to (94%), and did, initiate (95%) breastfeeding. At the time the survey was conducted, 57% of women were exclusively breastfeeding. Women who: had less than University level education, had a pre-pregnancy BMI in the overweight or obese category, and who smoked tobacco at the time of the survey had lower odds of exclusively breastfeeding. The most common self-reported reasons for breastfeeding cessation were breastfeeding challenges (47%) and low milk supply (40%). Women aged 26–35 years and 36 + years had greater odds of reporting breastfeeding cessation due to low milk supply (OR = 2.92, 95% CI: 1.11, 7.66; OR = 5.57, 95% CI: 1.70, 18.29) compared to women aged 18–25 years. While women who had completed a TAFE certificate or diploma had lower odds of reporting this as a reason for breastfeeding cessation (OR = 0.28; 95% CI: 0.11, 0.73) compared to women who had University level education. There were no other significant associations found between characteristics and reasons for ceasing breastfeeding. Conclusions: The most common reasons for breastfeeding cessation may be modifiable through the provision of breastfeeding support in the early postpartum period, with such support being tailored to women's age and level of education. Such support should aim to increase women's self-efficacy in breastfeeding, and be provided from the antenatal period and throughout the first six months postpartum. [ABSTRACT FROM AUTHOR]

Background: Early childhood caries (ECC) remains one of the most prevalent childhood diseases in Australia, disproportionately affecting disadvantaged populations. Aim: To investigate the ECC experience including risk factors, incidence of caries, pain and infection as well as relapse rates of caries and secondary dental general anaesthesia (GA). Design: A retrospective cohort study included dental records of children with ECC, aged <72 months at an Australian public dental hospital paediatric dentistry department from 2013 to 2015 (n = 102). Dental caries, pain, infection, referral patterns, demographic and caries risk factor data were recorded for 24 months. Descriptive statistics were used for patient characteristics and clinical data, and Kaplan–Meier curves and parametric exponential survival models for time‐to‐event series. Results: The study population demonstrated higher‐than‐national average dmft and disease progression at baseline. Major risk factors for the development of caries, pain and infection were daily consumption of sweetened beverages, poor oral hygiene, residing in lower socio‐economic areas, older age and being male. Rates of caries relapse and new referral for secondary treatment under general anaesthesia were relatively high. Conclusion: A high degree of ECC progression and recurrence in this population indicates a need for a more comprehensive approach to ECC addressing multilevel root causes and systemic risk factors. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore older adults' experiences of and approaches to managing their long-term health and mobility after traumatic injury. A longitudinal qualitative study was undertaken with older adults following traumatic injury in Victoria, Australia. Fifteen participants (≥65 years) were interviewed at three years post-injury (n = 15), and re-interviewed at four (n = 14) and five years (n = 12) post-injury. Using a framework approach, a longitudinal thematic analysis was performed. Older age at the time of injury was identified by participants as a key factor influencing their recovery. Many participants reported actively attempting to regain their strength and fitness in the first five years following injury. However, their age, injury impacts, other health conditions, and weight gain made it difficult to achieve recovery goals. Many older adults reported a decline in their physical function over time. While these experiences and persistent disability constrained or changed the quality of social relationships, community participation, and independence, several participants described adapting to their functional limitations, and managing their secondary conditions over time. In our cohort, the intertwined combination of ageing, injury, and comorbid conditions negatively affected health and mobility, reinforcing the need for preventative strategies. Older adults recovering from traumatic injury may benefit from specialised care pathways that offer long-term and tailored therapies, with programs and services specific to their needs and goals. An integrated service approach by injury insurers, health care, primary care, disability, and aged care could more clearly identify and effectively address the individual needs and goals of older adults with complex conditions. Health and social services that work with people with injuries to develop personalised coping strategies can reduce anxiety related to uncertainty about the future, promote well-being, and support participation in valued activities. [ABSTRACT FROM AUTHOR]

Objectives: To compare minimal trauma hip fractures (MTHF) between older Indigenous and non‐Indigenous Australians. Methods: Epidemiological study of retrospective New South Wales hospitalisation data (2005–2016) for MTHF among Indigenous and non‐Indigenous Australians over 40 years of age. Results: Estimated age‐standardised rates of MTHF were lower among Indigenous Australians than non‐Indigenous Australians (142.2 vs. 161.7 per 100,000) with a direct standardised rate ratio of 0.887 (95%CI 0.78–0.99, p = 0.031). However, for both male and female Indigenous Australians, MTHF occur at a younger age than in non‐Indigenous Australians (age 40–74: 52% vs. 19%, p < 0.001). Proportions of MTHF are higher among women and were almost double among rural Indigenous Australians compared with rural non‐Indigenous Australians (59% vs. 31%, p < 0.001). Conclusions: New South Wales Hospitalisation data showed that estimated age‐standardised rates of MTHF appear lower among Indigenous Australians than in non‐Indigenous Australians but also occur at a younger age for Indigenous people. MTHF are more common among rural Indigenous Australians and women. [ABSTRACT FROM AUTHOR]

