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Background: In 2009, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) published College Statement C-Gyn 25: 'Prophylactic oophorectomy at the time of hysterectomy for benign gynaecological disease, which recommended that caution should be exercised in performing bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy for benign disease in women younger than 65 years of age.' Aims: The aims of the study were to assess current practice with regard to prophylactic oophorectomy in this setting and to assess knowledge about the College Statement. We also sought to review the evidence behind the Statement. Method: An anonymous email survey of all consultant gynaecologists and gynaecology registrars in Sydney West Area Health Service (SWAHS) was conducted. Results: The response rate was 52%. The survey found that there was an increasing tendency to remove ovaries with increasing patient age, and over 60% of gynaecologists would routinely recommend removal of ovaries during a hysterectomy for benign disease in a 60 year old woman. The survey also revealed a lack of knowledge as to the existence or content of the College Statement. A review of the literature found that evidence suggesting benefit in retention of ovaries in postmenopausal women has been extrapolated from a modelling study, observational studies or from data on premenopausal oophorectomy. Conclusion: A survey of gynaecologists revealed that few currently appear to adhere to the College Statement regarding prophylactic oophorectomy at the time of hysterectomy for benign disease. High quality evidence regarding either harm or benefit following retention of ovaries after menopause is lacking. Nevertheless, dialogue between clinicians and patients on this topic is important. [ABSTRACT FROM AUTHOR]

Eley DS, Eley RM. International Journal of Nursing Practice 2011; 17: 380-387 Personality traits of Australian nurses and doctors: Challenging stereotypes? This study compared temperament and character traits of Australian registered nurses and general practitioners. A cross-sectional quantitative design used the Temperament and Character Inventory. Total sample size was 426. Only main effects were detected. Nurses were higher in the temperament traits of Novelty Seeking and Reward Dependence, lower in the character traits of Self-Directedness and Cooperativeness but higher in Self-Transcendence compared with the sample of doctors. Differences in personality profiles between registered nurses and general practitioners might challenge existing stereotypes between these professions. Further exploration of traits exclusive to and shared among health professions would supplement a broad conceptualization of specialities and support the enhancement of appropriate training and career counselling. Awareness of one's temperament and character can lead to a clearer understanding of how they function in the workplace and might encourage reflection on and insight into the implications of their personality and career plans. [ABSTRACT FROM AUTHOR]

Objective: To show how fractional polynomial methods can usefully replace the practice of arbitrarily categorizing data in epidemiology and health services research. Methods: A health service setting is used to illustrate a structured and transparent way of representing non-linear data without arbitrary grouping. Results: When age is a regressor its effects on an outcome will be interpreted differently depending upon the placing of cutpoints or the use of a polynomial transformation. Conclusions: Although it is common practice, categorization comes at a cost. Information is lost, and accuracy and statistical power reduced, leading to spurious statistical interpretation of the data. The fractional polynomial method is widely supported by statistical software programs, and deserves greater attention and use. [ABSTRACT FROM AUTHOR]

The article reports on risk factors for glaucoma. It presents a novel glaucoma risk-factor reference guide of patient history-related risks of developing glaucoma, based on evidence strength and level of concern in the literature included in the review. It mentions that this reference guide assist primary health care providers during regular health assessments, to efficiently and effectively identify individuals who are potentially at high risk of glaucoma.

The aim of the present study was to characterize sedentary time (ST) and sedentary bouts among young children, across a typical week and by day type (childcare days, non-childcare days and weekends), over a 12-month period. ST % (ST/accelerometer wear time*100) and number of sedentary bouts/hours were assessed using accelerometers at two time-points 12-months apart in 153 toddlers and 74 pre-schoolers. Differences between baseline and follow-up according to the whole week and the different day types were calculated using linear mixed models with adjustment for age, sex, socio-economic status and zBMI. During the weekend, toddlers had more 20–30 min/h sedentary bouts at follow-up than at baseline (MD: 0.03). In pre-schoolers, ST % (MD:-8.4), the number of 1–4 min/h (MD:-1.45), 5–9 min/h (MD: −0.46) and 10–19 min/h sedentary bouts (MD:-0.11) were lower at baseline, compared to follow-up, on non-childcare days; as were the number of 5–9 min/h sedentary bouts on weekends (MD:0.40). P < 0.05 for all. This study found that longer sedentary bouts (20–30 min/h) tended to decrease among toddlers and pre-schoolers, whereas ST and shorter sedentary bouts increased over 12-months, particularly among pre-schoolers on non-childcare weekdays. Non-childcare days, and home environment may be targeted for intervention to reduce ST and sedentary bouts among pre-schoolers. [ABSTRACT FROM AUTHOR]

Purpose: Frequently the infection with coronavirus 2 (SARS-CoV-2) can be asymptomatic or provoke only mild symptoms. These cases often remain unnoticed, so it is difficult to estimate the actual numbers of infections. Aim of this study was to determine the seroprevalence of anti-SARS-CoV-2 total antibody in Austrian blood donors. Methods: 20,228 blood donors aged between 18 and 72 years resident in four Austrian federal states were screened for anti-SARS-CoV-2 total antibody between 5th of June and 4th of December 2020. To evaluate the impact of sex, age, AB0-blood group and donation period on the anti-SARS-CoV-2 seroprevalence, multiple logistic regression was done. Results: Our data reveal an anti-SARS-CoV-2 seroprevalence of 2.5% overall, significantly depending on the time point of blood donation: after the first Austrian lockdown the seroprevalence was lower compared to the following months, when the rate was constantly rising. While younger blood donors showed significantly higher seroprevalence, no differences were found concerning sex or AB0 blood group. Conclusion: Broad testing strategies are required to better determine the number of SARS-CoV-2 infections. Screening blood donors as a representative group for the adult population could be a valid tool to determine the number of recorded and unrecorded cases of SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Purpose To determine the nature and prevalence of workers' concerns regarding workplaces reopening during the pandemic. To identify characteristics of workers and industries where particular concerns are more common. Method Prospective cohort study of 1063 employed Australian adults, enrolled at the start of the pandemic. Data on attitudes to workplaces reopening were collected 1 July–30 September 2020. The frequency of concerns describes infection risk and changes to work and impact on home life. Regression models examined associations between demographic and industry factors with reopening concerns. Results More than four in five (82.4%) of workers reported concerns about workplace infection risk. Just over half (53.4%) reported concerns about impacts to work and home life. Concerns were more prevalent for workers reporting psychological distress, financial stress, and among those exclusively working from home. Concerns regarding infection risk were common for workers in health care (IRR 1.16, 95% CI [1.01, 1.33]), retail (IRR 1.31, 95% CI [1.06, 1.61]), and accommodation/food service industries (IRR 1.25, 95% CI [1.01, 1.55]). Concerns regarding changes to work and home life were more common for female workers (IRR 1.24, 95% CI [1.07, 1.43]), and partners/spouses with dependent children (IRR 1.44, 95% CI [1.16, 1.79]). Conclusion Concerns of COVID-19 infection in the workplace are common. Many workers are also concerned about changes to their work and home life. The prevalence of concerns is related to the nature of work and responsibilities at home. Actions that reduce risk of workplace transmission, coupled with effective communication of infection controls, may alleviate worker concerns whilst recognising workers' family and social circumstances. [ABSTRACT FROM AUTHOR]

