Search

Introduction: Culturally safe and meaningful cognitive assessment methods for use with Aboriginal and Torres Strait Islander peoples are scarce. Concerns are raised regarding the efficacy of existing methods in cross‐cultural contexts. The Perceive, Recall, Plan and Perform (PRPP) Assessment offers a person‐centred alternative whereby cognitive strategy application is examined during performance of culturally relevant everyday tasks. This paper explores its use with Aboriginal and Torres Strait Islander peoples in Australia. Methods: A critical case study design was applied to examine the effectiveness and relevance of the PRPP Assessment with two Aboriginal Australian people in the Northern Territory of Australia. 'Ivan' and 'Jean' were each receiving occupational therapy through a rehabilitation service over a 6‐month period following acquired brain injuries. Ivan and Jean were assessed performing everyday tasks of interest and importance to them as part of routine care. A partnership approach was adopted throughout the process, and both consented to their stories being told. Results: The PRPP Assessment was able to measure changes in Ivan's and Jean's cognitive strategy use and its impact on performance of meaningful tasks. Ivan demonstrated a 46% increase in performance mastery and a 29% increase in cognitive strategy use with most improvements identified in his ability to sense information, initiate action, and continue performance. Jean demonstrated a 71% increase in performance mastery and a 32% increase in cognitive strategy use. Her greatest improvements were in the ability to recall schemes, self‐evaluate, and initiate action. Conclusion: The two critical case stories shared in this study suggest that the PRPP Assessment has emerging evidence of clinical utility when used with Aboriginal people with acquired brain impairment. The information gained revealed strengths in performance; it was effective in measuring change in cognitive strategy use, was able to inform the goal setting process, and guided intervention to support cognitive strategy use during task performance. [ABSTRACT FROM AUTHOR]

Background Many patients who require an interpreter have difficulty remembering information from their medical consultations. Memory aids such as consultation audio-recordings may be of benefit to these patients. However, there is no established means of measuring patients' memory of medical information. Objectives This study aimed to develop a method for eliciting and coding recall of medical information in non-English-speaking patients. Design This method, called Patient-Interpreter-Clinician coding ( PICcode), was developed in the context of a phase II trial conducted in two outpatient oncology clinics in Melbourne, Australia, and was refined iteratively through consultation with an expert panel and piloting. Between-coder differences in early versions of the coding system were resolved through discussion and consensus resulting in refinements to PICcode. Results The final version of PICcode involved transcribing, translating and coding of audio-recorded consultations and semi-structured interviews ( SSI). The SSIs were designed to elicit patients' free-recall of medical information. Every unit of medical information in the consultation was identified and categorized in a coding tree. SSIs were coded to identify the extent to which information was recalled from the consultation. Discussion The iterative changes involved in developing PICcode assisted in clarifying precise details of the process and produced a widely applicable coding system. PICcode is the most comprehensively described method of determining the amount of information that patients who use an interpreter recall from their medical consultations. PICcode can be adapted for English-speaking patients and other healthcare populations. [ABSTRACT FROM AUTHOR]

The frequency effect in short-term serial recall is influenced by the composition of lists. In pure lists, a robust advantage in the recall of high-frequency (HF) words is observed, yet in alternating mixed lists, HF and low-frequency (LF) words are recalled equally well. It has been argued that the preexisting associations between all list items determine a single, global level of supportive activation that assists item recall. Preexisting associations between items are assumed to be a function of language co-occurrence; HF-HF associations are high, LF-LF associations are low, and mixed associations are intermediate in activation strength. This account, however, is based on results when alternating lists with equal numbers of HF and LF words were used. It is possible that directional association between adjacent list items is responsible for the recall patterns reported. In the present experiment, the recall of three forms of mixed lists-those with equal numbers of HF and LF items and pure lists-was examined to test the extent to which item-to-item associations are present in serial recall. Furthermore, conditional probabilities were used to examine more closely the evidence for a contribution, since correct-in-position scoring may mask recall that is dependent on the recall of prior items. The results suggest that an item-to-item effect is clearly present for early but not late list items, and they implicate an additional factor, perhaps the availability of resources at output, in the recall of late list items. [ABSTRACT FROM AUTHOR]

Introduction: Ecologically valid assessment linking cognitive strategies to observed functional performance has been strongly advocated. This study examines the construct validity of one such assessment: the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis for the evaluation of adults with brain injury. Method: Eighteen occupational therapists observed videoed patient performance (n = 16) of personal and instrumental activities of daily living, then used the PRPP System of Task Analysis to identify task performance errors and to attribute these errors to underlying cognitive strategy deficits. Multifaceted Rasch analysis was used to generate a hierarchy of test items and to propose a linear continuum, along which the difficulty of test items, raters, patients and tasks could be measured simultaneously. The generated hierarchy was examined for congruency with theories of information processing and neurorehabilitation. Results: Test items, raters, patients and tasks demonstrated 'fit' with the Rasch model. Construct validity was well supported by strong parallels between the Rasch-generated hierarchy of PRPP items and conceptual models of information processing and occupational performance. Conclusion: The PRPP System of Task Analysis is a valid measure of cognitive strategy use during the occupational performance of adults with brain injury, demonstrating high levels of fit with Rasch modelling for test items, raters and patients. [ABSTRACT FROM AUTHOR]

In health economics, the use of patient recall of health care utilisation information is common, including in national health surveys. However, the types and magnitude of measurement error that relate to different recall periods are not well understood. This study assessed the accuracy of recalled doctor visits over 2-week, 3-month, and 12-month periods by comparing self-report with routine administrative Australian Medicare data. Approximately 5,000 patients enrolled in an Australian study were pseudo-randomised using birth dates to report visits to a doctor over three separate recall periods. When comparing patient recall with visits recorded in administrative information from Medicare Australia, both bias and variance were minimised for the 12-month recall period. This may reflect telescoping that occurs with shorter recall periods (participants pulling in important events that fall outside the period). Using shorter recall periods scaled to represent longer periods is likely to bias results. There were associations between recall error and patient characteristics. The impact of recall error is demonstrated with a cost-effectiveness analysis using costs of doctor visits and a regression example predicting number of doctor visits. The findings have important implications for surveying health service utilisation for use in economic evaluation, econometric analyses, and routine national health surveys. [ABSTRACT FROM AUTHOR]

Purpose: To assess any effects of a state-wide sodium reduction intervention on sodium intake, sources of dietary sodium and discretionary salt use at a population level. Methods: Data (24-h urinary sodium excretion, self-report survey, a 24-h dietary recall) were collected cross-sectionally at baseline (2016/2017) and follow-up (2020) from adults in Victoria, Australia. Intervention activities included consumer awareness advertising campaign, public debate generation via mass media, strengthening existing policy initiatives and supporting food innovation with industry. Results: There were 339 participants at baseline and 211 at follow-up, with 144 and 90 of participants completing a 24-h dietary recall, respectively. There was no difference in adjusted 24-h urinary sodium excretion between baseline and follow-up (134 vs 131 mmol/24 h; p = 0.260). There were no differences in the percentage of participants adding salt during cooking (63% vs 68%; p = 0.244), adding salt at the table (34% vs 37%; p = 0.400) or regularly taking action to control salt/sodium intake (22% vs 21%; p = 0.793). There were large differences in the quantity of dietary sodium sourced from retail stores (57% vs 77%, p < 0.001), and less sodium was sourced from foods at fresh food markets (13% vs 2%; p ≤ 0.001) at follow-up. No large differences were apparent for foods with different levels of processing or for food groups. Conclusion: There was no clear population-level effect of the 4-year multi-component Victorian Salt Reduction Intervention on sodium intake with Victorian adults continuing to consume sodium above recommended levels. The findings indicate that more intensive and sustained efforts aiming at the retail and food industry with national level support are likely to be required to achieve a measurable improvement in sodium intake at a state level. [ABSTRACT FROM AUTHOR]

Aim: This paper explores how food regulators respond to food incidents and the barriers and enablers associated with doing so. Methods: Twenty‐six semi‐structured interviews lasting between 30 and 60 minutes were undertaken with Australian food regulators. Regulators worked across food policy development, implementation, enforcement and standards setting. These interviews ascertained food regulators' views on food safety and responses to real and hypothetical food incidents. Data were analysed using thematic analysis. Results: Food regulators reported that working together with other food regulators is an important part of effective food regulation and response to food incidents. Strategies for working together included clarifying expectations and developing formal documents such as a memorandum of understanding. However, challenges in working together were reported, including different risk thresholds, different political agendas and a lack of clarity on regulators' roles. Conclusions: A focus on partnerships and good communication between food regulators is likely to facilitate effective management of food incidents, and maximise the chances that food incidents do not lead to increased consumer morbidity and mortality as a result of a poor response to a food incident. [ABSTRACT FROM AUTHOR]

