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Purpose: To explore complex system behavior and subsequent team performance in professional rugby union. Methods: Here, we present 2 studies. In the first, we used global positioning system technology to measure player clustering during stoppages in play in nearly 100 games of professional rugby union to explore team (complex system) behavior and performance. In the second, we measured stress hormones (cortisol and testosterone) prior to team meetings and analyzed these relative to amount of time and the frequency with which players looked at peer presenters, as well as subsequent training performance, to explain how stress may lead to behaviors observed in the first study and subsequent match performance. Results: No link between player clustering during stoppages of play and performance was observed. When players (complex system agents) demonstrated greater levels of stress (as indicated by greater cortisol-awakening response and a greater decline in testosterone-to-cortisol ratio across the morning), they tended to look at peer presenters more; however, training quality declined (P =.02). Correlational analysis also showed that training quality was related to testosterone-to-cortisol ratio (P =.04). Conclusions: Team behavior is complex and can be unpredictable. It is possible that under stress, complex system agents (ie, rugby union players) look at (and cluster toward) their teammates more; however, meaningful interaction may not necessarily occur. Furthermore, while complex system (team) analysis may be valuable strategically in rugby union in the context of describing behavior, without understanding "how" or "why" intrateam/interagent behaviors emerge it may have little meaning. [ABSTRACT FROM AUTHOR]

Psychology is a high burnout profession; however, little empirical research has examined the emotional labour (i.e., surface acting, deep acting, expression of naturally felt emotions) of psychologists who provide psychological therapy. The present study examined whether a relationship exists between emotional labour and wellbeing (operationalised as burnout and affective symptoms) in this sample, and whether individual or work-related factors moderate this relationship. 113 Australian psychologists who provide regular psychological therapy responded to an anonymous, online, cross-sectional survey. This survey collected information on demographic and workplace variables; it also contained measures of emotional labour and wellbeing. The results indicated that, at a bivariate level, surface acting was a significant predictor of adverse wellbeing; deep acting had no predictive qualities; and the expression of naturally felt emotions was a significant predictor of improved wellbeing. Surface acting appeared to be the most salient predictor, and its relationship to burnout was moderated by compensation type. Reported rates of burnout were high within our sample, and our findings suggest that the masking of emotions by psychologists (i.e., surface acting) may be a contributing factor to adverse wellbeing. These findings carry implications for psychological training and practice. What is already known about this topic: Psychologists work in emotion-eliciting environments, which can necessitate the regulation of their emotions. Across industries, burnout arises when demands exceed resources; for psychologists, this may include instances in which the emotional demands of their work exceed their capacity to regulate effectively. Emotional labour, or the regulation of emotions in the workplace, is a reliable predictor of adverse wellbeing in the general working population; however, there has been little empirical examination of emotional labour in psychologists. What this topic adds: Psychologists who provide therapy report high rates of burnout. Psychologists adopt each emotional labour strategy (surface acting, deep acting, expression of naturally felt emotions) at comparable rates to previously published rates for workers in other work domains. Surface acting is a salient predictor of burnout in psychologists, even when controlling for the engagement in deep acting or the expression of naturally felt emotions. [ABSTRACT FROM AUTHOR]

Aim: To develop and test the psychometric properties of an expanded catheter self‐management scale for patients with in‐dwelling urinary catheters. Design: A cross‐sectional validation study. Despite the utility of the original 13‐item catheter self‐management scale, this instrument did not include bowel management, general hygiene and drainage bag care, which are fundamental skills in urinary catheter self‐management to prevent common problems resulting in unnecessary hospital presentations. The expanded catheter self‐management scale was developed with 10 additional items to comprehensively assess all five essential aspects of urinary catheter self‐management. Methods: A total of 101 adult community‐dwelling patients living with indwelling urinary catheters were recruited from Western Sydney, Australia. Using exploratory factor analysis with Varimax rotation, the number of factors to be extracted from the expanded 23‐item expanded catheter self‐management scale was determined using a scree plot. The reliability of the overall scale and subscales was measured using Cronbach's alpha. Convergent validity was assessed using Spearman's correlations between clinical characteristics, overall scale and subscales. Results: The 23‐item expanded catheter self‐management scale yielded a 5‐factor solution, labelled as: (i) self‐monitoring of catheter function, (ii) proactive, help‐seeking behaviour function, (iii) bowel self‐care function, (iv) hygiene‐related catheter site function and (v) drainage bag care function. Cronbach's alpha of the expanded catheter self‐management scale indicating all 23 items contributed to the overall alpha value. Convergent validity results showed a negative correlation between the overall expanded catheter self‐management scale and catheter‐related problems. Conclusion: The 5‐factor structure provided a comprehensive assessment of key aspects of urinary catheter self‐management essential to reduce the likelihood of catheter‐related hospital presentations. Implications: The expanded catheter self‐management scale can be used to assess and monitor effective patient‐centred interventions for optimal self‐management to prevent catheter‐related problems and improve the quality of life of patients. Impact: Many patients start their journey of living with a urinary catheter unexpectedly and are not supported with quality information to care for their catheter.The findings of this study show the correlation between catheter self‐management skills and catheter‐related problems.The expanded catheter self‐management scale (E‐CSM) assists with analysing the self‐management skills of patients living with a catheter and developing tailored interventions to prevent problems and improve their quality of life. In addition, this screening tool can be included in policies, guidelines, and care plans as a standard for improving catheter management and developing educational resources for patients. Reporting Method: STROBE checklist was used to report all aspects of this study comprehensively and accurately. Patient or Public Contribution: Patients living with indwelling urinary catheter and their carers have participated in surveys, interviews and co‐designing interventions. This paper reports the psychometric analysis of the expanded catheter self‐management scale (E‐CSM) used in the patient survey as part of the main study 'Improving Quality of Life of Patients Living with Indwelling Urinary Catheters: IQ‐IDC Study' (Alex et al. in Collegian, 29:405–413, 2021). We greatly value our consumers' contributions and continue to communicate the progress of the study to them. Their contributions will be acknowledged in all publications and presentations. In addition, all participants will be provided the option of receiving the interventions and publications generated from this study. [ABSTRACT FROM AUTHOR]

With rates of coercive control (CC) increasing, there is a need to ensure that intervention programs are underpinned by evidence-based research. Current interventions are scarce, with their efficacy rarely established. Most current interventions appear to rely on victims seeking support from formal sources/agencies, despite suggestions that victims are more likely to confide in people they know, such as their friends. Researchers suggest that a victim's friends may provide an effective source of support and intervention. The aim of this study was to fill the gap in the literature exploring whether the closeness of the relationship to the victim, bystander gender, and bystander concerns influenced attitudes toward intervening in CC situations. The study used an experimental design, whereby participants were randomly allocated to read a vignette depicting a CC scenario involving a friend, colleague, or stranger, and quantitative methods were used to examine bystanders' willingness and concerns about intervening. The sample was 340 Australian participants (229 female, 111 male), recruited from social media, namely community Facebook groups. The results indicated that friends were significantly more willing to intervene than colleagues or strangers, while strangers reported the highest concerns about intervening. Females reported significantly higher willingness to intervene than men despite also reporting higher concerns. Exploratory analysis of concerns about intervening revealed that the participants were most concerned about risk of harm and their beliefs in their ability to successfully intervene. These findings have implications for bystander intervention programs and campaigns, including offering a range of potential directions to enhance intervention program content. [ABSTRACT FROM AUTHOR]

Aim: To determine the reliability of hospital discharge codes for heart failure (HF), acute myocardial infarction (AMI) and stroke compared with adjudicated diagnosis, and to pilot a scalable approach to adjudicate records on a population‐based sample. Methods: A population‐based sample of 685 people with diabetes admitted (1274 admissions) to one of three Australian hospitals during 2018–2020 were randomly selected for this study. All medical records were reviewed and adjudicated. Results: Cardiovascular diseases were the most common primary reason for hospitalisation in people with diabetes, accounting for ~17% (215/1274) of all hospitalisations, with HF as the leading cause. ICD‐10 codes substantially underestimated HF prevalence and had the lowest agreement with the adjudicated diagnosis of HF (Kappa = 0.81), compared with AMI and stroke (Kappa ≥ 0.91). While ICD‐10 codes provided suboptimal sensitivity (72%) for HF, the performance was better for AMI (sensitivity 84%; specificity 100%) and stroke (sensitivity 85%; specificity 100%). A novel approach to screen possible HF cases only required adjudicating 8% (105/1274) of records, correctly identified 78/81 of HF admissions and yielded 96% sensitivity and 98% specificity. Conclusions: While ICD‐10 codes appear reliable for AMI or stroke, a more complex diagnosis such as HF benefits from a two‐stage process to screen for suspected HF cases that need adjudicating. The next step is to validate this novel approach on large multi‐centre studies in diabetes. [ABSTRACT FROM AUTHOR]