Intimate partner sexual violence (IPSV) is a common yet hidden form of violence against women. It encompasses a range of behaviors, including rape and sexual assault, and also more subtle behaviors such as the use of coercion and blackmail to obtain sex. It is typically described as an aspect of intimate partner violence, yet, although it often co-occurs with physical or psychological abuse, the contextual factors and nuances of sexual violence perpetrated by an intimate partner are likely to be very different. IPSV also differs greatly from sexual assault perpetrated by a stranger or other known person. Despite this, ecological theories and models developed to help understand and prevent violence against women have neglected or excluded IPSV. This is problematic given the serious mental and physical health problems consistently associated with it. In response, this article aims to explore the ecological factors that may be associated with IPSV at the individual, relationship, community, and societal levels. It draws on both inductive and deductive thematic analysis of N = 38 in-depth, unstructured interviews with women victim/survivors. Individual-level factors included sexual inexperience and past trauma (for victims), and fragile masculinity and a sense of entitlement to sex (for perpetrators). Relationship-level factors included a large age gap in the relationship and co-occurring psychological abuse. Community-level factors were identified as failure to talk about sex, isolation, and lack of support, while societal-level factors included the idea that sex is a woman's duty in a relationship, and that "real rape" is perpetrated by strangers. These factors are incorporated into a proposed ecological model that is unique to IPSV, furthering our understanding of this complex problem and its areas of overlap and difference with intimate partner violence and sexual violence. With refinement and testing through large-scale quantitative studies, this model may be critical in guiding future prevention efforts. [ABSTRACT FROM AUTHOR]

The present study is the first to investigate factors influencing professional mental health support seeking in Women of Refugee Background (WoRB) in Australia. WoRB are a vulnerable population with a range of complex mental health needs. Despite this, research has indicated that WoRB are an underrepresented population in the utilisation of mental health support services. This is a particular concern in Australia, due to an increasing number of WoRB being resettled. A multivariate logistical regression was conducted on a sample of 450 WoRB resettled in Australia from the Building a New Life in Australia (BNLA) data set to investigate factors associated with seeking professional mental health support. Several factors were identified as being significantly associated with professional mental health support seeking in WoRB resettled in Australia, including age, resettlement location, marital status, prearrival trauma involving violence against women, language barriers and health‐related variables, including mental distress and long‐term disability. The current study provides a unique insight into professional mental health support seeking from a gendered perspective in WoRB resettled in Australia. Insights into factors that influence seeking professional mental health support in this highly vulnerable population must inform mental health practice, service delivery and policies. [ABSTRACT FROM AUTHOR]

Aim: Water is critical for human survival, yet water intake equations may not reflect contemporary populations. This research aims to determine the total water intake of a representative Australian population, per kilogram of body weight (mL/kg) and stratified by age and sex. Methods: A secondary analysis of the 2011 to 2013 National Nutrition and Physical Activity Survey (n = 10 146) was conducted. Dietary intake from food and beverages was assessed by a 24‐hour recall, with respondent's weight objectively measured. Data were descriptively analysed, with multiple linear regressions used to identify the impact of demographic and physiologic factors on total water intake (mL/kg). Results: The median (interquartile range) daily total water intake per kilogram of body weight for children (2‐8 years), adolescents (9‐18 years) and adults (19+ years) were 77.1 (57.4‐100) mL/kg, 40.4 (29.3‐53.4) mL/kg and 35.5 mL/kg (26.1‐47.8), respectively. Increasing height and waist circumference were associated with reduced total water intake, with a change of −1.03 mL/kg (−1.43, −0.618) [coefficient (95% confidence interval)] in children for height and −0.448 mL/kg (−0.484, −0.412) in adults for waist circumference. Similarly, seasonality decreased intake, with greatest reductions in winter [adolescents: −4.11 mL/kg (−6.83, −1.40)]. In comparison, being male, living in rural areas and having a physical occupation were associated with greater intake, by 1.73 mL/kg (0.347, 3.10), 4.74 mL/kg (3.47, 6.00) and 2.82 (trade workers: 1.08, 4.59) in adults, respectively. Conclusions: Total water intake (mL/kg) decreased with age in both sexes. The results highlight possibilities to incorporate other factors into water intake equations to improve their accuracy. [ABSTRACT FROM AUTHOR]

Objective. The COVID-19 pandemic in Australia coincided with an early trend of reduced visits to the emergency department (ED), but to determine which patients presented less requires closer evaluation. Identifying which patient groups are presenting less frequently will provide a better understanding of health care utilisation behaviours during a pandemic and inform healthcare providers of the potential challenges in managing these groups. Methods. This single-centre retrospective study examined trends in presentations in 2020 to a private, mixed paediatric and adult ED in an inner city suburb within the state of Victoria that treats both COVID-19 and non-COVID-19 patients. The 2019 dataset was used as a reference baseline for comparison. All analyses were performed using baseline characteristics and triage data. Results. The total number of visits to the ED dropped from 24 775 in 2019 to 22 754 in 2020, representing an overall reduction of 8%. Significant reductions in daily presentations and admissions from the ED were observed in the months immediately following the peak of the two COVID-19 waves in the state of Victoria. Visits by those in the 0- to 17-year age group, triage categories 4 and 5 and musculoskeletal presentations were also reduced for most of 2020. Gastrointestinal/abdominal and urological/renal presentations were reduced immediately after the first COVID-19 wave, whereas infectious diseases visits were reduced during and after the second COVID-19 wave. Conclusions. These findings add to the growing body of evidence regarding emergency care underutilisation during the COVID-19 pandemic. Reduced private ED presentations were observed overall and in paediatric patients, lower acuity triage categories, musculoskeletal, abdominal/gastrointestinal and urological/renal presentations during the first wave, whereas infectious disease cases were reduced during the second wave. [ABSTRACT FROM AUTHOR]

Background: More than 80% of the African population depend on traditional medicine as a primary healthcare. Although the African migrant community is increasing in Australia, there is no research documenting if and how African migrant communities have maintained or changed their use of traditional health practices after migration. This study aims to answer the following research questions: does acculturation influence the use of traditional medicine? and how are cultural health practices or beliefs manifested among African migrant women in Australia? Method: A mixed methods design which involved a cross-sectional survey (n = 319) and individual interviews (n = 15) was conducted. Survey data were analysed using SPSS (version 23) and logistic regression model was used to test associations. Qualitative data were analysed thematically using NVivo 11 software to identify themes and conceptual categories in the participants' responses. The study was informed by acculturation theory. Result: Both the survey and the interview data indicated that cultural health practices were retained as an important form of healthcare for African migrant women in Sydney. The findings indicated that African migrants continued to use traditional medicines as part of their cultural identity and to build cohesive ethnic community to share traditional values and cultural practices. Women who relatively stayed for shorter period of time in Australia and migrated at a later age were more likely to use TM. Conclusion: Acculturation proxy measures increased the likelihood of TM use suggesting African migrant women retain their cultural health practices in Australia and use of TM was manifested as part of their cultural identity. The findings have implications to improve the provision of culturally sensitive and responsive health services when caring for African migrant women. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has a direct impact on the employment of older people. This adds to the challenge of ageism. The World Health Organization has started a worldwide campaign to combat ageism and has called for more research and evidence-based strategies that have the potential to be scaled up. This study specifically aims to identify solutions to combat the adverse effects of COVID-19 on the global ageing workforce. Methods: We present 15 case studies from different countries and report on what those countries are doing or not doing to address the impact of COVID-19 on ageing workers. Results: We provide examples of how COVID-19 influences older people's ability to work and stay healthy, and offer case studies of what governments, organizations or individuals can do to help ensure older people can obtain, maintain and, potentially, expand their current work. Case studies come from Australia, Austria, Canada, China, Germany, Israel, Japan, Nigeria, Romania, Singapore, Sweden, South Korea, Thailand, United Kingdom (UK), and the United States (US). Across the countries, the impact of COVID-19 on older workers is shown as widening inequalities. A particular challenge has arisen because of a large proportion of older people, often with limited education and working in the informal sector within rural areas, e.g. in Nigeria, Thailand and China. Remedies to the particular disadvantage experienced by older workers in the context of COVID are presented. These range from funding support to encouraging business continuity, innovative product and service developments, community action, new business models and localized, national and international actions. The case studies can be seen as frequently fitting within strategies that have been proven to work in reducing ageism within the workplace. They include policy and laws that have increased benefits to workers during lockdowns (most countries); educational activities such as coaching seniorpreneurship (e,g, Australia); intergenerational contact interventions such as younger Thai people who moved back to rural areas and sharing their digital knowledge with older people and where older people reciprocate by teaching the younger people farming knowledge. Conclusion: Global sharing of this knowledge among international, national and local governments and organizations, businesses, policy makers and health and human resources experts will further understanding of the issues that are faced by older workers. This will facilitate the replication or scalability of solutions as called for in the WHO call to combat ageism in 2021. We suggest that policy makers, business owners, researchers and international organisations build on the case studies by investing in evidence-based strategies to create inclusive workplaces. Such action will thus help to challenge ageism, reduce inequity, improve business continuity and add to the quality of life of older workers. [ABSTRACT FROM AUTHOR]