Purpose: The Functional External Memory Aid Tool (FEMAT) is a performancebased measure of applied cognitive-linguistic abilities and attempted use of compensatory aids and strategies (e.g., using a calendar to recall an appointment) through completion of simulated everyday living tasks. The FEMAT was originally developed in the United States (US), and a need arose from clinicians to adapt the FEMAT for use in other countries. The aim of this study is to describe the cultural adaptation process that resulted in the United Kingdom (UK) and Australian (AU) versions of the FEMAT via international clinical research partnerships. Method: The FEMAT was adapted into UK and AU cultures using established guidelines for cultural and linguistic adaptation. The adaptation was completed by researchers and clinicians from the US, UK, and AU, and we followed a sixstep process: (a) preparation, (b) forward translation, (c) back translation, (d) committee review, (e) field testing, and (f) finalization. Results: The FEMAT items and materials were successfully adapted from the source culture (i.e., English-US) to the target cultures (i.e., English-UK, English- AU). Through the adaptation process, the FEMAT items were determined to be conceptually appropriate for each culture and minimal modifications were made to the FEMAT materials (e.g., voicemail recordings recorded in target dialect). The finalized FEMAT-English-UK and the FEMAT-English-AU versions are available for free on the FEMAT website. Conclusions: Through successful international clinical research collaborations, the FEMAT was successfully adapted for use in other English-speaking cultures. This work provides guidance to streamline future FEMAT cultural adaptations. [ABSTRACT FROM AUTHOR]

Background Late diagnosis is a considered to be a major factor contributing to poorer cancer survival rates in the UK. Interventions have focussed on the promotion of earlier diagnosis in patients with potential cancer symptoms. However, to assess the effectiveness of these interventions, the time from symptom onset to presentation needs to be reliably and accurately measured. This qualitative study explored the use of calendar landmarking instruments in cancer symptom research. Methods We performed a secondary analysis of transcripts of interviews using the calendar landmarking instrument, undertaken with patients who had either been diagnosed with cancer (n = 40, IRCO study, Western Australia), or who had symptoms suggestive of cancer (n = 38, SYMPTOM study, North East and Eastern England). We used constant comparison methods to identify use of the calendar landmarking instruments and the impact of their application. Results The calendar landmarking instrument appeared to help many patients, either by acting as a prompt or helping to refine recall of events. A combination of personal (e.g. birthday) and national (e.g. Christmas) landmarks seemed to be the most effective. Calendar landmarking instruments appeared more useful where the time period between onset of symptoms and date of first consultation was less than three months. The interviewee's age, gender and cancer type did not appear to influence whether or not the instrument facilitated recall, and there were no instances where the use of the instrument resulted in the disclosure of a new first symptom. Symptoms of similar chronic conditions could create difficulties when applying the instrument; it was difficult for these participants to characterise and disentangle their symptoms which prompted their decisions to seek help. Some participants tended to prefer to use their own, already personalised, diaries to assist in their recall of events. Conclusions This study is the first to describe the potential role of calendar landmarking instruments to support research interviews which explore symptoms and events along the cancer diagnostic pathway. The major challenge remains as to whether they actually improve accuracy of recall. [ABSTRACT FROM AUTHOR]

The effectiveness of exercise programs for chronic low back pain (CLBP) is dependent upon patient adherence which is problematic to measure accurately. This cross-sectional observational study aimed to compare patient-reported levels of adherence with physiotherapists' perceptions of patient adherence; and to explore the proportion of patients who could accurately recall and demonstrate the exercises contained within their prescribed exercise program for CLBP. Participating patients (n = 61) included those attending for a follow-up consultation with a physiotherapist (n = 15) at a consenting practice (n = 6) who had been prescribed an exercise program for CLBP. Patients were asked to self-report their level of adherence to the exercise program which was then compared to their physiotherapist's perception of adherence. Patients were also asked to recall and demonstrate the exercise program to an independent researcher, which was compared to the prescribed program. Results indicated that in total, 24 patients (39%; 95% CI: 27–52%) self-reported as being completely adherent compared with 10 patients (16%; 95% CI: 8–28%) who were perceived by their physiotherapists as completely adherent (raw agreement: 0.21). However, only nine patients (15%, 95% CI: 7–26%) were able to accurately recall and demonstrate their prescribed exercise program to the researcher, of which eight of these nine patients self-reported complete adherence to the exercise program. In comparison, only four of these nine patients were perceived by the physiotherapist to be completely adherent. These results suggest that patient adherence to home-based exercise programs for CLBP might be assessed more accurately using multi-faceted measures which include an observational component. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Describe the type and amount of beverages consumed by Australian children at age 2, 3.7 and 5; investigate the longitudinal relationship between intake of sweet beverages with fruits and vegetables or milk/alternatives, and body mass index (BMI) z‐score. Methods: Mothers in the NOURISH trial completed a single 24‐hour recall of their child's intake, at age 2 (n = 515), 3.7 (n = 426) and 5 (n = 405). Anthropometry was measured by study staff. At each time point, proportion of children consuming at least one beverage on 24‐hour recall from the following groups was determined; essential—cow's milk/alternatives, breast milk; non‐essential—formula, sweet beverages. For consumers, intake (grams) of each beverage and proportion total estimated energy intake was calculated. The longitudinal relationship between intake of sweet beverages, and fruit and vegetable intake (g/kg body weight), with BMI z‐score at 2, 3.7 and 5 years was examined using structural equation modelling. A second model investigated relationship with intake of milk/alternatives. Results: Sweet beverages were consumed by 38, 55 and 47% of children at each time point. Intake of sweet beverages strongly correlated between two and five years; however, intake was not associated with BMIz and did not appear to displace fruit and vegetable intake. Intake of cow's milk declined over time and was negatively associated with intake of sweet beverages at two and five years. Conclusions: Tracking of intake over time supports the notion that children's early experience of sweet tastes is a strong predictor of future intake. Limiting exposure to sweet beverages in early childhood remains an important strategy in the development of healthy food preferences and promotion of dietary quality. [ABSTRACT FROM AUTHOR]

Smoking is disproportionately prevalent among Aboriginal and Torres Strait Islander Australian peoples, with 39% of Indigenous Australians aged over 15 years smoking daily. Efforts to reduce the prevalence include culturally focused media campaigns, designed through community consultation, that highlight the need to determine how such health messaging is perceived by smokers. This study aimed to examine Indigenous Australian smokers' reactions to a culturally focused anti-smoking mass media campaign. Intercept surveying across health services and events recorded demographics, smoking status, quit attempts, smoking health effects, anti-smoking campaign recall, social support, and campaign reactions. Participants rated four different campaign images in five domains: (1) whether it made them stop and think; (2) personal relevance; (3) believability of design and message; (4) prompting concern about smoking; and (5) motivation towards quitting. Cluster analysis was used to identify smoker types. Smoking health effects knowledge was high, and did not differ by quit readiness, attempts, or social support. Cessation support access was higher among those with greater readiness to quit. Social smoking behaviour and confidence to support others quitting did not significantly differ between participants, however importance of others quitting did. Quit readiness, attempts, and social support were associated with reaction to campaign design, but not message recall. Four types of smokers were identified using smoking characteristics, who differed in campaign message reactions. Culturally focused anti-smoking media can benefit from exploring how smoker types can be used to differentiate messaging by smokers' profile characteristics, to support mass media smoking cessation efforts. [ABSTRACT FROM AUTHOR]

Background and aims: Evidence on the associations between child maltreatment (CM), alcohol use disorders (AUDs) and other substance use disorders (SUDs) comes largely from retrospective studies. These rely on self‐reported data, which may be impacted by recall bias. Using prospective CM reports to statutory agencies, we measured associations between CM notifications and inpatient admissions for AUDs and SUDs up to 40 years of age. Design, setting and participants: Observational study linking administrative health data from Queensland, Australia to prospective birth cohort data comprising both agency‐reported and substantiated notifications of CM. Measurements: Outcomes were inpatient admissions for AUDs and SUDs based on ICD‐10‐Australian modification (AM)‐coded primary diagnoses. Unadjusted and adjusted logistic regression analyses were undertaken. Findings Ten per cent (n = 609) of the cohort had a history of agency‐reported or substantiated CM notifications before age 15. These individuals had higher adjusted odds of being admitted for AUDs and SUDs. For AUDs, the adjusted odds of inpatient admission were 2.86 [95% confidence interval (CI) = 1.73–4.74] greater where there was any previous agency‐reported CM and 3.38 (95% CI = 1.94–5.89) greater where there was any previous substantiated CM. For SUDs, the adjusted odds of inpatient admission were 3.34 (95% CI = 2.42–4.61) greater where there was any previous agency‐reported CM and 2.98 (95% CI = 2.04–4.36) greater where there was any previous substantiated CM. Conclusions: People with a history of child maltreatment appear to have significantly higher odds of inpatient admissions for alcohol use disorders and other substance use disorders up to 40 years of age compared to people with no history of child maltreatment. [ABSTRACT FROM AUTHOR]