Child-caregiver attachment is important for healthy child development and is often targeted by relationship-based parenting interventions for young children. To assess the efficacy of these interventions, attachment must be measured accurately at multiple timepoints across the toddler years, coinciding with different stages of development. Among others, populations referred for treatment of externalizing behavior problems are of particular importance here. The Strange Situation Procedure (SSP) and Attachment Q-Set (AQS) are empirically-validated measures of child-caregiver attachment with unique strengths and weaknesses. However, there are no published investigations on concurrent relations between the two measures using clinically-referred, mental health populations. Previous research has reached mixed conclusions when comparing the observer-report AQS and SSP for children from other populations and based on child age. Using a clinical sample of 69 Australian mother-toddler dyads referred for disruptive behavior problems, this study examined associations among behavior problems, dichotomous SSP classifications of security and organization, AQS security scores, and child age. In line with hypotheses, a small to medium negative correlation between AQS security and externalizing behavior was found. Unexpectedly, no significant associations were found between dichotomous SSP security and externalizing behavior nor between SSP organization and externalizing behavior. Although AQS security scores and SSP classifications were not significantly correlated for the sample as a whole, there was a moderate positive correlation between the two measures for children aged 19–25 months. Implications for future research measuring attachment in this population, with relevance for relationship-based parenting intervention outcome studies are discussed. Highlights: AQS scores were correlated with externalizing behavior in toddlers clinically-referred for behavior problems. SSP classifications were not significantly associated with externalizing behavior in this sample. AQS scores were not significantly associated with SSP classifications for the sample as a whole. AQS scores were significantly correlated with SSP classifications for a subsample of children 19–25 months of age. Implications for measuring attachment as an intervention outcome with this population are discussed. [ABSTRACT FROM AUTHOR]

Nitrous oxide is commonly used in Australia for labour analgesia. Its use in labour is potentially associated with aerosol generation. During the first wave of the COVID‐19 pandemic of 2020, nitrous oxide was suspended on many birthing units to reduce the risk of transmission. We aimed to determine the impact of withholding nitrous oxide for labour analgesia, during the COVID‐19 pandemic, on epidural rates, opioid analgesia use, and maternal and neonatal outcomes. Withholding nitrous oxide for labour analgesia did not alter epidural rates but did significantly increase opioid analgesia use. Caesarean section rates, post‐partum blood loss and neonatal APGAR scores did not change. [ABSTRACT FROM AUTHOR]

Background: Environmental factors inside licensed venues have been found to influence the intoxication levels and consumption practices of patrons. The consumption of alcohol mixed with energy drinks (AmED) occurs primarily at or prior to attending licensed venues, however there is a lack of in situ research investigating AmED use in these contexts. Given that AmED use has been linked with increased alcohol consumption, intoxication, illicit substance use, and risk taking behaviours, this paper explores the environmental correlates and levels of intoxication associated with AmED use in licensed venues.Methods: Structured observations were undertaken in five Australian cities on Friday and Saturday nights. Covert teams spent 4-5h in venues and recorded hourly observations on patron, venue, and staff characteristics, alcohol, illicit drug and AmED consumption patterns and intoxication levels.Results: 898 hourly observations were recorded across 68 venues. All but one venue served energy drinks, and patron AmED use was observed during 34.9% of hourly records. AmED use was more prevalent after 12am and in nightclub venues compared to bars and pubs, and was positively associated with high intoxication levels, illicit drug use, and younger crowds. After controlling for environmental factors (i.e. venue crowding, service practices, venue characteristics, patron demographics and behaviour) AmED use did not predict high intoxication at a venue level in multivariable models.Conclusion: AmED consumption is ubiquitous in the licensed venues of Australian night-time entertainment districts, particularly busy nightclub venues where intoxication and risky consumption are heightened. However, AmED use was not associated with high patron intoxication when environmental factors were considered. [ABSTRACT FROM AUTHOR]

Objective To investigate the association of cigarette smoking at baseline and trajectories of dysmenorrhoea in a large sample of Australian women. Design A prospective cohort study. Setting Australian (population-based survey). Participants A total of 9067 young women, with at least three measures of dysmenorrhoea, randomly sampled from the national Medicare database and followed up from 2000 to 2012. Main outcome measures Trajectories of dysmenorrhoea. Results At baseline, approximately 25% reported dysmenorrhoea and 26% were current smokers. Four trajectory groups were identified for dysmenorrhoea: normative (42%), late onset (11%), recovering (33%) and chronic (14%), with the chronic group showing high probabilities of reporting dysmenorrhoea over time. Compared with never-smokers, a significantly higher odds of being in the chronic group was detected for smokers, with ORs being 1.33 (95% CI 1.05 to 1.68) for ex-smokers and 1.41 (95% CI 1.17 to 1.70) for current smokers, after adjusting for sociodemographic, lifestyle and reproductive factors. An inverse relationship was identified for earlier age of smoking initiation, with the respective ORs of 1.59 (95% CI 1.18 to 2.15), 1.50 (95% CI 1.18 to 1.90) and 1.26 (95% CI 1.03 to 1.55) for initiation of smoking ≤13, 14-15 or ≥16 years. No consistent relationship was evident between smoking behaviour and the odds of being in the other trajectory groups. Conclusions Smoking and early initiation of smoking are associated with increased risk of chronic dysmenorrhoea. The immediate adverse health effects of smoking provide further support for smoking prevention programme to target young women, especially teenagers. [ABSTRACT FROM AUTHOR]