This paper examines the interrelationship between suicide, health, socioeconomic, and psychosocial factors in contributing to suicide in older adults in rural Australia. Drawing on a coronial dataset of suicide cases and a mixed methods sociological autopsy approach, our study integrated a quantitative analysis of 792 suicide cases with a qualitative analysis of medico-legal reports from 30 cases. The sociological autopsy provided novel insights into the entanglement of policy and service provision at the state-level with individual end-of-life decisions. Particular attention is drawn to age and gendered dimensions of suicide, especially in relation to health and social issues. The study showed a continuity between suicide and the patterning of an individual's life course, including experiences and consequences of inequality and marginality; a desire to meet culturally–normative ideals of autonomy; and a fragmented, under-funded, and intimidating social care system that offered limited options. • Sociological autopsy applied to unique coronial dataset of older adult suicide. • Combines quantitative and qualitative analyses of data from medico-legal reports. • Age and gendered differences in health and social issues related to suicide. • State-level policies and practices intersect with individual end-of-life decisions. • Imperative of prevention creates harmful environments and consequences. [ABSTRACT FROM AUTHOR]

Background/Objectives: Frailty is common in people with heart failure (HF) and associated with poorer outcomes. The aim of this study was to describe the characteristics, exercise participation, and outcomes of frail and not‐frail participants enrolled in a randomized trial of exercise training (ET) within a cardiac rehabilitation (CR) program. Design Secondary analysis of EJECTION‐HF randomized trial (ACTRN12608000263392). Setting: Five HF‐specific CR programs in Queensland, Australia. Participants: Adults recently hospitalized with HF. Intervention: All participated in CR including home exercise prescription and monitoring; half were randomized to center‐based ET. Measurements A frailty index (FI) was constructed at randomization and 6‐month follow‐up. Outcomes included ET attendance, change in 6‐min walk distance (6MWD), improved FI (>0.09 units) at 6 months, achieving physical activity (PA) guidelines at 6 months, and 12 month all‐cause death or readmission. Results: The FI was measured in 256 participants at randomization: 110 (43%) were not‐frail (FI 0.2 or less), 119 (46%) were frail (FI >0.2 to 0.39), and 27 (11%) were very frail (FI ≥0.4). Frailty was more common with older age, female gender, decompensated HF, worse HF symptoms, and preserved ejection fraction. ET attendance did not differ by frailty group. Participants who were more frail had lower 6WMD at enrollment, but similar improvement over 6 months. Mean FI improved by 0.03 units at 6 months (95% CI 0.02–0.04, p < 0.001). Participants who were more frail had significantly greater improvements in FI compared with not‐frail participants and were often able to achieve PA guidelines, both in intervention and control groups. Neither baseline frailty nor intervention was significantly associated with 12‐month death or readmission. Conclusion: Frail people with HF participating in CR that includes home and/or center‐based ET often achieve PA guidelines, and some may have meaningful reductions in frailty. See related editorial by Pandey et al. [ABSTRACT FROM AUTHOR]

Background and Aims: Past research has found that young smokers are more likely to make quit attempts; however, there are conflicting findings regarding age and quit success. This study examined the degree to which smoker age is related to making quit attempts and quit success. Design Ten waves of the International Tobacco Control Policy Cohort survey (ITC‐4C) collected between 2002 and 2014, with nine wave‐to‐wave transitions with predictors at the first wave predicting quit attempts and success by the next wave. Setting: Canada, the United States, the United Kingdom and Australia. Participants: Data from 15 874 smokers categorized into four age groups at baseline (18–24, 25–39, 40–54 and 55+ years). Measurements Age, quit attempts and success (defined as ≥ 30 days abstinence confirmed, if possible, on a third wave for recent attempts). Findings Older smokers were more likely to smoke daily (χ2 = 1557.86, r = 0.136, P < 0.001) than younger smokers. Daily smokers were less likely to report quit attempts (38.1 versus 58.2%) and to achieve 30 days of abstinence (22.9 versus 34.3%) than non‐daily smokers. Older daily smokers were less likely to make quit attempts [0.61, confidence interval (CI) = 0.54–0.70, P < 0.001], even after controlling for indicators of nicotine dependence, country, sex, education, income, relationship status and household composition, than younger smokers. Younger smokers (< 25) were more likely to succeed for at least 30 days of abstinence, but only when compared with those aged 40–54 (OR = 0.83, 95% CI = 0.68–0.99). However, when controlling for heaviness of smoking the age effect disappeared. Significant interactions with age were found between age and intention when predicting quit attempts, and age and heaviness of smoking when predicting quit success. Conclusions: An international cohort study indicates that young smokers are more likely to attempt to quit and appear to have similar levels of success in abstaining from smoking compared with older smokers when controlling for dependence. Quit success in all ages is most predicted by lower levels of nicotine dependence. [ABSTRACT FROM AUTHOR]

Aims: To explore the relationship between blood sampling techniques and haemolysis. Background: Haemolysis rates of blood samples have been thought to be influenced by the method of collection. There is a lack of research evidence available to clearly show the comparative risk of haemolysis across different blood sampling methods, including venepuncture and use of peripheral intravenous cannulas. Design: A prospective cohort study. Reporting followed the STROBE checklist. Methods: A trained observer was used to record blood sampling techniques over a 10‐week period between April and June 2019. These records were then linked to pathology haemolysis results. Multivariable logistic regression was used to model patient and blood draw characteristics affecting haemolysis. Results: Most of the blood samples were not haemolysed (n = 324, 87.1%). Multivariable analysis showed haemolysis was associated with increased tourniquet duration and if the level of tube was less than half full. Univariable analysis showed haemolysis was associated with increased age of the patient, the difficulty of cannulation/ venepuncture and increased number of attempts. No difference was found in the haemolysis rate related to the qualification of the blood collector. Conclusion: There was no significant difference in haemolysis rates associated with sampling blood from a PIVC compared with venepuncture. Research should be undertaken to determine whether education on the factors influencing haemolysis is useful in decreasing haemolysis rates. Relevance to clinical practice: There was no association with increased haemolysis rates when drawing blood via venepuncture compared with a peripheral intravenous cannula. Haemolysis of blood samples was associated with increased tourniquet duration, if level of the tube was less than half‐filled, increased age of the patient and difficulty of blood draw. Awareness of the risk of haemolysis associated with specific blood sampling methods may assist clinicians to improve care. [ABSTRACT FROM AUTHOR]

