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Growth from conception through age 2 years, the "First 1,000 days," is important for long-term health of the growing fetus and child and is influenced by several factors including breastfeeding and complementary feeding. Low- and middle-income countries face a complicated array of factors that influence healthy growth, ranging from high food insecurity, poor sanitation, limited prenatal or neonatal care, and high levels of poverty that exacerbate the "vicious cycle" associated with intergenerational promotion of growth retardation. It is now well recognized that the period prior to conception, both maternal and paternal health and diet, play an important role in fetal development, giving rise to the concept of the "First 1,000 Days+". Breastfeeding and complementary feeding practices can be improved through a combination of interventions such as baby-friendly hospitals, regulations for marketing of foods and beverages to children, adequate counseling and support, and sound social and behavior change communication, but continued research is warranted to make such programs more universal and fully effective. Thus, improving the overall understanding of factors that influence growth, such as improved breastfeeding and age-appropriate and adequate complementary feeding, is critical to reducing the global prevalence of the double burden of malnutrition. [ABSTRACT FROM AUTHOR]

Background: Over the past decades, self-directed models of care have been implemented throughout the world to support older people, including those with dementia, to live at home. However, there is limited information about how self-directed home care is experienced by older people with cognitive impairment and dementia, and how their thinking informs their care choices and quality of life., Methods: We used the ASCOT-Easy Read, a staggered reveal method, talk aloud techniques, probing questions, and physical assistance to support users of self-directed home care in Australia with cognitive impairment and dementia to discuss their Social Care Related Quality of Life (SCRQoL). Interviews were recorded, transcribed and analysed thematically in NVivo. Demographic, functional, cognitive and SCRQoL scores were analysed in Excel and SPSS. Analysis of both the quantitative and qualitative data for each participant allowed us to examine consistency or discordance between ratings and participants' comments about their experiences within each domain., Results: Twenty six older people with cognitive impairment and/or dementia completed an interview. Ratings of SCRQoL were more favourable in lower order domains (e.g. food and drink, personal cleanliness, accommodation comfort and cleanliness and safety) than in the higher order domains (e.g. occupation and social participation). Overall SCRQOL also varied significantly from 0.40 to 0.97. Despite variable ratings, all participants described unmet needs associated with limitations in personal function and mobility, transport and the amount and flexibility of home care services they received. Qualitative comments suggest many experienced more significant limitations than some of their ratings may imply. This was attributed to adaptation and acceptance of limitations as a normal part of aging. The choice to remain living in one's own home was perceived as the most important outcome., Conclusions: Some older people living at home with cognitive impairment and/or dementia adapt and accept their limitations as a normal part of the aging process. This affects expectations about their lives at home and their support. Rather than relying on self-direction, supports to live well at home could be enhanced by a greater emphasis on comprehensive needs assessment and more supports to promote reablement and enhance personal and community level participation., Competing Interests: Declarations. Ethical approval: The study was granted ethical approval by the University Human Research Ethics Committee at the University of Wollongong (HE16/236). Written consent was obtained from all subjects and/or their legal guardian(s). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: To explore the factors that influence clinicians (occupational therapists, physiotherapists, vascular surgeons, and rehabilitation medicine physicians) when prescribing prosthetic rehabilitation. Additionally, the study aimed to gain insight into clinicians' perspectives regarding the role of patient cognition in prosthetic rehabilitation., Materials and Methods: This research constitutes one segment of a broader action research study which was undertaken in 2022. A total of thirty-four key clinicians involved in the amputation and prosthetic rehabilitation pathway within a local health district in Australia were engaged through a combination of group and individual interviews as well as surveys., Results: Five essential considerations when prescribing prosthetic rehabilitation emerged. These included patient's goals, medical history, quality of life, cognitive abilities, and the support available on discharge. This study also revealed variations in opinions among different disciplines concerning appropriateness of prosthetic rehabilitation for the patient cohort. Despite this, there was a desire to build a consensus around a shared approach of identification for patients and clinicians., Conclusion: The identification of these key pillars for clinician consideration has simplified a complex area of care. These pillars could be used to guide pertinent conversations regarding prosthetic rehabilitation and are closely linked with the patient's cognition.

Cervical cancer is a preventable disease and is related to persistent health equities. Whilst several priority populations face health inequities related to cervical cancer prevention, my co-authors and I bring special attention to those who identify as culturally and linguistically diverse (CALD). By reflecting on some of our research and work experiences, we propose four ways that governments and policymakers can enact the community engagement goals of the published and proposed cervical cancer prevention and treatment strategies for CALD communities. This includes: (1) Developing a culturally appropriate approach to collecting and interpreting cultural, ethnic and linguistic data; (2) Building and adapting the effective multicultural community policies and partnerships developed during COVID-19; (3) Incorporating national strategy recommendations across all relevant government policies and (4) Sustainably resourcing and supporting participatory health promotion activities and interventions. By implementing the recommendations above, Australia will continue to lead the elimination of cervical cancer as a public health problem. It will demonstrate how genuine and authentic CALD partnerships and collaborations can reduce national CALD health inequities., (© 2024 Australian Health Promotion Association.)

