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To guide prevention and intervention efforts, the prevalence and impact of child sexual abuse (CSA) victimization among detained and incarcerated populations requires further examination, particularly with consideration of multi-type maltreatment experiences and sex-based variations. This longitudinal population-based study explores these relationships in an Australian birth cohort comprising all individuals born in Queensland in 1983 and 1984 (n = 82,409; 48.68% female). Data include all notified and substantiated harm(s) from child protection services (0 to 17 years), and sentences to youth detention and/or adult incarceration between ages 10 and 30. Findings indicate greater prevalence of CSA amongst detained/incarcerated individuals compared to the general population but emphasize the impact of cooccurring maltreatment (particularly neglect) on the likelihood of custodial outcomes. Important sex-based differences were noted in the intersection of CSA victimization and detention/incarceration. Findings reinforce the need for trauma-informed practices when working with custodial populations, particularly females, and highlight opportunities for prevention of detention/incarceration in at-risk populations, in line with a broader public health approach to child protection. [ABSTRACT FROM AUTHOR]

Most prior research on violence among tertiary students has been restricted to dating and sexual violence and neglected cross-cultural variation. To provide more comprehensive and intersectional understandings, this study examined the prevalence and cultural differences in intimate partner and family violence among women tertiary students in Australia. Data were collected from 1,845 women studying at post-secondary institutions and weighted by age and country of birth to reflect the population composition. Eighty-seven percent (86.7%) of participants reported having experienced violence (physical, sexual, psychological, and/or financial) from an intimate partner and/or family member during adulthood. Students who identified as Anglo were more likely to report victimization by intimate partners, while those who identified as non-Anglo and multicultural were more likely to report victimization by family members. The findings highlight the need for tertiary education institutions to prioritize preventing and responding to intimate partner and family violence in their culturally diverse student bodies. [ABSTRACT FROM AUTHOR]

Background: Information on inappropriate dosing of direct oral anticoagulants (DOACs) is scarce in the Australian context. Aim: To describe the prevalence and potential predictors of inappropriate dosing of DOACs. Methods: Patients who received DOACs during admission under a general medical unit over a 2‐year period (from January 2017 to December 2018) were retrospectively studied. Appropriateness of the dosing regimen was verified against the recommendations of the Therapeutic Goods Administration of Australia. Data were obtained from medical records and analysed in univariate and multivariate logistic regression models. The variables associated with under‐ and overdosing were also determined. Results: A total of 203 (mean age 71.6 ± 14.5 years, females 52%) patients were studied. Inappropriate dosing occurred in 44 (22%) patients: underdosing 27 (13%) and overdosing 17 (8%). Age ≥75 years (P < 0.01), lower estimated creatinine clearance (CrCl) (P < 0.01), prescription of DOAC prior to index admission (P < 0.01) and higher Charlson Comorbidity Index (P < 0.01), HAS‐BLED (P < 0.01) and CHA2DS2‐VASc (P < 0.01) scores had a significant univariate association with inappropriate dosing. However, in the multivariate logistic regression only lower CrCl (odds ratio (OR) 1.04, 95% confidence interval (CI): 1.01–1.07, P < 0.01) and prescription of DOAC prior to index admission (OR 2.62, 95% CI: 1.01–6.75, P = 0.047) remained significantly associated with inappropriate dosing. Impaired renal function also had a significant association with underdosing (OR 1.04, 95% CI: 1.01–1.07, P = 0.01) and borderline significance with overdosing (OR 1.03, 95% CI: 1.00–1.07, P = 0.06). Conclusion: Inappropriate dosing of DOACs, especially underdosing, is common in clinical practice. Clinicians should exercise due diligence when prescribing DOACs to patients with renal impairment and in outpatient settings. [ABSTRACT FROM AUTHOR]

Introduction: Access to after‐hours care (AHC) is an important aspect of general practice service provision. Objective: To establish the prevalence and associations of early‐career GPs' provision of AHC. Design: An analysis of data from the New alumni Experiences of Training and independent Unsupervised Practice (NEXT‐UP) cross‐sectional questionnaire‐based study. Participants were early‐career GPs (6‐month to 2‐year post‐Fellowship) following the completion of GP vocational training in NSW, the ACT, Victoria or Tasmania. The outcome factor was 'current provision of after‐hours care'. Associations of the outcome were established using multivariable logistic regression. Findings: Three hundred and fifty‐four early‐career GPs participated (response rate 28%). Of these, 322 had responses available for analysis of currently performing AHC. Of these observations, 128 (40%) reported current provision of AHC (55% of rural participants and 32% of urban participants). On multivariable analysis, participants who provided any AHC during training were more likely to be providing AHC (odds ratio (OR) 5.51, [95% confidence interval (CI) 2.80–10.80], p < 0.001). Current rural location and in‐training rural experience were strongly associated with currently providing AHC in univariable but not multivariable analysis. Discussion: Early‐career GPs who provided AHC during training, compared with those who did not, were more than five times more likely to provide after‐hours care in their first 2 years after gaining Fellowship, suggesting participation in AHC during training may have a role in preparing registrars to provide AHC as independent practitioners. Conclusion: These findings may inform future GP vocational training policy and practice concerning registrars' provision of AHC during training. [ABSTRACT FROM AUTHOR]

Background: Alcohol use is a key preventable risk factor for serious injury. To effectively prevent alcohol-related injuries, we rely on the accurate surveillance of alcohol involvement in injury events. This often involves the use of administrative data, such as International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding. Objective: To evaluate the completeness and accuracy of using administrative coding for the surveillance of alcohol involvement in major trauma injury events by comparing patient blood alcohol concentration (BAC) with ICD-10-AM coding. Method: This retrospective cohort study examined 2918 injury patients aged ≥18 years who presented to a major trauma centre in Victoria, Australia, over a 2-year period, of which 78% (n = 2286) had BAC data available. Results: While 15% of patients had a non-zero BAC, only 4% had an ICD-10-AM code suggesting acute alcohol involvement. The agreement between blood alcohol test results and ICD-10-AM coding of acute alcohol involvement was fair (κ = 0.33, 95% confidence interval: 0.27–0.38). Of the 341 patients with a non-zero BAC, 82 (24.0%) had ICD-10-AM codes related to acute alcohol involvement. Supplementary factors Y90 Evidence of alcohol involvement determined by blood alcohol level codes, which specifically describe patient BAC, were assigned to just 29% of eligible patients with a non-zero BAC. Conclusion: ICD-10-AM coding underestimated the proportion of alcohol-related injuries compared to patient BAC. Implications: Given the current role of administrative data in the surveillance of alcohol-related injuries, these findings may have significant implications for the implementation of cost-effective strategies for preventing alcohol-related injuries. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between metabolic syndrome (MetS) and frailty, and determine whether co-existent MetS and frailty affect disability-free survival (DFS), assessed through a composite of death, dementia or physical disability. Design: Longitudinal study. Setting and Participants: Community-dwelling older adults from Australia and the United States (n=18,264) from "ASPirin in Reducing Events in the Elderly" (ASPREE) study. Measurements: MetS was defined according to American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines (2018). A modified Fried phenotype and a deficit accumulation Frailty Index (FI) were used to assess frailty. Association between MetS and frailty was examined using multinomial logistic regression. Cox regression was used to analyze the association between MetS, frailty and DFS over a median follow-up of 4.7 years. Results: Among 18,264 participants, 49.9% met the criteria for MetS at baseline. Participants with Mets were more likely to be pre-frail [Relative Risk Ratio (RRR): 1.22; 95%Confidence Interval (CI): 1.14, 1.30)] or frail (RRR: 1.66; 95%CI: 1.32, 2.08) than those without MetS. MetS alone did not shorten DFS while pre-frailty or frailty alone did [Hazard Ratio (HR): 1.68; 95%CI: 1.45, 1.94; HR: 2.65; 95%CI:1.92, 3.66, respectively]. Co-existent MetS with pre-frailty/frailty did not change the risk of shortened DFS. Conclusions: MetS was associated with pre-frailty or frailty in community-dwelling older individuals. Pre-frailty or frailty increased the risk of reduced DFS but presence of MetS did not change this risk. Assessment of frailty may be more important than MetS in predicting survival free of dementia or physical disability. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate coping styles, posttraumatic stress, and mental health symptoms among a sample of community members affected by 2019–20 Australian bushfires. Using a convenience sampling approach, an online survey was used to assess a range of coping strategies, posttraumatic stress and symptoms of depression, anxiety, and stress among the affected community members of Black Summer bushfires. The results revealed that study participants reported moderate symptoms of depression and stress, and severe levels of anxiety. Additionally, participants reported use of both approach and avoidance coping strategies following the bushfire event as well as experiencing symptoms of posttraumatic stress, such as having intrusive thoughts and symptoms of avoidance and hyperarousal. Despite the durability of many individuals, others remain affected by the event and there is evidence there may be longer term mental health consequences of the bushfires for some people. Given these findings, it is imperative that mental health services be readily available for people in the bushfire‐affected areas. Mental health nurses have an important role to play in supporting individuals affected by disasters. Awareness of the short‐ and long‐term impacts of disasters on the mental health of people is paramount for mental health nurses. [ABSTRACT FROM AUTHOR]