People with communication differences are known to have poorer hospital outcomes than their peers. However, the combined impact of aphasia and cultural/linguistic differences on care and outcomes after stroke remains unknown. To investigate the association between cultural/linguistic differences, defined as those requiring an interpreter, and the provision of acute evidence-based stroke care and in-hospital outcomes for people with aphasia. Cross-sectional, observational data collected in the Stroke Foundation National Audit of Acute Services (2017, 2019, 2021) were used. Multivariable regression models compared evidence-based care and in-hospital outcomes (e.g., length of stay) by interpreter status. Models were adjusted for sex, hospital location, stroke type and severity, with clustering by hospital. Among 3122 people with aphasia (median age 78, 49% female) from 126 hospitals, 193 (6%) required an interpreter (median age 78, 55% female). Compared to people with aphasia not requiring an interpreter, those requiring an interpreter had similar care access but less often had their mood assessed (OR 0.50, 95% CI 0.32, 0.76), were more likely to have physiotherapy assessments (96% vs 90% p = 0.011) and carer training (OR 4.83, 95% CI 1.70, 13.70), had a 2 day longer median length of stay (8 days vs 6 days, p = 0.003), and were less likely to be independent on discharge (OR 0.54, 95% CI 0.33, 0.89). Some differences exist in the management and outcomes for people with post-stroke aphasia who require an interpreter. Further research to explore their needs and the practical issues underpinning their clinical care pathways is required. [ABSTRACT FROM AUTHOR]

Purpose: Young adults eat erratically and later in the day which may impact weight and cardiometabolic health. This cross-sectional study examined relationships between chrononutritional patterns and diet quality in two young adult populations: a university and community sample. Methods: Three days of dietary data were collected including food images captured using wearable cameras. Chrononutritional variables were extracted: time of first and last eating occasions, caloric midpoint (time at which 50% of daily energy was consumed), number of eating occasions per day, eating window, day-to-day variability of the above metrics, and evening eating (≥20:00h). The Healthy Eating Index for Australian Adults scored diet quality. Statistical analyses controlled for gender, body mass index, and socio-economic status. Results: No significant associations between chrononutritional patterns and diet quality were found for all participants (n = 95). However, differences in diet quality were found between university (n = 54) and community (n = 41) samples with average diet quality scores of 59.1 (SD 9.7) and 47.3 (SD 14.4), respectively. Of those who extended eating ≥20:00 h, university participants had better diet quality (62.9±SE 2.5 vs. 44.3±SE 2.3, p < 0.001) and discretionary scores (7.9±SE 0.9 vs. 1.6±SE 0.6, p < 0.001) than community participants. University participants consumed predominately healthful dinners and fruit ≥20:00h whereas community participants consumed predominately discretionary foods. Conclusion: For the general young adult population, meal timing needs to be considered. Food choices made by this cohort may be poorer during evenings when the desire for energy-dense nutrient-poor foods is stronger. However, meal timing may be less relevant for young adults who already engage in healthy dietary patterns. [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]

Simple Summary: Microsatellite instability (MSI) is a hallmark of colorectal cancer (CRC) that is present in 10–15% of all patients with this condition. MSI results from the inactivation of the mismatch repair (MMR) pathway in tumors due to germline MMR mutations, known as Lynch syndrome or sporadic epigenetic gene silencing, leading to an increased mutation rate and genomic instability. In this study, we assessed the utility of the polymerase chain reaction (PCR)-based molecular method as an alternative to immunohistochemistry for determining MSI status in formalin-fixed paraffin-embedded tissues and investigated the clinicopathological significance and prognostic value of MSI in CRC. We found that patients with MSI-high (i.e., high MSI) had better overall and disease-free survival than those with microsatellite stability, and this result was significant in patients with right-sided CRC. Our results demonstrate that PCR-based MSI detection may serve as a useful prognostic predictor in patients with CRC and may have clinical value in the management of these patients. Given the crucial predictive implications of microsatellite instability (MSI) in colorectal cancer (CRC), MSI screening is commonly performed in those with and at risk for CRC. Here, we compared results from immunohistochemistry (IHC) and the droplet digital PCR (ddPCR) MSI assay on formalin-fixed paraffin-embedded tumor samples from 48 patients who underwent surgery for colon and rectal cancer by calculating Cohen's kappa measurement (k), revealing high agreement between the methods (k = 0.915). We performed Kaplan–Meier survival analyses and univariate and multivariate Cox regression to assess the prognostic significance of ddPCR-based MSI and to identify clinicopathological features associated with CRC outcome. Patients with MSI-high had better overall survival (OS; p = 0.038) and disease-free survival (DFS; p = 0.049) than those with microsatellite stability (MSS). When stratified by primary tumor location, right-sided CRC patients with MSI-high showed improved DFS, relative to those with MSS (p < 0.001), but left-sided CRC patients did not. In multivariate analyses, MSI-high was associated with improved OS (hazard ratio (HR) = 0.221, 95% confidence interval (CI): 0.026–0.870, p = 0.042), whereas the loss of DNA mismatch repair protein MutL homolog 1 (MLH1) expression was associated with worse OS (HR = 0.133, 95% CI: 0.001–1.152, p = 0.049). Our results suggest ddPCR is a promising tool for MSI detection. Given the opposing effects of MSI-high and MLH1 loss on OS, both ddPCR and IHC may be complementary for the prognostic assessment of CRC. [ABSTRACT FROM AUTHOR]

Australian Early Development Census (AEDC) data for the Australian Capital Territory (ACT) indicates a concerning increase in the proportion of children who are at risk or developmentally vulnerable in the domains of communication and general knowledge, and language and cognitive skills. This study investigated the effectiveness of speech-language pathologist and educator collaboration to build educator capacity to promote oral language and emergent literacy skills in preschool children. A quasi-experimental, pre-test post-test design was used to evaluate the effectiveness of interprofessional delivery of Read It Again – KindergartenQ! on (a) children's oral language and emergent literacy outcomes, (b) educators' oral language and emergent literacy instructional practices, and (c) quality of the classroom environment. Children demonstrated improved print knowledge and narrative skills. One of the two educators demonstrated a significant increase in their use of oral language and emergent literacy promoting strategies in their day-to-day interactions with children. No significant changes were observed in the classroom environment. Interprofessional collaboration with a coaching component is an effective method of improving children's emergent literacy skills and educator instructional practices. [ABSTRACT FROM AUTHOR]

Practitioners who work with children and young people such as educators, psychologists, and social workers, are required to understand and respond to various sexual behaviours in children and young people. However, there is a dearth of training programmes dealing with sexual development. To reduce over- and under-reporting of risk, which can have serious adverse outcomes, it is essential to educate practitioners in understanding and responding appropriately to sexual behaviours. This study evaluated Traffic Lights® professional development training programme – a one-day programme offered across Queensland, Australia, with the goal of educating practitioners and promoting safe and respectful sexual health among children and young people. Thirty postgraduate psychology students working with/interested in working with children and young people received Traffic Lights® training, and accuracy of understanding and responding to sexual behaviours presented in scenarios was assessed pre- and post-training. Participant responses were scored using criteria developed by a local sexual health organisation's research specialists. Findings revealed no significant improvement in understanding and responding to sexual behaviours in children and young people. Implications of this study include recommendations for small-scale evaluations with sexual health experts and follow-up research, which is critical given the need for evidence-based practice in this area. [ABSTRACT FROM AUTHOR]

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

Background: The percentage of total body surface area (%TBSA) burned and burn depth provide valuable information on burn injury severity. Objective: This study investigated the concordance between The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes and expert burn clinicians in assessing burn injury severity. Method: We conducted a retrospective population-based review of all patients who sustained a burn injury between July 1, 2009, and June 30, 2019, requiring admission into a specialist burn service across Australia and New Zealand. The %TBSA burned (including the percentage of full thickness burns) recorded by expert burn clinicians within the Burns Registry of Australia and New Zealand (BRANZ) were compared to ICD-10-AM coding. Results: 20,642 cases (71.5%) with ICD-10-AM code data were recorded. Overall, kappa scores (95% confidence interval [CI]) for burn size ranged from 0.64 (95% CI 0.63–0.66) to 0.86 (95% CI 0.78–0.94) indicating substantial to almost perfect agreement across all %TBSA groups. When stratified by depth, the lowest agreement was observed for < 10% TBSA and < 10% full thickness (kappa 0.03; 95% CI 0.02–0.04) and the highest agreement was observed for burns of ≥ 90% TBSA and ≥ 90% full thickness (kappa 0.72; 95% CI 0.58–0.85). Conclusion: Overall, there was substantial agreement between the BRANZ and ICD-10-AM coded data for %TBSA classification. When %TBSA classification was stratified by burn depth, greater agreement was observed for larger and deeper burns compared with smaller and superficial burns. Implications: Greater consistency in the classification of burns is needed. [ABSTRACT FROM AUTHOR]