Issue Addressed: Health literacy (HL) can be developed throughout the lifespan starting from the early years highlighting that educational institutions, curriculum and teachers are powerful settings, places and people that can foster HL in youth. Current research shows that Australian teachers need more support to teach health education that promotes students' HL, with limited research focusing on pre-service teachers (PST). This study aims to identify the HL strengths and challenges of PST at one Australian university across two initial teacher education programs (HPE and primary) and compare their health literacy profiles with that of the Australian general population., Methods: The Health Literacy Questionnaire (HLQ) was administered in March and April, 2022 to measure HL in Australian PST. The research setting was a university in Sydney, Australia, with two of the University's undergraduate initial teacher education (ITE) programs (Health and Physical Education [HPE] and Primary). Of the 24 PST in the HPE cohort, 23 consented. Of the 70 PST in the Primary cohort, 34 consented. The results were compared with Australian Bureau of Statistics data., Results: The participants' median age was 22.3(4.3) years (SD), age ranged from 20 to 54 years, with 36% of participants under the age of 22 years. When comparing the PST data with the general population there were two significant differences: (1) PST scored significantly higher than the general population for Domain 4 (Social support for health, 3.41 vs. 3.19; p < 0.001; d = 0.57); and (2) the PST scored significantly lower for Domain 9 (Understand health information enough to know what to do, 4.02 vs. 4.27; p < 0.01; d = -0.43). In addition, we found that primary PST had significantly lower scores for domains 5-9 (demonstrative of interactive and critical HL), compared with the general Australian population., Conclusions: Findings show that PST strengths are that they perceive that there they are able to access social support for health, however the PST find it more difficult to analyse and apply health information, compared with the general Australian population. SO WHAT?: Further understanding of health literacy profiles of Australian PST should influence the design of ITE programs and its health education curricular to ensure that PST are able to further develop their HL understandings and capabilities., (© 2024 The Author(s). Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Aims/hypothesis: The diagnosis of type 2 diabetes is increasing in young people worldwide. This study evaluated the frequency and clinical characteristics of young people presenting with type 2 diabetes from the multinational SWEET e.V Registry 2012-2021, including the first years of the COVID-19 pandemic., Methods: This is a longitudinal observational study based on the SWEET Registry, which collects demographic and clinical data on children and adolescents with diabetes from centres worldwide, with the diagnosis and classification of diabetes provided locally by each centre according to International Society for Paediatric and Adolescent Diabetes definitions. By July 2022, the SWEET Registry included 96,931 individuals from 130 centres with a total of 1,154,555 visits. Data were analysed by region: Europe (EU), Australia and New Zealand (AU/NZ), South America (SA), North America (NA) and Asia/Middle East and Africa (AS/AF). Trends in proportions for the two-year periods, calculated as cases with type 2 diabetes diagnoses over all cases with diabetes diagnoses, were estimated using logistic regression models adjusted for age at onset and sex., Results: Overall, there were 2819 of 58,170 new cases (4.8%) with type 2 diabetes: 614 in EU, 293 in AU/NZ, 79 in SA, 1211 in NA and 622 in AS/AF. The proportion of type 2 diabetes increased from 3.2% to 6.0% from 2012/2013 to 2020/2021, a relative rate of increase of 9% per two-year period (95% CI 5.9, 12.3; p<0.001). In the two-year period of the COVID-19 pandemic, type 2 diabetes continued to follow the observed trend, with a proportion of 6.0% in 2020-2021 compared with 5.4% in 2018-2019. High variability in the proportion of type 2 diabetes was observed across regions, with the lowest values observed in EU and the highest in NA. A significant increase in the proportion of type 2 diabetes was observed in EU, AU/NZ and NA. The median HbA 1c was not uniform and was highest in AS/AF (85 mmol/mol [9.9%]; IQR 55-111 [7.2-12.3%]) and lowest in EU (63 mmol/mol [7.9%]; IQR 48-99 [6.5-11.2%]), and the difference between EU and NA (median value 73 mmol/mol [8.8%]; IQR 50-105 [6.7-11.8%]) was statistically significant (p=0.047). There was also a difference in BMI SD score by region: the lowest median BMI SD score was 2.2 (IQR 1.4-2.7) in AS/AF and the highest was 3.1 (IQR 2.5-3.6) in AU/NZ., Conclusions/interpretation: The multinational SWEET data from the years 2012 to 2021 inclusive support recent findings of a worldwide increase in type 2 diabetes in young people, albeit with regional differences. This increase highlights the need for ongoing preventive measures and available advanced treatment modalities worldwide., Competing Interests: Acknowledgements: The SWEET e.V. Registry is funded by the SWEET members, including the SWEET corporate members, namely Abbott, Boehringer Ingelheim, Dexcom, Insulet, Eli Lilly, Medtronic Europe, Novo Nordisk and Sanofi. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the corporate members. The authors thank the following individuals for their support of this work: S. Tittel and S. Lanzinger for data management, and A. Hungele and R. Ranz for the SWEET-DPV software (all from Ulm University, Germany); M. Witsch (Centre Hospitalier de Luxembourg, Luxembourg), T. Danne and O. Kordonouri (Kinder- und Jugendkrankenhaus Auf Der Bult, Hannover, Germany) for centre integration; K. Klee and N. Koller (Kinder- und Jugendkrankenhaus Auf Der Bult) for initiating the SWEET collaboration; and S. Lanzinger and R. Holl (both Ulm University) for invaluable support. Finally, the authors thank all centres of the SWEET network, especially the collaboration centres that participated in this investigation. Parts of this study were presented in the oral presentation session at the 83rd Scientific Session of the American Diabetes Association (San Diego, 23–26 June 2023), and in the poster presentation session at the 57th European Diabetes Epidemiology Group annual meeting (Soesterberg, the Netherlands, 22–25 April 2023). Data availability: Access to the programming code may be provided by the corresponding author if requested. For reasons of data protection, data at the individual level cannot be provided. Funding: Open Access funding enabled and organized by Projekt DEAL. The SWEET Registry is a non-profit charity registered in Hannover, Germany. It is financed through membership fees from the participating centres (based on the income of the country of residence, according to the World Bank) and corporate members. We acknowledge with gratitude the support from the following SWEET corporate members (in alphabetical order): Abbott, Boehringer Ingelheim, Dexcom, Insulet, Eli Lilly, Medtronic Europe, Novo Nordisk and Sanofi. The SWEET project is an ongoing registered research collaboration (ClinicalTrials.gov registration number NCT04427189). Authors’ relationships and activities: The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work. Contribution statement: RG and VC designed the study, participated in data interpretation and wrote the manuscript. AJE performed the statistical analysis, participated in data interpretation, and reviewed and edited the manuscript. SB, NAC, FC, JK, CJ, EFG, AV, SS and SA researched data and reviewed and edited the manuscript. All authors approved the final version of the manuscript. RG, VC and AJE are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis., (© 2024. The Author(s).)

Background: Online grocery shopping is a growing source of food purchases in many countries. We investigated the effect of nudging consumers towards purchases of lower sodium products using a web browser extension., Methods: This trial was conducted among individuals with hypertension who shopped for their groceries online in Australia. From July 2021 to June 2023, participants were randomised to use the SaltSwitch Online Grocery Shopping web browser extension or continue their usual grocery shopping for 12 weeks. The SaltSwitch extension modified a retailer's online shopping interface to suggest similar but lower sodium alternative products to those initially selected. The primary outcome was the difference in mean sodium density (mg sodium per 1000 kcal of energy) of packaged food purchases between the intervention and control groups., Results: We randomised 185 participants of average age 56.0 (SD 11.0) years. Most were women (64%), White (89%), had BMI > 25 kg/m 2 (91%), and were taking anti-hypertensive medication (83%). Demographic and medical characteristics were similar across the randomised groups. 182 (98%) completed the trial. Over the 12-week intervention, the sodium density of groceries purchased by the intervention group compared to the control group was 204 mg/1000 kcal lower (95%CI, -352 to -56) (P = 0.01). The reduction in sodium density of purchases was apparent in weeks 1-4 and sustained through the end of the trial. 86% of participants in the intervention group made at least one switch to a lower sodium product. There were no detectable effects on blood pressure, spot urine sodium concentration, or other secondary outcomes across the 12-week study period., Conclusions: Online shopping platforms provide a novel opportunity to support purchases of lower sodium foods. While the reductions in sodium density of purchases were moderate in size, population health benefits could nonetheless be large if they were sustained over time and at scale, with large and growing numbers of online grocery shoppers and a high prevalence of elevated blood pressure amongst adults., Trial Registration: ACTRN12621000642886., Competing Interests: Declarations. Ethics approval and consent to participate: The trial received ethics approval from the University of New South Wales Human Research Ethics Committee (HC200970). Consent for publication: Not applicable. Competing interests: JHYW is a member of the Editorial Board of International Journal of Behavioral Nutrition and Physical Activity. JHYW was not involved in the journal’s peer review process of, or decisions related to, this manuscript. In the last 3 years, JHYW has received grant support from New South Wales (NSW) Health, Ian Potter Foundation, Hort Innovation, and Future Food System Cooperative Research Centre, as well as travel support by AusVeg, all outside of the present work. In the last 3 years, MDH has received travel support from the World Heart Federation. MDH has planned patents for combination therapy for the treatment of heart failure. AJC and CNM were academic partners on a healthy supermarket intervention trial that includes Australian local government and supermarket retail (IGA) collaborators, with funding from the Australian National Health and Medical Research Council (NHMRC), the Victorian Health Promotion Foundation (VicHealth) and Deakin University. The George Institute for Global Health has a patent, license, and has received investment funding with intent to commercialize fixed-dose combination therapy for hypertension through its social enterprise business, George Medicines. The George Institute has also previously received funding from Australian supermarket retailers to independently assess and provide advice on improving the healthiness of private label (home brand) product ranges. BN is supported by an Australian NHMRC fellowship. AES is supported by a NHMRC Investigator Grant (APP2017504), has received funding from the MRFF and NSW Health, and has also received speaker honoraria or sat on Advisory Boards for Servier, Medtronic, Sanofi, AstraZeneca, Omron, Aktiia, Skylabs, and Abbott. CA has received research funding from NHMRC, MRFF and NSW Health and has also received honoraria or sat on Advisory Boards for Novo Nordisk, Amgen and Astra Zeneca., (© 2024. The Author(s).)