Objective: The primary aim was to determine the 12‐month period prevalence of and time to osteoporosis treatment following minimal trauma hip fractures in patients who were recommended treatment by an orthogeriatrics service. The secondary aim was to determine the factors associated with receiving treatment including the impact of osteoporosis clinic follow‐up. Methods: A retrospective cohort study of patients with minimal trauma hip fractures admitted at a tertiary hospital in Sydney between 1 April 2017 and 31 March 2019 was performed. Baseline characteristics were collected from medical records. Osteoporosis treatment data were collected from patients and general practitioners. Univariate and multivariate logistic regression analyses were used to determine the factors associated with receiving osteoporosis treatment. Results: There were 189 participants who consented to participate with a mean age of 84.6 years. Most (76.7%) were females, 18.5% were nursing home residents, 70.9% had normal cognition, 20.6% were taking osteoporosis treatment prior to admission, 61.9% had osteoporosis treatment recommendations documented on the discharge summary, and 10.1% were followed up in the osteoporosis clinic. Ninety‐eight patients (51.9%) received treatment within the first 12 months after fracture with a median time to treatment of 90 days. Factors associated with receiving osteoporosis treatment within 12 months on multivariate analysis included normal cognition (p = 0.03), taking osteoporosis treatment prior to admission (p < 0.001), including treatment recommendations in the discharge summary (p = 0.006) and osteoporosis clinic follow‐up (p < 0.001). Conclusions: Osteoporosis treatment after hip fracture remains suboptimal at this hospital. Patient and health service factors associated with treatment uptake could inform future quality improvement work. [ABSTRACT FROM AUTHOR]

COVID-19 symptoms range from severe respiratory failure to mild anorexia, cough and smell and taste alterations, adversely impacting nutritional intake. The aim of this paper was to establish malnutrition risk, Nutrition Impact Symptoms (NIS) and associations with reduced oral intake. A retrospective observational cohort of all people testing positive for COVID-19 was conducted. Malnutrition risk, nutritional status, weight, reduced oral intake and NIS on and during admission were collected. Dietetic consultation frequency and mode were captured. Some 80% (48/60) of participants reported at least one NIS, and 58% (25/60) reported two or more. Most frequent reported symptoms were cough (60%), sore throat (35%) and reduced appetite (28%). Significant associations existed between ≥2 NIS (p=0.006), reduced appetite (p=0.000) and reduced oral intake, with 20% requiring ongoing nutrition support and consultation. High NIS prevalence confirms systematised nutrition support pathways are indicated through incorporation into standard care across the healthcare continuum, including community care. [ABSTRACT FROM AUTHOR]

To establish the prevalence of obesity in an inpatient rehabilitation setting, examine its impact on hospital outcomes, and explore staff perceptions of caring for patients with obesity. A retrospective audit of inpatients admitted to a sub-acute rehabilitation hospital over 12 months. Hospital outcomes included length of stay (LOS), Functional Independence measure (FIM), and discharge destination. Linear regression models were used to determine whether obesity was associated with hospital outcomes. Staff working on rehabilitation wards were invited to complete a survey exploring their perceptions on caring for those who are obese. Of 1280 episodes of care, 359 (28%) patients were classified as obese with a body mass index ≥30 kg/m2. Obesity was not associated with LOS or functional improvement after controlling for age, gender, and admission FIM. One hundred and twelve hospital staff (response rate 71%) completed the survey. Most rated their bariatric care knowledge as average (45%) or good (36%). The majority (60%) perceived that patients with obesity have longer LOS than those who are non-obese. One-third of patients admitted to inpatient subacute rehabilitation were classified as obese. Whilst obesity was not associated with poorer hospital outcomes, staff perceived that obesity negatively impacts on care requirements and LOS. A third of patients admitted to a public, inpatient rehabilitation setting may be classified as obese based on their body mass index. Although staff perceived that obesity negatively impacts on length of stay and functional gains, there was no evidence that obesity was associated with poorer hospital outcomes. Patients who are classified as obese were able to achieve comparable hospital outcomes including length of stay in the rehabilitation setting to those who are not obese. [ABSTRACT FROM AUTHOR]

Violence against social workers and other social service practitioners is prevalent across countries and service delivery settings, often accepted as implicit in working with vulnerable clients. A corresponding scholarly focus on workplace violence, and the factors that affect it, is, however, still developing. This is particularly stark in the domestic and family violence (DFV) and sexual assault (SA) sectors. To address this gap, this article explores the extent and impact of practitioners' exposure to workplace violence, and the mix of work and organisational factors that predict it. Analysis of survey data from Australian DFV and SA practitioners (N  = 903) enables a focus on the two main sources of workplace violence: violence from clients and violence from colleagues. Both types of violence were found to be prevalent, gendered and associated with emotional strain and intention to leave. We argue that in DFV and SA sectors, which respond to multiple forms of gendered violence, understanding the multifaceted nature of workplace violence, and the structural arrangements that underpin it, is necessary for planning strategies to prevent and address it. [ABSTRACT FROM AUTHOR]

Background: In Australia, general practitioners (GPs) are recognised as an essential source of postpartum care. However, there remains a paucity of research pertaining to this, and in particular, to that of GP trainees (in Australia, termed 'registrars'). Previous post‐graduate experience in obstetrics and gynaecology (O&G) is not a prerequisite for GP training, and thus, it is imperative that vocational training provides adequate exposure to postpartum consultations. Aim: To investigate the prevalence and associations of Australian GP registrars' (trainees') experience in postpartum care. Materials and Methods: A cross‐sectional study employing data from the Registrar Clinical Encounters in Training (ReCEnT) project. ReCEnT is an ongoing cohort study where GP registrars record 60 consecutive consultations mid‐way through each training term. The outcome variable was postpartum problem/diagnosis (compared to all other problems/diagnoses). The independent variables included registrar, practice, patient, consultation, clinical and educational factors. Analyses employed univariate and multivariable regression. Results: Analysis included 2234 registrars (response rate 96.1%), 289 594 consultations, and 453 786 problems/diagnoses. Postpartum care (897) comprised 0.2% (95% CI: 0.19–0.21) of all problems/diagnoses in 0.3% (95% CI: 0.27–0.31) of all consultations. Significant multivariable associations included registrar's gender (female) and obtainment of post‐graduate O&G qualifications. Postpartum consultations were longer and resulted in more learning goals being generated. Discussion: An overall low prevalence was established. Both male registrars, and those without pre‐existing O&G qualifications, may have particularly limited experience. These findings should inform educational policy and practice regarding postpartum care experience in general practice training. [ABSTRACT FROM AUTHOR]