Background and aim: The effect of the COVID‐19 pandemic on alcohol consumption is currently unclear. This study aimed to provide early estimates of how stress and demographics will interact with shifts in harmful alcohol consumption from before the COVID‐19 outbreak to 2 months into social distancing. Design Cross‐sectional convenience sample. Setting: Australia. Participants: A total of 1684 Australians aged 18–65 years who drink at least monthly. Measurements Items from the Alcohol Use Disorders Identification Test (AUDIT) and the stress subscale of the Depression Anxiety and Stress Scale (DASS). Findings Overall, harmful drinking decreased during social distancing measures in our sample [2019 score = 8.2, 95% confidence interval (CI) = 7.9–8.4; during the pandemic = 7.3, 95% CI = 7.1–7.6]. Younger drinkers, particularly young women, decreased their consumption the most, but there was a small increase in consumption in middle‐aged women. Drinkers experiencing high levels of stress also reported a relatively higher shift in harmful consumption compared with those with low levels of stress (β = 0.65, P = 0.003), despite reporting a small decrease overall. Conclusions: The closure of licensed premises and social distancing measures in Australia in response to the COVID‐19 outbreak appear to have reduced harmful alcohol consumption in younger drinkers, particularly young women. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether perceived opinions of primary care are associated with student career preferences after graduation among a rural clinical school cohort and whether the preferred location of practice moderates these relationships. Design: Cross‐sectional study using data from the national Federation of Rural Australian Medical Educators survey. Participants/Setting: Medical students across 18 Australian universities who completed a clinical year in a rural setting in 2019. Main outcome measure(s): Career preference in primary care after graduation. Results: The survey was completed by 624 students (response rate = 69.9%). A preference for primary care was reported by 35.5% (95% CI: 29.4‐42.0) of students and was more likely among those age 30+ years, with a rural background, or preferring to practise rurally after graduation. Students reported that primary care was more commonly respected by medical academics (66.8%) than peers (24.0%) or junior/hospital doctors (24.0%). In adjusted analysis, none of the perceived opinions were associated with student career preferences. However, among students aiming to work in small rural locations, a career in primary care was associated with more frequent reports that peers had poor opinions of primary care (P =.004). Conclusion: Rural clinical school students perceive negative opinions of primary care, particularly among peers and junior/hospital doctors. Students aiming to work in small towns after graduation are more likely to report negative opinions among their peers, suggesting they may be more attuned to negative attitudes. This points to the need for a community of practice of like‐minded peers and clinicians to preserve the career interest of these students. [ABSTRACT FROM AUTHOR]

Background: Globally, there is growing concern regarding workers' illicit drug use and its implications for health and workplace safety. Young workers in male-dominated industries, such as construction, may be more susceptible to illicit drug use, risky drinking and its associated harms. Purpose/objectives: To investigate drug use and perceptions of risk among male construction workers, drawing comparisons between workers under 25 years with older age groups. Methods: Workers in Sydney, Australia (N = 511) completed a survey measuring past year illicit drug and alcohol use, psychological distress and perceptions of drug-related risks to health and safety. Prevalence in the total sample was compared with national estimates, and differences between younger and older survey respondents were examined using logistic regression models. Results: Survey respondents' cocaine, meth/amphetamine and cannabis use was significantly higher than estimates of male employees nationally (OR = 6.60, 3.58, 1.61, respectively). Young workers ≤24 were more likely to frequently use illicit drugs, drink heavily, and report psychological distress than those aged 35+. Workers ≤24 were least likely to perceive that drug use posed high risks to health or safety when compared with 25-34 and 35+ age groups. Conclusions/importance: The findings highlight the high prevalence of illicit drug use amongst young construction workers, representing threats to workplace safety even if used outside work hours. Greater emphasis on potential adverse effects of alcohol and drug use and closer examination of contributory workplace factors are required. These findings have practical implications to inform occupational health and safety programs and interventions in high-risk workplaces. [ABSTRACT FROM AUTHOR]

Background: When aiming to develop dietary messaging to achieve reductions in added sugar intakes, it is necessary to identify key food contributors. Food contributors are not expected to remain static over time. Therefore, the present study aimed to compare the total added sugars (AS) intake and related food sources for adult respondents of two Australian national consumption surveys. Methods: Repeated 24‐h recall data from the 1995 National Nutrition Survey (1995NNS, n = 10 851) and the 2011–12 National Nutrition and Physical Activity Survey (2012NNPAS, n = 9341) was used to estimate AS consumption. Food group sources of AS were examined per consumer and per capita and the food group predictors of energy provided by AS were determined. Results: A significant difference in total AS intake was identified by age and gender between the surveys (all P < 0.001). Increased variability in food group contributions per consumer was also identified. Nine of the top 20 food groups from the 1995NNS differed (P < 0.001) in their contribution to AS in 2012NNPAS per consumer. Fewer changes were apparent at the population level, with >40% AS coming from only three food groups. Age‐stratified analyses showed that the 'sugar, honeys and syrups' and the 'sweetened beverages' food groups were the top contributors between the surveys up to the age group of 70 years. 'Sugar, honey and syrups', 'chocolate and chocolate‐based confectionery,' and 'other confectionery' (all, P < 0.001) were significant predictors of AS intake (1995NNS, r2 = 0.755; 2012NNPAS r2 = 0.740). Conclusions: At a population level, food group contributions to AS intakes for Australian adults have not changed substantially over time, yet notable shifts in AS can be seen when targeting only the consumers of these food sources. 'Cake type desserts' appear to be increasingly consumed though 'sweetened beverages' remain a major contributor to AS intakes warranting targeted public health strategies. [ABSTRACT FROM AUTHOR]

The experience of being bullied is widespread among autistic youth. Relatively little empirical work has been done on the relationship between the bullying of these youth and school refusal (SR). This study of 67 school-age autistic boys (M = 11.7 years, SD = 2.3 years) examined several factors that may contribute to SR. Data regarding boys' age, generalised anxiety disorder (GAD), major depressive disorder (MDD), key ASD diagnostic criteria, and frequency of being bullied were collected. Results indicated that, while boys displaying emerging SR also had significantly higher GAD and MDD than boys without emerging SR, only the frequency of being bullied made a significant contribution to emerging SR. Implications for prevention and treatment of SR among autistic youth are discussed. [ABSTRACT FROM AUTHOR]

Background: ASPirin in Reducing Events in the Elderly, a randomized, double-blind, placebo-controlled trial of daily low-dose aspirin (100 mg) in older adults, showed an increase in all-cause mortality, primarily due to cancer. In contrast, prior randomized controlled trials, mainly involving younger individuals, demonstrated a delayed cancer benefit with aspirin. We now report a detailed analysis of cancer incidence and mortality.Methods: 19 114 Australian and US community-dwelling participants aged 70 years and older (US minorities 65 years and older) without cardiovascular disease, dementia, or physical disability were randomly assigned and followed for a median of 4.7 years. Fatal and nonfatal cancer events, a prespecified secondary endpoint, were adjudicated based on clinical records.Results: 981 cancer events occurred in the aspirin and 952 in the placebo groups. There was no statistically significant difference between groups for all incident cancers (hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 0.95 to 1.14), hematological cancer (HR = 0.98, 95% CI = 0.73 to 1.30), or all solid cancers (HR = 1.05, 95% CI = 0.95 to 1.15), including by specific tumor type. However, aspirin was associated with an increased risk of incident cancer that had metastasized (HR = 1.19, 95% CI = 1.00 to 1.43) or was stage 4 at diagnosis (HR = 1.22, 95% CI = 1.02 to 1.45), and with higher risk of death for cancers that presented at stages 3 (HR = 2.11, 95% CI = 1.03 to 4.33) or 4 (HR = 1.31, 95% CI = 1.04 to 1.64).Conclusions: In older adults, aspirin treatment had an adverse effect on later stages of cancer evolution. These findings suggest that in older persons, aspirin may accelerate the progression of cancer and, thus, suggest caution with its use in this age group. [ABSTRACT FROM AUTHOR]

