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Purpose: To examine associations between exercise heart rate (HRex) during a continuous-fixed submaximal fitness test (CF-SMFT) and an intermittent-variable protocol (semistandardized kicking drill [SSD]) in Australian Football athletes, controlling for external intensities, within-session scheduling, and environmental conditions. Methods: Forty-four professional male Australian Football athletes (22.8 [8.0] y) were monitored over 10 sessions involving a 3-minute CF-SMFT (12 km·h−1) as the first activity and a SSD administered 35.7 (8.0) minutes after the CF-SMFT. Initial heart rate and HRex were collected, with external intensities measured as average velocity (in meters per minute) and average acceleration–deceleration (in meters per second squared). Environmental conditions were sampled. A penalized hierarchical linear mixed model was tuned for a Bayesian information criterion minima using a 10-fold cross-validation, with out-of-sample prediction accuracy assessed via root-mean-squared error. Results: SSD average acceleration–deceleration, initial heart rate, temperature, and ground hardness were significant moderators in the tuned model. When model covariates were held constant, a 1%-point change in SSD HRex associated with a 0.4%-point change in CF-SMFT HRex (95% CI, 0.3–0.5). The tuned model predicted CF-SMFT HRex with an average root-mean-squared error of 2.64 (0.57) over the 10-fold cross-validation, with 74% and 86% of out-of-sample predictions falling within 2.7%-points and 3.7%-points, respectively, from observed values, representing the lower and upper limits for detecting meaningful changes in HRex according to the documented typical error. Conclusions: Our findings support the use of an SSD to monitor physiological state in Australian Football athletes, despite varied scheduling within session. Model predictions of CF-SMFT HRex from SSD HRex closely aligned with observed values, considering measurement imprecision. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine factors associated with participation of community-dwelling older Australians (≥65 years) in the Exercise Right for Active Ageing program, consisting of 12 low- to moderate-intensity group exercise classes, delivered weekly, in person or online, by accredited exercise scientists and physiologists across Australia. Out of 6,949 participants recruited, 6,626 (95%) attended one or more classes and were included in the primary analysis, and 49% of participants attended all 12 classes. Factors associated with higher class attendance included participation in yoga/flexibility/mobility classes, attendance at a free trial class (adjusted incidence rate ratio [95% confidence interval]: 1.05 [1.03, 1.08]), and attending online classes (1.19 [1.11, 1.26]). Factors associated with lower class attendance included state of residence, living in inner regional areas (0.95 [0.93, 0.98]), and having two or more comorbidities (0.97 [0.95, 0.99]). High class attendance suggests that the Exercise Right for Active Ageing program was well received by older Australians, particularly in states less impacted by COVID-19 lockdowns. [ABSTRACT FROM AUTHOR]

Context: Hip and groin injuries are common in field sports such as football, with measurement of hip strength and range of motion (ROM) recommended for assessment of these conditions. We aimed to report hip strength, hip ROM, and functional task performance in young elite Australian football athletes. Design: Cross-sectional study. Methods: Fifty-eight newly drafted Australian Football League athletes completed hip abduction, adduction, internal rotation, external rotation, and flexion strength testing with an adjustable stabilized or hand-held dynamometer. Hip internal rotation and external rotation, bent knee fall out, and ankle dorsiflexion ROM were also measured. Players completed hop for distance, side bridge, and star excursion balance functional tests. We compared findings between the dominant and nondominant limbs. Results: We found small deficits unlikely to be clinically meaningful in the dominant limb for hip abduction and adduction strength, and a small deficit in the nondominant limb for external rotation strength and side bridge time. Athletes had lower hip internal rotation (mean difference 2.56°; 95% confidence interval, 0.87 to 4.26) and total rotation ROM (2.03°; 95% confidence interval, 0.06 to 4.01) on the dominant limb. Conclusions: There were no meaningful differences between dominant and nondominant limbs for hip strength, ROM, or functional tests. Our results may be used for benchmarking young male Australian football athletes when targeting optimal strength and returning from injury. [ABSTRACT FROM AUTHOR]