Issue Addressed: The aim of this study was to use a novel approach to geographically model the relationship between socio-economic disadvantage and prevalence of profound and severe disability.Method: This study used national census data and the survey of disability, ageing and carers data to geographically model the relationship between socio-economic disadvantage and prevalence of profound and severe disability.Result: The results in this study show that there were more people living in the least disadvantaged areas (wealthiest) when compared to the most disadvantaged (poorest) areas. Whereas for people with a disability as the relative socio-economic disadvantage of the area increased, the number of people reporting any disability also increased, with the highest number coming from the most disadvantaged areas. The maps show a significant distribution with fewer cases of disability in metropolitan areas and relatively higher number in the rural area along with the higher proportion of people with disability living in the relatively more disadvantaged areas.Conclusion: Socio-economic profile is one of the key factors influencing the various aspects of health and hence should hold an important place during policy making. Policy should be formulated and implemented to help reduce the inequality by either directly aiming at the most disadvantaged group or by trying to bridge the gap between them. SO WHAT?: This paper provides a geographic visualisation of the distribution of people with profound and severe disability to help identify priority areas with high prevalence of disability. [ABSTRACT FROM AUTHOR]

Aims: To describe the associations between dysphagia and malnutrition risk and to identify predictors for dysphagia in a group of persons at risk of malnutrition in hospitals and nursing homes. Design: A secondary analysis of cross‐sectional data from the years 2012–2016. Methods: The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool for Adults (MUST). The data were compared regarding malnutrition risk and dysphagia. Regression analyses were conducted to identify variables that were associated with the risk of malnutrition and dysphagia. Results: Patients (N = 17,580) were included in the study sample. The prevalence of dysphagia was 6.6% and the prevalence of malnutrition risk was 18.9%. A multivariable logistic regression analysis resulted in the identification of dysphagia and cancer as variables with the highest odds ratios with regard to malnutrition risk. Patients with cancer, stroke or respiratory diseases represent a high‐risk group for the co‐occurrence of dysphagia and risk of malnutrition. Conclusions: Screening for dysphagia should be carried out on patients at risk of malnutrition as an integral part of their admission to a healthcare institution and especially on the higher risk group of patients with cancer, a stroke or a respiratory disease. Impact: What problem did the study address? This study identified the relationship between dysphagia and malnutrition risk and associated factors. What were the main findings? Dysphagia among patients in the research sample was associated with more than two times higher prevalence of the malnutrition risk. Where and on whom will the research have an impact? Thorough malnutrition risk and dysphagia screening lead to better nursing care. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and clinical management characteristics of chiropractors practising in urban and rural or remote Australia. Design: A cross‐sectional analysis of the Australian Chiropractic Research Network project data. Setting: Nationally representative sample of registered chiropractors practising in Australia. Participants: Chiropractors who participated in the Australian Chiropractic Research Network project and answered a question about practising in urban or rural or remote areas in the practitioner questionnaire. Main outcome measure: The demographics, practice characteristics and clinical management of chiropractors. Results: The majority of chiropractors indicated that they practise in urban areas only, while 22.8% (n = 435) practice in rural or remote areas only and 4.0% (n = 77) practice in both urban and rural or remote areas. Statistically significant predictors of chiropractors who practice in rural or remote areas, as compared to urban areas, included more patient visits per week, practising in more than one location, no imaging facilities on site, often treating degenerative spinal conditions or migraine, often treating people aged over 65 years, frequently treating Aboriginal and Torres Strait Islander people and frequently using biomechanical pelvic blocking or the sacro‐occipital technique. Conclusion: A substantial number of chiropractors practice in rural or remote Australia and these rural or remote‐based chiropractors are more likely to treat a wide range of musculoskeletal cases and include an Indigenously diverse group of patients than their urban‐located colleagues. Unique practice challenges for rural or remote chiropractors include a higher workload and a lack of diagnostic tools. Chiropractors should be acknowledged and considered within rural or remote health care policy and service provision. [ABSTRACT FROM AUTHOR]

Objective: Limited international evidence suggests general practice registrars' emergency department (ED) referral rates exceed those of established general practitioners (GPs). The aim of the present study was to fill an evidence gap by establishing the prevalence, nature and associations of Australian GP registrar ED referrals. Methods: A cross-sectional analysis was performed of the Registrar Clinical Encounters in Training (ReCEnT) cohort study of GP registrars' consultation experiences, between 2010 and 2015. The outcome factor in logistic regression analysis was referral to an ED. Independent variables included patient-level, registrar-level, practice-level and consultation-level factors. Results: In all, 1161 GP registrars (response rate 95.5%) contributed data from 166 966 consultations, comprising 258 381 individual problems. Based on responses, 0.5% of problems resulted in ED referral, of which nearly 25% comprised chest pain, abdominal pain and fractures. Significant (P < 0.05) associations of ED referral included patient age <15 and >34 years, the patient being new to the registrar, one particular regional training provider (RTP), in-consultation information or assistance being sought and learning goals being generated. Outer regional-, remote- or very remote-based registrars made significantly fewer ED referrals than more urban registrars. Of the problems referred to the ED, 45.5% involved the seeking of in-consultation information or assistance, predominantly from supervisors. Conclusions: Registrars' ED referral rates are nearly twice those of established GPs. The findings of the present study suggest acute illnesses or injuries present registrars with clinical challenges and real learning opportunities, and highlight the importance of continuity of care, even for acute presentations. What is known about the topic?: A GP's decision concerning continued community- versus hospital-based management of acute presentations demands careful consideration of a suite of factors, including implications for patient care and resource expenditure. General practice vocational training is a critical period for the development of GP registrars' long-term patterns of practice. Although limited international evidence suggests GP registrars and early career GPs refer patients to the ED at a higher rate than their more experienced peers, these studies involved small subject numbers and did not investigate associations of registrars making an ED referral. Relevant Australian studies focusing on GP registrars' ED referral patterns are lacking. What does this paper add?: The present ongoing cohort study is the first to establish the patterns of ED referrals made by Australian GP registrars, encompassing five general practice RTPs across five states, with participating registrars practising in urban, rural, remote and very remote practices. Several significant associations were found with GP registrars making ED referrals, including patient age, continuity of care, the registrar's RTP, assistance sought by the registrar and rurality of the registrar's practice. What are the implications for practitioners?: The higher likelihood of GP registrars seeing acute presentations than their more established practice colleagues, coupled with a demonstrated association of registrars seeking in-consultation assistance for such presentations, highlights the importance of GP supervisor accessibility in facilitating ED referral appropriateness and in the development of registrars' safe clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Despite growing literature on psychotic experiences, no nationally representative study has reported on the prevalence of both hallucinatory experiences and delusional experiences in Australian adolescents. Also, while many studies have examined the association between psychotic experiences and certain demographic and clinical correlates, there are more variables of interest to be investigated, including disordered eating behaviour and hours of sleep. The aims of this study were to examine (1) the prevalence of hallucinatory experiences and delusional experiences in Australian adolescents, and (2) the associations between different types of psychotic experiences with a broad range of demographic, clinical, and psychosocial variables. Methods: A random sample of Australian adolescents aged 14- to 17-year-olds were recruited in 2013-2014 as part of the Young Minds Matter Survey. Participants completed self-report questions regarding five different psychotic experience types (auditory and visual hallucinatory experiences, and thoughts read, special messages, spied upon) experienced in the past 12 months. Using logistic regression analyses, we investigated associations between psychotic experiences and demographic, clinical, and psychosocial factors. Results: The 12-month prevalence ranged from 3.3% (95% confidence interval = [2.6, 4.3]) for special messages to 14.0% (95% confidence interval = [12.3, 15.8]) for auditory hallucinatory experiences. At the bivariate level, each psychotic experience subtype was associated with increased likelihood of major depression, being bullied, psychological distress, low selfesteem, mental health service use and insufficient sleep (<8 hours per night). Multivariate analyses revealed both auditory and visual hallucinatory experiences were associated with an increased likelihood of four of these variables (depression, being bullied, service use, insufficient sleep), whereas associations with delusional experiences were inconsistent. Conclusion: Hallucinatory and delusional experiences are common in Australian adolescents. Hallucinatory experiences, rather than delusional experiences, may be more clinically relevant in this demographic. When psychotic experiences are endorsed by adolescents, further assessment is indicated so as to ascertain more detail on the phenomenology of the experiences to better understand their clinical relevance. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the study was to assess the utility of national Aboriginal survey data in a regional geospatial analysis of daily smoking prevalence for Aboriginal and Torres Strait Islander Australians and discuss the appropriateness of this analysis for policy and program impact assessment. Methods. Data from the last two Australian Bureau of Statistics (ABS) national surveys of Aboriginal and Torres Strait Islander people, the National Aboriginal and Torres Strait Islander Social Survey 2014-15 (n = 7022 adults) and the National Aboriginal and Torres Strait Islander Health Survey 2012-13 (n = 10 896 adults), were used to map the prevalence of smoking by Indigenous regions. Results. Daily smoking prevalence in 2014-15 at Indigenous regions ranges from 27.1% (95%CI 18.9-35.3) in the Toowoomba region in Queensland to 68.0% (95%CI 58.1-77.9) in the Katherine region in the Northern Territory. The confidence intervals are wide and there is no significant difference in daily smoking prevalence between the two time periods for any region. Conclusion. There are significant limitations with analysing national survey data at finer geographical scales. Given the national program for Indigenous tobacco control is a regional model, evaluation requires finer geographical analysis of smoking prevalence to inform public health progress, policy and program effects. Options to improve the data currently collected include increasing national survey sample sizes, implementing a smoking status question in census surveys, investing in current cohort studies focused on this population or implementing localised surveys. [ABSTRACT FROM AUTHOR]