Background: Chronic wet cough in children is the hallmark symptom of protracted bacterial bronchitis (PBB) and if left untreated can lead to bronchiectasis, which is prevalent in Indigenous populations. Underrecognition of chronic wet cough by parents and clinicians and underdiagnosis of PBB by clinicians are known.Research Question: We aimed to improve recognition and management of chronic wet cough in Aboriginal children using knowledge translation (KT), a methodologic approach that can be adapted for use in Indigenous contexts to facilitate effective and sustained translation of research into practice.Study Design and Methods: A mixed-methods KT study undertaken at a remote-based Aboriginal primary medical service (February 2017 to December 2019). Our KT strategy included the following: (1) culturally secure (ie, ensuring Aboriginal people are treated regarding their unique cultural needs and differences) knowledge dissemination to facilitate family health seeking for chronic wet cough in children, and (2) an implementation strategy to facilitate correct diagnosis and management of chronic wet cough and PBB by physicians.Results: Post-KT, health seeking for chronic wet cough increased by 184% (pre = eight of 630 children [1.3%], post = 23 of 636 children [3.6%]; P = .007; 95% CI, 0.7%-4.0%). Physician proficiency in management of chronic wet cough improved significantly as reflected by improved chronic cough-related quality of life (P < .001; 95% CI, 0.8-3.0) and improved physician assessment of cough quality (P < .001; 95% CI, 10.4%-23.0%), duration (P < .001; 95% CI, 11.1%-24.1%), and appropriate antibiotic prescription (P = .010; 95% CI, 6.6%-55.7%).Interpretation: Health seeking for children with chronic wet cough can be facilitated through provision of culturally secure health information. Physician proficiency in the management of PBB can be improved with KT strategies which include training in culturally informed management, leading to better health outcomes. Comprehensive strategies that include both families and health systems are required to ensure that chronic wet cough in children is detected and optimally managed. [ABSTRACT FROM AUTHOR]

Objective: To explore reasons for the gap between the perception that high home ownership provides a strong pillar of funding for aged care accommodation and the actuality of half of those in residential care having this cost met by the Accommodation Supplement. Methods: Review of data from Australian Bureau of Statistics and administrative sources, and recent research studies. Results: Trends in payment methods show continuing reliance on the Accommodation Supplement. Reasons are found in patterns of home ownership at older ages, changes in tenure and living arrangements over the age range, and increasing use of the exchange value of housing assets. Policy tensions arise between protecting access for low means residents and requiring those who are able to pay to do so. Conclusions: The housing assets pillar at advanced ages is not as strong as early in retirement and makes it increasingly unreliable as a source of funding. [ABSTRACT FROM AUTHOR]

Background: Central venous access devices (CVAD) are commonly employed in the management of cancer patients. While having several benefits they are associated with significant risks. Aim: To review the incidence and risk factors for catheter‐related thrombosis (CRT) in cancer patients with a CVAD. Methods: We performed a prospective observational cohort study of adult patients with cancer requiring a CVAD between 1 January 2004 and 29 June 2016. The rate of, and risk factors for the development of, symptomatic CRT were evaluated. Results: A total of 4920 central lines was inserted into 3130 patients. The incidence of CRT was 3.6%. CRT developed a median of 12 days following line insertion. Peripherally inserted central catheters (PICC) were associated with the highest rates of CRT (hazards ratio (HR) 22.2, 95% confidence interval (CI) 2.9–170.6). Older age groups developed CRT at lower rates (HR 0.57; 95% CI 0.39–0.84 for age 50–61 years, and HR 0.63; 95% CI 0.45–0.89 for age >61 years) compared to age <50 years. Increased CRT was seen in patients with prior CRT (HR 1.81; 95% CI 1.19–2.77). There was a trend to more CRT events with a Khorana tumour score of 1 compared to those with a score of 0 (HR 1.37, 95% CI 1.00–1.88). Hodgkin lymphoma, germ cell and oesophagus cancers had the highest CRT rates. Side of insertion was not associated with thrombosis risk (HR 0.77; 95% CI 0.57–1.05; P = 0.10). Conclusions: Age <50 years, PICC lines and prior CRT were associated with highest CRT rate. Cancer subtype and insertion side were not predictive of thrombosis. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Urinary tract infection (UTI) is a common presentation to general practitioners (GPs). There is increasing antimicrobial resistance in urinary pathogens in many healthcare systems. Adherence to principles of antimicrobial stewardship is important to combat this problem. Our aim was to describe the prevalence of presentations of clinically diagnosed new UTI to early‐career GPs, to describe management choices made, and to identify associations of prescribing antibiotics at the index consultation for UTI. Method: This is a cross‐sectional analysis of the Registrar Clinical Encounters in Training cohort study. Early‐career GPs from five Australian states (urban to very remote practices) collected data on 60 consecutive patient encounters during each of three 6‐month training terms. Proportions of problems being new UTIs, antibiotics prescribed, urine microscopy and culture ordered were calculated. Univariate and multivariable logistic regressions established associations of patient, registrar, and practice factors with prescribing antibiotics for a new UTI. Results: One thousand three hundred thirty‐three early‐career GPs diagnosed 2850 new UTIs from 189 736 consultations (1.5%; 95% CI, 1.4‐1.6). Antibiotics were prescribed at 86% (95% CI, 84.7‐87.2) of these index consultations. Antibiotic choice followed Australian therapeutic guideline recommendations. Urine microscopy and culture were requested at the index consultation less than recommended by guidelines in men, 69.2% (95% CI, 62.6‐75.1), and children, 80.8% (95% CI, 76.4‐84.6). Adults were significantly more likely to be treated with antibiotics at the index consultation than children under 16. Conclusions: A new UTI is a common presentation to Australian early‐career GPs. There is general adherence to guidelines for antibiotic choice in UTIs. Further research is needed, however, to understand some decisions made when managing UTI in children and men. This may reflect diagnostic uncertainty with consequent attention to antibiotic stewardship by deferring antibiotic prescription. [ABSTRACT FROM AUTHOR]

Objective. Over the past decade, various programs and reforms have targeted the issue of people aged ,65 years living in 'permanent' residential aged care (PRAC). As context for ongoing policy discourse, the aim of this study was to evaluate trends in rates of young people entering and leaving PRAC from 2008 to 2018. Methods. Counts of people aged ,65 years entering, remaining in and exiting PRAC were obtained from the National Aged Care Data Clearinghouse. Age standardisation was used to control for changes in the age and size of the Australian population. Annual age-standardised rates of admissions (subtracting transfers) and exits to the community were calculated. Linear regression models tested for a sustained increase or decrease in age-standardised rates nationally and within state and age subgroups. Results. Notwithstanding year-to-year variation, neither admissions (subtracting transfers) nor exits to the community showed statistically significant increasing or decreasing trends in the national age-standardised rates. Admission rates varied by age and state. Conclusions. Many more young people are admitted to PRAC each year than return to community living, with no sustained change between 2008 and 2018 at the national level. Age standardisation is crucial for evaluating systemic population-level change regarding younger people in PRAC. [ABSTRACT FROM AUTHOR]

Background: Seasonal influenza and pertussis cause significant morbidity and mortality among expectant mothers and infants. Vaccination during the antenatal period is an important public health intervention, minimising rates of maternal, neonatal and infant infection. Aims: The primary aim of this project was to establish the rates of antenatal vaccine uptake. Secondly, the study aimed to determine socio‐demographic factors significant to vaccine uptake. Thirdly, the project aimed to produce a thematic analysis of the factors affecting vaccination uptake during pregnancy. Materials and Methods: A cross‐sectional observational study was conducted among women attending a large maternity hospital, in the western suburbs of Melbourne, for perinatal care. Data were collected via self‐completed questionnaires after delivery. Data from the questionnaires were entered into an electronic database, and STATA was used to undertake correlation analysis. Results: Over a 12‐month period 1678 women completed questionnaires and 1305 were eligible for further analysis. The uptake of influenza vaccine was 48.3%, pertussis vaccine uptake was higher, at 82.9%. Uptake of influenza and pertussis vaccines strongly correlated with recommendations from healthcare providers (odds ratios 29.7 and 63.8 respectively). Maternal country of birth, age and parity were significant predictors of vaccine uptake. In thematic analysis, healthcare provider recommendation and the perceived risk of the disease were factors resulting in vaccination. Conclusion: This study determined the rate of antenatal vaccine uptake and significant socio‐demographic determinants affecting uptake at a large maternity hospital in metropolitan Melbourne. Ensuring healthcare providers recommend vaccination is likely to improve coverage. [ABSTRACT FROM AUTHOR]