Purpose: Quantifying training intensity provides a comprehensive understanding of the training stimulus. Recent technological advances may have improved the feasibility of using heart-rate (HR) monitoring in swimming. However, the implementation of HR monitoring is yet to be assessed longitudinally in the daily training environment of swimmers. This study aimed to assess the implementation of HR by comparing the training-intensity distribution from an external measure, planned volume at set intensities (PVSI), with the internal training-intensity distribution measured using time in HR zones. Methods: Using a longitudinal observational design, 10 competitive swimmers (8 male and 2 female, age: 22.0 [2.3] y, Fédération Internationale de Natation point score: 842.9 [58.5], mean [SD]) were monitored daily for 6 months. Each session, HR data, and coached-planned and athlete-reported session rating of perceived exertion (Modified Category Ratio 10 scale) were recorded. Based on previously determined training zones from an incremental step test, PVSI was calculated using the planned distance and planned intensity of each swim bout. Training-intensity distributions were analyzed using a linear mixed model (lme4). Results: The model revealed a small to moderate relationship between PVSI and time in HR zone, based on the Nakagawa R-squared value (range.14–.42). Conclusions: Training-intensity distribution differed between the internal measure (ie, HR) and the external measure of intensity (ie, PVSI). This demonstrates that internal and planned external measures of intensity cannot be used interchangeably to monitor training. Further research should explore how to best integrate these measures to better understand training in swimming. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to examine whether various athletic performances, anthropometric measures, and playing experience differentiate selected and nonselected ultimate Frisbee players trialing to compete in the world championship. Methods: Forty-three Australian male ultimate Frisbee players (age = 21.2 [1.2] y; height = 1.7 [6.8] m; body mass = 69.7 [8.2] kg; playing experience = 3.5 [1.5] y) participated in a 30-m sprint test, single-leg run-up jump approach (both left [JumpLL], and right leg [JumpRL]) and a stationary bilateral vertical jump (JumpBIL), and change-of-direction speed test. Following a selection camp, players were subdivided according to their selection or nonselection into the team. Results: A multivariate analysis of variance revealed that height, 10-m sprint time, acceleration, JumpLL, JumpRL, and JumpBIL were significantly greater for selected players than nonselected players (P <.05). Area under the curve (AUC) was greatest for JumpRL (AUC = 79%; optimal cutoff value of 37.5 cm, sensitivity and specificity values of 77% and 71%, respectively), JumpLL (AUC = 74%; optimal cutoff 38.5 cm, sensitivity and specificity values 77% and 77%, respectively), and JumpBIL (AUC = 78%; optimal cutoff value of 40.5 cm, sensitivity and specificity values 71% and 79%, respectively). The largest AUC (AUC = 81%; 95% CI 0.66–0.97; P =.001) was found when combining the explanatory variables that demonstrated moderate to large effect sizes (ie, height, playing experience, 10-m sprint, acceleration, JumpLL, JumpRL, and JumpBIL), with sensitivity of 93% and specificity of 71%. Conclusion: These athletic performance and anthropometric characteristics differentiating selected and nonselected players may help inform targeted training and player-development strategies. [ABSTRACT FROM AUTHOR]

Background: Most people diagnosed with dementia live and die in community settings. This study aimed to: (i) describe the palliative care needs of patients with dementia at commencement of community palliative care; (ii) compare palliative care needs between patients with dementia and those with lung cancer and cardiovascular disease (CVD). Methods: This is a population-based descriptive study that involved 8,727, 7,539 and 25,279 patients who accessed community palliative care across Australia principally because of dementia, CVD and lung cancer. Patients' functional abilities, symptom burden and clinical condition were assessed at commencement of community alliative care using five validated instruments: Resource Utilisation Groups—Activities of Daily Living, Australia-modified Karnofsky Performance Status, Symptoms Assessment Scale, Palliative Care Problem Severity Score and Palliative Care Phase. We fitted ordinal logistic regression models to examine the differences in these assessments for dementia versus CVD and lung cancer, respectively. Results: Overall, patients with dementia generally had low levels of distress from symptoms but poor functional problems. Compared to the other two diagnostic groups, palliative care for dementia was often initiated later and with shorter contacts. Also, patients with dementia presented with poorer functional performance (adjusted OR (aOR) = 4.02, Confidence Interval (CI): 3.68 – 4.38 for dementia vs CVD; aOR = 17.59, CI: 15.92 – 19.44 for dementia vs lung cancer) and dependency (aOR = 5.68, CI: 5.28 – 6.12 for dementia vs CVD; aOR = 24.97, CI: 22.77 – 27.39 for dementia vs lung cancer), but experienced lower levels of distress and problem severity for the majority of symptoms. Conclusion: Community palliative care is often an ideal care option for many patients, particularly for those with dementia. We call for expansion of the palliative care workforce and options for home care support to optimize accessibility of community palliative care for dementia. [ABSTRACT FROM AUTHOR]