To describe the prevalence, severity and nature of depression in a sample of prostate cancer ( PCa) survivors 10 years after diagnosis and treatment, 146 Australian patients from the RADAR trial who received their diagnosis 10 years previously completed the Zung Self-rating Depression Scale and a background questionnaire. Prevalence rates for clinically significant depression and severe depression were higher than those reported for the non- PCa men of the same age in Australia. The most common subtype of depression was Anhedonia, followed by Cognitive depression. Change in eating habits was the most powerful depression symptom predicting Anhedonia. By providing the first detailed documentation of major depression prevalence in PCa survivors, plus describing the nature of that depression, these data suggest that there is an ongoing need to provide treatments for these men and that those treatments should be focussed upon loss of previously available sources of enjoyment. [ABSTRACT FROM AUTHOR]

Background: cross-national comparisons can be used to explore therapeutic areas and identify potential medication issues. Methods: we used cross-sectional pharmacy supply data to explore medication use for nursing home residents in Australia (AU n = 26 homes, 1,560 residents) and the Netherlands (NL n = 6 homes, 2,037 residents). Binary logistic regression analysis was used to calculate the sex and aged adjusted odds ratios (OR) and associated 95% confidence intervals with a flexible Bonferroni-Holm procedure used to adjust for multiple hypothesis testing. Results: total use of antipsychotics (AU: 37.7%, NL: 40.3%; OR 0.91 (0.79-1.04, P = 0.16) and antibacterials (66.8% AU, 62.4% NL, OR 1.08 (0.93-1.24, P = 0.31) was similar, but choice of individual agents differed between the two countries. Differences were observed in the use of antithrombotics (46.7% AU, 64.7% NL, OR 0.48 (0.42-0.56, P > 0.01), ophthal-mologicals (44.3% AU, 22.1% NL, OR 2.80 (2.42-3.24, P < 0.001), laxatives (77.1% AU, 65.8% NL, OR 1.65 (1.41-1.92, P< 0.001). Conclusion: while the general prevalence of medication use in nursing home residents was similar across the two countries, distinct differences existed in the choice of agent among therapeutic groups. Comparing use between countries identified a number of potential medication related problem areas that need further exploration. [ABSTRACT FROM AUTHOR]

Background: Whether general practitioner (GP) registrars have adequate exposure to, and feel confident in, managing children’s health during training is unknown.Objectives: To determine the prevalence and associations of GP registrars’ paediatric vs. non-paediatric consultations.Methods: Cross-sectional analysis from a cohort study of Australian GP registrars’ 2010–2014 consultations.Results: 889 registrars contributed details for 26,427 (21.8% (95% CI: 21.4–22.2) paediatric consultations. Paediatric patients were more likely to be male and new to the practice. Although paediatric patients were less likely to have a chronic disease (OR 0.38, 95% CI 0.36, 0.40) and presented with fewer problems (OR 0.59, 95% CI 0.57, 0.61), registrars were more likely to seek in-consultation advice (OR 1.25, 95% CI 1.19, 1.31) and generate learning goals (OR 1.12, 95% CI 1.07, 1.18) for paediatric consultations.Discussion: GP registrars appear to feel less confident in managing paediatric compared with adult consultations, suggesting an unmet training need. [ABSTRACT FROM AUTHOR]

Objectives To assess the changes in the oral health-related quality of life ( OHRQoL) of 221 preschool children who presented to the emergency department with the consequences of untreated dental caries requiring dental extractions under general anaesthesia ( DEGA). Methods Two hundred and twenty-one healthy preschool children, who required emergency DEGA, were recruited over a period of 12 months. The same parent or caregiver completed the Early Childhood Oral Health Impact Scale ( ECOHIS) questionnaire; both, prior to the DEGA and at the 2-week post-treatment visit. Data were analysed using repeated anova with adjustments for multiple comparisons using the Bonferroni tests with the significance level set at 5%. Results One hundred and twenty-six participants, with a mean age of 4.02 and a mean dmft score of 8.27 ( SD = 4.13), completed the 2-week post-treatment questionnaires. The overall ECOHIS, CIS, and FIS scores decreased significantly ( P < 0.001) after emergency DEGA, demonstrating large effect sizes. The biggest decrease in prevalence after emergency DEGA was observed for the items of pain in teeth, trouble sleeping, being irritated or frustrated, difficulty drinking food, and parents being upset. Conclusions The OHRQoL of preschool children, who presented to the emergency department with the consequences of untreated dental caries, was significantly improved following emergency DEGA. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of occipital bending (an occipital lobe crossing or twisting across the midline) in subjects with schizophrenia and matched healthy controls. Method: Occipital bending prevalence was investigated in 37 patients with schizophrenia and 44 healthy controls. Results: Ratings showed that prevalence was nearly three times higher among schizophrenia patients (13/37 [35.1%]) than in control subjects (6/44 [13.6%]). Furthermore, those with schizophrenia had greater normalized gray matter volume but less white matter volume and had larger brain-to-cranial ratio. Conclusion: The results suggest that occipital bending is more prevalent among schizophrenia patients than healthy subjects and that schizophrenia patients have different gray matter-white matter proportions. Although the cause and clinical ramifications of occipital bending are unclear, the results infer that occipital bending may be a marker of psychiatric illness. [ABSTRACT FROM AUTHOR]