Background Differences in demographics, presenting characteristics, and treatment of heart disease in women may contribute to adverse outcomes. The purpose of this paper was to describe gender differences in the epidemiology, treatment, and outcomes of all admissions for acute coronary syndrome (ACS) in Victoria that occurred between June 2007 and July 2009. Methods We undertook a retrospective cohort study of all patients admitted to Victorian hospitals with a first time diagnosis of ACS. Use of angiograms, percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and adverse outcomes (death and/or unplanned readmission) were compared by gender and hierarchical logistic regression models were used to account for confounding variables. Results Of a total of 28,985 ACS patients, 10,455 (36%) were women. Compared with men, women were older (aged ≥75 years: 54% vs 31%; p < .001), more likely to present with multiple comorbidities (>1 comorbidity: 53% vs 46%; p < .001), and more likely to be diagnosed with non–ST-segment elevation ACS (86% vs 80%; p < .001). Women were less likely to receive coronary interventions (angiogram: adjusted odds ratio [aOR], 0.71; 95% CI, 0.66–0.75; PCI: aOR, 0.73; 95% CI, 0.66–0.80; CABG: aOR, 0.58; 95% CI, 0.53–0.64). Adverse outcomes were similar in women and men after accounting for confounding variables. Conclusions Our results show that women in Victoria were less likely to receive coronary interventions after an admission for ACS. Clinicians should be wary of inherent gender bias in decisions to refer patients for angiography. [ABSTRACT FROM AUTHOR]

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

Post‐diagnosis young onset dementia (YOD) care is often fragmented, with services delivered across aged care, healthcare, and social care sectors. The aim of this project was to test the feasibility and potential effectiveness of a learning collaborative implementation strategy for improving the cross‐sector integration of care for people with YOD and to generate data to refine the implementation strategy for scaleup. We conducted a longitudinal mixed methods process evaluation and recruited one representative from three Australian aged care organisations, three disability care organisations and three organisations (n = 9) contracted to deliver care navigation services. One representative from each organisation joined a learning collaborative within their local area and completed a six‐module online education package incorporating written resources, webinars, collaboration and expert mentoring. Participants identified gaps in services in their region and barriers to care integration and developed a shared plan to implement change. Normalisation Process Theory was applied to understand the acceptability, penetration and sustainability of the implementation strategy as well as barriers and enabling factors. Dementia knowledge measured by the Dementia Knowledge and Awareness Scale was high among the professionals at the start of the implementation period (mean = 39.67, SD = 9.84) and did not change by the end (mean = 39.67, SD = 8.23). Quantitative data demonstrated that clinicians dedicated on average half of the recommended time commitment to the project. However, qualitative data identified that the learning collaborative strategy enhanced commitment to implementing integrated care and promoted action towards integrating previously disparate care services. Participant commitment to the project was influenced by their sense of obligation to their team, and teams that established clear expectations and communication strategies early were able to collaborate and use the implementation plan more effectively (demonstrating collective action). Teams were less likely to engage in the collective action or reflexive monitoring required to improve care integration if they did not feel engaged with their learning collaborative. Learning collaboratives hold promise as a strategy to improve cross‐sector service collaboration for people with YOD and their families but must maximise group cohesion and shared commitment to change. [ABSTRACT FROM AUTHOR]

The existing psychosocial Support activities in the Northern Territory, Australia, are mostly delivered through individualised outreach and client‐centred Support programs and do not currently have a strong Peer focus. To address this gap, a Peer‐Led Education Pilot was developed and implemented in Darwin, Australia. The pilot was comprised of three separate but overarching stages, and each stage was independently evaluated. In this article, results from Stage 1 will be presented, with a specific focus on the role of Peer‐to‐Peer communication in improving participants' mental health and Recovery skills. This stage involved the delivery of the My Recovery program to self‐nominated participants, and the evaluation was aimed at reporting on the appropriateness and effectiveness of the program. The evaluation was qualitative in design involving individual pre‐ and post‐program interviews with program participants (npre = 14, npost = 16) between August and October 2019. The program was well received by participants and helped build their capacity to understand and self‐manage their mental health and/or alcohol and other drug issues in an inclusive, non‐clinical, non‐judgemental space. The results highlighted the importance of including a strong Peer focus in the existing psychosocial Support services available for people with mental health issues in Darwin. The findings also underscored the inclusion of those with lived experience of mental health challenges in the design and delivery of such programs. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and predictors of physical activity, sedentary behaviour and fatigue five years after total knee replacement surgery. Design: A longitudinal cohort study. Setting: Community-dwelling adults who had previously undergone total knee replacement. Methods: Five-year follow-up questionnaire data were obtained from participants previously enrolled in a randomised controlled trial examining rehabilitation after total knee replacement. Main study outcomes at one year did not differ between randomisation groups, hence data were pooled for the present longitudinal analysis. Before and one and five years after surgery, participants completed questionnaires (Active Australia Survey, WOMAC, SF12 v2, demographics and fatigue). Results: 272/422 community-dwelling adults (45–74 years) completed the questionnaires at five years. Excessive sedentary behaviour was evident in 91% of the cohort, predicted by excessive sedentary behaviour and lack of energy at one year. Inadequate physical activity at five years was evident for 59% of the cohort, predicted by higher fatigue and comorbidity scores pre-surgery and inadequate physical activity at one year. Just under half (47%) of the cohort experienced clinically-important fatigue at five years, predicted by clinically-important fatigue before and one year after surgery, lack of sleep before surgery and physical activity one year after surgery. Conclusion: Documenting physical activity, sedentary behaviour and fatigue before and one year after knee replacement is important to identify those at risk of longer-term inadequate physical activity, excessive sedentary behaviour and clinically-important fatigue. Interventions to maintain activity and reduce sedentary behaviour are needed to reap the potential health benefits of total knee replacement surgery. [ABSTRACT FROM AUTHOR]