This study aimed to investigate the effect of precarious employment (PE) on the mental health of Australians. Building on previous research, we conceptualised PE as a multidimensional construct, accounted for gender differences in the associations, and our modelling strategy addressed the possibility of reverse causality bias. Data was pooled panel data from 15 waves (2005-2019) of the HILDA survey (n = 14,237). Using PCA, we created two multidimensional measures of PE: objective and subjective. Fixed effects (FE) regression models (attending to unmeasured time-invariant confounders) estimated the change in mental health associated with a change in PE, and instrumental variable (IV) analyses (addressing endogeneity bias) obtained an unbiased estimate of effect of subjective PE on mental health (with ordinary least squares (OLS) models as baseline). For both genders, FE models showed that objective and subjective multidimensional PE both had a strong negative association with mental health (stronger for subjective PE). IV analysis indicated OLS models overestimate the relationship between subjective PE and mental health for men but underestimate it for women, providing causal evidence that subjective PE is important for women's mental health. Overall, findings suggest that targeted PE policies have the potential to provide significant population mental health gains, particularly for working women., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The HILDA Survey is conducted by the Melbourne Institute of Applied Economic and Social Research at the University of Melbourne on behalf of the Australian Commonwealth Government Department of Social Services (DSS). All respondents provided informed consent to participate in the HILDA Survey. The study was approved by the Human Research Ethics Committee at the University of Melbourne and conformed to the principles embodied in the Declaration of Helsinki., (© 2024. The Author(s).)

Background and Objectives: Critiques of the concept of successful aging (SA) include attention to its foundation on an individualized western medical approach that emphasizes personal choice, agency, and lifestyle. This paper aims to examine how individual notions of SA can be linked to, and co-constituted by, relational and intergenerational notions of personhood within the broader socioeconomic, familial, and cultural contexts of migration., Research Design and Methods: Qualitative research was conducted in Australia (2020-2021) with 42 Vietnamese migrants using ethnographic interviews and participant observation. Data analysis applied inductive reasoning and intersectional analysis to investigate the notion of SA from the perspectives of research participants., Results: Vietnamese migrants identified 3 dimensions of SA as significant: family fulfillment, individual achievements, and social engagement and protection. Family fulfilment is the most important; other dimensions are rendered meaningless without it. We found out that different generations interpreted SA in varying ways. Adult children prioritize personal success, self-independence, and longevity whereas grandparents place greater emphasis on the success of their adult children and maintenance of intergenerational relationships., Discussion and Implications: Migrant understandings of SA are deeply influenced by the sociocultural contexts of both their homeland and current residence. The emphasis on family in shaping SA reflects a social-relational understanding that contrasts with dominant individualistic models of SA. Given the social-relational dimension of SA, further research should investigate how distinct migrant experiences of SA shape access to wellbeing in later life., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Gerontological Society of America.)

Background: Respiratory syncytial virus (RSV) is a leading cause of respiratory illness among infants. A maternal RSV vaccine that protects young infants has recently been approved for registration in Australia. We estimated the population benefits of a future year-round maternal RSV vaccination program in terms of prevented RSV infections and hospitalisations in Australia., Methods: We described RSV transmission using an age-structured compartmental model calibrated to Australian aggregated monthly RSV-coded hospitalisations in children aged <5 years. We accounted for mother and infant interactions in the model to capture herd effects more realistically. Using the model, we estimated the annual age-specific RSV infections and hospitalisations prevented for a range of assumptions for vaccine efficacy, coverage, and durability to estimate the future impact of year-round maternal RSV vaccination on infants and the wider population., Results: Assuming base case vaccine efficacy, 6 months duration of protection and 70% coverage, RSV hospitalisations were predicted to fall by 60% (from 3.0 to 1.2 per 100 persons) in infants aged <3 months and 40% (from 1.9 to 1.1 per 100 persons) in 3-5-month-olds. These benefits were primarily due to direct protection to infants of vaccinated mothers. This vaccine program was predicted to reduce the population-level RSV infection by about 4%. Coverage and duration assumptions were influential, with higher coverage leading to larger declines in infants <6 months, and increased duration of protection leading to additional declines in infection and hospitalisation risk in older infants aged 6-8 months., Conclusions: With vaccine uptake similar to that achieved for other maternal vaccines in Australia, a year-round RSV maternal vaccination program is predicted to approximately halve the number of RSV hospitalisations in infants younger than 6 months. There was a small herd effect predicted in the base case but potential for larger benefits if vaccine coverage or the duration of protection exceeds base case assumptions., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Allen Nazareno reports financial support was provided by University of New South Wales School of Population Health. James Wood reports a relationship with Australian Technical Advisory Group on Immunisation that includes: board membership. Alexandra Hogan reports a relationship with World Health Organization Immunization and vaccines related implementation research advisory committee (IVIR-AC) that includes: board membership. Alexandra Hogan reports a relationship with National Health and Medical Research Council that includes: funding grants. David Muscatello reports a relationship with National Institute of Health and Medical Research Great West Regional Delegation that includes: funding grants. Anthony Newall reports a relationship with Center for Innovation and Value Research that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: Well-being is a complex, multi-dimensional, dynamic, and evolving concept, covering social, economic, health, cultural and spiritual dimensions of human living, and often used synonymously with happiness, life satisfaction, prosperity, and quality of life. We review the existing key wellbeing frameworks applied in Australia both for the wider public and Indigenous peoples. The aim is to provide a comprehensive overview of various applied frameworks, along with a critical analysis of domains or dimensions comprising those frameworks, and to analyse the role of nature in those frameworks., Methodology: We conducted a critical analysis of the main frameworks applied in Australia to date to measure the well-being of the mainstream (mainly non-Indigenous) and Indigenous populations. This study is particularly timely given the Australian Government's interest in revising the well-being frameworks as mentioned in the Government "Measuring What Matters" statement., Results: The existing well-being frameworks in Australia either overlook or hardly consider the role of nature and its services which are important to support human well-being. Likewise, for Indigenous peoples " Country" (Indigenous clan land) is vital for their well-being as their living is imbued with "Country". The role of nature/"Country" needs to be considered in revising the well-being frameworks, indicators and measures to inform and develop appropriate policies and programs in Australia., Conclusion: To develop appropriate welfare policies and programs for achieving socio-economic and other wellbeing outcomes, it is essential to evolve and conceptualize wellbeing frameworks (and related indicators and measures) in line with people's contemporary values, particularly considering the role of nature and its services.