Background Zygapophysial joints (Z joints) can be a source of back pain and of neck pain, but the cause of pain is not known. Some authors attribute the pain to osteoarthritis but without citing evidence. Objectives The present review was undertaken to determine if there was sufficient evidence of association between spinal pain and osteoarthritis of Z joints to justify osteoarthritis being held to be the cause of pain. The null hypothesis was that osteoarthritis of Z joints does not cause back pain or neck pain. Eligibility criteria Relevant studies were ones that provided primary data on the association between pain and osteoarthritis of Z joints. These could be population studies, diagnostic studies, or case-control studies. Sources of evidence The database of PubMed was searched using the terms: Lumbar or cervical, zygapophysial or facet, pain, and osteoarthritis or degeneration or degenerative. Charting methods Data pertinent to the research question were extracted from original articles and tabulated for reporting. Odds ratios for associations were calculated, as were the prevalence rates of osteoarthritis in subjects with pain, and conversely the prevalence rates of pain in subjects with osteoarthritis. Results The searches retrieved 11 population studies, 4 diagnostic studies, and 3 cases control studies. No study showed any positive association between osteoarthritis of Z joints and pain. All studies found pain to be independent of the presence or severity of osteoarthritis. Osteoarthritis was as common in subjects with no pain as in subjects with pain. The null hypothesis was not refuted. Conclusion The published evidence does not support the belief that osteoarthritis causes Z joint pain. All the evidence contradicts this belief. [ABSTRACT FROM AUTHOR]

Limited estimates exist on risk factors for epithelial ovarian cancer (EOC) in Asian, Hispanic, and Native Hawaiian/Pacific Islander women. Participants in this study included 1734 Asian (n  = 785 case and 949 control participants), 266 Native Hawaiian/Pacific Islander (n  = 99 case and 167 control participants), 1149 Hispanic (n  = 505 case and 644 control participants), and 24 189 White (n  = 9981 case and 14 208 control participants) from 11 studies in the Ovarian Cancer Association Consortium. Logistic regression models estimated odds ratios (ORs) and 95% CIs for risk associations by race and ethnicity. Heterogeneity in EOC risk associations by race and ethnicity (P  ≤ .02) was observed for oral contraceptive (OC) use, parity, tubal ligation, and smoking. We observed inverse associations with EOC risk for OC use and parity across all groups; associations were strongest in Native Hawaiian/Pacific Islander and Asian women. The inverse association for tubal ligation with risk was most pronounced for Native Hawaiian/Pacific Islander participants (odds ratio (OR) = 0.25; 95% CI, 0.13-0.48) compared with Asian and White participants (OR = 0.68 [95% CI, 0.51-0.90] and OR = 0.78 [95% CI, 0.73-0.85], respectively). Differences in EOC risk factor associations were observed across racial and ethnic groups, which could be due, in part, to varying prevalence of EOC histotypes. Inclusion of greater diversity in future studies is essential to inform prevention strategies. This article is part of a Special Collection on Gynecological Cancers. [ABSTRACT FROM AUTHOR]

The association of air pollution and greenspace with respiratory pathogen acquisition and respiratory health was investigated in a community-based birth-cohort of 158 Australian children. Weekly nasal swabs and daily symptom-diaries were collected for 2-years, with annual reviews from ages 3-7-years. Annual exposure to fine-particulate-matter (PM2.5), nitrogen-dioxide (NO2), and normalised-difference-vegetation-index (NDVI) was estimated for pregnancy and the first 2-years-of-life. We examined rhinovirus, any respiratory virus, Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae detections in the first 3-months-of-life, age at initial pathogen detection, wheezing in the first 2-years, and asthma at ages 5-7-years. Our findings suggest that higher NDVI was associated with fewer viral and M. catarrhalis detections in the first 3-months, while increased PM2.5 and NO2 were linked to earlier symptomatic rhinovirus and H. influenzae detections, respectively. However, no associations were observed with wheezing or asthma. Early-life exposure to air pollution and greenspace may influence early-life respiratory pathogen acquisition and illness. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disabilities are at much higher risk of preventable deaths compared to the general community. However, studies identifying the cause of death in people with intellectual disability are generally based on one primary cause which is frequently attributed to the person's disability. Therefore, the aim of this study was to identify the most common associated causes that may have contributed to the deaths of Australians with intellectual or learning disabilities, particularly those that may be avoidable. Methods: Linked data that had previously been used to identify underlying causes of deaths were re‐analysed to determine other contributing causes of death in Australians with intellectual disabilities aged under 65 years who accessed disability services between July 2013 and June 2018. Findings: Two thousand three hundred and thirty‐three deaths occurred among 180,790 people with intellectual disability. Contributing causes of death with the greatest disparities compared to the general community were lung diseases due to external agents (adjusted rate ratio (RR) 70.6 (95% confidence interval [95% CI] 63.7–78.2), influenza and pneumonia (RR 18.3; 95% CI 16.4–20.4), and coronary heart disease (RR 3.3; 95% CI 2.8–3.8). Conclusions: Analysing all contributing causes of death in people with intellectual disabilities can ensure that the higher rates of preventable deaths in people with intellectual disability are identified and addressed earlier in the disability and health sectors. Accessible Summary: Only one major cause of a person's death is usually counted, but other information on contributing causes is often available.We used national data across Australia to look at contributing causes of death in people with intellectual or learning disabilities.Counting contributing causes of death is important because it can help to find ways that deaths of people with intellectual disabilities may be prevented.We found that people with intellectual disabilities were much more likely than other people to have contributing causes of death from lung infections, choking, flu and heart problems.Knowing that these causes happen more often in people with intellectual disabilities, can help health and disability services to identify these causes earlier and may prevent deaths. [ABSTRACT FROM AUTHOR]