Background: We sought to provide the first point prevalence estimates of muscle dysmorphia (MD), a form of body dysmorphic disorder characterized by a preoccupation with perceived insufficient muscularity, in adolescents. Methods: Data were taken from a survey of 3618 Australian adolescents (11.172–19.76 years; 49.3% girls). Measures captured demographic characteristics, symptoms of MD and eating disorders, psychological distress and functional impairment. Diagnostic criteria for MD developed by Pope et al. (1997, Psychosomatics , 38(6), 548–557) were applied, entailing preoccupation with insufficient muscularity causing significant levels of distress or disability that cannot be better accounted for by an eating disorder. Results: The point prevalence of MD was 2.2% [95% confidence interval (CI) 1.6–3.0%] among boys and 1.4% (95% CI 0.9–2.0%) among girls. Prevalence was not associated with gender (V = 0.031) or socioeconomic status (SES) (partial η 2 < 0.001), but was marginally associated with older age (partial η 2 = 0.001). Boys with MD were more likely than girls with MD to report severe preoccupation with muscularity (V = 0.259) and a weight-lifting regime that interfered with their life (V = 0.286), whereas girls with MD were more likely to report discomfort with body exposure (V = 0.380). Conclusions: While future epidemiological research using diagnostic interviews is needed to verify these estimates, the findings suggest that MD is relatively common from early to late adolescence. Gender differences in MD prevalence may be minimal; however, the symptom profile appears to diverge between boys and girls. These findings provide a platform for future, analytical research designed to inform clinical and public health interventions. [ABSTRACT FROM AUTHOR]

Objective: The Australian COVID‐19 Frontline Healthcare Workers study examined the prevalence and severity of mental health symptoms during the second wave of the COVID‐19 pandemic. This substudy examined the differences in psychological well‐being between rural and metropolitan health care workers (HCWs). Design: A nationwide survey conducted between August and October 2020. Setting and Participants: Australian HCWs were recruited through multiple strategies. Main outcome measures: Demographics, mental health outcomes (anxiety, depression, post‐traumatic stress disorder [PTSD] and burnout). Results: Complete responses were included from 7846 participants, with 1473 (18.8%) in regional or remote ('rural') areas and 81.2% in metropolitan areas. Rural participants were older, more likely to work in allied health, nursing or in health administration, and had worked longer in their profession than metropolitan participants. Levels of resilience were similar (p = 0.132), but there was significantly higher prevalence of pre‐COVID‐19 pandemic mental illness in the rural workforce (p < 0.001). There were high levels of current mental health issues: moderate–severe PTSD (rural 38.0%; metropolitan 41.0% p = 0.031); high depersonalisation (rural 18.1%; metropolitan 20.7% p = 0.047); and high emotional exhaustion (rural 46.5%; metropolitan 43.3% p = 0.002). Among rural participants, mental health symptoms were associated with younger age, worry about being blamed if they contracted COVID‐19, fear of transmitting COVID‐19 to their family, experiencing worsening relationships and working in primary care or allied health. Conclusion: Despite having low COVID‐19 case numbers in rural Australian health services compared with metropolitan counterparts over the course of 2020, there were widespread mental health impacts on the workforce. Rural health services need specific and flexible training, education, work policies and practices that support psychological well‐being now in preparedness for ongoing or future crises. [ABSTRACT FROM AUTHOR]

Background: To better understand the potential role of social media (SM) as a self‐management tool for individuals with endometriosis and to assess its current use by endometriosis patients. Aims: The primary outcome was use of SM for health in patients with endometriosis. Secondary outcomes included preferred SM platforms for health information sharing and factors that influenced use, positive and negative experiences and reported impacts on health. Materials and Methods: A single‐centre, cross‐sectional study performed within benign gynaecology units at a tertiary hospital in Melbourne, Australia. One hundred patients with a confirmed diagnosis of endometriosis participated. Individuals did not have to be users of SM. Data were collected through an electronic third‐party survey tool (SurveyMonkey®). Analysis methods included descriptive statistical analysis, frequency counts, as well as cross‐tabulation to examine statistical association between variables. Free‐text responses were qualitatively analysed using deductive‐inductive semantic thematic analysis. Results: Social media was used for health by 76% of patients with endometriosis in this study. SM users were younger, had pelvic pain for more than six months and reported higher rates of psychosocial impact and symptoms from endometriosis. Respondents reported overall positive impacts on psychological, social and cognitive health outcomes (76%) from SM use. Conclusion: In our cohort, a high number of people with endometriosis are using SM for health. These individuals are more likely to suffer both physical and psychosocial impacts from endometriosis. Hospitals and health organisations may consider support of the endometriosis community through SM. [ABSTRACT FROM AUTHOR]