Understanding the key determinants of residential water conservation is crucial for designing effective water demand management policies in arid and semiarid regions. While extant literature has frequently identified such determinants using statistical significance and correlations, there is a growing emphasis on understanding these determinants using probabilistic sufficiency and deterministic necessity logics. Integrating these two logics to test an integrated model of the Theories of Planned Behaviour (TPB) and Protection Motivation (PMT), this study identifies and differentiates the probabilistic sufficient and necessary conditions or "must have" factors that need to exist for residential water conservation intentions and behaviours to occur. Combining partial least square structural equation modeling (PLS-SEM) and necessary condition analysis (NCA) to analyse 346 responses from residents in Australia's Northern Territory (NT), we found that attitude, self-efficacy, perceived vulnerability, and response efficacy are probabilistic sufficient and necessary conditions for water conservation intention. Self-efficacy and intention further provided probabilistic sufficient and necessary conditions for water conservation behaviour. Based on the findings, the TPB-PMT constructs are categorised into four groups and the bottleneck table is used to indicate the minimum levels of the identified necessary conditions that must exist to realise the highest levels of water conservation intention and behaviour. This study further draws on these two logics to conduct a combined importance-performance map analysis (cIPMA) to provide guidelines for policymakers and water authorities on how to better prioritise water management actions to improve residential water conservation intentions and behaviours., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Accessible Summary What is known on the subject Health professionals, including nurses, are shown to have stigmatizing attitudes towards mental illness. For nursing students who are in their formative years of professional development, mental illness stigma can severely impact the care they provide. Little research has investigated multi-national comparisons of nursing students' attitudes towards mental illness. What this paper adds to existing knowledge This study shows that between countries, there were substantial differences amongst nursing students in stigmatizing attitudes towards mental illness. Cultural perspectives may explain some of these differences. What are the implications for practice Regardless of location, stigmatizing attitudes are present at varying levels. Each nation can take steps to reduce these by acknowledging the presence of stigmatizing attitudes amongst nurses, educating nurses regarding the negative impacts of stigma on patient outcomes, and decrease stigmatizing attitudes by facilitating opportunities for nurses (particularly student nurses) to have direct contact with people with lived experiences of mental illness., Abstract: INTRODUCTION: Stigmatizing attitudes perpetuated by nursing professionals are a pervasive problem for people experiencing mental health issues. This global issue has detrimental consequences; inhibiting one's life chances and help-seeking behaviours. To date, few studies have compared nursing students' attitudes towards mental illness from a multi-national perspective., Aim: To compare undergraduate nursing students' attitudes towards mental illness across six countries: Australia, India, Jordan, Saudi Arabia, Taiwan and USA., Method: In a cross-sectional design, data were collected from undergraduate nursing students (N = 426) using the Social Distance Scale. A one-way analysis of variance was used to compare differences between countries., Results: Nursing students' attitudes to mental illness differed between countries. Social Distance Scores were highest amongst nursing students from Jordan and Saudi Arabia. Students from Taiwan and India possessed moderate stigma scores. Social Distance Scores from the USA and Australia were lowest., Discussion: Clear differences in stigmatizing attitudes emerged between countries; these are discussed in relation to possible cultural influences., Implications for Practice: It is suggested that educating nurses, combined with direct contact with people with lived experiences of mental illness, can reduce stigmatizing attitudes regardless of country, location or educational institution., (© 2024 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Frailty is an important concept in the care of older adults. Over the past two decades, significant advances have been made in measuring frailty. While it is now well-recognised that frailty status is an important determinant of outcomes from medical illnesses or surgical interventions, frailty measurement is not currently routinely integrated into clinical practice. In the community setting, it is uncommon for general practitioners to deliver frailty-optimised care. In hospitals, there is substantial variability in how people living with frailty are managed. This variability is notable between and even within disciplines. Furthermore, gains from understanding frailty mechanisms and risk factors are not yet applied/implemented at scale to delay the progression of frailty in community-dwellers. The Australian Frailty Network (AFN) is a national collaborative group of researchers, clinicians, non-government organisations, consumers and policymakers, in which the engagement and active involvement of consumers has been embedded from the outset. The AFN aims to generate new knowledge to improve health outcomes, to ensure evidence-based management is translated into clinical practice and to build capacity in multidisciplinary and translational frailty research. Here, we describe the development of the AFN, highlighting important milestones: (i) securing funding for the network and flagship elements; (ii) an inaugural summit to establish the strategic vision, values and scope with end-users; (iii) sabbatical visits to learn from international examples; and (iv) developing the governance structure and an actionable plan encompassing consumer engagement, research, education and policy and practice to maximise impact., (© 2024 The Author(s). Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)

Purpose: To understand from the perspectives of school professionals, parents and young people the socio-ecological factors that may facilitate and prevent e-cigarette use among young people in Perth, Western Australia., Methods: Purposive sampling was used to recruit school professionals, parents and young people for one-on-one ( n  = 35) or joint ( n  = 3) interviews (in-person n  = 11 or online n  = 27). Data were analysed using thematic analysis and classified into four domains based on the socio-ecological model: i) individual, ii) interpersonal, iii) organizational/community and iv) societal/policy., Results: Factors that were found to support vaping among young people included sensation-seeking and risk-taking behaviour; a low-risk perception of vapes; attractive characteristics of vapes; ease of access; perception vaping is a social activity; and lack of knowledge about vaping among parents and school professionals. Vaping prevention messages originating from the familial, educational and community spheres are lacking but wanted by adults and young people., Conclusions: The pervasiveness of the e-cigarette trade and persistent challenges related to surveillance and enforcement need to be addressed to reduce exposure and access to e-cigarettes. A mixture of "hard" and "soft" public policy tools involving key stakeholders in a range of settings is needed to prevent e-cigarette access and uptake by young people.

Objectives: To critically examine which stakeholders are participating in voluntary assisted dying (VAD) research, to identify the representation of Australians living with dementia., Methods: A scoping review of peer-reviewed literature to examine which stakeholders are represented in Australian VAD research was conducted. This review was informed by the Arksey and O'Malley Framework for Scoping Reviews, and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR). Searches were conducted systematically across key academic databases to gather Australian research articles written in English that were published between 2017 and August 2023., Results: After screening, 21 publications formed the dataset. Of the 21 publications, none of them represented Australians living with dementia. The voice of one person living with a terminal illness was included in a study of care partners, and four studies explored the views of community members. The most dominant voices in the dataset were health-care practitioners, who were represented in 16 studies., Conclusions: Australian VAD research is a contested space where all stakeholders with a relevant contribution to policy and practice must be represented in contemporary Australian research. As living experience experts with a wealth of experiential knowledge to contribute, the voices of people living with dementia need to be represented in future Australian VAD research through inclusive research design, to ensure a greater balance in stakeholder representation across the VAD literature., (© 2024 The Author(s). Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)

For a long time, ecological monitoring across Australia has utilised a wide variety of different methodologies resulting in data that is difficult to analyse across place or time. In response to these limitations, a new systematic approach to ecological monitoring has been developed in collaboration between the Terrestrial Ecosystem Research Network and the Australian Department of Climate Change, Energy, the Environment and Water - the Ecological Monitoring System Australia (EMSA). A qualitative approach involving focus groups and semi-structured interviews was undertaken to review perceptions of the introduction of the EMSA protocols amongst Natural Resource Management practitioners and other key stakeholders. We found that environmental management stakeholders recognise there will be many advantages from the standardisation of ecological monitoring. However, key concerns emerged regarding the capacity needed to implement the standard protocols, the utility of the resultant data for regional projects, and the scope for adaptive co-management under the EMSA. Stakeholders emphasised the need for autonomy and flexibility, so their participation in protocol development can facilitate regional adoption of the standards. Respondents' concerns about a perceived lack of genuine consultation and acknowledgement of feedback revealed the importance of clear communication at all stages of an environmental management project aiming to standardise practices. Our findings indicate that reflexivity will be vital to address the complexity involved in standardisation of ecological monitoring. Formal processes of social learning will need to be integrated into environmental management approaches to account for the increasing complexity of socio-ecological systems as they are challenged by global change., (© 2024. The Author(s).)

This study explores the impact of sex on delays experienced by Australian military veterans in accessing advocacy support services within the veterans' non-profit sector. A detailed analysis of intake records from 150 injured veterans who entered the Returned and Services League of Australia's advocacy program in 2021 reveals significant disparities between male and female veterans in seeking assistance. On average, male veterans delay accessing support by 20.4 years post-service, compared to 9.1 years for female veterans. These prolonged delays hinder veterans' ability to secure financial and medical support from the Department of Veterans' Affairs, limiting timely access to essential healthcare services. As a result, delays can exacerbate physical and psychological symptoms, impede recovery, and increase the risk of suicide. The findings provide valuable insights for international healthcare professionals on the influence of military culture and traditional masculine norms in shaping veterans' help-seeking behaviors. By understanding these dynamics, healthcare practitioners can develop targeted, sex-sensitive interventions that address specific barriers faced by male and female veterans. Ensuring timely access to advocacy support is crucial for improving health outcomes and reducing suicide risk in this vulnerable population.