Aims The COVID-19 pandemic presents the opportunity to learn about solitary drinking as many people were forced to spend time at home. The aim of this study is to examine the relationship between solitary drinking and living without other adults on alcohol consumption. Methods A longitudinal study with four survey waves (between May and November 2020) obtained seven-day drinking diary data from Australian adults living in New South Wales. In May, a convenience sample of 586 participants (M age = 35.3, SD = 14.8; 65.3% women) completed the first wave. Participants then completed a survey in June (n  = 319, 54.4% response rate), July/August (n  = 225, 38.4% response rate), and November (n  = 222, 37.9% response rate). Information about alcohol consumption including risky drinking (more than four drinks on one occasion), household structure, solitary drinking, and demographics were collected. We conducted random-effects panel bivariate and multivariable regression analyses predicting the number of standard drinks and risky drinking. Results Participants with solitary drinking occasions consumed more and had more risky drinking occasions than participants with no solitary drinking occasions, which was also found to be the case during lockdown. Living without other adults was associated with less consumption and less risky drinking than living with other adults. However, participants who lived without other adults and had frequent solitary drinking occasions (solitary drinking in >50% drinking occasions) reported more consumption than participants without a solitary drinking occasion. Conclusions Individuals who consume alcohol alone and live without other adults or spend long periods of time at home may be more at risk of alcohol-related harm. [ABSTRACT FROM AUTHOR]

Aims: To investigate anxiety and depression after primary treatment for ovarian cancer in relation to diet quality and intake. Methods: In a cohort of women with ovarian cancer in Australia, levels of anxiety and depression (normal, subclinical, and clinical) were assessed using the Hospital Anxiety and Depression Scale at 9 months post‐diagnosis. Dietary intake was assessed using a validated food frequency questionnaire at 12 months post‐diagnosis and scored using the Healthy Eating Index 2015. Multinomial logistic regression and bivariate analyses were used to investigate relationships between levels of anxiety and depression and subsequent diet quality and intake of food groups. Results: Of 595 women, anxiety and depression were identified among 128 (21%) and 80 (13%) women, respectively. Compared to women without anxiety or depression, women with subclinical anxiety (odds ratio = 0.49, 95% confidence interval: 0.25–0.98) and those with clinical depression (odds ratio = 0.25, 95% confidence interval: 0.07–0.93) were less likely to score in the highest quartile for diet quality. Separate adjustment for age, education, employment, disease stage, body mass index, and smoking status did not attenuate these associations. In bivariate analyses, women with subclinical anxiety were more likely to report higher intakes of sweet foods. Those with clinical depression were more likely to report lower intakes of orange vegetables and wholegrains, higher intakes of sweetened beverages, and not consume alcohol or soya foods. Conclusions: Anxiety or depression after primary treatment for ovarian cancer may be associated with poorer diet quality. Efforts to improve diet quality post‐treatment should consider support for mental health. [ABSTRACT FROM AUTHOR]

There are few short, validated tools to assess young children's obesity‐related dietary behaviours, limiting the rapid screening of dietary behaviours in research and practice‐based early obesity prevention. This study aimed to develop and assess the reliability and validity of a caregiver‐reported short dietary questionnaire to rapidly assess obesity‐related dietary behaviours in children aged 6 months to 5 years. The Early Prevention of Obesity in Childhood Dietary Questionnaire (EPOCH‐DQ) was developed using a rigorous process to determine content and structural validity. Three age‐appropriate versions were developed for (1) infants, aged 6–12 months, (2) toddlers, aged 1–2.9 years and (3) pre‐schoolers, aged 3–5 years. The questionnaire (7–15 items) measures dietary behaviours, including diet risk from non‐core food and beverage intake, diet quality from vegetable frequency, bread type and infant feeding practices. Test–retest reliability was assessed from repeated administrations 1 week apart (n = 126). Internal consistency, concurrent validity (against a comparison questionnaire, the InFANT Food Frequency Questionnaire), construct validity and interpretability were assessed (n = 209). Most scores were highly correlated and significantly associated (p < 0.05) for validity (rs: 0.45–0.89, percentage agreement 68%–100%) and reliability (intraclass correlation coefficient: 0.61–0.99) for diet risk, diet quality and feeding practice items. The EPOCH‐DQ shows acceptable validity and reliability for screening of obesity‐related behaviours of children under 5 years of age. The short length and, thus, low participant burden of the EPOCH‐DQ allows for potential applications in various settings. Future testing of the EPOCH‐DQ should evaluate culturally and socio‐economically diverse populations and establish the predictive validity and sensitivity to detect change. Key messages: Accurate measurement of obesity‐related dietary behaviours is essential for the evaluation of early obesity prevention programmes and monitoring population trends.The 7–15 item Early Prevention of Obesity in Childhood Dietary Questionnaire (EPOCH‐DQ) was shown to have acceptable validity and reliability for assessing obesity‐related behaviours of children aged 6 months to 5 years of age.The short length and thus low participant burden of the EPOCH‐DQ allows for potential applications in various settings, including research, population health monitoring and use by health professionals.Future testing of the EPOCH‐DQ should include evaluation across culturally and socio‐economically diverse populations and determine the predictive validity and sensitivity to detect change of the EPOCH‐DQ. [ABSTRACT FROM AUTHOR]

Background Emergency department (ED) clinicians are more frequently providing care, including end-of-life care, to older people. Objectives To estimate the need for ED end-of-life care for people aged ≥65 years, describe characteristics of those dying within 48 hours of ED presentation and compare those dying in ED with those dying elsewhere. Methods We conducted a retrospective cohort study analysing data from 177 hospitals in Australia and New Zealand. Data on older people presenting to ED from January to December 2018, and those who died within 48 hours of ED presentation, were analysed using simple descriptive statistics and univariate logistic regression. Results From participating hospitals in Australia or New Zealand, 10,921 deaths in older people occurred. The 48-hour mortality rate was 6.43 per 1,000 ED presentations (95% confidence interval: 6.31–6.56). Just over a quarter (n = 3,067, 28.1%) died in ED. About one-quarter of the cohort (n = 2,887, 26.4%) was triaged into less urgent triage categories. Factors with an increased risk of dying in ED included age 65–74 years, ambulance arrival, most urgent triage categories, principal diagnosis of circulatory system disorder, and not identifying as an Aboriginal or Torres Strait Islander person. Of the 7,677 older people admitted, half (n = 3,836, 50.0%) had an encounter for palliative care prior to, or during, this presentation. Conclusions Our findings provide insight into the challenges of recognising the dying older patient and differentiating those appropriate for end-of-life care. We support recommendations for national advanced care planning registers and suggest a review of triage systems with an older person-focused lens. [ABSTRACT FROM AUTHOR]

To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464) The willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement. As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists. As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary. [ABSTRACT FROM AUTHOR]

Despite significant evidence worldwide that parents support school-based delivery of relationships and sexuality education (RSE), Australian data has generally lacked larger, nationally representative samples. Furthermore, misguided perceptions of parental attitudes are known to impact delivery. In response, online survey data were collected from 2,427 parents (56.5% female) nationwide, to examine their attitudes towards school-based RSE. Most had a child enrolled in a government school (65.3% primary, 55.7% secondary); and reported diverse religious affiliations (38.7% no religion, 21.3% Catholic, 11.1% Anglican) and voting preferences (26.7% Australian Labour Party, 25.1% Liberal/National, 23.6% undecided). Overall, 89.9% of parents supported schools to deliver RSE, with some modest differences being associated with particular demographic variables. Beyond widespread support for RSE, parents emphatically endorsed schools to address a diverse range of RSE-related issues (n = 40 topics). Parents' responses also provided insight regarding when certain topics should first be introduced and the quality of current RSE provision in schools. Findings from this descriptive overview challenge the currently overstated assumption that parents do not support RSE in schools. Such persistent and obstructive discourse is counterproductive to evidence-based strategies that seek to strengthen young people's personal and social development in a comprehensive and contemporary manner. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate if a new Mental health IN DiabeteS Optimal Health Program (MINDS OHP) compared with usual care in adults with Type 1 and Type 2 diabetes would improve psychosocial outcomes including self-efficacy and quality of life. Design and Main Outcome Measures This initial randomised controlled trial evaluated MINDS OHP compared with usual care. Participants were recruited through outpatient clinics and community organisations. The intervention group received nine sessions with assessments over twelve months. Primary outcomes were self-efficacy and quality of life. Secondary outcomes included diabetes distress and anxiety. There were 51 participants in the control group (mean age = 52) and 55 in the intervention group (mean age = 55). There were significant main effects of time in general self-efficacy, diabetes distress, diabetes self-efficacy, and illness perceptions, however no significant between-group differences in primary or secondary outcomes. Post-hoc analyses revealed MINDS OHP improved diabetes self-efficacy for participants with mild to severe depression and anxiety, with a small effect. Initial evaluation found MINDS OHP was associated with improved diabetes self-efficacy for adults with diabetes, for people with mild to severe levels of distress, with small effect. Further research is required to explore whether this disease-specific, collaborative care-focused intervention benefits the mental health of people with diabetes. [ABSTRACT FROM AUTHOR]