Purpose: Emergency and disaster management planning is an emerging role with limited practical guidance on how it should be implemented by community, disability, health and rehabilitation service providers. This study examined the emergency preparedness of service providers and how they viewed their role and contributions to disaster risk reduction, including their capacity and willingness to facilitate preparedness planning with their clients. Materials and Methods: A questionnaire was developed and administered nationally. Descriptive statistics, multivariate regression analyses, and thematic analysis of open-ended questions provide insight on the knowledge, tools and training needs of service providers to contribute to preparedness of themselves and the people they support. Results: Facilitating emergency preparedness with people with disability was strongly associated with a high level of mental preparedness, household preparedness scores, and completion of Person-Centred Emergency Preparedness (P-CEP) training. Perceived lack of funding, insufficient tools, and exclusion of emergency planning from job descriptions were negatively associated with facilitating emergency preparedness with clients. Conclusions: Study findings lay the groundwork for development of the role and capabilities of individual service providers including the need to equip disability, health and rehabilitation service providers with training and tools to prepare themselves and the people they support for emergencies. IMPLICATIONS FOR REHABILITATION: Participation in emergency training such as psychological first aid, evacuation drills, and Person-Centred Emergency Preparedness (P-CEP) can increase the personal preparedness of service providers. Rehabilitation professionals are advised to develop their capabilities in emergency preparedness before facilitating emergency planning with their clients. Rehabilitation professionals should connect with their local emergency services to learn about disaster risks and preparedness actions they can take to increase personal emergency preparedness for themselves and their clients. [ABSTRACT FROM AUTHOR]

Background This study investigated how different spaces within multigenerational local parks are being used by older people and other age groups. Methods Observation of park visitors occurred in six Victorian parks one month after park refurbishment. Parks were classified into six spaces based on equipment/amenities and associated expected activity. Observations were summarized descriptively, and negative binomial regression models were used to examine the association between visitor counts and classified targeted areas. Results A total of 12 501 people visited the parks with 4.1% older visitors. The number of older visitors in each park area was consistently less than other age groups, with counts of older visitors being 50% less in mixed spaces (95% confidence interval [CI] 0.38, 0.65), 40% less in adult exercise equipment areas (95% CI 0.46, 0.77) and 59% less in walking paths (95% CI 0.31, 0.55). The number of older visitors engaging in physical activity were significantly greater in walking paths (incidence rate ratios 1.75; 95% CI 1.16, 2.64) compared with children's play spaces. Conclusion The number of visitors across different age groups varied significantly between the park targeted areas. Most spaces were mainly used by the intended target age group/user, with no particular area used by all age groups in similar proportions. [ABSTRACT FROM AUTHOR]

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

Most physical activity (PA) maintenance research has concerned adherence to small-scale interventions or infrequent observation in cohort studies. We analysed individual attendance trajectories and their drivers in a large-scale 'real-world' community-based weekly PA event (parkrun) cohort in Australia. Data were weekly attendance (walking/running) of 223 224 unique parkrun participants over their first 3 years of participation. An unweighted moving average of participation in the preceding 12 weeks from the 12th week since the first participation to the 156th week was calculated and submitted to a cluster analysis of attendance patterns. Association of individual- (demographic, personal parkrun performance) and site-level (aggregated site-level participant characteristics and area-level measures) covariates with cluster membership was estimated with multinomial logistic regression models. We identified four groups: Few-Timers (76.4%), Decliners (12.4%), Low Maintainers (6.9%) and High Maintainers (4.3%). In the first 12 weeks, attendances averaged 2, 6, 5 and 7.5 times for each cluster, respectively, and by 52 weeks, they were 0.17, 1.9, 3.4 and 7.6 times, respectively. Continuing participation (vs Few-Timers) was strongly associated with faster personal finish times, but slower performance at the site level. Higher running club/group membership at a participant's parkrun predicted higher odds of being a High Maintainer. Our identification of a Low Maintainer group shows a community-based initiative may sustain interest, despite not requiring continuous or near-continuous attendance. Where someone is placed 'in the pack' locally and degree of identification with others in the group may be bidirectionally associated with attendance, underscoring the importance of considering social environment of PA maintenance. [ABSTRACT FROM AUTHOR]