We report on Australian gay and bisexual men's (GBM) perceptions of preexposure prophylaxis (PrEP). Drawing on an online longitudinal cohort study, 1,404 free-text responses from HIV-negative or untested Australian GBM were qualitatively analysed. The chi-square statistic was then used to assess differences regarding PrEP-perceptions by participants' demographic and behavioral characteristics. Positive views of PrEP were twice more common than negative. Those with positive views thought PrEP helped overcome HIV fear and anxiety, enhanced sexual pleasure, and was a 'socially responsible' course of action. Those with negative views believed that people without medical conditions did not need medication and expressed concern that PrEP was replacing condoms, representing 'dangerous' behavior. Descriptive statistics revealed differences in PrEP-perceptions relating to age, recency of HIV testing, and PrEP eligibility. This study is the first to use free-text data to examine the frequency of Australian GBM's PrEP-perceptions, highlighting the potential benefits and challenges to its promotion. [ABSTRACT FROM AUTHOR]

Background: Long-chain omega-3 polyunsaturated fatty acids (LCn-3 PUFA) are essential nutrients and may be capable of delaying age-related cognitive decline. However, previous studies indicate that Australians are not meeting recommendations for LCn-3 PUFA intake. The current study therefore examined LCn-3 PUFA intake in an older Australia sample, as well as associations between LCn-3 PUFA intake and cognitive function. Methods: Cross-sectional data were collected from 90 adults aged 50 to 80 years. LCn-3 PUFA intake was assessed using a food frequency questionnaire and red blood cell fatty acid profiles were used to calculate the Omega-3 Index (RBC n-3 index). Cognitive function was measured using Addenbrooke's Cognitive Examination-Ill. Results: Positive associations were observed between age and RBC n-3 index (b=0.06, 95% CI: 0.01–0.10, P=0.01), and age and LCn-3 PUFA intake from fish oil capsules (b=17.5, 95% CI: 2.4 − 32.5 mg/day, P=0.02). When adjusting for LCn-3 PUFA from fish oil capsules, the association between age and RBC n-3 index was no longer significant. No associations were observed between LCn-3 PUFA intake and cognitive function. Conclusion: LCn-3 PUFA and fish oil consumption increased with age in this sample of older Australians, particularly due to supplement intake. However, LCn-3 PUFA intake was not associated with cognitive function. [ABSTRACT FROM AUTHOR]

Background: Children's play and leisure participation is often assessed by occupational therapists. As such, it is essential that therapists utilize play and leisure scales that are valid, reliable and responsive. Aim: To examine the convergent validity between the Children's Leisure Assessment Scale (CLASS) and Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE/PAC). Methods: Forty healthy Australian children (60% female; mean age 9.2 ± 2.01 years) completed the CLASS and CAPE/PAC. Spearman's rho correlations with bootstrapping were completed. Results: A number of the CLASS and CAPE/PAC subscales were significantly correlated. The CAPE's overall scale scores and CLASS's instrumental indoor activities, outdoor activities and games and sport activities subscales were significantly correlated (p > 0.05). The CAPE's Social domain showed several significant correlations with the CLASS's instrumental indoor activities, outdoor activities and self-enrichment activities domains (p < 0.05). Statistically significant relationships were found between the CLASS's outdoor activity preference and the PAC's recreational, physical, formal, informal and overall performance scores (r = 0.466–0.773, p < 0.05). Conclusions and Significance: Preliminary evidence in support of the convergent validity between the CAPE/PAC and CLASS was obtained. Limitations include a small sample size and convenience sampling. Further investigation of the psychometric properties of the CAPE/PAC and CLASS are recommended. [ABSTRACT FROM AUTHOR]

Background: Dementia is under-diagnosed in primary care. Timely diagnosis and care management improve outcomes for patients and caregivers. This research evaluated the effectiveness of a nationwide Continuing Medical Education (CME) program to enhance dementia-related awareness, practice, knowledge and confidence of general practitioners (GPs) in Australia. Methods: Data were collected from self-report surveys by GPs who participated in an accredited CME program face-to-face or online; program evaluations from GPs; and process evaluations from workshop facilitators. CME participants completed surveys at one or more time-points (pre-, post-program, six to 9 months follow-up) between 2015 and 2017. Paired samples t-test was used to determine difference in mean outcome scores (self-reported change in awareness, knowledge, confidence, practice) between time-points. Multivariable regression analyses were used to investigate associations between respondent characteristics and key variables. Qualitative feedback was analysed thematically. Results: Of 1352 GPs who completed a survey at one or more time-points (pre: 1303; post: 1017; follow-up: 138), mean scores increased between pre-CME and post-program for awareness (Mpost-pre = 0.9, p < 0.0005), practice-related items (Mpost-pre = 1.3, p < 0.0005), knowledge (Mpost-pre = 2.2, p < 0.0005), confidence (Mpost-pre = 2.1, p < 0.0005). Significant increases were seen in all four outcomes for GPs who completed these surveys at both pre- and follow-up time-points. Male participants and those who had practised for five or more years showed greater change in knowledge and confidence. Age, years in practice, and education delivery method significantly predicted post-program knowledge and confidence. Most respondents who completed additional program evaluations (> 90%) rated the training as relevant to their practice. These participants, and facilitators who completed process evaluations, suggested adding more content addressing patient capacity and legal issues, locality-specific specialist and support services, case studies and videos to illustrate concepts. Conclusions: The sustainability of change in key elements relating to health professionals' dementia awareness, knowledge and confidence indicated that dementia CME programs may contribute to improving capacity to provide timely dementia diagnosis and management in general practice. Low follow-up response rates warrant cautious interpretation of results. Dementia CME should be adopted in other contexts and updated as more research becomes available. [ABSTRACT FROM AUTHOR]