Arthritis is a long‐term musculoskeletal disease, requiring ongoing management. However, the financial burden of managing arthritis is under‐explored and is yet to be quantified from the perspective of individuals with the condition. Using an exploratory observational design, this study aimed to quantify arthritis‐related costs borne by a sample of working‐age adults aged 18–50 years who responded to the study advertisement. Participants completed a weekly cost diary for 6 weeks, detailing their personal non‐reimbursed (out‐of‐pocket) arthritis‐related costs. Financial distress was measured using the InCharge Financial Distress/Financial Well‐Being Scale. Costs data were analysed descriptively. Mann–Whitney U tests were used to examine relationships between residential location or employment status and out‐of‐pocket costs. Linear regression and Spearman's rho were used to estimate relationships between age or years since diagnosis and out‐of‐pocket costs, and between out‐of‐pocket costs and financial distress respectively. Sixteen adults (median age 40 years, 100% female) with a range of arthritis conditions (median (IQR): 8 (7.5) years since diagnosis) including rheumatoid arthritis, osteoarthritis, psoriatic arthritis, and ankylosing spondylitis completed the six‐week cost diary. All participants reported out‐of‐pocket expenditure related to arthritis. The median per‐person expenditure across the 6 weeks was AUD 1635. The highest reported costs per participant across the 6 weeks were for medical expenses (median AUD 197) and allied health appointments (median AUD 190). In total, the cohort spent AUD 15,272 across the study period. Perceived financial distress was high: median (IQR) financial distress 7 (2.25) on a 1 (lowest) to 10 (highest) scale. Positive relationships between age and costs, and between costs and financial distress were identified. These findings help us understand fiscal expenditure and related distress relevant to younger individuals with arthritis, and can be used to raise awareness of their financial concerns. [ABSTRACT FROM AUTHOR]

The unbalanced distribution of general practitioners (GPs) across geographic areas has been acknowledged as a problem in many countries around the world. Quantitative information regarding GPs' location decision over their lifecycle is essential in developing effective initiatives to address the unbalanced distribution and retention of GPs. This paper describes the age profile of GPs' location decision and relates it to individual characteristics. I use the Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors (2008–2012) with a sample size of 5810 male and 5797 female GPs. I employ a mixed logit model to estimate GPs' location decision. The results suggest that younger GPs are more prepared to go to rural and remote areas but they tend to migrate back to urban areas as they age. Coming from a rural background increases the likelihood of choosing rural areas, but with heterogeneity: While male GPs from a rural background tend to stay in rural and remote areas regardless of age, female GPs from a rural background are willing to migrate to urban areas as they age. GPs who obtain basic medical degrees overseas are likely to move back to urban areas in the later stage of their careers. Completing a basic medical degree at an older age increases the likelihood of working outside major cities. I also examine factors influencing GPs' location transition patterns and the results further confirm the association of individual characteristics and GPs' location–age profile. The findings can help target GPs who are most likely to practise and remain in rural and remote areas, and tailor policy initiatives to address the undesirable distribution and movement of GPs according to the identified heterogeneous age profile of their location decisions. [ABSTRACT FROM AUTHOR]

The role of the General Practitioner (GP) in testing for and managing men with prostate cancer (PCa) is significant. Very few studies have explored the attitudes and practices of Australian GPs in the context of the role of PCa testing. In this study, a 46-item web-based questionnaire was used to assess self-reported PCa testing attitudes and practices of GPs. This questionnaire was circulated to divisions of general practice and Medicare locals for further distribution to their GP members across Australia. GPs from all states and territories participated, and a total of 136 GPs completed the survey. Of the responding GPs, 57% always or usually offered PCa testing to asymptomatic men ≤70 years of age and 60% of GPs always or usually included a digital rectal examination (DRE). Many (80%) of the GPs stated that the current PCa testing guidelines were not clear. PCa testing was offered opportunistically by 56% while 39% offered testing at the patient's request. The results captured in this study represent a snapshot of GP attitudes and practices from across Australia. The results presented indicate a wide variation in the approaches to PCa testing in general practice across Australia, which in most part appear to be related to the lack of clarity of the current prostate cancer testing guidelines. [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcome measures are important in person-centered care, providing valuable information about patients' experiences. Disease-specific questionnaires add important information about a certain disease in comparison to generic questionnaires. Questionnaires need to be validated in the targeted population to achieve reliable data. The purpose with the study was to use Rasch measurement theory to evaluate the English version of the ASTA questionnaire. Methods: The Rasch model theory was used to evaluate global and item fit, targeting, response category functioning, local independency, unidimensionality, differential item functioning (DIF) for gender and age, and reliability. Results: The study included 202 patients undergoing DC conversion or catheter ablation at the Centre for Heart Rhythm Disorders at the University of Adelaide, Australia. The mean age was 67 years and 30% were women. Most patients had atrial fibrillation (n = 179), others had atrial flutter or had a combination. One of nine items demonstrated unsatisfactory model fit in the ASTA Symptom scale and two of 13 in the ASTA Health-Related Quality of Life (HRQoL) scale. Unidimensionality was supported for both scales. The targeting was acceptable except for the lower end of the scales. Both scales showed reversed thresholds for the response categories "quite a lot" and "a lot" (eight of ASTA symptoms and 12 of ASTA HRQoL items). Some problems with local dependency were detected in both scales. The reliability (person separation index) was satisfactory: 0.75 for the ASTA symptom scale and 0.77 for the ASTA HRQoL scale. No DIF for gender and age were detected. Conclusions: The English version of the ASTA questionnaire demonstrated satisfactory measurement properties according to the Rasch model. However, it needs to be evaluated in patients with other arrhythmias. The response categories should be considered as well as DIF in further validation. The ASTA questionnaire can be used for assessments of symptoms and HRQoL between groups of different ages and genders in patients with arrhythmia. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the complexity of stuttering behavior. It described and classified the complexity of stuttering behavior in relation to age, behavioral treatment outcomes, stuttering severity, anxiety-related mental health, impact of stuttering, and gender. Method: For this study, a taxonomy was developed--LBDL-C7--which was based on the Lidcombe Behavioral Data Language of stuttering. It was used by five experienced judges to analyze the complexity of stuttering behavior for 84 adults and adolescents before and after speech restructuring treatment. Data were 3,100 stuttering moments, which were analyzed with nominal logistic regression. Results: The complexity of stuttering behavior appears not to change as a result of treatment, but it does appear to change with advancing age. Complexity of stuttering behavior was found to be independently associated with clinician stuttering severity scores but not with percentage of syllables stuttered or self-reported stuttering severity. Complexity of stuttering behavior was not associated with gender, anxiety, or impact of stuttering. Conclusion: Clinical and research applications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Aims This study aimed to examine perceived social norms, the effect of parental drinking on these norms, alcohol use in front of children, and how norms and consumption vary based on child age and gender of the parent. Methods A cross-sectional online panel survey was undertaken with n  = 1000 Australian adults (including 670 parents) aged 18–59 years. The survey assessed: alcohol consumption in front of children; normative attitudes towards drinking in the presence of children; and perceived social norms. Results Overall, 33.9% of parents reported drinking a glass of alcohol each day or a couple of times a week, 18.2% reported getting slightly drunk and 7.8% indicated getting visibly drunk each day or a couple of times a week with their children present. In total, 37.5% reported drinking in front of their children at least weekly. Fathers were more likely to drink in front of children than mothers. Most parents deemed drinking small amounts of alcohol in front of children as acceptable but did not accept drunkenness. Respondents were less concerned about a father drinking one or two drinks in front of their children than a mother. Social expectations were not related to child age, but norms related to others' perceived behaviour were. Conclusions Many parents, particularly fathers consume alcohol in front of their children. There is a need to target health promotion strategies to adults and parents consuming in excess of health guidelines, and to the many parents who are consuming alcohol at higher levels in front of their children. [ABSTRACT FROM AUTHOR]