This study examined changes in physical and mental health quality-of-life and health services access before and after the onset of the COVID-19 pandemic among individuals of lower and higher socio-economic status (SES) in Australia. Difference-in-differences and logistic regression models were undertaken using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey and government data on COVID-19 lockdowns between January 2020 and February 2021. Individuals from higher SES reported larger decreases in mental health quality-of-life scores than those from lower SES after the onset of the pandemic. Those from lower SES reported less disruption with any health services (24.2% vs 30.4%; OR = 0.68; p  < 0.001), specifically dental services (8.2% vs 15.4%; OR = 0.51; p  < 0.001) and allied health services (5.9% vs 8.5%; OR = 0.60; p  < 0.001), compared with those from higher SES. Additional days under lockdown were associated with reduced access to all health services (OR = 1.19). Furthermore, long-term health conditions (higher SES: OR = 1.54) and scores indicative of poorer physical (lower SES: OR = 1.17; higher SES: OR = 1.07) and mental health (lower SES: OR = 1.16; higher SES: OR = 1.12) were associated with increased health services disruption. While individuals from higher SES were more likely than those from lower SES to experience greater relative declines in mental health and increased disruption with health services access, individuals with a greater apparent need for health services, regardless of SES, may have faced inequalities in accessing these services during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

'Healthy Youngsters, Healthy Dads' (HYHD) targets fathers to improve the health of their preschool-aged children. In a previous randomized trial, fathers and children experienced meaningful improvements in physical activity and eating behaviours. The next phase is to test the replicability and adaptability of HYHD when delivered in the community by trained facilitators. Fathers/father-figures and children aged 3–5 years were recruited from Newcastle, Australia into a 9-week, non-randomized trial with assessments at baseline, 10 weeks, and 12 months. The primary outcome was achievement of pre-registered targets for recruitment (≥ 96 dyads), attendance (≥ 70%), compliance (completing ≥ 70% of home-based tasks), fidelity (≥ 80% of content delivered as intended) and program satisfaction (≥ 4/5). Secondary outcomes included physical activity, nutrition, screen time and parenting measures. Process targets were surpassed for recruitment (140 fathers, 141 children), attendance (79% for fathers-only workshops, 81% for father–child sessions), compliance (80% of home-tasks completed), fidelity (99% for education, ≥ 97% for practical) and program satisfaction (4.8/5). Mixed effects regression models revealed significant effects in fathers for moderate-to-vigorous physical activity, co-physical activity, dietary intake and parenting practises, which were maintained at 12 months. Significant effects were also established for screen time at 10 weeks only. For children, significant effects were observed for screen time and dietary intake at 10 weeks, while effects on energy-dense, nutrient-poor foods and healthy, nutrient-dense core food intake were maintained at 12 months. Findings demonstrate the replicability and adaptability of HYHD when delivered in the community by local trained facilitators. Further investigation into how to optimally scale-up HYHD is warranted. [ABSTRACT FROM AUTHOR]

Purpose: This study examined maternal diet quality trajectories from pregnancy to 3.5 years postpartum and associated maternal factors. Methods: Data of 473 Australian women from the Healthy Beginnings Trial were used. A food frequency questionnaire collected dietary intake in pregnancy and 1, 2 and 3.5 years postpartum. Diet quality scores were calculated using the 2013 Dietary Guideline Index (DGI-2013) and RESIDential Environments Guideline Index (RDGI). Group-based trajectory modelling identified diet quality trajectories from pregnancy to 3.5 years postpartum. Multivariable logistic regression investigated factors associated with maternal diet quality trajectories. Results: Two stable trajectories of low or high diet quality were identified for the DGI-2013 and RDGI. Women who smoked had higher odds of following the low versus the high DGI-2013 (OR 1.77; 95%CI 1.15, 2.75) and RDGI (OR 1.80; 95%CI 1.17, 2.78) trajectories, respectively. Women who attended university had lower odds of following the low versus the high DGI-2013 (OR 0.41; 95%CI 0.22, 0.76) and RDGI (OR 0.38; 95%CI 0.21, 0.70) trajectories, respectively. Women who were married had lower odds of following the low versus the high DGI-2013 trajectory (OR 0.39; 95%CI 0.17, 0.89), and women who were unemployed had higher odds of following the low versus the high RDGI trajectory (OR 1.78; 95%CI 1.13, 2.78). Maternal age, country of birth, household composition and pre-pregnancy body mass index were not associated with diet quality trajectories. Conclusion: Maternal diet quality trajectories remained stable from pregnancy to 3.5 years postpartum. Women who smoked, completed high school or less, were not married or were unemployed tended to follow low, stable diet quality trajectories. [ABSTRACT FROM AUTHOR]