School-based social and emotional learning (SEL) programmes represent a practical method of improving social and emotional well-being in students. To date, however, what is less well understood is why a theoretically sound, appropriately administered, engaging universal SEL programme may be more effective for some children over others. In the present study, an established SEL programme, KooLKIDS Whole of Class, was delivered to 524, 8 to 12-year-old Australian primary school students. Classroom teachers completed pre- and post-measures regarding children's social-emotional competence and emotional and behavioural difficulties. Hierarchical linear modelling was used to examine which characteristics predicted differential improvement from the programme. Findings revealed that the pre-programme total score on emotional and behavioural difficulties was the strongest predictor of improvements in SEL, independent of age, sex or socioeconomic status. This implies that while universal SEL programmes represent an effective and relatively low-cost method of improving social competence for all children, they may be particularly effective for improving social and emotional competence in those with greater emotional and behavioural difficulties. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence and context of disability exclusion reported by people with disability, with and without communication and mobility problems. Methods: The 2015 Survey of Disability Ageing and Carers was used to measure the prevalence of reported exclusion. Tests of proportions were used to examine differences in prevalence rates. Proportional Venn diagrams were used to examine the intersection of measures of exclusion. Results: Approximately 53% of those with a communication or mobility difficulty reported at least one measure of exclusion. Among this group, 7% reported an instance of discrimination, 44% reported avoidance, and 29% reported an accessibility problem. The levels of discrimination and avoidance for those without communication or mobility difficulties were approximately half this level (16% avoidance and 3% discrimination). Avoidance and discrimination reduced with age, but accessibility was age‐invariant. Exclusion measures intersected and occurred in a variety of contexts. Conclusion: Despite protections provided in Australian law, disability exclusion persists and is high among those with communication and mobility difficulties. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence, context and types of discrimination reported by older Australians (aged 55 years and over) and associations between outcomes (trust, self‐efficacy and life satisfaction) and exposure to discrimination. Methods: The 2014 General Social Survey was used to measure discrimination. Multivariable logistic regression was used to examine associations between levels of trust, self‐efficacy and life satisfaction and exposure to discrimination. Results: A sizeable minority of older Australians with a disability reported discrimination (15%), with higher exposure for those with more severe or multiple disabilities. In addition to disability, age and nationality, race or ethnic group were cited as reasons for discrimination. Discrimination was reported across a variety of contexts, including everyday social interactions. Lower levels of trust, self‐efficacy and life satisfaction were associated with exposure to disability discrimination. Conclusions: Focusing on disability discrimination alone underestimates the level of exposure to discrimination. Discrimination may reinforce social exclusion by reducing trust and self‐efficacy in familial and community contexts. [ABSTRACT FROM AUTHOR]

Issue Addressed: Problematic alcohol consumption (PAC) affects one-third of homeless Australians, and it is expected that the rates will increase as the population ages. However, current policy does not recognise the importance of this problem. The aim of this narrative review was to examine the social determinants and other risk factors contributing to PAC in homeless Australians, the barriers to receiving help and possible solutions for the Australian context.Methods: PubMed and PsycINFO databases and Australian government websites were examined for the keywords "alcohol" and "homeless," and pertinent articles were selected for inclusion and for citation tracking of further relevant articles.Results: The causes of PAC in homeless Australians are multifactorial, and multidirectional, and include risk factors such as low socio-economic status, mental illness and having experienced trauma. There is significant stigma associated with both homelessness and PAC, which further isolates this group. Current policies to address PAC in the homeless are inadequate; however, there are a range of possible programs to reduce PAC in this group, and international harm reduction strategies have also shown success in improving outcomes for this group.Conclusion: There are numerous social risk factors that influence the development of PAC in the homeless. The introduction of harm reduction strategies, programs to enhance motivation and personal skills, as well as better mental health treatment, would all fill important gaps in services for homeless Australians with PAC. SO WHAT?: Health professionals can be advised that there are many social determinants that influence PAC in homeless Australians. There are important structural barriers to providing this marginalised group with the services they require; however, there is scope for the introduction of new programs, including harm reduction strategies, to meet the fundamental needs of this group. [ABSTRACT FROM AUTHOR]

Previous data have suggested that parents of boys with autism spectrum disorder (ASD) may rate their sons' generalised anxiety disorder (GAD) more severely than the boys do themselves. However, no reports have been published to date which examine this issue in a girls-only sample. This study investigated the extent and nature of mother–daughter agreement on ratings of GAD in a sample of 53 girls with an ASD with mild impairment, aged 6 to 17 years. Mothers rated their daughters' GAD more severely than the girls did themselves, despite confounding effects from the girls' medication and menarche status. Suggestions are made for the valid assessment of GAD in girls with an ASD. [ABSTRACT FROM AUTHOR]

After-hours general practitioner (GP) services can reduce emergency department demand, which is currently increasing in Australia. Understanding GP after-hours care may assist in service planning. From April 2014 to March 2015, 986 GPs recorded 38 275 consultations with start and finish times in the Bettering the Evaluation and Care of Health (BEACH) study, a national, cross-sectional, representative study of GP activity. GP and patient characteristics and the content of encounters in usual-hours and after-hours were compared. Significantly more after-hours than usual-hours encounters were with: GPs aged 60+ years; in metropolitan practices; and practices with 10+ GPs. Patients seen after-hours were more often: male; aged 15–64 years; new to practice; and less likely to hold a Commonwealth Concession Card. They were more likely to be prescribed antibiotics and less likely to: have chronic problems managed; be referred; receive psycholeptic or psychoanaleptic prescription; and undergo a procedure. Throat symptoms, fever and injury were more common reasons for encounter, while infections and injury were more frequently managed problems after-hours. The patient mix, GP characteristics, problems managed and management actions in after-hours care differ from those in usual-hours care in Australia. This greater understanding of after-hours care is the first step to informed resource allocation to improve the delivery of after-hours primary care. This study aimed to understand what happens at after-hours general practitioner services as it has been shown that these after-hours services can reduce emergency department demand. The patient mix, GP characteristics, problems managed and management actions in after-hours care differ significantly from those in usual-hours care in Australia. This greater understanding of after-hours care is the first step to informed resource allocation to improve the delivery of after-hours primary care. [ABSTRACT FROM AUTHOR]

For many populations at risk of social isolation, including Older Women Living Alone (OWLA), existing services to maintain independence and optimise well‐being are difficult to access, unsuitable or unavailable. Co‐creation is a strategy to develop 'person‐centred' services that meet the needs of individuals. We adapted an existing framework for co‐creation and used participatory action research methods, supported by an evidence base comprising a systematic review, analysis of routinely collected data and interviews, to develop person‐centred services for OWLA. This approach achieved co‐creation through an iterative process of consultation and review, involving a series of facilitated discussions with women living alone and stakeholders. A total of 13 women living alone, aged ≥55 years, and 11 stakeholders representing service providers and advocacy groups, were recruited to participate in these discussions. Sessions with between three and five OWLA, were held across Melbourne. The information was compiled and presented to service stakeholders in a single facilitated forum, held in central Melbourne. Smaller facilitated sessions with OWLA followed, to review and discuss the collated service stakeholder input. The information from these OWLA sessions were again compiled and directed back to the service stakeholders for consideration and further discussion. The two groups came together for a final forum to prioritise the co‐created ten services that they believed would be feasible and would address unmet need to support OWLA maintain independence. The process of co‐creation was time‐consuming and required considerable preparation to facilitate input from the target population. Small groups, gathering at convenient local locations, with transport support were essential in removing barriers to participation. However, co‐creation was a viable method of eliciting the women's preferences and developing services more likely to meet their needs. [ABSTRACT FROM AUTHOR]

Background. Measuring physical activity behaviours of stroke survivors in the inpatient setting is challenging. Authors of observational studies of early poststroke report that stroke survivors are "inactive and alone". Using activity monitoring devices may help refine clinical practice and inform therapeutic activity targets. Aim. To measure the physical activity behaviour of stroke survivors during acute inpatient hospitalisation. We hypothesized that greater levels of inactivity would be positively associated with stroke severity and age. Method. Using a cross-sectional study design, consecutive stroke patients admitted to an acute stroke unit (Geelong, Australia) and recruited within 48 hours of admission had their physical activity recorded using an ActivPAL™ accelerometer device over a minimum of 3 days. Activity was categorised as time spent inactive (lying or sitting), standing, or stepping. The number of steps per day was recorded. Demographic and ActivPal™ data are described. Results. Seventy-eight stroke survivors were recruited of whom 54 had complete data for 3 days, all starting within 2 days poststroke. Of the 54 participants, 32 had a mild stroke, 17 moderate, and five severe stroke. Nine were able to walk independently at admission. The median age was 82.5 years (interquartile range (IQR) 74-86), 26 were female. On average, during their inpatient stay, participants spent a median of 98% of their admission inactive. A median of 18 minutes per day was spent standing and less than a minute per day was spent walking amounting to a median of 169 steps taken per day. Conclusion. The ActivePal™ device was feasible to use in an acute stroke setting. We observed high levels of inactivity in the first days post-stroke, highlighting the ongoing challenge of promoting activity in the acute stroke period. To our knowledge, this is the largest study to provide objective data on time spent upright, walking, and sedentary using accelerometer data in an acute stroke setting. [ABSTRACT FROM AUTHOR]