Background: People with an acquired brain injury (ABI) find it challenging to use social media due to changes in their cognition and communication skills. Using social media can provide opportunities for positive connection, but there is a lack of interventions specifically designed to support safe and successful social media use after ABI. Aims: To investigate the outcomes of completing a social media skills intervention and identify barriers and facilitators for future implementation. Methods & Procedures: The study used a mixed‐methods, pre‐post‐intervention design. A total of 17 adults with an ABI were recruited. Participants completed an intervention that included a short self‐guided course about social media skills (social‐ABI‐lity course), and then participated in a private, moderated Facebook group over a 12‐week period (social‐ABI‐lity Facebook group). Data were collected over this period through observation of group activity and weekly surveys. They were also collected on social media use and quality of life at pre‐intervention, post‐intervention and after 3 months. Participants provided feedback on the experience of participating in the programme via a post‐intervention interview. Outcomes & Results: At post‐intervention, there were significant improvements in confidence in using Facebook (p = 0.002) and enjoyment of using Facebook to connect with others (p = 0.013). There was no significant change in reported quality of life, although participants described the multiple benefits of connection they perceived from involvement in the group. Observational data and feedback interviews were informative about the feasibility and acceptability of the intervention. Conclusions & Implications: This pilot study provided preliminary evidence that an intervention comprising a short, self‐guided training course and a private, moderated Facebook group improved outcomes for people with ABI. Key recommendations for future implementation include embedding active peer moderators within groups and taking an individualized approach to delivery of the intervention. WHAT THIS PAPER ADDS: What is already known on the subject: Research has documented the challenges that people with ABI experience in using social media, and the difficulty for rehabilitation clinicians in providing appropriate support in this field. What this paper adds to existing knowledge: This pilot study reports the outcomes of people with ABI completing a short, self‐guided social media skills course and participating in a private, moderated Facebook group. After the intervention, participants reported significantly increased confidence and enjoyment in using Facebook, described the benefits of connection found in the groups, and suggested potential improvements for future implementation. What are the potential or actual clinical implications of this work?: With the growing use of social media for connection and participation, there is a professional obligation to address social media communication skills in cognitive–communication rehabilitation for people with ABI. The findings of this study will inform interventions and future research to assist people with ABI to build their social media skills for communication, social support and a sense of connection. [ABSTRACT FROM AUTHOR]

Background: Quality of life is an important quality indicator for health and aged care sectors. However, self-reporting of quality of life is not always possible given the relatively high prevalence of cognitive impairment amongst older people, hence proxy reporting is often utilised as the default option. Internationally, there is little evidence on the impact of proxy perspective on interrater agreement between self and proxy report. Objectives: To assess the impacts of (i) cognition level and (ii) proxy perspective on interrater agreement using a utility instrument, the Quality of Life-Aged Care Consumers (QOL-ACC). Methods: A cross-sectional study was undertaken with aged care residents and family member proxies. Residents completed the self-report QOL-ACC, while proxies completed two proxy versions: proxy-proxy perspective (their own opinion), and proxy-person perspective (how they believe the resident would respond). Interrater agreement was assessed using quadratic weighted kappas for dimension-level data and concordance correlation coefficients and Bland-Altman plots for utility scores. Results: Sixty-three residents (22, no cognitive impairment; 41, mild-to-moderate cognitive impairment) and proxies participated. In the full sample and in the mild-to-moderate impairment group, the mean self-reported QOL-ACC utility score was significantly higher than the means reported by proxies, regardless of perspective (p < 0.01). Agreement with self-reported QOL-ACC utility scores was higher when proxies adopted a proxy-person perspective. Conclusion: Regardless of cognition level and proxy perspective, proxies tend to rate quality of life lower than residents. Further research is needed to explore the impact of such divergences for quality assessment and economic evaluation in aged care. [ABSTRACT FROM AUTHOR]

Objective: To (a) compare characteristics of patients who fall with those of patients who did not fall; and (b) characterise falls (time, injury severity and location) through three fall reporting methods (incident system reports, medical notes and clinician reports). Methods: A substudy design within a stepped‐wedge clinical trial was used: 3239 trial participants were recruited from two inpatient Geriatric Evaluation and Management Units and one general medicine ward in two Australian states. To compare the characteristics of patients who had fallen with those who had not, descriptive tests were used. To characterise falls through three reporting methods, bivariate logistic regressions were used. Results: Patients who had fallen were more likely than patients who had not fallen to be cognitively impaired (51% vs. 29%, p < 0.01), admitted with falls (38% vs. 28%, p = 0.01) and have poor health outcomes such as prolonged length of stay (24 [16–34] vs. 12 [8–19] days [IQR], p < 0.01) and less likely to be discharged directly to the community (62% vs. 47%, p < 0.01). Most falls were captured from medical notes (93%), with clinician (71%) and incident reports (68%) missing 21%–25% of falls. The proportion of injurious falls identified through incident reports was higher than medical records or clinician reports (40% vs. 34% vs. 37%). Conclusions: This study reaffirms the need to improve reporting falls in incident systems and at clinical handover to the team leader. Research should continue to use more than one method of identifying falls, but include data from medical records. Many falls cause injury, resulting in poor health outcomes. [ABSTRACT FROM AUTHOR]

Understanding adolescents' physical activity levels and underpinning contextual factors is crucial for health promotion. This cross-sectional study, using 24-hour time use diaries and sociodemographic variables from the Longitudinal Study of Australian Children, addressed gaps in understanding of physical activity in the before-school segment (the time between waking up and commencing classes). The study examined a) adolescents' time spent in before-school physical activity, focusing on location and shared presence, and b) sociodemographic correlates of before-school physical activity. Completed diaries by 12–13 year-olds (n = 3,201) revealed that adolescents reported an average of 10.8 minutes of daily before-school physical activity (average segment length: 114 min), mostly classified as active transport (5.7 min). Most before-school physical activity occurred in a location other than home or school (6.1 min) and with peers (6.1 min). Notably, 51% of boys and 60% of girls did not report any before-school physical activity. Through two-part regression, we found that boys, adolescents from single-parent households, and those with longer before-school segments are more likely to report before-school physical activity compared to their counterparts. Before-school initiatives should promote active transport and diverse opportunities in other settings. Research into barriers and facilitators may inform more inclusive and effective promotion strategies, including school-based initiatives. [ABSTRACT FROM AUTHOR]

Aims: To evaluate associations of age, transition readiness and anxiety in adolescents with chronic conditions and to compare perceptions of adolescents and their parents regarding health self‐management and transition readiness. Design: Cross‐sectional international study, reported following STROBE guidelines. Methods: Adolescents and young adults (N = 512, mean age 17.7) with a chronic medical condition and their parents (N = 322) from Finland and Australia. Data were collected through surveys (between September 2017 and December 2020). Adolescents reported the duration of their condition. Age at survey was defined by the response date of the questionnaires. Validated questionnaires were used to measure transition readiness (Am I ON TRAC? for Adult Care) and anxiety related to transition of care (State–Trait Anxiety Inventory short form). Perceptions of health self‐management and transition readiness were compared in adolescent/parent dyads. Associations were explored using Spearman's correlation. Results: Duration of condition and age at survey correlated weakly with transition readiness knowledge and behaviour. Higher transition readiness knowledge scores correlated with higher behaviour scores. Higher transition readiness behaviour scores were associated with lower levels of anxiety. Adolescents were less anxious than their parents and adolescents and parents mostly agreed about health self‐management and transition readiness. Conclusion: Transition readiness should be determined by an assessment of knowledge, self‐management and psychosocial skills instead of age alone. Further research should address how well transition readiness predicts positive health outcomes after the transfer of care. Implications for Patient Care: Transition readiness and self‐management skills should be formally assessed because positive feedback may decrease the anxiety of both adolescents and their parents regarding the transfer of care. Reporting Method: We have adhered to the STROBE statement, using STROBE checklist for cross‐sectional studies. Patient or Public Involvement Statement: No patient or public involvement. Trial and Protocol Registration: ClinicalTrials.org NCT04631965. [ABSTRACT FROM AUTHOR]