The purpose of this cross-sectional study was to identify the prevalence of incontinence and incontinence-associated dermatitis (IAD) in Australian acute care patients and to describe the products worn to manage incontinence, and those provided at the bedside for perineal skin care. Data on 376 inpatients were collected over 2 days at a major Australian teaching hospital. The mean age of the sample group was 62 years and 52% of the patients were male. The prevalence rate of incontinence was 24% (91/376). Urinary incontinence was significantly more prevalent in females (10%) than males (6%) ( χ2 = 4·458, df = 1, P = 0·035). IAD occurred in 10% (38/376) of the sample group, with 42% (38/91) of incontinent patients having IAD. Semi-formed and liquid stool were associated with IAD ( χ2 = 5·520, df = 1, P = 0·027). Clinical indication of fungal infection was present in 32% (12/38) of patients with IAD. Absorbent disposable briefs were the most common incontinence aids used (80%, 70/91), with soap/water and disposable washcloths being the clean-up products most commonly available (60%, 55/91) at the bedside. Further data are needed to validate this high prevalence. Studies that address prevention of IAD and the effectiveness of management strategies are also needed. [ABSTRACT FROM AUTHOR]

Aim To estimate the prevalence of diabetes, heart disease, hypertension and stroke in self-report and hospital data in two cohorts of women; measure sensitivity and agreement between data sources; and compare between cohorts. Methods Women born between 1946-1951 and 1921-1926 who participated in the Australian Longitudinal Study on Women's Health ( ALSWH); were New South Wales residents; and admitted to hospital (2004-2008) were included in the present study. The prevalence of diabetes, heart disease, hypertension and stroke was estimated using self-report (case 1 at latest survey, case 2 across multiple surveys) and hospital records. Agreement (kappa) and sensitivity (%) were calculated. Logistic regression measured the association between patient characteristics and agreement. Results Hypertension had the highest prevalence and estimates were higher for older women: 32.5% case 1, 45.4% case 2, 12.8% in hospital data (1946-1951 cohort); 57.8% case 1, 73.2% case 2, 38.2% in hospital data (1921-1926 cohort). Agreement was substantial for diabetes: κ = 0.75 case 1, κ = 0.70 case 2 (1946-1951 cohort); κ = 0.77 case 1, κ = 0.80 case 2 (1921-1926 cohort), and lower for other conditions. The 1946-1951 cohort had 2.08 times the odds of agreement for hypertension (95% CI 1.56 to 2.78; P < 0.0001), and 6.25 times the odds of agreement for heart disease (95% CI 4.35 to 10.0; P < 0.0001), compared with the 1921-1926 cohort. Conclusion Substantial agreement was found for diabetes, indicating accuracy of ascertainment using self-report or hospital data. Self-report data appears to be less accurate for heart disease and stroke. Hypertension was underestimated in hospital data. These findings have implications for epidemiological studies relying on self-report or administrative data. Geriatr Gerontol Int 2016; 16: 95-102. [ABSTRACT FROM AUTHOR]

Objective: We aimed to estimate the impact of past and future changes in obesity and diabetes prevalence in mid-life on disability prevalence for adult Australians.Methods: We analysed data from the Australian Diabetes, Obesity and Lifestyle study (AusDiab) including participants aged 45-64years, disability-free at baseline (1999/2000) with disability information at follow-up (2011/12) (n=2107). We used coefficients from multinomial logistic regression to predict 10-year probabilities of disability and death from baseline predictors (age, sex, obesity, smoking, diabetes and hypertension). We estimated the prevalence of disability attributable to past (1980) and expected future (2025) changes in obesity and diabetes prevalence using the life table approach.Results: We estimated that the prevalence of disability for those aged between 55 and 74years would have been 1697 cases per 100,000 persons less in 2010 (10.3% less) if the rates of obesity and diabetes observed in 2000 had been as low as the levels observed in 1980. However, if instead the prevalence of obesity and diabetes had been as high as the levels expected in 2025, then the prevalence of disability would have been an additional 2173 per 100,000 persons (an additional 13.2%).Conclusions: We demonstrate, for the first time, a substantial potential impact of obesity and diabetes trends on disability amongst those aged 55-74years. In Australian adults by 2025 we estimate that around 26% of disability cases would have been avoidable if there had been no change in obesity and diabetes prevalence since 1980. A similar impact is likely around the world in developed countries. [ABSTRACT FROM AUTHOR]

Background Polycystic ovary syndrome (PCOS) affects around 15% of Indigenous women who are also a group at high risk of cardiometabolic disease. Aim To explore the impact of PCOS on metabolic syndrome in Indigenous women. Methods A cross-sectional reproductive health questionnaire, biochemical and anthropometric assessments, of 109 Indigenous women (35 with PCOS and 74 without PCOS) aged 15-44 years in and around Darwin between 2003 and 2005. PCOS was defined using the National Institutes of Health criteria, and metabolic syndrome (MetS) using the National Cholesterol Education Programme Adult Treatment Programme III criteria. The outcome was prevalence of MetS by PCOS status; relationship of PCOS with MetS before and after adjustment for markers of obesity and insulin resistance. Results Women with PCOS had a significantly higher body mass index (BMI) ( P = 0.0001) and MetS was more frequent in women with PCOS (51%) than those without PCOS (23%) ( P = 0.003). The most frequent components of MetS in both groups were a high density lipoprotein cholesterol ≤1.29 mmol/L (80% PCOS, 55% non-PCOS) and a waist circumference >88 cm (77% PCOS, 41% non-PCOS); these were significantly more frequent in women with PCOS ( P = 0.01). In logistic regression models, PCOS was significantly associated with MetS by itself but not after adjustment for BMI or sex hormone binding globulin. Conclusions While MetS was more common in Indigenous women with PCOS, PCOS was not an independent predictor of MetS. This may be because obesity and insulin resistance are integral parts of PCOS and are the mechanisms through which PCOS exerts metabolic effects. [ABSTRACT FROM AUTHOR]

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

This study investigated if people born in refugee source countries are disproportionately represented among those receiving a diagnosis of mental illness within emergency departments (EDs). The setting was the Cities of Greater Dandenong and Casey, the resettlement region for one-twelfth of Australia's refugees. An epidemiological, secondary data analysis compared mental illness diagnoses received in EDs by refugee and non-refugee populations. Data was the Victorian Emergency Minimum Dataset in the 2008-09 financial year. Univariate and multivariate logistic regression created predictive models for mental illness using five variables: age, sex, refugee background, interpreter use and preferred language. Collinearity, model fit and model stability were examined. Multivariate analysis showed age and sex to be the only significant risk factors for mental illness diagnosis in EDs. 'Refugee status', 'interpreter use' and 'preferred language' were not associated with a mental health diagnosis following risk adjustment for the effects of age and sex. The disappearance of the univariate association after adjustment for age and sex is a salutary lesson for Medicare Locals and other health planners regarding the importance of adjusting analyses of health service data for demographic characteristics. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To date, studies of stigma relating to eating disorders have been largely confined to surveys of the public. We sought to examine the prevalence and correlates of stigma as reported by individuals with eating disorders. Method An online survey designed to assess frequency of exposure to potentially stigmatizing attitudes and beliefs as well as the perceived impact of this on health and well-being was completed by a cross-national sample of 317 individuals with anorexia nervosa ( n = 165), bulimia nervosa ( n = 66), or Eating Disorder Not Otherwise Specified (EDNOS; n = 86). Results Participants rated two beliefs as both particularly common and particularly damaging, namely 'I should be able to just pull myself together' and 'I am personally responsible for my condition'. Participants with bulimia nervosa more commonly experienced the belief that they had 'no self-control' and male participants more commonly experienced the belief that they were 'less of a man'. More frequent stigmatization was associated with higher levels of eating disorder psychopathology, a longer duration of disorder, lower self-esteem, and more self-stigma of seeking psychological help. Discussion Stigma towards individuals with eating disorders, as experienced by sufferers, is common and associated with numerous adverse outcomes. The perceptions that eating disorders are trivial and self-inflicted should be a focus of destigmatization interventions. Efforts to reduce stigma towards individuals with bulimia nervosa may need to focus on perceptions of self-control, whereas efforts to reduce stigma towards males with eating disorders may need to focus on perceptions of masculinity/manhood. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:767-774) [ABSTRACT FROM AUTHOR]