Background: Recommendations to define eating occasions (EO) currently exist for research in adults, but not for children or adolescents. We examined how varying EO definitions affect the characterization of eating patterns in children and adolescents. Methods: Cross-sectional dietary data collected using a 24-h recall data during the 2011–12 Australian National Nutrition and Physical Activity Survey (1364 boys and 1337 girls aged 2–18 years) were analyzed. Eight definitions were applied: participant-identified, time-of-day, and 6 neutral definitions (EO separated by 15- or 60-min and/or an additional energy criterion of 21 or 210 kJ). Frequency of and total energy intake from meals, snacks, and all EO were estimated. F tests stratified by gender and age-group, were used to assess differences between definitions. Agreement between definitions of meal and snack frequencies was assessed using intraclass correlation coefficients (ICC). Linear regression was used to estimate the proportion of variance in total energy intake (kJ) and BMI z-score predicted by each definition. Results: Mean frequencies of meals and snacks differed between the participant-identified and time-of-day definitions, in boys and girls and for all age groups (P < 0.01). Across the six neutral definitions, there were differences between mean frequencies of EO with the largest mean difference observed for children aged 2–3 y (boys: 2.3, girls: 2.5; P < 0.003). Between the participant-identified and time-of-day definitions, there was good agreement for frequencies of snacks (ICC for both genders: 0.93) but not meals (boys: 0.36; girls: 0.38). The 15-min time interval plus 210 kJ definition of an EO consistently predicted the most variance in total energy intake (R2 range = 8.1–34.8). Definitions that delineated meals and snacks better predicted variance in BMI z-score, when compared to the neutral definitions. Conclusions: How eating patterns are characterized vary depending on the EO definitions employed, particularly in young children. Variance in total energy intake was best predicted by a variation of the neutral definition whereas definitions that delineated meals and snacks performed better in relation to predicting BMI variance. Further international research that compares EO definitions in children will help inform a standard approach. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate whether variations in the way that pain intensity is measured in patients with neck pain influences the magnitude of pain ratings. The study uses data from 3 longitudinal studies ( n = 361 at baseline) on people with neck pain due to whiplash injuries. Pain measures included verbal rating scales, numerical rating scales and a visual analog scale. Different measures asked patient to rate current pain, average pain over 24 hours, over 1 week, or over 4 weeks. Scores were converted to a 0-100 scale and tracked over time, correlations between measures were calculated. Mixed models regression was used to explore the factors which influenced the differences between scores on the measures. Scores on the different measures were significantly different from each other in each dataset ( P < 0.02). The effect of recall period was significant in all datasets and the effect of number of response options was significant in 2 of 3 datasets. Pain intensity ratings appear to be sensitive to method of measurement. It is likely the length of recall time (eg, pain today vs. average pain over 4 weeks) has a significant influence on pain ratings. The influence of number of response options is less certain. Systematic reviewers should not uncritically rescale and pool absolute pain scores from instruments with varying scale descriptors or recall periods. [ABSTRACT FROM AUTHOR]

Young people's exposure to gambling marketing has had a clear impact on their gambling attitudes, risk perceptions and consumption intentions. Celebrities and social media influencers (SMIs) are increasingly used by the gambling industry in a wide range of promotions. While there is evidence that these types of promotions are influential in shaping young people's attitudes towards other harmful products, there is limited evidence in relation to gambling. Qualitative focus groups (n  = 22) with n  = 64, 12–17 year olds were conducted in Australia. These investigated young people's exposure to celebrity and SMI marketing for gambling and the influence they perceived this marketing had on young people's gambling attitudes. Reflexive thematic analysis was used to construct four themes from the data. First, young people perceived that celebrities and SMIs created additional appeal and recall of gambling advertisements because they were attention grabbing and familiar. Second, young people thought that celebrities and SMIs increased the trust, legitimacy and social acceptance of gambling. Third, the use of celebrities and SMIs lowered the perceptions of risk associated with gambling. Lastly, there were suggestions to reduce the impact of celebrity and SMI gambling promotions on young people, such as bans and restrictions. This study highlights the importance of a comprehensive approach to preventing young people's exposure to gambling marketing, that not only considers imposing stronger regulations to restrict the way the gambling industry is allowed to promote its products, but also aims to counter the novel ways the gambling industry attempts to appeal to children and young people. [ABSTRACT FROM AUTHOR]

Background: Diabetes distress, experienced by up to 40% of people with type 2 diabetes (T2D), is the negative emotional response to the burden of living with and managing diabetes. It is associated with suboptimal glycaemia and diabetes self-management. Research indicates that people with diabetes do not recall being asked about emotional distress by healthcare professionals. Aim: To explore the experiences, needs, and expectations of people with T2D regarding emotional support received in Australian general practice. Design & setting: Exploratory qualitative study in Victoria, Australia. Method: Semi-structured interviews were undertaken to explore emotional health and support received in general practice in 12 adults with T2D who primarily attend general practice. Interviews were audio-recorded, transcribed verbatim, and analysed using the framework approach. Results: The following three major themes were identified: (1) Beneath the surface of diabetes care; (2) Importance of GP--patient relationship; and (3) Communication counts. Participants experienced diabetes care as focused primarily on medical management rather than the emotional aspects of living with T2D. While people's experiences of diabetes care in general practice primarily focused on physical health, the GP care beyond the presenting complaint has an essential role in identifying emotional issues and enabling support. Emotional issues were more likely to be discussed and acknowledged by the GP where there was a long-standing relationship between GP and patient. Conclusion: Pre-existing positive GP--patient relationships and supportive communication enable people with 2TD to raise emotional issues as part of diabetes care. [ABSTRACT FROM AUTHOR]

Study Question: Can an artificial intelligence (AI) model predict human embryo ploidy status using static images captured by optical light microscopy?Summary Answer: Results demonstrated predictive accuracy for embryo euploidy and showed a significant correlation between AI score and euploidy rate, based on assessment of images of blastocysts at Day 5 after IVF.What Is Known Already: Euploid embryos displaying the normal human chromosomal complement of 46 chromosomes are preferentially selected for transfer over aneuploid embryos (abnormal complement), as they are associated with improved clinical outcomes. Currently, evaluation of embryo genetic status is most commonly performed by preimplantation genetic testing for aneuploidy (PGT-A), which involves embryo biopsy and genetic testing. The potential for embryo damage during biopsy, and the non-uniform nature of aneuploid cells in mosaic embryos, has prompted investigation of additional, non-invasive, whole embryo methods for evaluation of embryo genetic status.Study Design, Size, Duration: A total of 15 192 blastocyst-stage embryo images with associated clinical outcomes were provided by 10 different IVF clinics in the USA, India, Spain and Malaysia. The majority of data were retrospective, with two additional prospectively collected blind datasets provided by IVF clinics using the genetics AI model in clinical practice. Of these images, a total of 5050 images of embryos on Day 5 of in vitro culture were used for the development of the AI model. These Day 5 images were provided for 2438 consecutively treated women who had undergone IVF procedures in the USA between 2011 and 2020. The remaining images were used for evaluation of performance in different settings, or otherwise excluded for not matching the inclusion criteria.Participants/materials, Setting, Methods: The genetics AI model was trained using static 2-dimensional optical light microscope images of Day 5 blastocysts with linked genetic metadata obtained from PGT-A. The endpoint was ploidy status (euploid or aneuploid) based on PGT-A results. Predictive accuracy was determined by evaluating sensitivity (correct prediction of euploid), specificity (correct prediction of aneuploid) and overall accuracy. The Matthew correlation coefficient and receiver-operating characteristic curves and precision-recall curves (including AUC values), were also determined. Performance was also evaluated using correlation analyses and simulated cohort studies to evaluate ranking ability for euploid enrichment.Main Results and the Role Of Chance: Overall accuracy for the prediction of euploidy on a blind test dataset was 65.3%, with a sensitivity of 74.6%. When the blind test dataset was cleansed of poor quality and mislabeled images, overall accuracy increased to 77.4%. This performance may be relevant to clinical situations where confounding factors, such as variability in PGT-A testing, have been accounted for. There was a significant positive correlation between AI score and the proportion of euploid embryos, with very high scoring embryos (9.0-10.0) twice as likely to be euploid than the lowest-scoring embryos (0.0-2.4). When using the genetics AI model to rank embryos in a cohort, the probability of the top-ranked embryo being euploid was 82.4%, which was 26.4% more effective than using random ranking, and ∼13-19% more effective than using the Gardner score. The probability increased to 97.0% when considering the likelihood of one of the top two ranked embryos being euploid, and the probability of both top two ranked embryos being euploid was 66.4%. Additional analyses showed that the AI model generalized well to different patient demographics and could also be used for the evaluation of Day 6 embryos and for images taken using multiple time-lapse systems. Results suggested that the AI model could potentially be used to differentiate mosaic embryos based on the level of mosaicism.Limitations, Reasons For Caution: While the current investigation was performed using both retrospectively and prospectively collected data, it will be important to continue to evaluate real-world use of the genetics AI model. The endpoint described was euploidy based on the clinical outcome of PGT-A results only, so predictive accuracy for genetic status in utero or at birth was not evaluated. Rebiopsy studies of embryos using a range of PGT-A methods indicated a degree of variability in PGT-A results, which must be considered when interpreting the performance of the AI model.Wider Implications Of the Findings: These findings collectively support the use of this genetics AI model for the evaluation of embryo ploidy status in a clinical setting. Results can be used to aid in prioritizing and enriching for embryos that are likely to be euploid for multiple clinical purposes, including selection for transfer in the absence of alternative genetic testing methods, selection for cryopreservation for future use or selection for further confirmatory PGT-A testing, as required.Study Funding/competing Interest(s): Life Whisperer Diagnostics is a wholly owned subsidiary of the parent company, Presagen Holdings Pty Ltd. Funding for the study was provided by Presagen with grant funding received from the South Australian Government: Research, Commercialisation, and Startup Fund (RCSF). 'In kind' support and embryology expertise to guide algorithm development were provided by Ovation Fertility. 'In kind' support in terms of computational resources provided through the Amazon Web Services (AWS) Activate Program. J.M.M.H., D.P. and M.P. are co-owners of Life Whisperer and Presagen. S.M.D., M.A.D. and T.V.N. are employees or former employees of Life Whisperer. S.M.D, J.M.M.H, M.A.D, T.V.N., D.P. and M.P. are listed as inventors of patents relating to this work, and also have stock options in the parent company Presagen. M.V. sits on the advisory board for the global distributor of the technology described in this study and also received support for attending meetings.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim To evaluate the relationship between change in cannabis use and changed cognitive performance over 8 years. Design We used survey methodology with a cohort design. Setting and participants An Australian community sample aged 20-24 years at baseline. Measures We assessed cognitive performance with the California Verbal Learning Test (CVLT) (immediate and delayed), Spot-the-Word test (STW), Symbol Digit Modality test (SDMT) and Digit Backwards (DB). Groups of cannabis users were defined from self-reports across three waves as: 'never' ( n= 420) 'remain light' ( n= 71), 'former light' ( n= 231), 'remain heavy' ( n= 60), 'former heavy' ( n= 60) and 'always former' (since start of study) ( n= 657). Planned contrasts within mixed model repeated-measures analysis of variance was used for longitudinal analysis with an adjusted alpha of 0.01. Findings Data were obtained from 2404 participants with 1978 (82.3%) completing wave 3. At baseline there were significant differences between cannabis groups on CVLT (immediate and delayed) and SDMT. However, after controlling for education, gender, gender × group and gender × wave, there were no significant between-group differences and only CVLT immediate recall reached adjusted statistically significant longitudinal change associated with changed cannabis use (group × wave P= 0.007). Specifically, former heavy users improved their performance relative to remaining heavy users (estimated marginal means: former heavy 6.1-7.5: remain heavy 6.4-6.6). Conclusions Cessation of cannabis use appears to be associated with an improvement in capacity for recall of information that has just been learned. No other measures of cognitive performance were related to cannabis after controlling for confounds. [ABSTRACT FROM AUTHOR]