Introduction: The shortfall in medical workers in rural and remote Australia has led to health discrepancies in these regions. The University of Wollongong's medical program was designed to encourage graduates to work in these regions to address this shortfall. Objective: To compare rural and regional locations of work and choices of speciality between University of Wollongong's graduates and graduates from all Australian universities. Design: We conducted a longitudinal analysis on data available from the Medical Schools Outcome database, with graduate exit surveys linked to registrations of location and speciality. Rural and remote locations were identified as MM2‐7 regions using the Modified Monash Model. In total, 716 graduates from the University of Wollongong and 26 915 graduates from all Australian medical schools completed the MSOD exit survey in 2010‐2021 and registered with the Australian Health Practitioner Regulation Agency in 2022. The main outcome was the relative likelihood (relative risk) of cohorts working in rural and regional areas and of cohorts choosing general practice as their speciality. Findings: University of Wollongong's medical graduates were 1.51 times or 51% more likely to work in regional or rural areas (RR 1.51, 95% CI 1.34 to 1.71, p < 0.0001). Respondents who were 10 or more years post graduation were 1.57 times or 57% more likely to specialise in general practice than all other Australian medical graduates (RR 1.57 95% CI: 1.40 to 1.79, p < 0.0001). Discussion: The University of Wollongong's medical school is producing graduates to meet Australia's rural health workforce needs. This may be due to a higher intake of rural students, and a higher percentage of students taking rural placements. Conclusions: Rural health workforce needs can be addressed through rural‐focussed education strategies. [ABSTRACT FROM AUTHOR]

Background: Poor quality sleep in hospitals may be problematic for patients, negatively impacting their recovery and wellbeing. This project aimed to investigate the effectiveness of codesign in addressing key issues affecting sleep disruption in the healthcare setting. Methods: Codesign with patients, staff and consumer representatives was conducted in an acute metropolitan tertiary public hospital in Sydney, Australia. Through a four‐stage process, a multimodal intervention to address and reduce the impact of sleep disruptions among hospital inpatients was created. Pre‐ and post‐intervention evaluation was used to determine changes in patient‐reported sleep disruption. Results: 'The HUSH Project' (Help Us Support Healing) intervention resulted from the codesign process, which included the provision of HUSH Sleep Packs (with earplugs, eye masks and herbal tea), patient information resources, and ward‐based Sleep Champions. Survey data from 210 patients revealed a statistically significant decrease in patient‐reported noise disturbances for patients in shared rooms following the 4‐week intervention period of the HUSH program. Conclusion: The HUSH Project demonstrated that a novel multimodal intervention may be valuable in reducing sleep disruption in hospitals. These findings also indicate the benefits of using codesign methodology to support improvement projects that seek to enhance patient experiences of care. Patient or Public Contribution: This project utilised codesign methodology, which involved significant contributions from patients and consumer representatives, from research conceptualisation into intervention design, implementation and project evaluation. [ABSTRACT FROM AUTHOR]

Vancomycin's widespread use as the mainstay antibiotic against methicillin‐resistant Staphylococcus aureus infections is complicated by its narrow therapeutic index. Therapeutic drug monitoring using area under the concentration–time curve (AUC)–guided dosing is recommended to optimize therapy and prevent vancomycin‐associated nephrotoxicity (VAN). In 2018, a consultative therapeutic drug monitoring Advisory Service (the Service) was piloted at an Australian hospital to enable AUC‐guided vancomycin dosing. This study sought to compare the incidence of VAN pre‐ and post‐Service implementation. A 4‐year retrospective observational study of intravenous vancomycin therapy (greater than 48 hours) in adults (aged 18 years or older), spanning 3 years before and 1‐year after implementation of the Service was undertaken. Nephrotoxicity was defined as an increase in serum creatinine concentrations of 26.5 μmol/L or greater or 50% or more from baseline, on 2 or more consecutive days. Univariate analysis was performed to compare patients before and after implementation, and with and without VAN. Independent factors associated with VAN were identified using a multivariate model. In total, 971 courses of vancomycin therapy, administered to 781 patients, were included: 764 courses (603 patients) before implementation and 207 courses (163 patients) after implementation. The incidence of VAN decreased by 5% after Service implementation (15% before implementation vs 10% after implementation; P =.075). Independent factors associated with VAN were sepsis, heart failure, solid‐organ transplant, concomitant piperacillin–tazobactam, and average vancomycin AUC during therapy. In conclusion, there was a nonsignificant trend toward a reduced incidence of VAN after the Service. Larger prospective studies are needed to confirm the efficacy of the Service. [ABSTRACT FROM AUTHOR]

Background: To maintain and improve the quality of the cancer nursing workforce, it is crucial to understand the factors that influence retention and job satisfaction. We aimed to investigate the characteristics of cancer nurses in Australia and identify predictors of job satisfaction. Methods: We analysed data from an anonymous cross-sectional survey distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The survey was compared to national nursing registration data. Data were analysed with non-parametric tests, and a stepwise, linear regression model was developed to best predict job satisfaction. Results: Responses were received from 930 cancer nurses. Most respondents (85%) described themselves as experienced nurses, and more than half had post-graduate qualifications. We identified individual, organizational, and systemic factors that contribute to job satisfaction and can impact in workforce shortages. The findings include strategies to address and prioritize workforce challenges. There were 89 different titles for advanced practice nursing roles. Managing high workload was a reported challenge by 88%. Intention to stay less than 10 years was reported by nearly 60%; this was significantly correlated with job satisfaction and age. Significantly higher scores for job satisfaction were associated with those who had career progression opportunities, career development opportunities, adequate peer support and a clearly defined scope of role. Conversely, job satisfaction scores decreased the more people agreed there was a lack of leadership and they had insufficient resources to provide quality care. Conclusion: Cancer nurses are critical to the delivery of cancer care however, the workforce faces multiple challenges. This study provides an understanding of the Australian cancer nursing workforce characteristics, their roles and activities, and highlights important considerations for retaining nurses in the profession. [ABSTRACT FROM AUTHOR]

Numerous studies have investigated the physical health and development of children and adolescents conceived with assisted reproductive technology (ART). Less is known about the quality of life of ART-conceived adults. This study explores the contributions of being conceived with ART and psychosocial cofactors present in young adulthood to the quality of life of adults aged 22–35 years. Young adults conceived through ART or natural conception (NC) completed questionnaires which included a standardized measure of quality of life (World Health Organization Quality of Life – Brief assessment (WHOQoL-BREF)) when aged 18–28 years (T1) and again when aged 22–35 years (T2). The WHOQoL-BREF has four domains: (i) Physical, (ii) Psychological, (iii) Social relationships and (iv) Environment. A total of 193 ART-conceived and 86 NC individuals completed both questionnaires. When accounting for other cofactors in multivariable analyses, being ART-conceived was strongly associated with higher scores (better quality of life) on the Social relationships, and Environment WHOQoL-BREF domains at T2. In addition, less psychological distress, a better relationship with parents, a better financial situation, and perceptions of being about the right weight at T1 were associated with higher scores on one or more of the WHOQoL-BREF domains at T2. In conclusion, being ART-conceived can confer advantages in quality of life in adulthood, independent of psychosocial cofactors. [ABSTRACT FROM AUTHOR]

The utilisation of telehealth among culturally and linguistically diverse communities in Australia remains unexplored. We aimed to describe telehealth (telephone and videoconference) utilisation within a major health service and identify sociodemographic factors that may contribute to limited telehealth access. Methods. A cross-sectional study was performed using service activity data from four metropolitan hospitals in Queensland, Australia. Outpatient department data (January to December 2021) were examined. These data included patients (N = 153 427) of all ages who had an outpatient appointment within 10 speciality services (i.e. Hepatology, Gastroenterology, Immunology and Psychology) that were the most frequent videoconference users. This study measured telehealth utilisation across the four tertiary hospitals and its association with sociodemographic factors. Descriptive statistics and regression analysis were used. Multivariate regression models were adjusted by sex, socioeconomic level and language use. Results. Overall, 39% of appointments were delivered through telehealth, with 65% of all reported telehealth services involving a telephone consultation. People who required interpreter services were 66% less likely to use telehealth services (OR adjusted 0.33, 95% CI 0.31–0.36, P < 0.05) than English-speaking people. Among those using telehealth, people requiring interpreter services were 13% less likely to use videoconference than phone (OR adjusted 0.87, 95% CI 0.77–0.98, P < 0.005). Conclusion. There is a gap in Australian telehealth service use for people with culturally diverse backgrounds and limited English proficiency. This study highlights a critical need to determine how people from culturally diverse backgrounds would like to engage with digital care options such as telehealth and the necessary support to enable this. [ABSTRACT FROM AUTHOR]

Objective: Clinical decision aids (CDAs) can help clinicians with patient risk assessment. However, there is little data on CDA calculation, interpretation and documentation in real‐world ED settings. The ABCD2 score (range 0–7) is a CDA used for patients with transient ischaemic attack (TIA) and assesses risk of stroke, with a score of 0–3 being low risk. The aim of this study was to describe ABCD2 score documentation in patients with an ED diagnosis of TIA. Methods: Retrospective observational study of patients with a working diagnosis of a TIA in two Australian EDs. Data were gathered using routinely collected data from health informatics sources and medical records reviewed by a trained data abstractor. ABCD2 scores were calculated and compared with what was documented by the treating clinician. Data were presented using descriptive analysis and scatter plots. Results: Among the 367 patients with an ED diagnosis of TIA, clinicians documented an ABCD2 score in 45% (95% CI 40–50%, n = 165). Overall, there was very good agreement between calculated and documented scores (Cohen's kappa 0.90). The mean documented and calculated ABCD2 score were similar (3.8, SD = 1.5, n = 165 vs 3.7, SD = 1.8, n = 367). Documented scores on the threshold of low and high risk were more likely to be discordant with calculated scores. Conclusions: The ABCD2 score was documented in less than half of eligible patients. When documented, clinicians were generally accurate with their calculation and application of the ABCD2. No independent predictors of ABCD2 documentation were identified. [ABSTRACT FROM AUTHOR]