Use of tobacco products is higher in Arabic-speaking communities in Australia, compared to other populations. 70 persons identifying as being from Arabic-speaking communities in Western Sydney participated in focus group discussions to explore experiences and needs relating to tobacco, alcohol and other drug treatment. Tobacco was rated as the substance of highest concern in this sample, however a pattern of change was observed. Widespread cigarette use supported by gendered norms that particularly encouraged smoking among men was shifting, with some decline in the social acceptability of cigarette smoking linked to experience of health impacts and the financial cost to families. In contrast, waterpipe tobacco smoking was described as a common and acceptable practice across age and gender cohorts, despite some participants challenging the cultural and health rationales of this practice. Preventing tobacco-related harm among younger populations was highly valued among study participants, drawing on strong support for families as key influencer of health behaviors. Cessation strategies viewed as effective among community members spoken with commonly centered upon the notion of individual willpower, and appreciated the disincentivising impacts of high taxation on cigarettes. This study prioritizes community-informed perspectives for reducing tobacco related harms amongst Arabic-speaking populations in Australia and offers direction to health promoters, public health workers and policymakers. Results indicate opportunities exist to improve tobacco control outcomes through strategies that align prevention and treatment options with relevant community beliefs and norms, and build on existing harm reduction behaviors and support seeking behaviors [ABSTRACT FROM AUTHOR]

This study investigates how Ethiopian adoptees and adoptive parents in Australia experience attachment to each other post-adoption. Semi-structured interviews were conducted with eight Ethiopian adoptees and eight adoptive parents. Thematic analysis returned four themes, indicating that attachment experiences were affected by the following: age at adoption; separation anxiety and survival mechanisms; biological family access; and identity formation. The findings contribute to improved understanding of Ethiopian adoptees' attachment experiences in Australia, and highlight unmet needs surrounding post-adoption support, in particular, support relating to post-adoption attachment. [ABSTRACT FROM AUTHOR]

Fear of crime among older people has been a frequent topic in ageing research, criminology and urban studies. The 'environmental docility hypothesis' assumes that older people are more vulnerable to adverse neighbourhood conditions than younger age groups. Yet, few studies have tested this influential hypothesis using samples of respondents covering the complete adult lifespan. Looking at fear of crime, we investigated the person–environment interaction of age and neighbourhood disadvantage, using two independent surveys comprising 12,620 respondents aged 25–90 years residing in 435 neighbourhoods in four cities in Germany and Australia. We used multi-level analysis and cross-level interactions to model age-differential effects of neighbourhood disadvantage on fear. Contrary to the hypothesis, we found a weakening of neighbourhood effects on fear with age. The strong effect of neighbourhood disadvantage on fear of crime dropped by around half from the youngest (25 years) to the oldest age (90 years) in both countries. Younger people were almost as fearful as older people in the most disadvantaged neighbourhoods, but older people were considerably more fearful than younger ages in better-off neighbourhoods. We found limited empirical support for the assumption that this diminished association between neighbourhood disadvantage and fear can be explained by the stronger neighbourhood attachment of older people. The limitations of the analysis and potential future directions of research are discussed. [ABSTRACT FROM AUTHOR]

This systematic review was conducted to identify the incidence, nature and mechanisms of head, neck and facial (HNF) injuries in cricket and the reported use of helmets. Five databases were searched up to 30th November 2020. From peer-reviewed cricket injury studies published in English, studies reporting on HNF cricket injuries as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were selected. Twenty-nine studies were included. HNF injuries had a cumulative total of 794/5,886 injuries equating to 13% of all injuries. Non- specified HNF injuries (n=210, 26%) were the most prevalent type of injury followed by non-specified head injuries (n=130, 16%), other non-specified fractures (n=119, 15%) and concussions (n=60, 8%).The impact of the ball was reported as the most common mechanism for sustaining HNF injuries in cricket. The use of helmet was reported in only three studies (10%). From studies reporting on HNF cricket injuries, facial fractures, and concussions were the most common specified-types of injury. There is little evidence on reporting of HNF cricket injuries as per the international cricket consensus injury definitions, as well as the use of helmets at the time of injury. [ABSTRACT FROM AUTHOR]