This paper reports on a prospective study investigating the prevalence of maternal postpartum fatigue and sleepiness and highlights the potential increased crash risk faced by mothers when driving in the postpartum period. Twenty-four mothers from across Australia completed a sleep and driving diary for seven consecutive days at three time points; when their baby was 6, 12 and 18 weeks old. The results showed that the mothers’ sleep varied within the sample; however, on average sleep disruption and lack of sleep consolidation was experienced. A high proportion of the mothers reported fatigue and sleepiness impacting their functioning early in the postpartum period, with sleepiness being more enduring throughout the period. Of concern, a high proportion of driving journeys undertaken by the mothers were during high levels of sleepiness, particularly early in the postpartum period and during late night and early hours of the day. These findings have highlighted the need to educate mothers about the potential increased safety risk of driving during the postpartum period and identified key information that should be conveyed. [ABSTRACT FROM PUBLISHER]

Objective. Australian government health expenditure per capita has grown steadily across the past few decades, but little is known about trends in the age distribution of health expenditure. Methods. In this paper, the Australian Bureau of Statistics (ABS) fiscal incidence studies, which track expenditure at the household level between 1984 and 2010, are used to shed light on this topic. Results. The main finding was that spending has shifted focus from the younger half to the older half of the population. This shift is evident in three areas: (1) acute care (hospitals); (2) community health services (doctors); and (3) pharmaceuticals. Together, these areas account for approximately 88% of expenditure. The trend is independent of demographic aging. It is unlikely to reflect changes in population health. Its explanation is open to debate. Conclusions. Growth in expenditure per household has been more than threefold faster for elderly than young households. Across this period, expenditure per household per week has increased by 51% for the young, by 79% for the middle aged and by 179% for the elderly. This age-related growth is most prominent in expenditure on acute care, community health services and pharmaceuticals. [ABSTRACT FROM AUTHOR]

To investigate the cross-national relevance of community health promotion, this paper compared community variation in alcohol use and risk and protective factors for adolescents in Australia (State of Victoria, 2009) and the Netherlands (2007/2008). Multi-level analyses examined community variation in heavy episodic (binge) alcohol use [≥5 drinks in a session ≥once in the prior fortnight (>63 ml of ethanol)] and associations with predictors. Representative community samples of adolescents (12–17 years) were recruited. The participants were 7812 students from 36 Australian communities and 15 082 adolescents from 124 Dutch communities. Predictors included adolescent reports of family, school, peer and neighbourhood environments and community predictors (rural, disadvantage). The overall prevalence of alcohol use prevalence was similar in both nations. Australia had higher use at younger ages and no difference between genders. In the Netherlands older adolescents and males used alcohol at significantly higher rates. Although individual predictors were mostly similar, binge drinking was more strongly associated with poor family management, friends' use of drugs and community disorganization in Australia. Significant community variation in adolescent heavy alcohol use was observed in both countries, but was higher in the Netherlands [inter class correlation 6.1%, (95% CI: 4.5–8.3%)] than Australia (ICC 2.4%, 1.3–4.5%). Youth from rural areas drank at a higher level, especially in the Netherlands. Targeting community level adolescent alcohol use appears feasible in both countries. Although behavioural patterns and risk and protective influences are similar in the Netherlands and Australia, important differences should be taken into account in tailoring community interventions. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance in midlife women has been studied extensively, although less is known about sleep after menopause. This study examined the relative impact of sociodemographics, modifiable lifestyle factors, and health status on sleep disturbance in postmenopausal women from Queensland, Australia. Methods: The longitudinal Healthy Aging of Women (HOW) Study examines health-related quality of life (HRQOL measured by the 12-item Short Form [SF-12®] survey [Medical Outcomes Trust, Hanover, CA]); chronic illness; modifiable lifestyle factors, such as physical activity, alcohol consumption, smoking; and sleep disturbance (General Sleep Disturbance Scale [GSDS] (Lee, San Francisco, CA) ≥43 represents poor sleep) in midlife and older women from low- and high-socioeconomic rural and urban areas of South East Queensland, Australia. This article presents cross-sectional data from the 322 women, aged 60-70 years, participating in the HOW study in 2011. Results: For women in this study, sleep disturbance was relatively common, with 23% ( n=83) reporting poor sleeping (GSDS ≥43). Sleep-disturbance scores were strongly correlated with being unemployed or on a disability support pension (β=18.69, p<0.01), sedentary lifestyle (β=23.84, p<0.01), and lower mental (β=−0.60, p<0.01) and physical HRQOL scores (β=−0.32, p=0.01), and these variables explained almost one-third of variance in sleep-disturbance scores (ηρ2=29%). Conclusions: Multivariable analysis revealed that sleep disturbance was correlated with physical and mental HRQOL, disability, and sedentary lifestyle but not other lifestyle and sociodemographic characteristics. It may be, however, that modifiable lifestyle factors may indirectly impact sleep by influencing health status. [ABSTRACT FROM AUTHOR]

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BackgroundAlthough numerous studies have examined the latent structure of major depression, less attention has focused on mania. This paper presents the first investigation outside the USA to evaluate the psychometric properties of the DSM-IV criterion B mania symptoms using item response theory (IRT).MethodData were drawn from the Australian 2007 National Survey of Mental Health and Well-Being (NSMHWB, n = 8841). The psychometric performance of the mania symptoms was evaluated using a two-parameter logistic model. Because substance use disorders (SUDs) frequently co-occur with mania and can influence manic symptom expression, differential item functioning (DIF) between mania respondents with/without a SUD diagnosis was also assessed.ResultsFactor analysis supported a unidimensional trait underlying mania. The grandiosity symptom displayed the highest discrimination whereas discrimination was lowest for decreased need for sleep. Relatively speaking, grandiosity tapped the severe end and increased goal-oriented activities tapped the mild end of the mania severity continuum. The symptoms generally performed equivalently between those with/without a SUD diagnosis, with one exception; the activities with painful consequences symptom was endorsed at lower levels of severity, and hence more frequently, by those with a SUD diagnosis versus those without a SUD diagnosis.ConclusionsAccurate conceptualization of latent structure has crucial theoretical, statistical and clinical implications. The symptoms generally performed well in distinguishing between respondents with differing levels of liability, but others did not, suggesting modification is warranted to ensure optimal use in epidemiological samples. Given the dearth of psychometric evaluation studies of mania, further research replicating these results is necessary. [ABSTRACT FROM PUBLISHER]

Objective. To assess the prevalence, clinical and laboratory characteristics, and short-term outcomes of poststroke hip fracture (HF). Methods. A cross-sectional study of 761 consecutive patients aged ≥60 years (82.3 ± 8.8 years; 75% females) with osteoporotic HF. Results. The prevalence of poststroke HF was 13.1% occurring on average 2.4 years after the stroke. The poststroke group compared to the rest of the cohort had a higher proportion of women, subjects with dementia, history of TIA, hypertension, coronary artery disease, secondary hyperparathyroidism, higher serum vitamin B12 levels (>350 pmol/L), walking aid users, and living in residential care facilities. The majority of poststroke HF patients had vitamin D insufficiency (68%) and excess bone resorption (90%).This group had a 3-fold higher incidence of postoperative myocardial injury and need for institutionalisation. In multivariate analysis, independent indicators of poststroke HF were female sex (OR 3.6), history of TIA (OR 5.2), dementia (OR 4.1), hypertension (OR 3.2), use of walking aid (OR 2.5), and higher vitamin B12 level (OR 2.3). Only 15% of poststroke patients received antiosteoporotic therapy prior to HF. Conclusions. Approximately one in seven HFs occurs in older stroke survivors and are associated with poorer outcomes. Early implementation of fracture prevention strategies is needed. [ABSTRACT FROM AUTHOR]