Objectives: Childhood trauma is common and associated with mental ill health. While high rates of trauma are observed across individual disorders, there is evidence that trauma is associated with an admixture of affective, anxiety and psychotic symptoms in adults. Given that early onset of mental disorder and trauma exposure herald poor outcomes, it is important to examine trauma prevalence rates in youth mental health services and to determine whether this trauma-related clustering is present in help-seeking young people. Methods: We used data from the Transitions Study, a longitudinal investigation of young people attending headspace youth mental health services in Australia between January 2011 and August 2012. Participants were 775 young people aged 12–25. Childhood trauma was assessed using the Childhood Trauma Questionnaire. Multinomial regression was used to assess whether reported childhood trauma was more strongly associated with the co-occurrence of depression, anxiety, mania and psychosis symptoms than with any one in isolation. Results: Approximately 84% of participants reported some form of abuse (emotional: 68%; physical: 32%; sexual: 22%) or neglect (emotional: 65%; physical: 46%). Exposure to multiple trauma types was common. Childhood trauma was significantly associated with each symptom domain. More severe childhood trauma was more strongly associated with the co-occurrence of symptoms than with any one symptom domain in isolation, such that more severely trauma-exposed young people were more likely to experience increased symptom clustering. Conclusions: Childhood trauma is pervasive in youth mental health services and associated with a symptom profile that cuts across traditional diagnostic boundaries. [ABSTRACT FROM AUTHOR]

Objective s : Improved life expectancy has led to an ageing population of people living with HIV in most countries. Research on ageing among people living with HIV has predominantly focused on physical and health‐related quality of life rather than multidimensional quality of life. We measured quality of life among older people living with HIV in Australia and identified opportunities to guide the development and implementation of appropriate interventions. Methods: In a national health and wellbeing survey of Australian people living with HIV, participants aged ≥50 years completed additional questions relevant to ageing. Quality of life was measured using PozQoL, a validated multidimensional instrument assessing quality of life among people living with HIV (range 1–5). Exploratory bivariate analyses aimed to identify sociodemographic characteristics associated with quality of life. Adjusted linear regressions aimed to assess changes in PozQoL score associated with recent experiences (last 12 months) of four exposures: food insecurity, HIV‐related stigma, isolation from the HIV community, and difficulties accessing non‐HIV health services. Results: Among 319 older people living with HIV, the mean PozQol score was 3.30 (95% confidence interval [CI] 3.20–3.39). In bivariate analyses, PozQol scores were significantly higher among participants who were older (p = 0.006), had higher educational attainment (p = 0.009), were in a relationship (p = 0.005), were employed (p = 0.005), and had a higher income (p = 0.001). In adjusted regression models, PozQoL scores were lower among participants who reported recent experiences of food insecurity (β −0.49; 95% CI −0.74 to −0.24), stigma (β −0.53; 95% CI −0.73 to −0.33), isolation from the HIV community (β −0.49; 95% CI −0.70 to −0.29), and difficulties accessing non‐HIV health services (β −0.50; 95% CI −0.71 to −0.30). Conclusions: Overall, older people living with HIV in this study had a moderate quality of life. Our findings suggest that HIV services should integrate programmes to support economic security and foster connections within the HIV community and across health services. [ABSTRACT FROM AUTHOR]

Introduction: Vaccine hesitancy represents a state of uncertainty before a decision about vaccination is made. It can lead to limited vaccine uptake despite adequate supply and an efficacious product. Western Australia (WA) presents a unique challenge with a population widely spread across metropolitan and rural sites and diverse opinions regarding vaccination. Objective: To elicit and compare the common COVID‐19 vaccine concerns in rural and metropolitan WA, and to identify proposed solutions to vaccine hesitancy. Design: A voluntary online survey was distributed via social media over a 2‐week period in August 2021 during Phase 2A of the National COVID‐19 Vaccine Rollout Strategy. General practitioners and members of the public living in rural and metropolitan WA over the age of 18 were surveyed regarding COVID‐19 vaccine concerns (blood clots; long‐ and short‐term side effects; lack of testing; and other concerns) and suggested methods to address vaccine hesitancy. Data were analysed with a sequential mixed methods and thematic analysis approach. Findings: There were 468 general population respondents to our survey, of whom 19.0% (n = 89) lived rurally. A majority (52.6% [n = 246]) of general respondents expressed concerns about COVID‐19 vaccine safety. The commonest concerns were long‐ and short‐term side effects, blood clots and inadequate testing. There was a positive correlation between rurality and vaccine concerns; an inverse relationship between rurality and vaccine uptake; and an inverse relationship between vaccine concerns and uptake. Improved media coverage was the commonest solution suggested to address COVID‐19 vaccine hesitancy. Discussion: A significant proportion of respondents had concerns about vaccine safety; concerns were more common in rural respondents. Rural communities may benefit from location‐targeted media campaigns with a focus on breaking down barriers specific to these members of the population. Vaccine access is more challenging, and consistent messaging from trusted sources is of utmost importance to improve uptake. Conclusion: COVID‐19 vaccine hesitancy is more common in rural populations. Targeted media‐based education regarding vaccine safety may improve COVID‐19 vaccine uptake. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are prevalent across the globe. They have been associated with a range of demographic characteristics and poor outcomes throughout the life course, however, little is known of the Australian context. We aimed to estimate the prevalence of ACEs in an Australian sample and identify demographic characteristics of children who experience adversity. We used data from the National Health Survey Australia 2014–15 to explore adversities experienced by children (aged 0–17) living with the 4161 adult respondents. Three types of adversity were examined: living with only one parent, parental mental health condition, and parental substance use problem. Bivariate associations and hierarchical multiple regression analyses were used to investigate the relationships between the number of adversities reported and demographic characteristics. At least one-third of children had experienced one or more adversities, and almost 8% had experienced multiple adversities. Adversity was reported by respondents across all categories of demographic variables. The experience of adversity was significantly related to demographic characteristics measured at the level of geographic area, household, and individual. Adversity may be affecting at least one-third of Australian children, across a broad range of contexts. Implications for policy, practice and research are discussed. Highlights: At least one-third of children had experienced one or more adversities, and almost 8% had experienced multiple adversities. Adversity was reported by respondents across all categories of demographic variables. Experiencing adversity was related to demographic characteristics at the level of geographic area, household, and individual. [ABSTRACT FROM AUTHOR]

Objective: To enrich and compare three extracellular vesicles—EV subtypes (apoptotic bodies, microvesicles and small EV) from three periodontal cells (periodontal ligament cells—PDLCs, alveolar bone‐derived osteoblasts—OBs and gingival fibroblasts—GFs), and assess uptake and cell function changes in buccal fat pad‐derived mesenchymal stromal cells (BFP‐MSCs). Background: Periodontal cells such as PDLCs, OBs and GFs have the potential to enhance bone and periodontal regeneration, but face significant challenges, such as the regulatory and cost implications of in vitro cell culture and storage. To address these challenges, it is important to explore alternative 'cell‐free' strategies, such as extracellular vesicles which have emerged as promising tools in regenerative medicine, to facilitate osteogenic differentiation and bone regeneration. Methods and Materials: Serial centrifuges at 2600 and 16 000 g were used to isolate apoptotic bodies and microvesicles respectively. Small EV—sEV was enriched by our in‐house size exclusion chromatography (SEC). The cellular uptake, proliferation, migration and osteogenic/adipogenic differentiation genes were analysed after EVs uptake in BFP‐MSCs. Results: Three EV subtypes were enriched and characterised by morphology, particle size and EV‐associated protein expression—CD9. Cellular uptake of the three EVs subtypes was observed in BFP‐MSCs for up to 7 days. sEV from the three periodontal cells promoted proliferation, migration and osteogenic gene expression. hOBs‐sEV showed superior levels of osteogenesis markers compared to that hPDLCs‐sEV and hGFs‐sEV, while hOBs‐16k EV promoted adipogenic gene expression compared to that from hPDLCs and hGFs. Conclusions: Our proof‐of‐concept data demonstrate that hOBs‐sEV might be an alternative cell‐free therapeutic for bone tissue engineering. [ABSTRACT FROM AUTHOR]