The Western Australian (WA) 'LiveLighter' (LL) mass media campaign ran during June-August and September-October 2012. The principal campaign ad graphically depicts visceral fat of an overweight individual ('why' change message), whereas supporting ads demonstrate simple changes to increase activity and eat healthier ('how' to change message). Cross-sectional surveys among population samples aged 25-49 were undertaken pre-campaign (/V=2012) and following the two media waves (N=2005 and N = 2009) in the intervention (WA) and comparison state (Victoria) to estimate the population impact of LL. Campaign awareness was 54% after the first media wave and overweight adults were more likely to recall LL and perceive it as personally relevant. Recall was also higher among parents, but equal between socio-economic groups. The 'why' message about health-harms of overweight rated higher than 'how' messages about lifestyle change, on perceived message effectiveness which is predictive of health-related intention and behaviour change. State-by-time interactions showed population-level increases in self-referent thoughts about the health-harms of overweight (P < 0.05) and physical activity intentions (P < 0.05). Endorsement of stereotypes of overweight individuals did not increase after LL aired. LL was associated with some population-level improvements in proximal and intermediate markers of campaign impact. However, sustained campaign activity will be needed to impact behaviour. [ABSTRACT FROM AUTHOR]

Background: Mild cognitive impairment (MCI) has been reported after acute coronary syndrome (ACS), but it is uncertain who is at risk, particularly during inpatient admission. Objective: In this study, we aimed to explore the prevalence and cognitive domains affected in MCI during ACS admission and determine factors that identify patients most at risk of MCI. Methods: Inpatients with ACS were consecutively recruited from 2 tertiary hospital cardiac wards and screenedwith theMontreal Cognitive Assessment and theHopkins Verbal Learning Test. Screening included health literacy (Newest Vital Sign), depressive symptoms (Patient Health Questionnaire-9), and physical activity (Physical Activity Scale for the Elderly). Factors associated with MCI were determined using logistic regression. Results: Participants (n = 81) had amean (SD) age of 63.5 (10.9) years, and 82.7%weremale. In total,MCIwas identified in 52.5%, 42.5%with 1 screen and 10% with both. Individually, the Montreal Cognitive Assessment identified MCI in 48.1%, and the Hopkins Verbal Learning Test identified MCI in 13.8%. In Montreal Cognitive Assessment screening, the cognitive domains in which participants most frequently did not achieve the maximum points available were delayed recall (81. 5%), visuospatial executive function (48.1%), and attention (30.9%). Accounting for education, depression, physical activity, and ACS diagnosis, the likelihood of anMCI positive screen increased by 11%per year of age (odds ratio, 1.11; 95%confidence interval, 1.04-1.18) and by 3.6 times for thosewho are unmarried/unpartnered (odds ratio, 3.61; 95% confidence interval, 1.09-11.89). Conclusion: An estimated half of patients with ACS screen positive for MCI during admission,with single and older patientsmost at risk.Multiple areas of thinking were affected with potential impact on capacity for learning heart disease management. [ABSTRACT FROM AUTHOR]

Prominence, the expression of informational weight within utterances, can be signaled by prosodic highlighting (head-prominence, as in English) or by position (as in Korean edge-prominence). Prominence confers processing advantages, even if conveyed only by discourse manipulations. Here we compared processing of prominence in English and Korean, using a task that indexes processing success, namely recognition memory. In each language, participants' memory was tested for target words heard in sentences in which they were prominent due to prosody, position, both or neither. Prominence produced recall advantage, but the relative effects differed across language. For Korean listeners the positional advantage was greater, but for English listeners prosodic and syntactic prominence had equivalent and additive effects. In a further experiment semantic and phonological foils tested depth of processing of the recall targets. Both foil types were correctly rejected, suggesting that semantic processing had not reached the level at which word form was no longer available. Together the results suggest that prominence processing is primarily driven by universal effects of information structure; but language-specific differences in frequency of experience prompt different relative advantages of prominence signal types. Processing efficiency increases in each case, however, creating more accurate and more rapidly contactable memory representations. [ABSTRACT FROM AUTHOR]

To identify the characteristics of those who tend to hold stigmatising beliefs and behaviours towards people living with dementia to inform dementia education and the targeting of interventions to reduce dementia-related stigma. A nationally representative telephone survey of 1000 Australians aged 18–93 years was conducted to assess general knowledge of dementia and dementia-related stigma. A single open-ended question was used to assess participants' general knowledge of dementia. Modified items from the Lay Public Dimension of the Family Stigma in Alzheimer's Disease Scale were used to assess dementia-related stigma. Only 26% of participants demonstrated good dementia knowledge while almost half of the participants had a mixed understanding of dementia. Dementia-related negative cognitive attributions were found to be higher in (1) the older age cohorts, (2) amongst individuals who know someone with dementia, (3) speak a language other than English at home, and (4) have a better understanding of dementia. Older age cohorts, men, those who do not know someone with dementia, and those who speak a non-English language at home also reported significantly higher discriminatory behavioural reactions compared to the younger age cohorts, females, those who know someone with dementia, and those who speak English only at home. This study identifies a need for improved public education about dementia. A structured approach to the development of strategies that is specifically tailored to different age, gender and cultural groups may provide a beneficial approach to help improve dementia knowledge and reduce dementia-related stigma in the population. [ABSTRACT FROM AUTHOR]

Dietary patterns derived from factor analytic procedures have been demonstrated to predict demographic and health outcomes across a wide range of populations. To examine the potential utility of long-term dietary recall, in the present study, we examined associations between dietary patterns from across the lifespan and demographic and later-life cardiovascular-related health variables, using the Lifetime Diet Questionnaire (LDQ). The LDQ is a self-administered, non-quantitative, retrospective FFQ designed to assess dietary intake from childhood to older age. Participants (n 352) from the Older People, Omega-3 and Cognitive Health trial, aged 65–91 years, completed the LDQ. Exploratory factor analysis was conducted on the LDQ and plausible dietary patterns were derived. As a result, three patterns were extracted from each life period, with five distinct patterns overall; these were ‘traditional Australian’ and ‘non-traditional Australian’, ‘high-sugar and high-fat’, ‘vegetable’ and ‘fruit and vegetable’ patterns. In separate adjusted regression models, age, sex, education, income, parental background and childhood physical activity all significantly predicted dietary patterns across the lifespan. A ‘traditional Australian’ pattern in childhood predicted higher HDL-cholesterol levels and lower odds of cholesterol medication use; lower HDL-cholesterol levels were predicted by the adult ‘processed, high-sugar and high-fat’ pattern, and higher intake of a ‘non-traditional Australian’ pattern in adulthood also predicted lower odds of using cardiac medications. Lifetime dietary recall, as instantiated by the LDQ, provides a hitherto untapped source of long-term dietary information in older adults that may contribute to greater understanding of the impact exerted by early-life and cumulative dietary choices on later-life health. [ABSTRACT FROM PUBLISHER]

Objectives: Due to forecasted faculty shortages and increasing student enrollments in dental education, there is a need to attract talented clinicians into academia. To address this growing concern, we need to explore dental practitioners' perspectives on the academic career pathway, including enablers and barriers to entering the academic workforce.Methods: A mixed-methods electronic survey was disseminated through professional associations and dental groups on social media in 2018. Qualitative responses were examined using an inductive thematic analysis.Results: Participants (n = 85) considered an academic career highly regarded (80%) but indicated there was not a clear pathway (79%) and could not recall it being discussed during their dental studies (85%). It was perceived that experience, further study, and networks all played a significant role in forging an academic career. Perceived benefits to an academic career included professional development opportunities, good employment conditions, and making a meaningful contribution. Barriers included the geographical location of universities, losing clinical skills and the lack of a clear career pathway.Conclusion: Despite being a highly regarded career, clinicians admit the career pathway to academia is not clear. Improving awareness of academic career paths might be achieved by educating dental students and providing accessible resources to the wider profession. [ABSTRACT FROM AUTHOR]