Objectives: Mothers of young children are at-risk for low physical activity. Organised team sport provides additional social and mental health benefits above that of physical activity. To better understand engagement in team sport, this study aimed to apply the theory of planned behaviour, with the addition of maternal identity and social support., Design: A prospective two-part online study was conducted two weeks apart to collect data from 122 mothers in Australia (M = 32.22, SD = 4.42)., Methods: Two hierarchical multiple regression analyses were conducted to predict intention and engagement in team sports. A moderation was conducted to determine the effect of social support on the intention-behaviour relationship., Results: Results indicated that 65.1 % of the variance in intention was explained, with years since previously played (β = -0.17), attitudes (β = 0.20), subjective norms (β = 0.41), and perceived behavioural control (β = 0.16) being significant, and level of team sport social support, and maternal identity being non-significant. Additionally, 65.7 % of the variance in behaviour was explained, with perceived behavioural control (β = 0.28) and intention (β = 0.50) being significant, and years since previously played and social supportbeing non-significant. Social support moderated the relationship between intention and engagement, such that social support facilitated engagement., Conclusions: The findings show support for the predictive ability of the theory and mothers within a sporting context. Behaviour change techniques related to strengthening intention and personal agency could be used to inform interventions intending to increase team sports participation., Competing Interests: Declaration of interest statement None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: This explorative cross-country qualitative study aims to describe experiences of receiving a dementia diagnosis and experiences of support following a diagnosis in Australia, Canada, the Netherlands and Poland., Method: Qualitative study using projective techniques during online focus groups, online and telephone interviews with people with dementia and caregivers., Results: Twenty-three people with dementia and 53 caregivers participated. Qualitative content analysis revealed five themes; (1) 'Coming to terms with dementia' helped people deal with complex emotions to move forward. (3) 'The social network as a source of support' and (4) 'The challenges and realities of formal support' and impacted 'Coming to terms with dementia'. (2) 'Navigating life with dementia as a caregiver' highlights caregiver burden and was impacted by (4) 'The challenges and realities of formal support'. People were (5) 'Self-caring and preparing for tomorrow' as they focused on maintaining current health whilst planning the future. Despite differences in healthcare and post-diagnostic support systems, there were more similarities across countries than differences., Conclusion: Across countries, formal support and support from friends and family are crucial for people with dementia and caregivers to come to terms with dementia and maintain carer wellbeing to ultimately live well with dementia.

People on the autism spectrum can learn about autism from various sources, likely differing in the information, portrayal, and discussion they offer. The present study investigates where autistic people learn about autism, and whether their information source is associated with their level of autism knowledge, perceptions of stigma, and development and expression of an autism identity. A survey of 198 Australian adults with an autism diagnosis showed that learning about autism from conventional sources (e.g., professionals, parents) was associated with more internalised stigma, lower endorsement of special abilities and autism identity, whereas online blogs and social media showed the opposite pattern as well as more accurate knowledge of autism. The findings raise questions about how authoritative sources of information discuss autism., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Children's mental health status (MHS) is frequently influenced by their primary carers (PCs), underscoring the significance of monitoring disparities longitudinally. This research investigated the association between socio-demographic clusters and mental health trajectories among children and their PCs over time. Data from waves 6-9c2 of the Longitudinal Study of Australian Children (LSAC) were analyzed using Latent Class Analysis (LCA) to identify four socio-demographic classes among children aged 10-11 years at wave 6. Multinomial logistic regression and predictive marginal analysis explored associations between classes and mental health outcomes. PCs in Class 4 (disadvantaged and separated families with indigenous children) exhibited higher odds of borderline and abnormal MHS compared to Class 1 (prosperous and stable working families) across all waves. However, while MHS of PCs' impacted children consistently, the association with socio-demographic classes was significant only in wave 6. Class 4 children had elevated risks of mental illness compared to Class 1, while Class 3, characterized by educated working mothers, had lower risks. Reducing mental health risks entails addressing socio-economic disparities, supporting stable family structures, and offering tailored interventions like counseling and co-parenting support. Longitudinal monitoring and culturally sensitive approaches are crucial for promoting mental well-being across diverse groups., (© 2024 The Author(s). Applied Psychology: Health and Well‐Being published by John Wiley & Sons Ltd on behalf of International Association of Applied Psychology.)

Introduction: Ongoing improvement to residential treatment for substance use disorders is critical as it typically targets people with the highest need. Assessing multiple recovery indicators, such as cravings and mental health, at intake and following discharge is important in evaluating treatment effectiveness. To refine services, research should explore whether there are subgroups of individuals with different patterns of recovery following treatment., Methods: Participants (n = 554) were attending Australian Salvation Army residential treatment services for substance use issues. Data were collected by surveys at intake and 3-month post-discharge ('early recovery'). Recovery indicators were cravings, confidence to resist substance use and the Depression, Anxiety and Stress Scale. Subgroups of individuals based on these recovery indicators ('profiles') were identified using repeated measures latent profile analysis., Results: Five profiles were identified, three profiles improved over time (81.4%) and two (18.6%) deteriorated across all indicators. These two profiles had the poorest mental health and addiction scores at intake and reported shorter time in treatment compared to the three profiles showing improvement. There were no demographic or substance type differences between profiles., Discussion and Conclusions: By considering initial severity and multiple recovery indicators at early recovery, this study suggests that individuals at-risk of poor early recovery can be identified at intake. This opens opportunities for tailored treatment approaches to address both mental health and substance use, thereby potentially improving treatment outcomes and reducing the risk of relapse., (© 2024 The Author(s). Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background and Objectives: Chronic breathlessness is a frequent diagnostic challenge in primary care. Our aim is to evaluate the feasibility of a stepwise breathlessness diagnostic algorithm for primary care., Method: This mixed-methods study included: (1) a general practitioner (GP) nominal group technique study; (2) focus groups on GPs' views on the algorithm; and (3) analysis of algorithm alignment against patterns of diagnostic referrals and diagnoses of breathlessness presentations (2014-19) from the MedicineInsight primary care electronic health record (EHR) dataset of 1,961,264 patients (405 general practice sites)., Results: All the tests in our algorithm, except for echocardiography, were ranked in the top 10 tests used by most GPs for patients presenting with chronic breathlessness. Themes from the focus group include similarity with current practice and test accessibility. Analysis of EHR diagnostic referrals revealed that all tests in the algorithm are regularly utilised and covered the major tests needed for breathlessness diagnoses recorded., Discussion: The results of the three studies support the acceptability and feasibility of the clinical algorithm in primary care.