Speed and accuracy of lexical access change with healthy ageing and neurodegeneration. While a word's immediate phonological neighbourhood density (i.e. words differing by a single phoneme) influences access, connectivity to all words in the phonological network (i.e. closeness centrality) may influence processing. This study aimed to investigate the effect of closeness centrality on speed and accuracy of lexical processing pre- and post- a single word-training session in healthy younger and older adults, and adults with logopenic primary progressive aphasia (lvPPA), which affects phonological processing. Participants included 29 young and 17 older healthy controls, and 10 adults with lvPPA. Participants received one session of word-training on words with high or low closeness centrality, using a picture-word verification task. Changes in lexical decision reaction times (RT) and accuracy were measured. Baseline RT was unaffected by age and accuracy was at ceiling for controls. Post-training, only young adults' RT were significantly faster. Adults with lvPPA were slower and less accurate than controls at baseline, with no training effect. Closeness centrality did not influence performance. Absence of training effect for older adults suggests higher threshold to induce priming, possibly associated with insufficient dosage or fatigue. Implications for word-finding interventions with older adults are discussed. [ABSTRACT FROM AUTHOR]

People with disability face heightened vulnerability during disasters due to functional limitations and inadequate support. This study explores disaster preparedness, capabilities, and support needs among Australians with disability. A cross-sectional survey was conducted, aligned with the Person-Centred Emergency Preparedness (P-CEP) framework: a co-designed and tested framework that helps people with disability assess their capabilities, identify their needs, communicate with others, and plan for different emergency scenarios. Data collection involved self-administered online surveys and interviewer-administered telephone surveys through convenience sampling. Descriptive statistics and regression modelling were employed for data analysis. Of the 138 respondents, most were female (68.1%) and aged 60–69 (23.9%). While 60.3% had emergency plans, motivators included enhancing survival chances (36.7%) and past disaster experiences (22.7%). Barriers included uncertainty about preparation (22.0%) and difficulty obtaining information (11.3%). Those perceiving bushfire risk were more likely to have a plan (p = 0.004), while individuals living alone were less likely (p = 0.019). Common preparedness actions included safely storing important documents (57.5%), but fewer had backup plans for support workers (9.2%) or home generators (9.7%). Respondents with disaster experience highlighted diverse support needs, encompassing health, emotional well-being, and practical assistance. Inclusive disaster risk reduction should involve individuals with disability in assessing their capabilities and support requirements. This study underscores the necessity of tailored emergency preparedness measures to safeguard the well-being of this demographic. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between mental health workforce supply and spatial clusters of high versus low incidence of youth suicide. Methods: A cross-sectional analysis of spatial suicide clusters in young Australians (aged 10–25) from 2016 to 2020 was conducted using the scan statistic and suicide data from the National Coronial Information System. Mental health workforce was extracted from the 2020 National Health Workforce Dataset by local government areas. The Geographic Index of Relative Supply was used to estimate low and moderate-to-high mental health workforce supply for clusters characterised by a high and low incidence of suicide (termed suicide hotspots and coldspots, respectively). Univariate and multivariate logistic regression was used to determine the association between suicide clusters and a range of sociodemographic characteristics including mental health workforce supply. Results: Eight suicide hotspots and two suicide coldspots were identified. The multivariate analysis showed low mental health workforce supply was associated with increased odds of being involved in a suicide hotspot (adjusted odds ratio = 8.29; 95% confidence interval = 5.20–13.60), followed by residential remoteness (adjusted odds ratio = 2.85; 95% confidence interval = 1.68–4.89), and illicit drug consumption (adjusted odds ratio = 1.97; 1.24–3.11). Both coldspot clusters occurred in areas with moderate-to-high mental health workforce supply. Conclusion: Findings highlight the potential risk and protective roles that mental health workforce supply may play in the spatial distributions of youth suicide clusters. These findings have important implications for the provision of postvention and the prevention of suicide clusters. [ABSTRACT FROM AUTHOR]

Aim: To examine the associations between self‐efficacy, resilience and healthy ageing among older people who have an acute hospital admission. Design: A cross‐sectional study. Method s : Survey and medical record data were collected from older people on discharge from hospital. The survey measured self‐efficacy with the 6‐item General Self‐Efficacy scale (GSE‐6), resilience with the Brief Resilience Scale (BRS), and healthy ageing with the Selfie Ageing Index (SAI). Medical record data included potential confounders: co‐morbidities, frailty items, previous falls and previous admission in the last 28 days. Multi‐linear regression and Spearman's rank correlation coefficient were used to examine the independent associations between self‐efficacy, resilience and healthy ageing. Results: Responses were received from 143 older people (mean age 79). After adjusting for potential confounders, co‐morbidities (ß = ‐0.08, p = 0.001) remained negatively associated with healthy ageing, while self‐efficacy (ß = 0.03, p = 0.005) and resilience (ß = 0.05, p < 0.001) remained positively associated with healthy ageing (R2 = 0.243). Positive correlations were found between self‐efficacy (ρ = 0.33, p < 0.01), resilience (ρ = 0.38, p < 0.001) and healthy ageing. Positive correlations were also found between self‐efficacy and resilience (ρ = 0.38, p < 0.01). Those with lower self‐efficacy and resilience were more likely to report reduced activities of daily living, mobility, physical activity and mood. Conclusion: Findings indicate that while the number of co‐morbidities have negative consequences for healthy ageing among older people who are hospitalised, the promotion of self‐efficacy and resilience can potentially contribute to healthy ageing within the physical and psychological domains. Implications for Patient Care: Nurses can promote self‐efficacy, which can potentially increase resilience and help to improve self‐management of chronic conditions, functional ability in daily activities, mobility and physical activity and reduce both anxiety and depressive symptoms. Patient Contribution: Participant feedback throughout the data collection process assisted in the evaluation of study methods and data interpretation. This included processes such as assessing selected tools and clarifying the meanings of healthy ageing factors. [ABSTRACT FROM AUTHOR]

This study examined verbal and non‐verbal features of mother–infant shared book reading in Australia during the first year of life and explored the relationship between these features and infant cognition. Mother–infant dyads were observed in this cross‐sectional study reading an unfamiliar book in a laboratory setting when infants were aged 6 months (n = 17), 9 months (n = 14), or 12 months (n = 17). High frequency maternal behaviours coded from video were the production of attention attracting behaviours, immediate talk, and verbal encouragement to maintain infant book engagement. Few significant relationships were found for infant problem‐solving scores. Infant communication scores were however associated with non‐immediate talk at 6 months, maternal questions at 9 months, and non‐book related talk at 12 months. Shared book reading provides opportunities for verbal responsiveness and literacy engagement which likely serve as an important vehicle for facilitating early cognitive development. [ABSTRACT FROM AUTHOR]

Evaluate accessibility, effectiveness, acceptability and efficiency of a student- assisted teleaudiology model of care in a regional hospital in Queensland, Australia. Prospective mixed method service evaluation study. Demographic, service and satisfaction data were collected from 233 patients (children aged ≥5 and adults) who received teleaudiology assessment. Satisfaction data was collected from 27 hospital clinic staff (medical, nursing and clinic assistants) and 28 university audiology clinical educator participants. Experience and satisfaction data were collected from 16 teleaudiology clinic university students. Quantitative data was analysed using SPSS software. Qualitative data were analysed using inductive content analysis. Following introduction of the teleaudiology service in 2017 and evaluation during the first 6 months, 95% of patients were able to access audiology assessments on the same day as their Ear, Nose and Throat appointments. New referrals to the service were seen within a month. The audiology assessment battery was completed 95% of the time within an average of 33 minutes by the end of the study period. Patients, hospital and university staff and students reported high satisfaction with their experiences of teleaudiology, including its convenience and efficiency. A student-assisted teleaudiology model of care can deliver accessible, effective, and efficient services with high levels of satisfaction by participants. [ABSTRACT FROM AUTHOR]

Background/Aim: Although sensory approaches are recommended to relieve distress and agitation and reduce the use of seclusion and restraint, many Australian psychiatric units have struggled to sustain their practice. The aim of this study was to investigate the barriers and enablers influencing the use of different sensory approaches across one health region in Australia and to obtain recommendations for strategies to improve their use. Method: This cross‐sectional survey was informed by the Theoretical Domain Framework. Likert scale questions considered barriers and enablers to the use of non‐weighted sensory interventions, weighted modalities, sensory rooms, and sensory assessments/plans. Open‐ended questions explored participant concerns and recommendations to improve the use of sensory approaches. Results: Participants (n = 211) were from nursing, allied health, medical, and peer support staff across inpatient psychiatric units. Factors most frequently identified as enablers for using sensory approaches were beliefs of positive benefits to consumers (e.g. decreasing distress and agitation); belief it was within the staff's role; and knowledge of the approaches. Limited time was the most common identified barrier. Factors statistically associated with more frequent use were knowledge, skills, confidence, availability, and easy access to sensory tools/equipment. Only 30% of participants were concerned about potential risks of sensory approaches, with this risk mitigated through adequate supervision and thorough risk assessment. Recommendations to improve practice included improved access to, and maintenance of, equipment, more training, and increased staffing. Conclusion: This study revealed how barriers and enablers vary for different sensory approaches and how these factors impact their frequency of use in psychiatric units. It provides insights into staff recommendations to improve the use of sensory approaches in one health region in Australia. This knowledge will lead to the development of implementation strategies to address identified barriers and improve the use of sensory approaches in psychiatric units. [ABSTRACT FROM AUTHOR]