Aim: International research has shown that the characteristics of areas such as neighbourhood socioeconomic disadvantage, are associated with mental health; however, multilevel modelling approaches have shown that little variance in depression scores is explained at the area level. This study investigated the distribution of depression across suburbs in the Canberra and surrounding region of Australia, and the influence of area- and individual-level measures of socioeconomic position. Subject and methods: Analysis of data is taken from Wave 3 of the Personality and Total Health (PATH) through Life study with 3,342 respondents aged 28-32 years or 48-52 years who were residents of Canberra and Queanbeyan. Depression was assessed with the Patient Health Questionnaire. Multilevel logistic regression models were used to evaluate variance components and compare suburb measures of socioeconomic circumstances and respondent-reported household income. Results: Less than 1% of variance in the distribution of depression was explained at the area level. While area-level socioeconomic measures were associated with depression; this effect was weak and largely explained by the inclusion of individual-level income. Further analysis did demonstrate a non-linear relationship between area-level socioeconomic measures and depression, with some evidence of an association between the most disadvantaged suburbs and greater prevalence of depression over and above the effect of individual characteristics. Conclusion: We found little evidence of variance in depression at the area level but did find that the prevalence of depression was elevated in the most disadvantaged suburbs. Individual risk factors appear to have the strongest influence on depression. [ABSTRACT FROM AUTHOR]

Study design:Prospective cohort study.Objectives:To determine incidence of contracture and develop prediction models to identify patients susceptible to contracture after spinal cord injury.Setting:Two Sydney spinal cord injury units.Methods:A total of 92 consecutive patients with acute spinal cord injury were assessed within 35 days of injury and 1 year later. Incidence of contracture at 1 year was measured in all major appendicular joints by categorizing range of motion on a 4-point scale (0-no contracture to 3-severe contracture), and in the wrist, elbow, hip and ankle by measuring range of motion at standardized torque. Multivariate models were developed to predict contracture at 1 year using age, neurological status, spasticity, pain and limb fracture recorded at the time of injury.Results:At 1 year, 66% of participants developed at least one contracture (defined as 1 point deterioration on the 4-point scale). Incidence of contracture at each joint was: shoulder 43%, elbow and forearm 33%, wrist and hand 41%, hip 32%, knee 11% and ankle 40%. Incidence of contracture determined by standardized torque measures of range (defined as loss of 10 degrees) was: elbow 27%, wrist 26%, hip 23% and ankle 25%. Prediction models were statistically significant but lacked sufficient predictive accuracy to be clinically useful (R231%).Conclusion:The incidence of contracture in major joints 1 year after spinal cord injury ranges from 11-43%. The ankle, wrist and shoulder are most commonly affected. It is difficult to accurately predict those susceptible to contracture soon after injury. [ABSTRACT FROM AUTHOR]

In Australia, HIV prevalence estimates among gay men have been mainly based on self-reported HIV status collected in annual behavioural surveys. We measured biological HIV prevalence among gay men in Melbourne, Australia, using a facility based sampling method. We calculated HIV prevalence and used logistic regression to assess correlates of a positive HIV test. A total of 639 gay men were recruited completed a survey and provided oral fluid for HIV testing from seven venues in 2008. The median age of the participants was 35 years (range 18-75 years). Overall biological HIV prevalence was 9.5% (95% CI 7.5-12.0%) compared with 6.3% (95% CI 4.5-8.4%) for self-reported HIV positive status. We found a significant discrepancy between test detected biological and self-report HIV status in our study, with 19 men (31.1%) unaware of their HIV infection. These results highlight the importance of repeatable biological estimates to inform and evaluate HIV prevention strategies. [ABSTRACT FROM AUTHOR]

Objective: To examine differences between university students, vocational education and training (VET) students, tertiary students combined and non-students in the prevalence of psychological distress and the socio-demographic and economic characteristics associated with psychological distress.Method: The Kessler Psychological Distress Scale was used to estimate the prevalence of moderate (16–21) and high (22–50) distress with data from three national surveys: the 2007 Household, Income and Labour Dynamics in Australia (HILDA) survey, the 2007–08 National Health Survey (NHS), and the 2007 National Survey of Mental Health and Wellbeing (NSMHWB). Multinomial logistic regression models were also estimated using the HILDA survey to examine any differences in the characteristics associated with moderate and high distress between the groups.Results: There was evidence of a higher prevalence of moderate distress in tertiary students than non-students in the HILDA survey (27.1% vs 21.2%, p < 0.05) and the NSMHWB (27.4% vs 19.5%, p < 0.05), but not the NHS (26.1% vs 22.5%, p > 0.05). However, standardized rates for age and gender attenuated the difference in moderate distress in the HILDA survey and the NSMHWB. The prevalence of high distress was similar between the groups in all three surveys. The multinomial regression analyses using the HILDA survey showed the following subgroups of students to be at a greater risk of high distress relative to those with low distress: younger university students, and university and VET students with financial problems. Compared to VET students and non-students, younger university students and those who worked 1–39 hours per week in paid employment were at a greater risk of high distress.Conclusions: There is evidence that tertiary students have a greater prevalence of moderate, but not high distress than non-students. Financial factors increase the risk of high distress and are likely to take on more importance as the participation rate of socio-economically disadvantaged students increases. [ABSTRACT FROM PUBLISHER]

The article reports a study which was conducted to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient’s hospital admission. Drug charts of 200 patients from three hospitals in Australia and 1 in New Zealand were evaluated. The results revealed that the medication charts for 672/715 patients contained at least one simple error during the initial period of their hospital admission. At least one prescribing error was present on the charts of all patients prescribed more than 18 drugs. The frequency of error types differed across the four sites. The study demonstrated that simple errors and poor documentation of allergy are common but can be improved with the involvement of clinical pharmacists.

Objective: To determine the prevalence of undiagnosed vitamin B12 deficiency among residential aged care facility residents in southern Tasmania, Australia, and to identify associated risk factors. Design and Setting: Cross-sectional study of residents from five southern Tasmanian residential aged care facilities. Participants: Two hundred and fifty-nine residents without a prior diagnosis of vitamin B12 deficiency or recorded serum B12 level within the past 6 months were approached to have their serum B12 level tested. One hundred and sixty (61%) residents consented and their doctors were contacted for further consent. A total of 130 (50%) residents completed the study. Measurements: Clinical and demographic characteristics, and serum B12 level. Results: Of the 130 residents tested, 18 residents (14%) were considered vitamin B12 deficient (serum level <150 pmol/L), 47 (36%) were equivocal (150 pmol/L to 250 pmol/L) and 65 (50%) had normal serum B12 levels (>250 pmol/L). There was a weak negative correlation between age and serum B12 level in those residents not taking a multivitamin (n=120, r=−0.19, p<0.05). The use of a multivitamin or antipsychotic drug were associated with altered mean serum B12 levels (+137 pmol/L, p<0.001 and −70 pmol/L, p<0.001 respectively). Conclusion: As vitamin B12 deficiency can manifest in a range of symptoms that are frequently misdiagnosed, the finding of undetected deficiency in 14% of residents is a cause for concern. Oral multivitamin supplementation may help prevent deficiency, and potentially treat existing deficiencies in older institutionalised people. [ABSTRACT FROM AUTHOR]