Objective: As uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on women's perceptions and experiences of cervical screening in the context of an organised call-recall programme, in order to understand the barriers to informed uptake.Methods: We searched nine databases for English language peer-reviewed publications reporting on qualitative data from screening-eligible women, exploring barriers to cervical screening in countries that offer a nationally organised call-recall programme. Evidence was integrated using thematic synthesis.Results: Thirty-nine papers from the UK, Australia, Sweden and Korea were included. The majority of participants had attended screening at least once. Two broad themes were identified: (a) should I go for screening? and (b) screening is a big deal. In considering whether to attend, women discussed the personal relevance and value of screening. Women who had previously attended described how it was a big deal, physically and emotionally, and the varied threats that screening presents. Practical barriers affected whether women translated screening intentions into action.Conclusions: The variation in women's understanding and perceptions of cervical screening suggests that interventions tailored to decisional stage may be of value in increasing engagement with the invitation and uptake of screening in those who wish to take part. There is also a need for further research with women who have never attended screening, especially those who remain unaware or unengaged, as their perspectives are lacking in the existing literature. © 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Chronic disease identification and management is a significant issue in Australia, with general practice being the primary contact point for those at risk of, or living with, chronic disease. However, there is a well-described gap between guideline recommendations for chronic disease management and translation in the general practice setting. In 2018, a group of researchers, clinicians and software developers collaborated to develop a tool to support the identification and management of chronic disease in general practice, with the aim to create a platform that met the needs of general practice. The co-design process drew together core principles and expectations for the establishment of a technological platform, called Future Health Today (FHT), which would sit alongside the electronic medical record (EMR) management system within general practice. FHT used algorithms applied to EMR data to identify patients with, or at risk of, chronic disease and requiring review. Using chronic kidney disease as a clinical focus, the FHT prototype was piloted in a large, metropolitan general practice, and a large regional general practice. Based on user feedback, the prototype was further developed and improved. This paper provides a report on the key features and functionalities that participants identified and implemented in practice. Future Health Today is a new platform, co-designed by general practice for general practice, which aims to streamline the identification and management of chronic disease to improve health outcomes. This paper describes the development of the technology platform and how it was optimised through an implementation study in general practice. [ABSTRACT FROM AUTHOR]

Objectives. This study investigated social problem solving (SPS) and autobiographical memory specificity in complicated grief (CG). Design. The study employed a cross-sectional design, comparing the responses of bereaved individuals with and without CG. Methods. Twenty-one individuals with CG and twenty-two No-CG bereaved individuals completed a means-ends problem-solving (MEPS) task and a cue word autobiographical memory retrieval task (AMT). Results. CG was associated with significantly poorer performance on the MEPS and AMT tasks. After controlling for levels of depression and post-traumatic stress disorder, CG remained a significant independent predictor of MEPS scores. Categoric recall was not an independent predictor after controlling for symptoms. Conclusions. This finding indicates that CG is associated with deficits in SPS, which may contribute to maintenance of deficits associated with CG. [ABSTRACT FROM AUTHOR]

Undertaking research with young people presents an array of methodological challenges. We report the findings from a qualitative study that took place alongside a fetal alcohol spectrum disorder (FASD) prevalence study among detainees in Australia. Of 38 participants, 27 were Aboriginal youth. Interviews were conducted using "social yarning" and "research topic yarning," an Indigenous research method which allows for data collection in an exploratory, culturally safe way. A complex interplay emerged between social yarning and research topic yarning which provided a space to explore responsively with participants their experiences of FASD assessments. Flexibility, including language adaptation and visual descriptions about assessments, was utilized to assist participants recall and retell their experiences. There were, however, challenges in gathering data on the assessment experiences of some participants. We describe how employing a "yarning" method for collecting data could benefit children and young people undergoing neurodevelopmental assessments in the future. [ABSTRACT FROM AUTHOR]

Objective: This study explores socioecological factors facilitating the sexual and reproductive health and rights (SRHR) experiences of migrant and refugee youth (MRY) in Greater Western Sydney, Australia. MRY may be at higher risk for poorer SRH outcomes due to cultural, linguistic, and systemic barriers. Methods: Using participatory action research, 17 focus groups were conducted with 87 MRY aged 15–29 from diverse cultural backgrounds. Data were analysed thematically, using socioecological framework. Results: Key facilitators of MRY's SRHR were identified at the microsystem and exosystem levels, including (1) Peer dynamics and support, with friends serving as trusted confidants and sources of advice; (2) Safety and contraceptive choices, highlighting the importance of access to contraception and STI prevention; and (3) Digital platforms for SRHR information access, with online resources filling knowledge gaps. Conclusion: Findings suggest the need for SRHR interventions to leverage peer support networks, expand access to contraceptive options, and develop culturally appropriate digital resources for MRY. Further research is needed to identify and enhance facilitators across all socioecological levels to comprehensively support MRY's SRHR needs. Plain language summary: Migrants and refugee youth often struggle to access sexual and reproductive health information and services in their new countries. This study is an attempt to understand what helps young migrants and refugee maintain their sexual and reproductive health and rights in Greater Western Sydney, Australia. Our aim was to identify the positive factors in their environment that make it easier for them to access and use sexual health resources. We talked to 87 migrants and refugee youth aged 15–29 from various cultural backgrounds, conducting 17 group discussions about their experiences with sexual health. Our main results show three important factors that help these young people. The results were, that (1) Many young people trust their friends for advice and information about sexual health, (2) Having choices about contraception and ways to prevent sexually transmitted infections was important, and (3) The internet, especially social media and search engines, is a major source of sexual health information for young people. Understanding these helpful factors can guide better support for young migrants and refugees. It shows sexual health programs need to use peer support in sexual health programs, make sure young people can easily access contraception and protection and create trustworthy online resources about sexual health that are culturally appropriate. Our findings show more research is needed to find other ways to support young migrants and refugees with their sexual and reproductive health. This will help create better health services and education programs for these young people. [ABSTRACT FROM AUTHOR]

Background: Chronic, non-malignant diseases (CNMD) like chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and dementia in advanced stages are very burdensome for patients. Timely palliative care with strong collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams can reduce symptom burden, hospitalization rates, hospitalization costs and overall healthcare costs. The KOPAL-study on strengthening interprofessional collaboration for patients with palliative care needs tested the effect of an intervention comprising of a SPHC nurse assessment and an interprofessional case conference. This qualitative evaluative study explores patients', proxies' and their associates' motivation to participate in the KOPAL-study and views on the (benefits of the) intervention. Methods: We interviewed 13 male and 10 female patients as well as 14 proxies of patients with dementia and six associates of study participants using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim and analysed with deductive-inductive qualitative content analysis. Results: Motivation for participation was driven by curiosity, the aim to please the GP or to support research, respectively to help other patients. Few interviewees pointed out to have expected positive effects for themselves. The nurse visit was evaluated very positively. Positive changes concerning health care or quality of life were reported sparsely. Most study participants did not prepare for the SPHC nurse assessment. They had no expectations concerning potential benefits of such an assessment, the interdisciplinary case conference and an early integration of palliative care. The majority of interviewees reported that they did not talk about the nurse visit and the interprofessional case conference with their GPs. Conclusion: Our results lead to the conclusion that SPHC nurses can serve as an advocate for the patient and thereby support the patients' autonomy. GPs should actively discuss the results of the interdisciplinary case conference with patients and collaboratively decide on further actions. Patient participation in the interdisciplinary case conference could be another way to increase the effects of the intervention by empowering patients to not just passively receive the intervention. Trial registration: DRKS00017795 German Clinical Trials Register, 17Nov2021, version 05. [ABSTRACT FROM AUTHOR]

Background: Greater public transport use has been linked to higher physical activity levels. However, neither the amount of physical activity associated with each daily public transport trip performed, nor the potential total physical activity gain associated with an increase in trips/day, has been determined. Using objective measures, we aimed to quantify the association between public transport use, physical activity and sedentary time. Methods: A longitudinal study of Australian adults living in Hobart, Tasmania, who were infrequent bus users (≥ 18 years; used bus ≤ 2 times/week). The number of bus trips performed each day was determined from objective smartcard data provided by the public transportation (bus) provider across a 36-week study timeframe. Accelerometer measured steps/day (primary outcome), moderate-to-vigorous physical activity (min/day), and sedentary time (min/day) were assessed across four separate one-week periods. Results: Among 73 participants across 1483 day-level observations, on days that public transport was used, participants achieved significantly more steps (β = 2147.48; 95%CI = 1465.94, 2829.03), moderate to vigorous physical activity (β = 22.79; 95% CI = 14.33, 31.26), and sedentary time (β = 37.00; 95% CI = 19.80, 54.21) compared to days where no public transport trips were made. The largest increase in steps per day associated with a one-trip increase was observed when the number of trips performed each day increased from zero to one (β = 1761.63; 95%CI = 821.38, 2701.87). The increase in the number of steps per day was smaller and non-significant when the number of trips performed increased from one to two (β = 596.93; 95%CI=-585.16, 1779.01), and two to three or more (β = 632.39; 95%CI=-1331.45, 2596.24) trips per day. Significant increases in sedentary time were observed when the number of trips performed increased from zero to one (β = 39.38; 95%CI = 14.38, 64.39) and one to two (β = 48.76; 95%CI = 25.39, 72.12); but not when bus trips increased from two to three or more (β=-27.81; 95%CI=-76.00, 20.37). Conclusions: Greater public transport use was associated with higher physical activity and sedentary behaviour. Bus use may yield cumulative increases in steps that amount to 15–30% of the daily recommended physical activity target. A policy and public health focus on intersectoral action to promote public transport may yield meaningful increases in physical activity and subsequent health benefits. [ABSTRACT FROM AUTHOR]