Background: Respiratory syncytial virus (RSV) is a major cause of respiratory illness, with younger infants at greatest risk of hospitalisation. With the recent approval of a maternal RSV vaccine in Australia, it is timely to evaluate its potential costs and health benefits in Australia., Methods: We applied an integrated dynamic and economic evaluation model to estimate specific outcomes of RSV disease and the cost-effectiveness of a year-round maternal RSV vaccination program in Australia. Cost-effectiveness was estimated using the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained., Results: From a healthcare system perspective, the maternal vaccination program was estimated to be cost-effective at a vaccine price less than approximately 120 Australian dollars ($AU), assuming a willingness-to-pay (WTP) threshold of $AU 50,000/QALY gained. Most of the estimated cost-savings were from preventing RSV hospitalisations in infants aged <6 months. However, while 82% of the cost-savings were from preventing RSV hospitalisations in infants aged <6 months, only about 25% of the QALY gains were in this age group. The majority of the other QALY gains came via herd effects from prevention of death in older adults and to a lesser extent, prevention of nonmedically-attended illness in older teens and adults. When predicted cost-savings and QALY gains in those ≥6 months of age were excluded, the vaccine price required to meet the assumed WTP threshold fell to $AU 63., Conclusions: A maternal RSV vaccination program in Australia could provide value for money by reducing hospitalisations and associated costs among infants aged <6 months, depending on the vaccine price. We have provided evidence that herd effects beyond the target population may be an important consideration in assessing cost-effectiveness of maternal RSV vaccination., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Allen Nazareno reports financial support was provided by University of New South Wales School of Population Health. James Wood reports a relationship with Australian Technical Advisory Group that includes: board membership. Alexandra Hogan reports a relationship with World Health Organization Immunization and vaccines related implementation research advisory committee (IVIR-AC) that includes: board membership. Alexandra Hogan reports a relationship with National Health and Medical Research Council that includes: funding grants. David Muscatello reports a relationship with National Health and Medical Research Council that includes: funding grants. Anthony Newall reports a relationship with Center for Innovation and Value Research that includes: funding grants. Nusrat Homaira reports a relationship with Sanofi, Pfizer and Merck Sharp & Dohme Australia that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Improving support options for people who use methamphetamine is of critical national and global importance. The role of mutual-help groups within the treatment-seeking journey of people who use methamphetamine is unclear. Self-Management and Recovery Training ('SMART Recovery') mutual-help groups are led by a trained facilitator and support participants to work on individual goals, including, but not limited to abstinence. This study examined how people who use methamphetamine came to be involved in SMART Recovery mutual-help groups and factors associated with engagement., Methods: A sample of Australian SMART Recovery participants who self-reported using methamphetamine in the preceding 12-months (n = 18) discussed their history of substance use and experience of service provision in a semi-structured telephone interview. Interviews were audio-recorded, transcribed, and analysed using iterative categorization., Results: Participant initiation of SMART Recovery groups was described across two themes: i) delayed attendance and ii) use as an adjunct to other services. Factors associated with engagement were discussed in terms of: i) the 'fit' of SMART Recovery mutual-help groups; ii) coping and tolerance of discomfort; iii) the power of shared lived experience; iv) choice and autonomy; and v) short-term goal setting supports self-efficacy and the possibility of change., Discussion and Conclusions: SMART Recovery mutual-help groups show promise for engaging people who use methamphetamine. There is a clear need to improve awareness of mutual-help group options amongst service users, providers and the general community. Offering choice over mutual-help groups may help to engage people earlier and support improved linkage between services., Competing Interests: Declaration of competing interest No financial conflict of interest exists. At the time of the study authors AKB, BL, VM, FPD, ALB, LH, and PJK all volunteered as members of the SMART Recovery Australia Research Advisory Committee and AA was employed by SMART Recovery Australia as the National Program Manager and Trainer., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Vaping among 18-24-year-old Australians has increased from 5.8% in 2019 to 21% in 2023. This protocol describes a trial to investigate the dissemination and engagement achieved by three anti-vaping messages on Facebook., Methods: This research employs a 3-arm randomised experimental design. Three distinct anti-vaping messages will be disseminated via Facebook using Meta Ads Manager. Each arm has a message that focuses on either health risks, environmental impact, or anti-vape industry sentiment. The campaign will run for three months. The primary outcome is the engagement rate as a measure of the effectiveness of anti-vaping message, and the secondary outcomes include network indicators: size, density, centralisation, and centrality to evaluate the extent to which the messages are disseminated. Participants will be randomly exposed to one of the three messages. Data on reach and engagement will be compared across the groups., Discussion: This study will provide insights into the dissemination of social media-based anti-vaping campaigns. By evaluating engagement rates and network indicators, the research aims to identify which message themes engage most with young Australians. The findings will contribute to the development of more effective public health strategies for vaping cessation and prevention among youth., Trial Registration: The study was registered on July 19th 2024 with the Australian New Zealand Clinical Trials Registry (ACTRN12624000885594)., (© 2024. The Author(s).)

Background: Digital, or eHealth, interventions are highly promising approaches to help adolescents improve their health behaviours and reduce their risk of chronic disease. However, they often have low uptake and retention. There is also a paucity of high-quality research into the predictors of eHealth engagement, and a lack of studies that have systematically evaluated existing engagement strategies in adolescent populations. This paper describes the protocol for a randomised controlled trial which primarily aims to assess the effectiveness of different strategies in increasing engagement with a healthy lifestyles app, Health4Life. Associations between the engagement strategies and improvements in adolescent health behaviours (healthy eating, physical activity, sleep, recreational screen time, smoking, alcohol use) will also be examined, along with potential predictors of adolescents' intentions to use health apps and their use of the Health4Life app., Methods: The current study will aim to recruit 336 adolescent and parent/guardian dyads (total sample N = 672) primarily through Australia wide online advertising. All adolescent participants will have access to the Health4Life app (a multiple health behaviour change, self-monitoring mobile app). The trial will employ a 2 4 factorial design, where participants will be randomly allocated to receive 1 of 16 different combinations of the four engagement strategies to be evaluated: text messages, access to a health coach, access to additional gamified app content, and provision of parent/guardian information resources. Adolescents and parents/guardians will both complete consent processes, baseline assessments, and a follow-up assessment after 3 months. All participants will also be invited to complete a qualitative interview shortly after follow-up. The primary outcome, app engagement, will be assessed via an App Engagement Index (Ei) using data collected in the Health4Life app and the Mobile App Rating Scale - User version., Discussion: This research will contribute significantly to building our understanding of the types of strategies that are most effective in increasing adolescents' engagement with health apps and which factors may predict adolescents' use of health apps., Trial Registration: The trial is registered at the Australian New Zealand Clinical Trials Registry (ACTRN12623000399695). Date registered: 19/04/2023., (© 2024. The Author(s).)

Issue Addressed: While social determinants frameworks are still popular in research about First Nations health in Australia, a growing body of research prefers cultural determinants of health models. Cultural determinants models provide a holistic, strength-based framework to explain connections between health and contextual factors, including the potential role of music and its impact on social and emotional well-being. Given the growing international recognition of links between music, health, and wellbeing through bodies such as the World Health Organisation, this article examines whether and how music practices are acknowledged in First Nations determinants of health literature., Methods: We conducted a scoping narrative review of literature from five databases: Scopus, PsycInfo, CINAHL, PubMed and ProQuest Central. The search returned 60 articles published since 2017, which we analysed in NVivo for common themes., Results: Music was only explicitly identified as a determinant of health in two studies. Yet, participants in five studies identified music and song as directly impacting their social and emotional well-being. When we broadened our frame of analysis to include other forms of expressive cultural practice, one quarter of included studies empirically acknowledged the role of expressive cultural practice for social and emotional well-being., Conclusion: While many recent studies identify the impact of First Nations' expressive practices broadly, they miss important features of First Nations music as a potentially unique cultural, social, political and ecological determinant of health. SO WHAT?: There is an opportunity for future research and health determinant modelling to explicitly examine the role of First Nations music and other creative practices for social and emotional well-being., (© 2024 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

As breast screening services move towards use of healthcare AI (HCAI) for screen reading, research on public views of HCAI can inform more person-centered implementation. We synthesise reviews of public views of HCAI in general, and review primary studies of women's views of AI in breast screening. People generally appear open to HCAI and its potential benefits, despite a wide range of concerns; similarly, women are open towards AI in breast screening because of the potential benefits, but are concerned about a wide range of risks. Women want radiologists to remain central; oversight, evaluation and performance, care, equity and bias, transparency, and accountability are key issues; women may be less tolerant of AI error than of human error. Using our recent Australian primary study, we illustrate both the value of informing participants before collecting data, and women's views. The 40 screening-age women in this study stipulated four main conditions on breast screening AI implementation: 1) maintaining human control; 2) strong evidence of performance; 3) supporting familiarisation with AI; and 4) providing adequate reasons for introducing AI. Three solutions were offered to support familiarisation: transparency and information; slow and staged implementation; and allowing women to opt-out of AI reading. We provide recommendations to guide both implementation of AI in healthcare and research on public views of HCAI. Breast screening services should be transparent about AI use and share information about breast screening AI with women. Implementation should be slow and staged, providing opt-out options if possible. Screening services should demonstrate strong governance to maintain clinician control, demonstrate excellent AI system performance, assure data protection and bias mitigation, and give good reasons to justify implementation. When these measures are put in place, women are more likely to see HCAI use in breast screening as legitimate and acceptable., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