Objectives: Loneliness is common and becoming a public health concern. Although there is the clear evidence of the variable effect of temporal differences in loneliness (transient/situational and persistent/chronic) on health, their effect on dementia risk is unclear. This study aims to assess the effect of transient/situational and persistent/chronic loneliness on dementia risk. Method: Participants aged 55 years and older from the Hunter Community Study were recruited. Loneliness was measured using a single item measure. Dementia was defined as per International Classification of Disease—10 (ICD 10) codes. The Fine‐Gray subdistribution hazard model was performed to calculate dementia risk. Results: Of 1968 total participants with mean age of 66 years, (3%) 57 developed dementia and (7%) 135 died over the mean follow up of 10 years. Both persistent/chronic and transient/situational loneliness significantly increased the risk of all cause dementia in adjusted models (HR 2.74, 95% CI 1.11–6.88, p 0.03 and HR 2.35, 95% CI 1.21–4.55, p 0.01 respectively) with mean time to event of 9.7 years. Feeling lonely below the age of 70 years elevated the risk of dementia in later life (HR 4.01, 95% CI 1.40–11.50, p 0.01). Conclusions: Loneliness (both persistent/chronic and transient/situational) was associated with increased risk of all cause dementia, especially if loneliness was experienced before the age of 70 years. These results suggest that promoting coping strategies for loneliness especially in persons 70 years and younger may play a role in preventing dementia. [ABSTRACT FROM AUTHOR]

Aims: To describe the range of effects experienced due to the drinking of people respondents know and analyze risk and protective factors for harm from the drinking of partners and household members, other relatives and friends and co‐workers. Design, setting and participants: Surveys of 2574 participants' experiences were obtained from two samples: 1000 people responded to random digitally dialled Australian mobile calls and 1574 participants responded from the Life in AustraliaTM panel survey. Measurements: Respondents were asked whether they had been negatively affected in the previous 12 months by the drinking of persons they knew who were 'a heavy drinker or drank a lot sometimes' and the nature of these harms. Weighted logistic regressions were used to analyze differences in rates of key negative outcomes from known others' drinking by gender, age and socio‐economic status. Findings Almost two thirds [60.2%; 95% confidence interval (CI) = 57.7%–62.7%] of participants reported having heavy drinkers in their lives and 21.8% (95% CI = 19.8%–23.9%) reported being negatively affected by the drinking of people they knew well in some way. Participants reported a gamut of effects, including, most commonly, adverse social effects: having to transport relatives and friends who had been drinking, role failure and faults, being emotionally hurt or neglected, serious arguments, family problems, having to care for drinkers and verbal abuse. Less commonly, respondents reported physical or sexual harm, property damage, financial stress and threats from others' drinking. Women (odds ratio = 1.49; 95% CI = 1.13–1.95), younger people, rural, Australian‐born (vs. respondents born overseas in non‐English speaking countries) and more frequent drinkers were more likely to report harm from a drinker they knew than their counterparts after adjusting for other variables in the model. Conclusions: Australians appear to be commonly adversely affected by the drinking of people they know. Harms from known drinkers are more likely to be experienced by women than men, particularly from the people they live with and other relatives. [ABSTRACT FROM AUTHOR]

One of the most visible changes of the COVID-19 pandemic has been the swift and widespread adoption of telework. Existing knowledge on teleworking has been largely limited to employees from certain occupational groups who voluntarily engaged in telework, making it difficult to generalise prior findings. Using the Job-Demands Resources model as a theoretical framework, the objective of this study was to identify the job demands and job resources associated with telework satisfaction and telework performance during the pandemic. During a period of enforced teleworking during COVID-19 lockdown measures, this study surveyed employed individuals (N = 208) from Melbourne (Australia). Using ordinal logistic regression analyses, it was found that three job resources (home office comfort, technical support, and job security) were positively associated with both telework satisfaction and telework performance. Further, technical resources (job resource) was positively associated with telework satisfaction, whereas professional isolation (job demand) was negatively associated with telework satisfaction. During a mandated period of telework, this study identified several factors associated with important telework outcomes. As there has been a greater uptake of remote and hybrid working arrangements in Australia post-pandemic, these findings could help inform and optimise future telework policies. What is already known about this topic: Prior to the COVID-19 pandemic, teleworking was not a commonly used workplace practice. Existing knowledge on teleworking has been largely limited to employees from certain occupational groups who were interested in, and/or were able to engage in telework. The resulting selection bias might limit the generalisability of these findings to others with different abilities, preferences, and/or job types. What this topic adds: This study investigated the job demands and job resources associated with telework success during the COVID-19 pandemic. This study identified three job resources (home office comfort, technical support, and job security) associated with both telework satisfaction and telework performance. The findings from this study point to several telework environment, job, and organisational factors that managers and practitioners could consider when developing future telework guidelines within an Australian context. [ABSTRACT FROM AUTHOR]