Background: Strict patient isolation in hospital is associated with adverse health outcomes. However, there is a lack of high‐quality evidence for effective interventions to improve safety and quality of care for these patients. Aims: To identify patient reported areas for improvement in the care of patients in hospital isolation and to determine the feasibility of collecting patient reported outcomes using validated tools. Methods: Design: An exploratory mixed methods study. Setting: A major metropolitan teaching hospital in Melbourne, Australia. Participants: Patients in hospital isolation for transmissible infections. Data collection: Data were collected by (1) phone interviews with patients in isolation and (2) seven validated measurement tools to assess cognition, loneliness, nutritional status, quality of life, anxiety and depression and physical activity. Data were collected between September and December 2021. Data analysis: Interviews were transcribed and analysed using thematic analysis. Quantitative data were analysed descriptively including participant characteristics and outcome data. Results: Participants identified areas for improvement including activities to decrease boredom, more contact with staff to mitigate loneliness and increase comfort care, and formalised communication about clinical treatment and discharge plan. Patients with gastrointestinal symptoms were happier to be alone. There were operational challenges within the health service including delays and miscommunication. Only 70% of the participants completed all questionnaires. Conclusion: This study identified areas for improvement in care of patients in isolation and demonstrated that collecting patient reported outcomes using validated tools was feasible. The results of this research will inform development of an intervention to manage adverse effects. Implications for the Profession and/or Patient Care: Patients in hospital isolation require additional consideration to ensure that their needs are met to avoid adverse outcomes. The patient experience and comfort can be negatively affected when fundamental care is lacking. Reporting Method (EQUATOR): EQUATOR guidelines for Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR‐RHS). Patient or Public Contribution: Thirteen patients in hospital isolation agreed to participate in this study, sharing their experiences through interviews and assessment. [ABSTRACT FROM AUTHOR]

Background: Back pain is a huge global problem. For some people, the pain is so severe that they feel the need to present to an emergency department (ED). Our aim was to explore patient and staff perspectives for the development of a digital care pathway (DCP) for people with back pain who have presented to ED, including acceptability, barriers and facilitators. Methods: We used a descriptive phenomenology approach using semi‐structured interviews with patient and staff participants at a tertiary hospital. Interviews were transcribed and data codes were developed using inductive thematic analysis. Themes were discussed between researchers until consensus was achieved. Results: A total of 16 interviews were carried out, half of which involved patient participants. We identified three major themes: (i) expectations and experiences of staff and patients with low back pain in ED; (ii) a digital care pathway can empower patients and support clinicians in providing care; and (iii) acceptability, barriers, facilitators and recommendations of engaging with a DCP to track the trajectory of back pain. Each theme was further categorised into subthemes. Conclusion: Introducing a DCP was perceived as acceptable and beneficial by patients and staff. Both groups were aware of the potential participant burden if surveys were too long. Introducing a DCP could be a valuable adjunct to current management care models, providing a standardised source of education with the potential for individualised tracking and monitoring. The design and development of a DCP will need to consider reported facilitators and address perceived barriers for engagement. Patient or Public Contribution: This project sought insights from patients and staff about a digital care pathway. This forms the first step of patient and consumer consultation before implementing a digital care pathway. All consumers were offered the opportunity to review their responses and our interpretation. [ABSTRACT FROM AUTHOR]

Introduction: Indigenous women experience high rates of family violence‐related head injuries. At present, lived experience accounts from Indigenous women are absent, which results in incomplete understandings and inadequate responses that have detrimental impacts on them and their families. The aim of this study was to gain insight into Indigenous women's personal and family perspectives regarding violence‐related traumatic brain injury (TBI), including impacts on life, as well as decision‐making processes about healthcare access and engagement. Methods: Purposeful sampling was used to complete semi‐structured interviews with 18 Indigenous women living in regional and remote Australia who had experienced TBI from family violence. The data from these interviews were augmented by data from interviews and focus groups with 28 community members, including family members or carers of Indigenous women living with TBI from family violence. Results: Three themes were conceptualised based on the data and research aims: interweaving of the past and the present—ways women experience brain injury; factors that inform decision‐making to access healthcare; and managing everyday changes that result from TBI from family violence. Indigenous women described living with a range of symptoms following repeated head injuries including problems with memory, cognition and concentration. A range of strategies to manage long‐term symptoms of TBI were used by Indigenous women and when they did seek healthcare, Indigenous women were required to navigate a range of barriers. Conclusions: The findings identify a range of gaps in healthcare and housing supports for Indigenous women with TBI from violence, highlighting the significant investment needed to develop responsive and appropriate pathways of care in regional and remote areas. A range of suggestions are discussed including development of a specialised workforce who can provide apppropriate follow‐up support, co‐designed concussion clinics and educational resources. TBI must also be a key aspect of policy and practice for services working with Indigenous women who have experienced violence to ensure appropriate responses are provided. Public or Patient Contribution: Indigenous women shared their views and experiences of TBI from family violence as well as decision‐making about accessing healthcare and managing TBI symptoms. As such, study participants provided public contributions to the research. [ABSTRACT FROM AUTHOR]

This study aimed to assess differences in emotion and elaboration quality between clinical and community child cohorts in both past reminiscing and future worry conversations. We analyzed 54 Australian parents (46 mothers, 8 fathers) and their 8- to 12-year-old children (M = 9.63, SD = 1.29; 28 boys, 26 girls) in reminiscing interactions. Dyads were recruited from local schools (community cohort, n = 26) or a children's psychology clinic waitlist (clinical cohort, n = 28). Clinical cohort children engaged in less emotion exploration in both past and future conversations, as did parents for future conversations. Elaboration quality did not differ. Parent-son dyads differed in the clinical cohort, exhibiting significantly lower emotion resolution than the community cohort, or parent-daughter dyads when discussing past events. These findings suggest that discussing anticipated negative events may be a relevant point of family-based intervention for anxious children. Additionally, this study highlights the importance of parent-son emotional discussion. [ABSTRACT FROM AUTHOR]

Despite residing in a country that has the highest rates of skin cancer in the world, little is known about the knowledge, attitudes and sun protection practices of first generation Australian-born individuals with olive and darker skin types. Six focus groups with first generation Australian-born individuals of Asian, Mediterranean, Middle Eastern and Indian background were conducted. Participants had good knowledge of the dangers of skin cancer. Most correctly perceived darker skin types as protective and believed they were at low risk of skin cancer. Most participants could recall high profile mass media sun protection campaigns. Several participants suggested that greater representation of ethnic minorities and/or individuals with darker skin types would increase the personal relevance of campaigns. Beliefs that sun protection is not necessary on the basis of skin type highlights the need for further studies to explore fundamental differences in attitudes and practices between those with olive and darker skin and the general Australian population. [ABSTRACT FROM AUTHOR]

In their care of children and young people, foster carers report experiencing social isolation and a lack of support. This study examines the social network experiences of Australian foster carers who are members of Mockingbird Family. While well established in the United States and United Kingdom, Mockingbird Family was introduced to Australia offering a new approach to address the unique challenges of foster caring for vulnerable children and young people. The model geographically networks 6–10 foster care households in a 'constellation' with a central 'hub home provider' tasked with providing information, support, and respite care. This study employed a cross-sectional explanatory sequential mixed methods approach to investigate social connections and supports in the first four Australian Mockingbird Family constellations. A social network tool was used to survey participants (n = 27) and two focus groups (n = 20) to gather their experiences. Analysis found the highest mean social network connections with people from within their own Mockingbird Family constellations. Three measures of centrality were used indegree, betweenness and closeness, to report the connections and role of members within each constellation. Comparing constellations at different stages of maturity, the hub home provider was consistently ranked with high betweenness centrality as the bridge. In the longer-running constellations, the hub home provider was ranked with high indegree centrality or the primary source of advice or expert support. This indicated micro-network evolution that may potentially result in reduced reliance on statutory and other formal system supports over time. Changes to micro-dynamics in social support within constellations were explained qualitatively through three themes: leadership and expertise, information diffusion and communication, and trust and familiarity. Mockingbird Family was found to provide social connections and support networks amongst foster carers, indicating the model's capacity to strengthen supports to carers thereby strengthening the immediate environment of children and young people in care. [ABSTRACT FROM AUTHOR]