Objective: Negative attitudes towards ageing have been associated with poor mental well‐being, and protective factors are not well‐understood. This study examined the relationship between ageing attitudes and symptoms of anxiety and depression, and the potential moderating effect of age, and buffering effects of social support, physical activity and education. Methods: This study used a subsample of 482 adults aged 50+ years from a mail questionnaire study in Brisbane, Australia. Data were analysed using linear regression. Results: People with more positive ageing attitudes reported fewer symptoms of anxiety and depression, with no moderating effect of age. There was a significant interaction between ageing attitudes and education on depression, and a similar trend for anxiety. Conclusions: This study confirmed the adverse impacts of negative ageing attitudes on mental health and indicated that those with low education may be most vulnerable. This has implications for future research and targeting interventions for mental health promotion. [ABSTRACT FROM AUTHOR]

Purpose: Standardised testing tools within an Aboriginal Australian context have been found to produce inaccurate results due to language and cultural differences. The primary aim of the study is to compare Aboriginal children's scores in urban NSW across two language assessment tools: the Early Language Inventory (ERLI) and the Australian English Communicative Development Inventory, short form (OZI-SF). These tools are vocabulary checklists for children aged approximately 12–30 months. OZI-SF is an Australian tool for mainstream use and ERLI has been developed with and for Aboriginal families, but not in urban contexts, so its suitability there is unknown, given the great cultural and linguistic diversity among Aboriginal people across Australia. The second aim is to identify which tool is more culturally appropriate for urban Aboriginal families through parent perspectives. Method: Overall, 30 parents (of 31 children) participated in the study to complete the ERLI, and 14 parents from this sample completed both the ERLI and OZI-SF and interviews to explore child scores and parent perspectives, in a mixed methods approach. Result: Aboriginal children (N = 14) scored higher on the ERLI than the OZI-SF. Gender and age were significant contributors to the scores as scores were higher for older children and higher for girls than boys. In answer to the second aim, four themes emerged to explain parental perspectives and their preference for the ERLI, which supported connection to culture and language. Conclusion: Findings have implications for paediatric language assessments with urban Aboriginal families in clinical, educational and research settings. [ABSTRACT FROM AUTHOR]

Assumptions about time, value, labour, and health coalesce in the policy decision to extend the pension eligibility age in Australia from 65 to 67 years. Acknowledging the multiple, often incompatible ways in which time is conceptualised and experienced, we question the expectation of extending Australians' working lives. Drawing on semi-structured interviews with 19 male and female bus drivers over the age of 55 in Australia, we illustrate that older blue collar workers may accumulate chronic health conditions that not only limit their ability to maintain the strict time-discipline required to remain in the workforce, but also introduce demands on their time beyond paid employment (including those required for the management of chronic health conditions). Poor health, and the multiple ways in which it constrains labour participation and time, fosters diverse, unequal, and uneven experiences of the final years of work for these blue collar workers, which may not allow them to meet the policy expectation to work until the age of 67. We argue that by failing to acknowledge the long-term health effects of blue collar work and its work-limiting bodily effects, raising the pension age devalues industrial work histories and manual labour. Finally, acknowledging the social milestone of retirement, we question the moral dimensions of extending the pension eligibility age. [ABSTRACT FROM AUTHOR]

Background: In Australia, the National Health and Medical Research Council has banned the use of assisted reproductive technology for social sex selection, but notes “there is limited research into the question of whether Australians support the use of sex selection for non-medical purposes”. This paper investigates Australian attitudes to sex-selection technology by different means (IVF, abortion, and a hypothetical pill), for different reasons (medical, family balancing, any reason), and by differing respondent characteristics (age, sex, education and religiosity). Methods: In 2007 and 2016, the Australian Survey of Social Attitudes (AuSSA) collected data on the attitudes of Australian adults to sex selection through IVF, abortion, and a hypothetical pill. We calculate population-weighted distributions and 95% confidence intervals of responses, and carry out logistic regressions to investigate the demographic characteristics of Australians who strongly disapprove of IVF or abortion for sex selection. Results: In 2016, around three-quarters of AuSSA respondents were opposed to legalising sex selection through IVF for any reason, or for family balancing for a second or third child. Thirty-seven per cent were opposed to IVF for medical sex selection. Two-thirds of respondents in both 2007 and 2016 disapproved or strongly disapproved of IVF for sex selection, while the proportion who strongly disapproved increased from 31 to 40%. Disapproval/strong disapproval of abortion for sex selection increased from 74 to 81% from 2007 to 2016, while strong disapproval alone rose from 44 to 55%. More than 70% of respondents in both 2007 and 2016 stated that a hypothetical pill for sex selection should not be legal. Our analysis finds that female, young, more-educated, and more religious respondents are more likely to strongly disapprove of sex selection via IVF or abortion, and that the increase in those who strongly disapprove from 2007 to 2016 is statistically significant. Conclusions: Australians generally disapprove of the use of sex-selection technology. If legislation is to be guided by community attitudes, then the prohibition against sex selection for non-medical purposes through assisted reproductive technology should be maintained. [ABSTRACT FROM AUTHOR]