COVID-19 has changed the world in many ways, and while some families were divided by geographical distances and mandatory "stay-at-home" orders during lockdowns, others became fractured owing to decisions about vaccination. This novel exploratory qualitative study questions how family systems and COVID-19 attitudes influenced the vaccine decisions of 10 Australian First Nations individuals. Despite the significance of family in decision making, the advice of respected family members became insignificant when nonvaccination resulted in the undesirable consequences of coercive government mandates. The thematic analysis identifies themes of choice, repeated wrongs of the past, trust, relationships, isolation, and parenting anxiety. It also demonstrates the resiliency of First Nations families, evident in the creative ways family systems adapted during the pandemic. This study has implications for governments and health service planning toward community COVID-19 support systems in a postpandemic context and provides ideas for further research into First Nations service provision during health crises. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This article reports on promising pilot research which indicates that intergenerational musical practices in diverse First Nations families and communities in Vanuatu and Australia can shape cultural determinants of health (CDoH). We contend that such strength- and culture-based approaches to health promotion may help to disrupt colonial and deficit constructions of First Nations People and our health and wellbeing. The pilot study used Indigenist yarning which prioritized First Nations ideas, concepts, and knowledges during informal and relational semi-structured interviews with 9 diverse First Nations musicians in Australia and Vanuatu. The pilot study underpins an ongoing international 3-year research project examining First Nations music as a determinant of health led by Griffith University, The University of the Sunshine Coast, The University of Queensland, and Edith Cowan University. Yarning interviews were analyzed using collaborative thematic analysis and Indigenous visual art responses. Major themes emerging from the data related to intergenerational music activity and transmission. Themes include Music as an intergenerational medium of cultures; Music as a bond between older and younger generations; Intergenerational musical activism and advocacy; and Musical lineages and strengths. Intergenerational musical practices in diverse First Nations families may provide protective cultural, social, economic, educative, and professional determinants of health. The study indicates that more research and new theory may unlock the potential of First Nations musical activities as protective and agentic cultural practices in our families and communities., Competing Interests: The authors declare no other conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Spiritual wellbeing is known to be a predictor of increased patient coping in hospital settings. Therefore, access to a valid and reliable measure of spiritual wellbeing amongst general hospital patients is highly recommended. The aim of this study was to investigate the dimensionality, reliability, and validity of the Functional Assessment of Chronic Illness Therapy Spiritual Wellbeing scale (FACIT-Sp-12) in a heterogeneous cohort of hospital patients. A cross-sectional survey was administered to 897 adult patients across six hospitals in Sydney, Australia. Confirmatory factor analysis for the three-factor FACIT-12-Sp indicated a poor fit, but after removal of Item 12, the three-factor FACIT-11-Sp presented a good fit to the data. Reliability testing indicated acceptable to good internal consistency. Validity was supported by statistically significant differences between patients who considered themselves 'both spiritual and religious' and 'not religious or spiritual'. While some caution should be taken when using the FACIT-Sp due to several limitations, nevertheless, in a general hospital population in Australia, the three-factor FACIT-11-Sp indicated good dimensionality, reliability, and validity., (© 2024. The Author(s).)

Issue Addressed: Dietary intake and physical activity behaviours of many Australian children are not meeting recommendations, particularly for those living in socioeconomically disadvantaged circumstances. This study aimed to design and assess the feasibility and acceptability of a suite of narrative videos and text messages focused on healthy eating and physical activity behaviours appropriate for parents of young children from socioeconomically disadvantaged backgrounds., Methods: Parents of 1-5-year-old children (n = 6) were recruited to develop a suite of 12 narrative videos on healthy eating and physical activity behaviours, underpinned by theory. Twelve complementary text messages were subsequently developed. A different group of parents (n = 16) recruited from socioeconomically disadvantaged areas reviewed the videos and text messages over 6 weeks and provided feedback via surveys and qualitative interviews (n = 13)., Results: There was a high level of engagement with and acceptability of the videos and text message content. Participants found the videos easy to access and they liked the narrative style. Screen time videos and text messages relating to screen time, play and physical activity, role modelling and fussy eating were most useful., Conclusions: Narrative style healthy eating, physical activity and screen time videos and complementary text messages were highly acceptable to the sample of parents of 1-5-year-old children from socioeconomically disadvantaged areas recruited from the Illawarra Shoalhaven region of NSW, Australia. SO WHAT?: Short narrative style videos and text messages are an easy to process and acceptable method of delivering healthy lifestyle promotion content to parents., (© 2023 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Introduction: People living with young-onset dementia and their care-partners are at risk of a range of adverse mental health outcomes and social isolation. There are few interventions aimed at supporting couples affected by young-onset dementia, which poses unique psychosocial challenges for younger people., Methodology: This pre-post interventional mixed methods pilot study aimed to assess the feasibility and acceptability of an online group program for people with young-onset dementia and their care-partners living at home in Australia. The Music And Psychology and Social connections (MAPS) program aimed to address: (1) the challenges and changes associated with young-onset dementia; and (2) coping and wellbeing. The program involved six weekly two-hour sessions co-facilitated by a psychologist and music therapist, and a private Facebook group. The primary outcomes of feasibility and acceptability were assessed through a post-program focus group, separate individual feedback sessions with each couple, and a program evaluation questionnaire. Thematic analysis was conducted on the focus group transcripts and field notes from couple feedback sessions. We also examined the preliminary utility of MAPS in improving mental health and social connectedness, using quantitative pre-post-measures., Results: Five couples completed the MAPS program. The most common dementia type was Alzheimer's Disease. Participant attendance was 87% across all sessions. Qualitative findings supported acceptability of the program with four emergent themes: being connected to others with shared experiences; reframing thoughts and feelings about dementia; music as a therapeutic tool; and benefits of MAPS., Conclusion: The high retention rate, qualitative findings and positive program evaluation suggest MAPS may be a promising, feasible and acceptable program for couples affected by young-onset dementia., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: To explore patient and family narratives about their recognition and response to clinical deterioration and their interactions with clinicians prior to and during Medical Emergency Team (MET) activations in hospital., Background: Research on clinical deterioration has mostly focused on clinicians' roles. Although patients and families can identify subtle cues of early deterioration, little research has focused on their experience of recognising, speaking up and communicating with clinicians during this period of instability., Design: A narrative inquiry., Methods: Using narrative interviewing techniques, 33 adult patients and 14 family members of patients, who had received a MET call, in one private and one public academic teaching hospital in Melbourne, Australia were interviewed. Narrative analysis was conducted on the data., Results: The core story of help seeking for recognition and response by clinicians to patient deterioration yielded four subplots: (1) identifying deterioration, recognition that something was not right and different from earlier; (2) voicing concerns to their nurse or by family members on their behalf; (3) being heard, desiring a response acknowledging the legitimacy of their concerns; and (4) once concerns were expressed, there was an expectation of and trust in clinicians to act on the concerns and manage the situation., Conclusion: Clinical deterioration results in an additional burden for hospitalised patients and families to speak up, seek help and resolve their concerns. Educating patients and families on what to be concerned about and when to notify staff requires a close partnership with clinicians., Implications for the Profession And/or Patient Care: Clinicians must create an environment that enables patients and families to speak up. They must be alert to both subjective and objective information, to acknowledge and to act on the information accordingly., Reporting Method: The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting., Patient or Public Contribution: The consumer researcher was involved in design, data analysis and publication preparation., (© 2024 The Author(s). Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia., Methods: Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19-30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels., Results: Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information., Conclusions: Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks., (© 2024. The Author(s).)

The dingo is a wild dog endemic to Australia with enigmatic origins. Dingoes are one of two remaining unadmixed populations of an early East Asian dog lineage, the other being wild dogs from the New Guinea highlands, but morphological connections between these canid groups have long proved elusive. Here, we investigate this issue through a morphometric study of ancient dingo remains found at Lake Mungo and Lake Milkengay, in western New South Wales. Direct accelerated mass spectrometry (AMS) radiocarbon dates from an ancient Lake Mungo dingo demonstrate that dingoes with a considerably smaller build than the predominant modern morphotype were present in semi-arid southeastern Australia c.3000-3300 calBP. 3D geometric morphometric analysis of a near-complete Mungo cranium finds closest links to East Asian and New Guinean dogs, providing the first morphological evidence of links between early dingoes and their northern relatives. This ancient type is no longer extant within the range of modern dingo variability, but populations from nearby southeastern Australia show a closer resemblance than those to the north and west. Our results reaffirm prior characterisations of regional variability in dingo phenotype as not exclusively derived from recent domestic dog hybridisation but as having an earlier precedent, and suggest further that the dingo's phenotype has changed over time., (© 2024. The Author(s).)