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

To investigate the effects of COVID-19 on individuals with tinnitus and their views to guide future tinnitus care. A mixed-methods cross-sectional research design. An online survey was completed by 365 individuals with tinnitus from Australia and other countries. Tinnitus was reported to be more bothersome during the pandemic by 36% of respondents, whereas 59% reported no change and 5% reported less bothersome tinnitus. Nearly half of the respondents had received COVID-19 vaccination(s) and 12% of them reported more bothersome tinnitus while 2% developed tinnitus post-vaccination. Australian respondents spent less time in self-isolation or quarantine and saw fewer change in in-person social contact than respondents from other countries. More than 70% of respondents thought that tinnitus care services were insufficient both before and during the pandemic. Regarding their opinions on how to improve tinnitus care in the future, five themes including alleviation of condition, government policies, reduced barriers, self- and public-awareness, and hearing devices were identified. A majority of respondents did not perceive any change in tinnitus perception and one-third of respondents had worsened tinnitus during the pandemic. To improve tinnitus care, better awareness and more accessible resources and management are crucial. [ABSTRACT FROM AUTHOR]

Background: Clinical quality registries provide rich and useful data for clinical quality monitoring and research purposes but are susceptible to data quality issues that can impact their usage. Objective : This study assessed the concordance between comorbidities recorded in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and those in state-based hospital admission datasets. Method: All patients in New South Wales, South Australia, Tasmania, Victoria and Western Australia recorded in ANZDATA as requiring chronic kidney replacement therapy (KRT) between 01/07/2000 and 31/12/2015 were linked with state-based hospital admission datasets. Coronary artery disease, diabetes mellitus, cerebrovascular disease, chronic lung disease and peripheral vascular disease recorded in ANZDATA at each annual census date were compared overall, over time and between different KRT modalities to comorbidities recorded in hospital admission datasets, as defined by the International Classification of Diseases (ICD-10-AM), using both the kappa statistic and logistic regression analysis. Results: 29, 334 patients with 207,369 hospital admissions were identified. Comparison was made at census date for every patient comparison. Overall agreement was "very good" for diabetes mellitus (92%, k = 0.84) and "poor" to "fair" (21–61%, k = 0.02–0.22) for others. Diabetes mellitus recording had the highest accuracy (sensitivity 93% (±SE 0.2) and specificity 93% (±SE 0.2)), and cerebrovascular disease had the lowest (sensitivity 54% (±SE 0.2) and specificity 21% (±SE 0.3)). The false positive rates for cerebrovascular disease, peripheral vascular disease and chronic airway disease ranged between 18 and 33%. The probability of a false positive was lowest for kidney transplant patients for all comorbidities and highest for patients on haemodialysis. Conclusions and Implications: Agreement between the clinical quality registry and hospital admission datasets was variable, with the prevalence of comorbidities being higher in ANZDATA. [ABSTRACT FROM AUTHOR]

Background: Perceptual, cognitive and previous clinical experience may influence a novice Videofluoroscopic Swallowing Study (VFSS) analyst's trajectory towards competency. Understanding these factors may allow trainees to be better prepared for VFSS training and may allow training to be developed to accommodate differences between trainees. Aims: This study explored a range of factors previously suggested in the literature as influencing the development of novice analysts' VFSS skills. We hypothesised that knowledge of swallow anatomy and physiology, visual perceptual skills, self‐efficacy and interest, and prior clinical exposure would all influence VFSS novice analysts' skill development. Methods & Procedures: Participants were undergraduate speech pathology students recruited from an Australian university, who had completed the required theoretical units in dysphagia. Data assessing the factors of interest were collected—the participants identified anatomical structures on a still radiographic image, completed a physiology questionnaire, completed subsections of the Developmental Test of Visual Processing—Adults, self‐reported the number of dysphagia cases they managed on placement, and self‐rated their confidence and interest. Data for 64 participants relating to the factors of interest were compared with their ability to accurately identify swallowing impairments following 15 h of VFSS analytical training, using correlation and regression analysis. Outcomes & Results: Success in VFSS analytical training was best predicted by clinical exposure to dysphagia cases and the ability to identify anatomical landmarks on still radiographic images. Conclusions & Implications: Novice analysts vary in the acquisition of beginner‐level VFSS analytical skill. Our findings suggest that speech pathologists who are new to VFSS may benefit from clinical exposure to dysphagia cases, sound foundational knowledge of anatomy relevant to swallowing and the ability to see the anatomical landmarks on still radiographic images. Further research is required to equip VFSS trainers and trainees for training, to understand differences between learners during skill development. WHAT THIS PAPER ADDS: What is already known on the subject: The existing literature suggests that no vice Video fluoroscopic Swallowing Study (VFSS) analysts training may be influenced by their personal characteristics and experience. What this study adds: This study found that student clinicians, clinical exposure to dysphagia cases and their ability to identify anatomical landmarks relevant to swallowing on still radiographic images prior to training best predicted their ability to identify swallowing impairments after training. What are the clinical implications of this work?: Given the expense of training health professionals, further research is required into the factors that successfully prepare clinicians for VFSS training, including clinical exposure, foundational knowledge of anatomy relevant to swallowing and the ability to identify the anatomical landmarks on still radiographic images. [ABSTRACT FROM AUTHOR]

Objectives: To quantify physical activity in patients prior to and during an acute general medical hospital admission and explore relationships between mobility, pre‐ and in‐hospital physical activity. Methods: This was a prospective, single‐site secondary observational study conducted on general medical wards at a tertiary hospital. Prehospital physical activity was measured via the Physical Activity Scale for the Elderly (PASE; scored 0–400); in‐hospital physical activity was measured via accelerometry (time at metabolic equivalents [METs] > 1.5), and mobility was measured via the de Morton Mobility Index (DEMMI). Associations were determined via Spearman's correlations. Results: Forty‐six participants were included: median age 81 [76–85] years, 59% female, DEMMI on admission 39 [30–49]. Prehospital physical activity was low (PASE median 27.1 [1.6–61.9]). In‐hospital physical activity was also low (0.5 [0.2–1.5] hours per day being physically active and 54 [16–194] steps per day taken). No statistically significant relationships existed between pre‐ and in‐hospital physical activity (Spearman's rho (ρ) 0.24, 95% CI −0.08–0.53, p = 0.07). However, physical activity levels in the pre‐ and in‐hospital settings were positively associated with patients' mobility in‐hospital (Spearman's ρ 0.44, 95% CI 0.15–0.67, p = 0.002; Spearman's ρ 0.40, 95% CI 0.08–0.645, p = 0.011 respectively). Conclusions: Physical activity is low both before and during a general medical admission. Assessment of usual physical activity patterns should be part of the clinical assessment of patients in general medicine; however, the low activity levels observed indicate a need for valid and reliable tools suitable for an older, frail cohort. Findings will inform the development of physical activity guidelines during hospitalisation. [ABSTRACT FROM AUTHOR]

Background: Implementation of exercise training in people with kidney failure may be affected by clinicians' attitudes. Objectives: To investigate Danish nephrology nurses' and medical doctors' attitudes towards: exercise for people undergoing dialysis; use of physical activity interventions in chronic kidney disease; and to compare Danish and previously reported Australian nurse attitudes. Design: Cross‐sectional survey. Participants: Nurses and medical doctors from the nephrology field in Denmark. Measurements: The questionnaire attitudes towards exercise in dialysis, and questions about exercise advice, counselling and interventions. Results: Nephrology nurses (n = 167) and 17 medical doctors (women 92%, age 47 ± 11 years) from 19 dialysis units participated. There were no differences between nurses' and medical doctors attitudes about training. Ninety‐five % and 88% of nurses and medical doctors, respectively, agreed that most people undergoing dialysis could benefit from exercise. Exercise training was offered to people undergoing haemodialyses in 88% of 17 departments. Danish nurses reported more positive attitudes than Australian towards exercise (p < 0.05). Ninety‐five % and 86% of the Danish and Australian nurses, respectively, agreed/strongly agreed that most people undergoing dialysis could benefit from exercise. Six % and 35% of the Danish and Australian nurses, respectively, agreed/strongly agreed that most people with dialysis were too sick to exercise. Conclusion: Danish nephrology nurses and medical doctors had mostly positive attitudes to exercise training to people undergoing dialysis, and exercise to people with dialysis was offered frequently. Danish and Australian nurses had positive attitudes to exercise to people undergoing dialysis, it was however more positive in Danish nurses. [ABSTRACT FROM AUTHOR]