Understanding the psychological wellbeing of people with cancer is a key component of assessment and intervention in quality cancer care. However, the unique experiences of rural cancer populations are less often explored than those from urban centres. The aim of this study was to perform a meta-analysis of Australian studies that compared the psychological wellbeing experiences of people with cancer from rural and urban locations. Five databases were searched, and 19 studies, involving 16,947 participants, assessing and comparing the psychological wellbeing of rural and urban populations with cancer were included. The analysis indicated that Australian rural cancer populations have greater odds of worse psychological wellbeing than those from urban areas (OR = 1.54, 95% CI [1.01, 2.35], p = 0.044). This disparity remains when cancer types are analysed separately, with a slightly smaller odds ratio for rural people with breast cancer (OR = 1.29, 95%CI [1.01, 1.64], p = 0.046) and a slightly larger odds ratio when cancers excluding breast cancer were reviewed (OR = 1.78, 95% CI [1.59, 2.01], p = <.001). Significant heterogeneity was found. Despite increasing emphasis in Australia on psychological wellbeing throughout the cancer journey, there remain significant disparities whereby rural people experience greater impacts upon their psychological wellbeing. The wellbeing of Australian rural populations with cancer remains an area in which clinical and political focus is imperative. Whilst screening is a necessary first step, additional clinical implications for improving rural access to appropriately skilled health professionals who provide oncology-specific assessment and intervention are suggested. What is already known: Cancer is a major public health issue, and its psychosocial impacts are substantial, not just on patients but on their families and the broader community. The prevalence of clinically significant psychological distress is higher amongst people with cancer than the general population. However, identification, treatment, and provision of psychological support is inconsistent across services and geographical areas, and notably lacking in rural areas. Disparities in screening, assessment and intervention for psychological wellbeing in people with cancer remain, despite the fact that systematic application of screening, appropriate referral, and intervention can improve quality of life and reduce healthcare costs associated with inpatient and outpatient cancer care. What this paper adds: This article extends outcomes from previous systematic reviews and analyses from Australia and internationally with the addition of meta-analytic methods. It was specifically designed to solely focus on Australian cancer populations. The results suggest that Australian rural populations with cancer may have anywhere from 30% to 70% greater odds of experiencing poorer psychological wellbeing than those from urban areas. This paper highlights ongoing disparities in rural psycho-oncology that may be impacting wellbeing outcomes from rural people in Australia, and urges psychologists, other health professionals, and policy-makers to proactively address these inequities with improved screening, assessment and intervention for their rural populations. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine which method to triage intensive care patients using chronic comorbidity in a pandemic was perceived to be the fairest by the general public. Secondary objectives were to determine whether the public perceived it fair to provide preferential intensive care triage to vulnerable or disadvantaged people, and frontline healthcare workers. Methods: A postal survey of 2000 registered voters randomly selected from the Australian Electoral Commission electoral roll was performed. The main outcome measures were respondents' fairness rating of four hypothetical intensive care triage methods that assess comorbidity (chronic medical conditions, long-term survival, function and frailty); and respondents' fairness rating of providing preferential triage to vulnerable or disadvantaged people, and frontline healthcare workers. Results: The proportion of respondents who considered it fair to triage based on chronic medical conditions, long-term survival, function and frailty, was 52.1, 56.1, 65.0 and 62.4%, respectively. The proportion of respondents who considered it unfair to triage based on these four comorbidities was 31.9, 30.9, 23.8 and 23.2%, respectively. More respondents considered it unfair to preferentially triage vulnerable or disadvantaged people, than fair (41.8% versus 21.2%). More respondents considered it fair to preferentially triage frontline healthcare workers, than unfair (44.2% versus 30.0%). Conclusion: Respondents in this survey perceived all four hypothetical methods to triage intensive care patients based on comorbidity in a pandemic disaster to be fair. However, the sizable minority who consider this to be unfair indicates that these triage methods could encounter significant opposition if they were to be enacted in health policy. What is known about the topic? Triage systems can be used to prioritise the order in which patients are treated in a pandemic, but the views of the general public on using chronic comorbidity as intensive care unit (ICU) triage criteria are unknown. What does this paper add? This Australian survey, conducted during the coronavirus disease 2019 pandemic, demonstrated that the majority of respondents perceived ICU triage methods based on comorbidity to be fair, but significant ethical issues exist. What are the implications for practitioners? It may be possible to develop an ICU triage protocol for future pandemics in Australia, but further research is required. [ABSTRACT FROM AUTHOR]