Objective: Primarily to determine mid‐term functional outcome for patients with distal radius fracture (DRF) and to compare this between operative and conservatively managed patients. Secondarily to examine for differences in age, gender and number of instability factors between management groups. Methods: Eligible patients (age 18 years or more, closed DRF managed to completion of care within Monash Health), presenting between 1 January and 31 December 2016. Completion of the patient‐rated wrist evaluation (PRWE) questionnaire was sought at 6–12 months post‐injury. Management was noted (operative or conservative). Age, sex and number of defined instability factors present (dorsal angulation >20°, intra‐articular fracture, associated ulna fracture, dorsal comminution, radial shortening >2 mm) are reported and compared between management groups. Results: Of 369 eligible patients, 199 (54%) completed a PRWE. Median age was 60 years (interquartile range [IQR] 45–71), 150 (75%) were women, median number of instability factors present was 2 (IQR 1–4) and 45 (23%) underwent operative management. Difference in PRWE scores between operative and conservatively managed patients was not significant (20 [IQR 7–36] vs 16 [IQR 5–35]). Differences in age and gender between management groups were not significant. Significantly more in the operative group had presence of four or more instability factors (44% [95% confidence interval 30–60] vs 20% [14–27]). Conclusion: The mid‐term median PRWE score was 18 (IQR 5–36). This was not significantly different between operative and conservatively managed patients. Operation was more likely when four or more instability factors were present. [ABSTRACT FROM AUTHOR]

Background Unlike some other safety critical professions, there is no mandatory age of retirement for doctors, including surgeons. Medical regulators in Australia are implementing additional checks on doctors from the age of 70. We describe expert opinions on assuring performance and supporting career transitions among older surgeons. Methods In this qualitative study, experts in four countries were purposively selected for their expertise in surgical governance. Experts responded to interviews (Australia, New Zealand and UK) or a survey (Canada). A tiered framework of interventions was developed by integrating findings with previous literature and responsive regulation theory. Results 52 experts participated. Participants valued the contribution of senior surgeons, while acknowledging that age- related changes can affect performance. Participants perceived that identity, relationships and finances influence retirement decisions. Experts were divided on the need for age- specific testing, with some favouring whole- of- career approaches to assuring safe care. A lack of validated tools for assessing performance of older surgeons was highlighted. Participants identified three options for addressing performance concerns-- remediate, restrict or retire--and emphasised the need for co- ordinated and timely responses. Conclusion Experts perceive the need for a staged approach to assessing the performance of older surgeons and tailoring interventions. Most older surgeons are seen to make decisions around career transitions with self- awareness and concern for patient safety. Some older surgeons may benefit from additional guidance and support from employers and professional colleges. A few poorly performing older surgeons, who are recalcitrant or lack insight, require regulatory action to protect patient safety. Developing robust processes to assess performance, remediate deficits and adjust scopes of practice could help to support safe career transitions at any age. [ABSTRACT FROM AUTHOR]

Objective: Adopting a socio‐ecological perspective, we used data extracted from clinical casefiles to investigate factors associated with externalising and internalising problems in a large, representative sample of children with a diagnosis of dyslexia. Method: This study is a secondary analysis of data collected by the Dyslexia‐SPELD Foundation in Western Australia. Casefiles for school‐aged children who had received a dyslexia diagnosis in 2014 and 2015 were identified (n = 1,235), and a subset of casefiles were randomly selected for data extraction (n = 454). Of the sample, 58% (n = 262) were male, 42% (n = 192) were female. Ages ranged between 6 and 17 years (M = 12.32, SD = 3.07). Casefiles include results from assessments of literacy‐related achievement, as well as parent‐reported information on behavioural and socio‐emotional development. Results: After controlling for child age, gender, and reading ability, it was found that low self‐esteem, difficulties in emotion regulation, and social skills difficulties were all associated with externalising problems. Additionally, low self‐esteem, difficulties in emotion regulation, and bullying victimisation were all associated with internalising problems. Peer relationship difficulties were indirectly associated with both externalising and internalising problems through associations with low self‐esteem and difficulties in emotion regulation. Conclusion: Self‐esteem, bullying victimisation, emotion regulation, social skills, and peer problems are salient correlates of externalising and internalising problems in children with a diagnosis of dyslexia. Implications for intervention are discussed, both universal school‐based mental health promotion programs, as well as more targeted programs for children with dyslexia. [ABSTRACT FROM AUTHOR]

There is widespread recognition that workplace stress can have profound negative impacts on nurses' well‐being and practice. Resilience is a process of positive adaptation to stress and adversity. This study aimed to describe mental health nurses' most challenging workplace stressors, and their psychological well‐being, workplace resilience, and level of caring behaviours, explore the relationships between these factors, and describe differences in workplace resilience for sociodemographic characteristics. In a descriptive correlational study using convenience sampling, data were collected from N = 498 nurses working in mental health roles or settings in Victoria Australia via an online cross‐sectional survey. Key findings included weak to strong (r = 0.301 to r = 0.750) positive relationships between workplace resilience with psychological well‐being across all stressor categories (consumer/carer; colleague; organizational role; and organizational service). Psychological well‐being was moderately high, but lower for nurses indicating consumer/carer‐related stressors as their most stressful challenge. There were weak to moderate (r = 0.306 to r = 0.549) positive relationships between workplace resilience and psychological well‐being, and no relationship between resilience and caring behaviours. Workplace resilience was lower (P < 0.05) for less experienced nurses compared with those with >5 years' experience, and lower for younger nurses compared with those aged ≥40 years. To improve their resilience and prevent psychological distress, there is prime opportunity to support nursing students with well‐being and resilience‐building strategies during their undergraduate education, and to support new graduates with similar programmes when they enter the workforce. [ABSTRACT FROM AUTHOR]

Background: While research in high‐income countries (HICs) has established high costs associated with alcohol's harm to others (AHTO) in the workplace, scant attention has been paid to AHTO in the workplace in lower‐ or middle‐income countries (LMICs). Aim: To compare estimates and predictors of alcohol's impacts upon coworkers among workers in 12 countries. Methods: Cross‐sectional surveys from 9,693 men and 8,606 women employed in Switzerland, Australia, the United States, Ireland, New Zealand, Chile, Nigeria, Lao PDR, Thailand, Vietnam, India, and Sri Lanka. Five questions were asked about harms in the past year because of coworkers' drinking: Had they (i) covered for another worker; (ii) worked extra hours; (iii) been involved in an accident or close call; or had their (iv) own productivity been reduced; or (v) ability to do their job been affected? Logistic regression and meta‐analyses were estimated with 1 or more harms (vs. none) as the dependent variable, adjusting for age, sex, rurality of location, and the respondent worker's own drinking. Results: Between 1% (New Zealand) and 16% (Thailand) of workers reported that they had been adversely affected by a coworker's drinking in the previous year (with most countries in the 6 to 13% range). Smaller percentages (<1% to 12%) reported being in an accident or close call due to others' drinking. Employed men were more likely to report harm from coworkers' drinking than employed women in all countries apart from the United States, New Zealand, and Vietnam, and own drinking pattern was associated with increased harm in 5 countries. Harms were distributed fairly equally across age and geographic regions. Harm from coworkers' drinking was less prevalent among men in HICs compared with LMICs. Conclusions: Workforce impairment because of drinking extends beyond the drinker in a range of countries and impacts productivity and economic development, particularly affecting men in LMICs. [ABSTRACT FROM AUTHOR]