Objective: To examine the impact of breathlessness on quality of life, health care use, productivity loss, and economic costs in Australia., Study Design: National internet-based survey of Australian adults drawn from a web-based survey panel (National Breathlessness Survey)., Participants, Setting: Australian adults (18 years or older), nationally representative by age group, gender, state of residence, and postcode-based socio-economic status (Index of Relative Socioeconomic Disadvantage quintile), 13-30 October 2019., Main Outcome Measures: Quality of life assessed with the EQ-5D 5-level version (EQ-5D-5L) and visual analogue scale (EQ-VAS), health care use, productivity loss, and societal cost, each by severity of breathlessness (modified Medical Research Council [mMRC] dyspnoea scale; mMRC grade 1: mild breathlessness; mMRC grades 2-4: clinically important breathlessness)., Results: Of 10 072 adults who completed the survey, mild breathlessness was reported by 3044 respondents (30.2%), and clinically important breathlessness by 961 (9.5%). The mean EQ-VAS score was 74.8 points (95% confidence interval [CI], 74.3-75.3 points) and the mean EQ-5D-5L score 0.846 (95% CI, 0.841-0.850) for respondents with mMRC grade 0 breathlessness; for each measure, the mean value declined with increasing severity of breathlessness (trends: each P < 0.001). Respondents with clinically important breathlessness were more likely than those with mild breathlessness to report non-urgent general practitioner visits, urgent general practitioner visits, and specialist visits (exception: mMRC scores of 4) during the preceding year. Among the 2839 respondents of working age, the likelihood of being employed declined with increasing breathlessness severity (mMRC grades 4 v 1: adjusted odds ratio, 0.34; 95% CI, 0.22-0.53). Adjusted mean annual societal cost per person was $1413 (95% CI, $1326-1501) for respondents with mMRC grade 1 breathlessness, $2065 (95% CI, $1766-2365) at mMRC grade 2, $1795 (95% CI, $1371-2218) at mMRC grade 3, and $2075 (95% CI, $1389-2762) at mMRC grade 4., Conclusion: Breathlessness imposes major burdens on individuals, the health care system, and the economy., (© 2024 The Author(s). Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Introduction: Harms arising from alcohol and other drug (AOD) use are disproportionately felt by men living in rural locations. The detrimental impact of AOD use is compounded by a range of barriers to help-seeking. Online recovery support services (including mutual-help groups) are increasingly used to reach people who might not otherwise seek support for AOD use. Scant research examines the experiences of men attending online mutual-help groups, with the little available evidence focused on 12-step approaches and people living in urban areas. This short communication compared the characteristics and experiences of rural and urban men attending online Self-Management and Recovery Training (SMART Recovery) mutual-help groups in Australia., Methods: A link to a voluntary online questionnaire was automatically provided at the end of each online group as part of routine data collection. Questions assessed participants' demographics, main reason for attending, engagement, experiences and perceived utility of the group. This study is a secondary analysis examining data provided by male attendees located in rural (n=259) and urban (n=996) areas., Results: Alcohol use for both rural and urban attendees (73% v 66.8%) was the most frequently reported reason for attending SMART Recovery groups. Rural attendees were older than their urban counterparts (p<0.001) and were less likely to endorse 'other' drug use as a reason for attending (28.6% v 16.6%, p<0.001). Participants reported a high level of satisfaction with online SMART Recovery groups. No significant differences were found between the two groups. Rural and urban men reported that they felt welcome (93.1% v 95.1%) and supported (90% vs 92.5%), had the opportunity to contribute to discussions (91.5% v 92.1%), and felt the group was well facilitated (91.1% v 94.4%). Rural and urban attendees also experienced the groups as helpful (88.8% v 91.8%), took away practical strategies (86.5% v 85.2%) and planned to continue to attend the groups in the future (91.1% v 92.3%). Around a quarter of rural (20.8%) and urban (27.0%) attendees experienced technical difficulties during the meeting., Discussion and Conclusion: This study contributes new knowledge regarding similarities and differences in the experience of online SMART Recovery groups from the perspective of men living in rural and urban areas. Despite around a quarter of participants experiencing technical difficulties, their self-reported engagement, experience and perceived utility of the online group were highly rated. Online recovery support services provide a promising option for reaching men who experience issues with their AOD use, particularly in rural areas where access to face-to-face services is limited.

Background: Children and families from priority populations experienced significant psychosocial and mental health issues to the COVID-19 pandemic. Yet they also faced significant barriers to service access, particularly families from culturally and linguistically diverse (CALD) backgrounds. With most child and family health nurse clinics ceasing in-person consultations due to the pandemic, many children missed out on health and developmental checks. The aim of this study was to investigate the perspectives and experiences of family members and service providers from an urban, CALD community regarding the implementation of a digital, developmental surveillance, Watch Me Grow-Electronic (WMG-E) program., Methods: Semi-structured interviews were conducted with 17 family members, service navigators, and service providers in a multicultural community in South Western Sydney, Australia. This qualitative study is an implementation evaluation which formed as part of a larger, two-site, randomised controlled trial of the WMG-E program. A reflexive thematic analysis approach, using inductive coding, was adopted to analyse the data., Results: Participants highlighted the comprehensive and personalised support offered by existing child and family health services. The WMG-E was deemed beneficial because the weblink was easy and quick to use and it enabled access to a service navigator who support family access to relevant services. However, the WMG-E was problematic because of technology or language barriers, and it did not facilitate immediate clinician involvement when families completed the weblink., Conclusions: Families and service providers in this qualitative study found that using WMG-E empowered parents and caregivers to access developmental screening and learn more about their child's development and engage with relevant services. This beds down a new and innovative solution to the current service delivery gap and create mechanisms that can engage families currently not accessing services, and increases knowledge around navigating the health and social care services. Notwithstanding the issues that were raised by families and service providers, which include accessibility challenges for CALD communities, absence of clinical oversight during screening, and narrow scope of engagement with available services being offered, it is worth noting that improvements regarding these implementation factors must be considered and addressed in order to have longevity and sustainability of the program., Trial Registration: The study is part of a large randomised controlled trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement., (© 2024. Crown.)

Background: Before the COVID-19 pandemic, stagnating life expectancy trends were reported in some high-income countries (HICs). Despite previous evidence from country-specific studies, there is a lack of comparative research that provides a broader perspective and challenges existing assumptions. This study aims to examine longevity trends and patterns in six English-speaking countries (Australia, Canada, Ireland, New Zealand, United Kingdom, United States) by combining period and cohort perspectives and to compare them with other HICs., Methods: Using data from the Human Mortality and World Health Organization Mortality Databases, we estimated partial life expectancy, lifespan inequality and cohort survival differences for 1970-2021, as well as the contribution of causes of death to the gap in life expectancy between English-speaking countries and the average for other HICs in 2017-19., Results: In the pre-pandemic period, the increase in life expectancy slowed in all English-speaking countries, except Ireland, mainly due to stagnating or rising mortality at young-middle ages. Relative to other HICs, those born in Anglophone countries since the 1970s experienced relative survival disadvantage, largely attributable to injuries (mainly suicides) and substance-related mortality (mainly poisonings). In contrast, older cohorts enjoyed advantages for females in Australia and Canada and for males in all English-speaking countries except the United States., Conclusions: Although future gains in life expectancy in wealthy societies will increasingly depend on reducing mortality at older ages, adverse health trends at younger ages are a cause for concern. This emerging and avoidable threat to health equity in English-speaking countries should be the focus of further research and policy action., (© The Author(s) 2024. Published by Oxford University Press on behalf of the International Epidemiological Association.)