Background: To report the national prevalence, years lived with disability (YLDs) and attributable risk factors for all musculoskeletal conditions and separately for low back pain (LBP), as well as compare the disability burden related to musculoskeletal with other health conditions in Australia in 2019. Methods: Global Burden of Disease (GBD) 2019 study meta-data on all musculoskeletal conditions and LBP specifically were accessed and aggregated. Counts and age-standardised rates, for both sexes and across all ages, for prevalence, YLDs and attributable risk factors are reported. Results: In 2019, musculoskeletal conditions were estimated to be the leading cause of YLDs in Australia (20.1%). There were 7,219,894.5 (95% UI: 6,847,113–7,616,567) prevalent cases of musculoskeletal conditions and 685,363 (95% UI: 487,722–921,471) YLDs due to musculoskeletal conditions. There were 2,676,192 (95% UI: 2,339,327–3,061,066) prevalent cases of LBP and 298,624 (95% UI: 209,364–402,395) YLDs due to LBP. LBP was attributed to 44% of YLDs due to musculoskeletal conditions. In 2019, 22.3% and 39.8% of YLDs due to musculoskeletal conditions and LBP, respectively, were attributed to modifiable GBD risk factors. Conclusions: The ongoing high burden due to musculoskeletal conditions impacts Australians across the life course, and in particular females and older Australians. Strategies for integrative and organisational interventions in the Australian healthcare system should support high-value care and address key modifiable risk factors for disability such as smoking, occupational ergonomic factors and obesity. [ABSTRACT FROM AUTHOR]

Objective: To explore rural motor vehicle collision (MVC) fatalities by trends over time, mode of transport, age, state, sex, and Aboriginal and Torres Strait Islander status. Design: A retrospective total population‐based time series was conducted using the Australian Bureau of Statistics (ABS) death registration data. Setting: All statistical local area (SLA) within Australia from 2006 to 2017. Participants: Australian residents whose deaths were registered with the ABS between 01 January 2006 and 31 December 2017 where the underlying cause of death was related to unintentional transport accidents. Main outcome measures: Fatality rates were determined using population data collected from the 2006, 2011 and 2016 census. Trends over time by rurality were analysed by financial year. Rates of transport deaths by vehicle type were determined by rurality. Risk ratios were calculated to compare demographic groups based on sex, Aboriginal and Torres Strait Islander status and age. A 3‐year scorecard was organised by state and rurality using 99.7% confidence intervals. Results: Motor vehicle collision fatalities increase with increasing remoteness. Females, children from 0 to 14 years, pedestrians, and Aboriginal and Torres Strait Islander peoples are at a significantly higher risk of fatal MVCs than their respective metropolitan counterparts. The 3‐year scorecard indicates that road fatality rates in the NT, WA, and all rural and remote areas required immediate attention and targeted action. Conclusions: There is a need for investment in MVC fatality prevention in rural Australia from inner regional to remote areas in order to meet the road safety targets established by the National Road Safety Strategy. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine the mental well-being of audiologists in the midst of the COVID-19 pandemic. A cross-sectional online survey was conducted during the COVID-19 pandemic, between 23 June and 13 August 2020. A self-report survey included screening measures for psychological distress (PHQ-4: anxiety and depression) and loneliness (UCLA-3). 239 audiologists from around the world. The prevalence of psychological distress was 12.1% (subscales for anxiety 16.3% and depression 10.4%), and loneliness 32.2%. Depression and loneliness were higher in those participants self-reporting perceived job insecurity, with psychological distress (anxiety and depression) higher in those from South Africa. Accessibility to Employee Assistance Programs (EAPs) appears to be a protective factor. Well-being interventions, such as EAPS, are needed to support audiologists during challenging times like the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Demographers have historically studied fertility with reference to female populations. As bearers and prime nurturers of children, women have been more reliable sources of data, and their lives are more strongly impacted by parenthood. Greater concern with men's role in fertility decision-making and child socialization has, however, lately focused more attention on measuring male fertility. This paper estimates age-specific and total paternity rates for Australia during 1976-2010. Australia has long published ages of fathers for marital births, but from 1976, with cohabitation proliferating, also began publishing them for non-marital births where paternity was acknowledged. The methodology developed here estimates annual paternal age distributions for non-marital births where paternity was not acknowledged, enabling age-specific and total paternity rates to be estimated and compared with female fertility rates. [ABSTRACT FROM AUTHOR]

Should there be a female age limit on public funding for assisted reproductive technology (ART)? The question bears significant economic and sociopolitical implications and has been contentious in many countries. We conceptualise the question as one of justice in resource allocation, using three much-debated substantive principles of justice—the capacity to benefit, personal responsibility, and need—to structure and then explore a complex of arguments. Capacity-to-benefit arguments are not decisive: There are no clear cost-effectiveness grounds to restrict funding to those older women who still bear some capacity to benefit from ART. Personal responsibility arguments are challenged by structural determinants of delayed motherhood. Nor are need arguments decisive: They can speak either for or against a female age limit, depending on the conception of need used. We demonstrate how these principles can differ not only in content but also in the relative importance they are accorded by governments. Wide variation in ART public funding policy might be better understood in this light. We conclude with some inter-country comparison. New Zealand and Swedish policies are uncommonly transparent and thus demonstrate particularly well how the arguments we explore have been put into practice. [ABSTRACT FROM AUTHOR]