Objective. To assess whether Indigenous Australians age prematurely compared with other Australians, as implied by Australian Government aged care policy, which uses age 50 years and over for population-based planning for Indigenous people compared with 70 years for non-indigenous people. Methods. Cross-sectional analysis of aged care assessment, hospital and health survey data comparing Indigenous and non-indigenous age-specific prevalence of health conditions. Analysis of life tables for Indigenous and non-indigenous populations comparing life expectancy at different ages. Results. At age 63 for women and age 65 for men, Indigenous people had the same life expectancy as non-indigenous people at age 70. There is no consistent pattern of a 20-year lead in age-specific prevalence of age-associated conditions for Indigenous compared with other Australians. There is high prevalence from middle-age onwards of some conditions, particularly diabetes (type unspecified), but there is little or no lead for others. Conclusion. The idea that Indigenous people age prematurely is not well supported by this study of a series of discrete conditions. The current focus and type of services provided by the aged care sector may not be the best way to respond to the excessive burden of chronic disease and disability of middle-aged Indigenous people. [ABSTRACT FROM AUTHOR]

Background: Estimates of the prevalence of paraproteinaemia vary, from 1% in persons aged over 25 years to 10% in those aged over 80 years, although there are limited data from well-defined populations. We sought to determine the prevalence of paraproteinaemia in Australians aged 50 years and over, and to determine risks factors for its presence. Methods: We performed a population-based, cross-sectional study using data and serum collected in the Blue Mountains Eye Study. Serum samples from 2933 patients were analysed by capillary zone electrophoresis and, where indicated, immunosubtraction, which allowed for both quantitation and isotype detection. Results: A paraprotein was detected in 134 of the 2933 samples, giving an overall prevalence of 4.6% (95% confidence interval, 3.8-5.3%). The presence of a paraprotein was strongly age-related ( Ptrend= 0.001), with a prevalence of 2.8% in persons aged 50-59 years, rising steadily to 9.1% in those aged 80 years and over. The prevalence was significantly higher in men (5.9%) compared with women (4.0%) ( P= 0.03). Conclusion: We conclude that approximately one in 20 Australians aged 50 years or over harbours a paraprotein, a prevalence that appears higher than from similar cohorts in other countries. [ABSTRACT FROM AUTHOR]

Armfield JM. A comparison of three continuous scales used to determine the prevalence of clinically significant dental fear. Community Dent Oral Epidemiol 2011; 39: 554-563. © 2011 John Wiley & Sons A/S Abstract - Objective: To assess the level of agreement and concordance of three different dental anxiety and fear scales and determine whether using commensurate cut-points reduces discrepancies in the estimated prevalence of high dental fear. Methods: A representative sample of the Australian adult population completed a computer-assisted telephone interview (CATI) with additional data obtained on a random sample of 25% of those completing the CATI. Participants completed three measures of dental anxiety and fear: the Dental Anxiety Scale, the Index of Dental Anxiety and Fear, and a single-item question. Cut-points were determined to equivalize the range of possible score responses defining a case of high dental fear for each scale. Results: A total of 1084 people completed the CATI and returned a questionnaire (response rate = 71.4%). Prevalence estimates ranged from 7.3% to 28.4% depending upon both the scale and cut-point used. The overall percent agreement between the scales was high, but the overlap between the scales in those people determined to have high dental fear was considerably lower. Using different cut-points to define a case significantly altered the sensitivity and specificity of the scale in predicting dental avoidance, problem-oriented visiting and fear of lack of control. Conclusions: Equivalizing scale cut-points does reduce variation in prevalence estimates of high dental fear across scales, but variation remains because of differences in the nature of, and content covered by, each scale. Dichotomizing scores on continuous scales to obtain prevalence estimates of high dental fear should be appropriately justified, correctly interpreted and supplemented by results describing the distribution of scores. [ABSTRACT FROM AUTHOR]

Aim: To investigate the relationship between socio-demographic characteristics, acculturation, weight status and dietary intake among a group of women from India and Pakistan living in Brisbane, Australia. Methods: Cross-sectional survey of a convenience sample of 22 women that collected: socio-demographic details; levels of acculturation; food intake using a specifically designed food frequency questionnaire and food diary; and anthropometric measurements. Data were compared with women from South Australia. Results: Women had a mean age of 38 years (24-50) and had been in Australia for an average of 4 years (1-25). Half (50%) of the women were categorised as overweight or obese and over two-thirds (68%) had a waist measurement indicative of a high risk of chronic disease. A higher proportion of women from Pakistan were overweight and obese compared with Indian women. Women in this sample appeared to have a higher consumption of dairy, bread and cereals, vegetables and baked goods/snacks and were more likely to consume full-fat milk compared with other Australian women. Breakfast was the meal most likely to have been 'Australianised'. Conclusion: Despite the results not reaching statistical significance, these findings do point to areas worthy of further investigation. These include the relationship between acculturation factors with dietary intake and the prevalence of overweight and obesity. Given the high prevalence of overweight and obesity in this small sample, there appears to be a need to investigate diet and physical activity in specific groups to inform the development of culturally relevant chronic disease identification and management programmes. [ABSTRACT FROM AUTHOR]

Brennan DS, Singh KA. General health and oral health self-ratings, and impact of oral problems among older adults. Eur J Oral Sci 2011; 119: 469-473. © 2011 Eur J Oral Sci The aim was to assess associations of general and oral health perceptions, and the impact of general and oral health functional problems on general health perceptions. Data were collected from adults, 60-71 yr of age in 2008, and included global self-ratings of general and oral health, Oral Health Impact Profile (OHIP-14) scores, and health problem scores [using the five items from the EuroQol instrument (EQ-5D)]. Responses were collected from 444 subjects (response rate = 68.8%). Self-rated general and oral health showed fair to good agreement (kappa = 0.47). Adjusted estimates of self-rated general health showed that worse ratings were associated with lower social status [prevalence ratio (PR) = 0.42] and with more health problems (PR = 0.64). Adjusted estimates of self-rated oral health also showed that worse ratings were associated with lower social status (PR = 0.48) and with more health problems (PR = 0.63), as well as with higher OHIP scores (PR = 0.21). The interaction of health problems and OHIP scores was significant for self-rated general health, with self-rated general health being worse when both health problems and OHIP score were higher. For older adults, general health and oral health were associated, although oral health impact was only associated with general health for those with more health problems, indicating that those in worse health suffer more impact from oral health problems. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the effectiveness of a tailored footwear programme on lower-limb comfort in professional rugby league players. The study was conducted over 30 weeks and involved two professional teams (n = 59 players) from the Australian National Rugby League competition. One team was assigned to a footwear programme (intervention), while players from the control group continued usual practices of self-selected footwear. The tailored footwear programme consisting of player education, prescription of footwear, and frequent rotation of footwear resulted in a lower incidence of injury and higher comfort ratings. The intervention group had fewer lower-limb injuries (P = 0.005; Cohen d = 0.72) and higher comfort ratings (P < 0.001, Cohen d = 1.24) than the control group. Specifically, the intervention group reported a lower incidence of poor comfort events (mean = 3.8, s = 2.7) than the control group (mean = 7.9, s = 3.7). Observations also included fewer time loss events in the intervention (mean = 6.3, s = 4.8) than the control group (mean = 11.0, s = 6.3) and reduced injuries per 1000 h in the intervention (24.79/1000) than the control group (30.76/1000). These findings should help medical advisers improve footwear comfort in sportspeople and so reduce the incidence of related injuries. [ABSTRACT FROM PUBLISHER]