Background: While patients from low socioeconomic (SES) backgrounds are at increased risk of developing chronic health conditions, typically managed within general practice, they report fewer positive consultation experiences with GPs than patients from higher SES groups. To our knowledge, existing research does not provide an in-depth understanding of the GP conducts that contribute to positive consultations. Aim: To identify the factors that patients from low SES backgrounds perceive as essential for creating good consultation experiences. Design & setting: This exploratory pilot study was performed in GP clinics in Melbourne, Australia. Method: We used an appreciative inquiry approach, focused on positive consultation experiences, previously shown to be helpful for researching sensitive topics. Nine patients from low SES backgrounds, who reported positive consultation experiences, undertook a semi-structured qualitative interview while watching the video recording of their GP consultation. Four different GPs were captured in the recordings. Inductive thematic coding was performed by two researchers. Results: The following four categories were developed: 1) the doctor’s demeanour and how the patient was made to feel during the consultation drove their engagement; 2) an established and collaborative therapeutic relationship was of high importance to patients; 3) a doctor’s therapeutic skillset was integral to patient confidence and comfort; and 4) patients appreciated verbal and non-verbal communication techniques. In each interview, the discussion about the video-recorded consultation often triggered reflections about previous consultations with the respective GP. Conclusion: For patients from low SES groups, positive consultation experiences were underpinned by perceived continuity of care with a specific GP who consistently showed good communication skills and key interpersonal characteristics. This research is a small step towards increasing our understanding of the experience of individuals from low SES backgrounds in primary care and the existing health inequities within this area. [ABSTRACT FROM AUTHOR]

There has been intense debate within the autistic and autism communities about the use of autism biobanks – repositories containing biological and phenotypic materials – and of genomic autism research more broadly. Here, we sought to understand the views and experiences of those contributing to one specific biobank, the Australian Autism Biobank. We adopted a multi-informant approach, conducting semi-structured interviews with 77 people, including 18 autistic probands, 46 parents and seven siblings, all of whom donated material to the Biobank, as well as six researchers employed on the project. Specifically, we asked: what motivated participants and researchers to contribute to the Australian Autism Biobank? And how did they feel about their involvement in that process? We analysed the data using reflexive thematic analysis, adopting an inductive approach within an essentialist framework. We identified three themes, which revealed a wide diversity of viewpoints, including positive conceptualisations of autism linked to neurodiversity and more negative conceptualisations linked to hopes for the development of genetic screening and reproductive choice. These findings have implications for the meaning, value and future directions of autism science. This research has been conducted using the Australian Autism Biobank resource. A lot of autism research has focused on finding genes that might cause autism. To conduct these genetic studies, researchers have created 'biobanks' – collections of biological samples (such as blood, saliva, urine, stool and hair) and other health information (such as cognitive assessments and medical histories). Our study focused on the Australian Autism Biobank, which collected biological and health information from almost 1000 Australian autistic children and their families. We wanted to know what people thought about giving their information to the Biobank and why they chose to do so. We spoke to 71 people who gave to the Biobank, including 18 autistic adolescents and young adults, 46 of their parents and seven of their siblings. We also spoke to six researchers who worked on the Biobank project. We found that people were interested in giving their information to the Biobank so they could understand why some people were autistic. Some people felt knowing why could help them make choices about having children in the future. People also wanted to be involved in the Biobank because they believed it could be a resource that could help others in the future. They also trusted that scientists would keep their information safe and were keen to know how that information might be used in the future. Our findings show that people have lots of different views about autism biobanks. We suggest researchers should listen to these different views as they develop their work. [ABSTRACT FROM AUTHOR]

Background: Despite the well-known benefits of physical activity, physical inactivity is presently a global health pandemic. Allied healthcare providers, such as chiropractors, knowingly recognise the importance of physical activity and are prepared to routinely discuss and/or counsel patients on this topic; however, little is known about Australian chiropractors in the physical activity setting. Our aim was to explore and identify factors associated with physical activity promotion among Australian chiropractors, including their knowledge of the physical activity and sedentary behaviour guidelines and their own levels of physical activity. Methods: From February to May 2021, a convenience sample of Australian chiropractors completed an online survey. Items assessed by Likert scale included: physical activity promotion frequency, with the type, quantity, barriers, perceptions, and feasibility. We asked questions about their familiarity with, and knowledge of, Australian Physical Activity and Sedentary Behaviour Guidelines, chiropractors' own physical activity, and whether the chiropractors met activity guidelines. Survey responses were descriptively reported. Univariable logistic regression models explored factors explaining frequent physical activity promotion. Results: Of 217 respondents, 64% reported that they frequently (≥ 70%) recommended a more physically active lifestyle. Only 15% often performed pre-exercise screening, 73% frequently prescribed resistance exercise, 19% reported time as the most frequent barrier, while 37% reported being not at all familiar with the guidelines. Univariable logistic regression models found male chiropractors were more likely to promote physical activity, [odds ratio (OR) = 2.33; 95% confidence interval (CI): 1.32–4.12)], while chiropractors who frequently treat children 0–3 years (OR = 0.5; 95% CI: 0.28–0.87), children 4–18 years (OR = 0.42; 95% CI: 0.21–0.86), and pregnant women (OR = 0.5; 95% CI: 0.26–0.94) were less likely. Chiropractors were more likely to promote physical activity if they were familiar with the activity guidelines (OR = 2.9; 95% CI: 1.32–6.41), were confident promoting (OR = 11.6; 95% CI: 1.37–98.71) and prescribing physical activity programs (OR = 4.5; 95% CI: 2.03–9.99). Conclusion: Most chiropractors confidently and regularly integrate physical activity into practice. Yet, despite acknowledging its importance, one third of chiropractors reported poor knowledge of the Physical Activity and Sedentary Behaviour Guidelines. Identifying barriers to the awareness, and implementation of physical activity guidelines should be further explored within chiropractic clinical settings. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the perspectives of Australiabased hearing health care consumers regarding the (a) provision and utilization of teleaudiology services, (b) experiences with teleaudiology, and (c) barriers and enablers to future teleaudiology use. Method: A national prospective self-report online survey was completed between April and October 2020, amid COVID-19. Data were analyzed using descriptive statistics (closed-answer items) and content analysis (open-text responses). A total of 381 participants (Mage = 72.07 years ± 10.08, 142 females) were recruited from different states and territories of Australia. Results: Despite positive outcomes reported by those who undertook teleaudiology appointments during COVID-19, results indicate low-consumer teleaudiology uptake. It can be inferred that consumers were not aware of teleaudiology as an appointment option, clinicians/clinic staff had not informed and/or supported teleaudiology as an option, and biases existed that prevented teleaudiology being more widely adopted. It is unclear whether consumers who were eligible for government subsidies understood that teleaudiology appointments were reimbursed through government funding. Barriers to future teleaudiology uptake were largely related to concerns regarding confidentiality and privacy. Conclusion: Lowconsumer uptake of teleaudiology appointments appears to be driven by consumer preference for in-person services, which appears to be driven by lack of knowledge regarding the availability and effectiveness of teleaudiology. [ABSTRACT FROM AUTHOR]

Objectives: This study explored the familiarity, perceptions and confidence of Australian radiology clinicians involved in reading screening mammograms, regarding artificial intelligence (AI) applications in breast cancer detection. Methods: Sixty-five radiologists, breast physicians and radiology trainees participated in an online survey that consisted of 23 multiple choice questions asking about their experience and familiarity with AI products. Furthermore, the survey asked about their confidence in using AI outputs and their preference for AI modes applied in a breast screening context. Participants' responses to questions were compared using Pearson's χ 2 test. Bonferroni-adjusted significance tests were used for pairwise comparisons. Results: Fifty-five percent of respondents had experience with AI in their workplaces, with automatic density measurement powered by machine learning being the most familiar AI product (69.4%). The top AI outputs with the highest ranks of perceived confidence were 'Displaying suspicious areas on mammograms with the percentage of cancer possibility' (67.8%) and 'Automatic mammogram classification (normal, benign, cancer, uncertain)' (64.6%). Radiology and breast physicians preferred using AI as second-reader mode (75.4% saying 'somewhat happy' to 'extremely happy') over triage (47.7%), pre-screening and first-reader modes (both with 26.2%) (P < 0.001). Conclusion: The majority of screen readers expressed increased confidence in utilising AI for highlighting suspicious areas on mammograms and for automatically classifying mammograms. They considered AI as an optimal second-reader mode being the most ideal use in a screening program. The findings provide valuable insights into the familiarities and expectations of radiologists and breast clinicians for the AI products that can enhance the effectiveness of the breast cancer screening programs, benefitting both healthcare professionals and patients alike. What is known about the topic? Artificial intelligence (AI) holds promise in providing computer-aided detection in health care, however, current research suggests that standalone AI applications in clinical practice fall short of matching the accuracy of a single radiologist. What does this paper add? The study showed a significant preference among clinicians for using AI as a supplementary tool, serving as a second-reader. Such an integrated approach, where AI aids in flagging suspicious areas on mammograms or offers automatic classification, reflects the ideal cooperation between breast screening readers and AI systems. What are the implications for practitioners? These insights shed light on clinicians' familiarity with and expectations of AI tools that can boost the effectiveness of breast screening programs. [ABSTRACT FROM AUTHOR]

Our objective was to evaluate the association of antioxidant intake and the inflammatory potential of the diet with functional decline in older men. A diet history questionnaire was used to collect dietary intake data from men aged ≥ 75 years (n 794) participating in the Concord Health and Aging in Men Project cohort study. Intake of vitamins A, C, E and Zn were compared with the Australian Nutrient Reference Values to determine adequacy. The Energy-adjusted Dietary Inflammatory Index (E-DIITM) was used to assess the inflammatory potential of the diet. Physical performance data were collected via handgrip strength and walking speed tests, and activities of daily living (ADL) and instrumental activities of daily living (IADL) questionnaires, at baseline and 3-year follow-up (n 616). Logistic regression analysis was used to identify associations between diet and incident poor physical function and disability. Both poor antioxidant intake and high E-DII scores at baseline were significantly associated with poor grip strength and ADL disability at 3-year follow-up. No significant associations with walking speed or IADL disability were observed. Individual micronutrient analysis revealed a significant association between the lowest two quartiles of vitamin C intake and poor grip strength. The lowest quartiles of intake for vitamins A, C, E and Zn were significantly associated with incident ADL disability. The study observed that poor antioxidant and anti-inflammatory food intake were associated with odds of developing disability and declining muscle strength in older men. Further interventional research is necessary to clarify the causality of these associations. [ABSTRACT FROM AUTHOR]

Background: Australian government strategies and frameworks have been developed in recent years to encourage the integration and coordination of primary care delivery; including patient-centred approaches to clinical and preventative care, and health promotion. This study aims to explore patient experiences of information-sharing and patient-centred care across various primary care clinical settings, with a particular focus on clinical encounters with GPs, naturopaths, osteopaths and acupuncturists. Methods: Data about healthcare utilisation and experiences from a 63-item cross-sectional survey obtained from a nationally representative sample of Australian adults aged ≥ 18 years were analysed. Chi-square and Kruskal-Wallis H tests were used to explore differences in the experiences of knowledge and information sharing during GP consultations among those who also consulted with a naturopath, osteopath or acupuncturist, compared those who had not. Logistic regression was used to investigate correlations between participants perceptions about GP consultation outcomes, and the GP's information-sharing behaviour or perceived experience of patient-centredness. Results: Across 2354 participants, verbal explanation (76.3%) and/or individualised handouts (16.8%) were the most common type of information shared in GP consultations. Individuals who consulted with a GP and a naturopath, an osteopath, or an acupuncturist reported a lower rate of receiving a verbal explanation from their GP but higher rate of receiving other types of information sources including handouts. Over one quarter of study participants who visited a GP did not discuss any of their health information with their GP. Information sharing was lower for individuals who also visited a naturopath, osteopath or acupuncturist. Participants scored their consultations with a GP as patient-centred, but these scores were lower among participants who also consulted with at least one other primary care practitioner type included in the study. Conclusions: Public health and health services researchers, policymakers and leaders of primary care professions have a role and responsibility to ensure practitioners are confident and competent in sharing health information with their patients that considers their health literacy needs, and the importance of patient-centred care. Research focussed on a more in-depth understanding of the differences and relationships observed across the primary care landscape in this study is recommended. [ABSTRACT FROM AUTHOR]

Low fitness and obesity at midlife are individually associated with later‐life decline in cognition and health. However, the relationship between profiles of midlife fitness and obesity with midlife cognition is unclear and was examined by this study. Participants from the third follow‐up of the Childhood Determinants of Adult Health study (2014–2019; aged 36–49 years) were assessed for obesity (body mass index [BMI]), cardiorespiratory (physical work capacity) and muscular fitness (isometric grip and leg strength), and these factors were entered into a latent profile analysis. Psychomotor‐attention, learning–working memory and global cognition composites were derived from z‐scores of individual CogState battery tests. Linear regression analyses examined associations between profiles of fitness and obesity with cognition, adjusting for age, sex, education, alcohol and smoking. Using data from 617 participants [44.4 ± 2.6 (mean ± SD) years, 52% female], we identified 5 mutually exclusive profiles of obesity and fitness. Relative to those with the lowest fitness and highest BMI (5% of sample), those with a profile of (1) highest muscular fitness and average BMI (9%), (2) average muscular fitness and BMI (61%) and (3) highest cardiorespiratory fitness (CRF) and below average BMI (7%) all exhibited better global cognition [at least 0.44 (0.12, 0.77) SD, 95% CI] and psychomotor‐attention performance [at least 0.59 (0.27, 0.91) SD, 95% CI]. Compared with low fitness and unhealthy BMI levels, possessing average or high muscular and CRF and a healthy BMI in midlife was associated with better cognitive performance. Enhancing fitness and reducing obesity in midlife could contribute to improved cognitive performance in middle age. Highlights: Profiles containing adults with a combination of low levels of cardiorespiratory and muscular fitness and higher levels of obesity were associated with lower psychomotor‐attention and global cognition at midlife.Possessing average or higher levels of fitness, and lower obesity at midlife, was associated with better cognitive performance at midlife compared to those with lower fitness and unhealthy BMIs.Maintaining fitness and reducing obesity at midlife may contribute to greater cognitive performance at midlife and beyond and reduce the risk of cognitive decline. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To document accurately the amount of quitting, length of quit attempts and prevalence of plans and serious thought about quitting among smokers. Design We used longitudinal data from 7 waves of the International Tobacco Control Policy Evaluation Four Country Survey (ITC-4). We considered point-prevalence data and cumulative prevalence over the 7 years of the study. We also derived annual estimates of quit activity from reports of quit attempts starting only within more recent time-frames, to control for biased recall. Setting Australia, Canada, the United Kingdom and the United States. Participants A total of 21 613 smokers recruited across seven waves. Measurements Reported life-time quit attempts, annual quit attempts, length of attempts, time since last attempt started, frequency of aborted attempts, plans to quit and serious thought about quitting. Findings Around 40.1% (95% CI: 39.6-40.6) of smokers report attempts to quit in a given year and report an average of 2.1 attempts. Based on free recall, this translates to an average annual quit attempt rate of 0.82 attempts per smoker. Estimates derived only from the preceding month to adjust for recall bias indicate an annual rate of approximately one attempt per smoker. There is a high prevalence of quit-related activity, with more than a third of smokers reporting thoughts or actions related to quitting in a given month. More than half the surveyed smokers eventually succeeded in quitting for at least 1 month, and a majority of these for over 6 months. Conclusions Smokers think a great deal about stopping and make many unsuccessful quit attempts. Many have been able to last for extended periods and yet they still relapsed. More attention needs to be focused on translating quit-related activity into long-term abstinence. [ABSTRACT FROM AUTHOR]

Aim: Regular consumption of fruit and vegetables has been associated with a decreased risk of a number of chronic diseases. An appropriate level of knowledge is important to successfully adhere to the dietary guidelines for eating fruit and vegetables. However, there is little research about the level of knowledge that young adults have about fruit and vegetable consumption. The current study aimed to investigate the recall and understanding of Australian dietary guidelines, food product and serving size knowledge in a population of young adults. Methods: One hundred and six undergraduate students completed online questionnaires regarding (1) knowledge of dietary recommendations; (2) knowledge of serving size information; and (3) foods that could be included as part of fruit and vegetable intake. Results: The results showed that the sample had significant knowledge gaps in all three areas. Approximately half (54%) of participants correctly reported the recommended daily intake of fruit and vegetables, the majority were not able to correctly report serving sizes (correct responses were 30-61%) and were not able to identify all ingredients from a recipe that counted towards fruit and vegetable intake. Conclusions: Past interventions have not tended to focus on the fruit and vegetable knowledge, or behaviours, of Australian young adults. On the basis of findings from this study, it appears that more work is needed to develop messages to effectively target this important group. [ABSTRACT FROM AUTHOR]

Crisis helplines are designed to provide short-term support to people in an immediate crisis. However, there is a group of users who call crisis helplines frequently over an extended period of time. The reasons for their ongoing use remain unclear. The aim of this study was to investigate the differences in the reasons for calling between frequent and other users of crisis helplines. This was achieved by examining the findings from a brief survey completed by callers to Lifeline Australia at the end of their call between February and July 2015. In the survey, callers reported on their socio-demographics, reasons for their current call and number of calls made in the past month. Survey respondents were categorised as frequent, episodic and one-off users, and analyses were conducted using ordered logistic regression. Three hundred and fifteen callers completed the survey, which represented 57% of eligible callers. Twenty-two per cent reported calling 20 times or more in the past month (frequent users), 51% reported calling between 2 and 19 times (episodic users) and 25% reported calling once (one-off users). Two per cent were unable to recall the number of calls they made in the past month. Frequent users reported similar reasons for calling as other users but they were more likely to call regularly to talk about their feelings [OR = 6.0; 95% CI: 3.7-9.8]. This pattern of service use is at odds with the current model of care offered by crisis helplines which is designed to provide one-off support. There is a need to investigate further the factors that drive frequent users to call crisis helplines regularly. [ABSTRACT FROM AUTHOR]

Home economics and health teachers are to be found in many parts of the world. They teach students about food in relation to its nutritional, safety and environmental properties. The effects of such teaching might be expected to be reflected in the food knowledge of adults who have undertaken school education in these areas. This study examined the food knowledge associations of school home economics and health education among Australian adults. Two separate online surveys were conducted nationwide among 2022 (November 2011) and 2146 Australian adults (November-December 2012). True/false and multiple choice questions in both surveys were used to assess nutrition, food safety and environmental knowledge. Knowledge scores were constructed and compared against respondents' experience of school health or home economics education via multiple regression analyses. The results from both studies showed that home economics (and similar) education was associated with higher levels of food knowledge among several age groups. The associations of home economics education with food knowledge differed across several Australian states and recall of home economics themes differed across the age groups. These findings suggest that home economics education may bring about long-lasting learning of food knowledge. Further research is required, however, to confirm the findings and to test the causal influence of home economics education on adults' food knowledge. [ABSTRACT FROM AUTHOR]