Objectives: In June 2020, modified‐release paracetamol (paracetamol‐MR) preparations were up‐scheduled from schedule‐2 (available in pharmacy) to schedule‐3 (available by request to a pharmacist only). The present study aims to ascertain whether up‐scheduling affected the frequency of paracetamol‐MR overdoses. Methods: This is a retrospective cohort study of two data sets from 1 June 2017 to 31 May 2022. Monash Health data were extracted using the diagnosis of paracetamol overdose coding and electronic medical records data. Calls regarding paracetamol‐MR overdoses to Victorian Poisons Information Centre (VPIC) were extracted from the Poisons centre call database. We used a quasi‐experimental research design with interrupted time series analysis to evaluate the immediate impact and change in trend of poisoning‐related calls and ED presentations before and after June 2020. The change in proportion of paracetamol‐MR cases in both databases was analysed using the Χ2 test. Results: The proportion of paracetamol‐MR cases in both data sets did not change. From Monash Health, there was no level change in monthly paracetamol‐MR overdose‐related presentations following re‐scheduling (rate ratio [RR] = 1.08, 95% confidence interval [CI] = 0.57–2.01). There was no change in monthly paracetamol‐MR overdose‐related calls to VPIC following re‐scheduling (RR = 1.05, 95% CI = 0.96–1.14). Conclusion: The proportion of paracetamol‐MR overdoses did not decrease after the up‐scheduling to S3. Similarly, the frequency of overdoses by month remained similar. Further limitations on access to paracetamol products may need to be considered. [ABSTRACT FROM AUTHOR]

Aims: To assess colposcopic performance and determine indicators for competency within the new Australian primary human papillomavirus (HPV) cervical screening program. Materials and methods: A retrospective observational study of 4542 women seen at The Royal Women's Hospital Colposcopy Clinic in Melbourne, from 1 December 2017 to 31 July 2020 after a higher‐risk cervical screening test (CST) result. Results: Histological CIN2+ was detected in 25.1% up to two years from first colposcopy visit (FCV). The majority (86.7%) of CIN2+ was detected early within the first six months of presentation. Biopsy rate overall was 96.1% with abnormal colposcopic impression. Of four colposcopists with a lower biopsy rate, only one was able to achieve this early detection rate. Biopsy was also taken in over 30% of cases with negative reflex cytology and normal colposcopy, with CIN2+ detected in 5.0% among positive HPV16/18 and 3.8% with non‐16/18 HPV. Positive predictive value of high‐grade colposcopic impression at FCV averaged 66.4% (range: 54.9–81.6% among our colposcopists) and is poorly correlated with early detection rate of CIN2+. Overall accuracy of colposcopy is 84.5% (range: 78.7–90.3%), buoyed by high true negative colposcopic predictions secondary to high rates of negative reflex cytology referral with the new screening algorithm and is also unlikely to be a useful colposcopy indicator. Conclusions: Early detection rate of CIN2+ within the first six months of presentation is a useful measure of colposcopy competency and we would encourage our National Cancer Screening Register to explore this with the participating colposcopists. [ABSTRACT FROM AUTHOR]

People with endometriosis use cannabis to manage their symptoms. This study aimed to identify costs, modes of administration, product composition, and self‐reported effectiveness for those accessing medicinal cannabis in Australia. There were 192 survey responses analysed. Most (63.5%) used a 'cannabis clinic' doctor, incurring an initial consultation cost of $100–$200+ (10.2% Medicare bulk‐billed) and median cannabinoid medicine costs of $300AUD per month. Cost was a major barrier to access, necessitating reducing dosage (76.1%) and/or consuming illicit cannabis (42.9%), despite a prescription. Most (77%) medical consumers used two or more cannabis products, with delta‐9‐tetrahydrocannabinol predominant oil and flower products most frequently prescribed. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the indications for maternal TORCH (Toxoplasma gondii, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV)) serology, with a focus on the yield in isolated fetal growth restriction (FGR). Materials and Methods: A retrospective review of antenatal TORCH testing between January 2014 and December 2018 was carried out at two hospitals in Melbourne, Australia. TORCH testing ordered for pregnancy losses and stillbirth was excluded. Results: Medical records of 718 pregnancies were reviewed, representing 760 fetuses. Isolated FGR was the indication for TORCH screening in 71.2% of pregnancies. Screens ordered for isolated FGR were positive in 7.4% (95% CI 5.5–10.0%). There were 49 positive maternal immunoglobulin M (CMV = 34, Toxoplasma = 15). Two acute maternal infections during pregnancy were diagnosed (CMV = 1, Toxoplasma = 1), with both screens ordered to assess symptomatic maternal illness. There was one neonatal CMV infection, born to a woman with symptomatic primary CMV. No maternal or neonatal rubella or HSV infections were identified. We found a diagnostic yield of TORCH screening for isolated FGR of 0.0% (95% CI 0.00–0.8%). An estimated AUD$64 269.75 was expended on maternal TORCH screens in this study. Conclusion: Maternal TORCH testing for isolated FGR is of no diagnostic yield and should be abandoned. [ABSTRACT FROM AUTHOR]

Background: Few interventions for food addiction (FA) report on dietary intake variables. The present study comprised a three‐arm randomised controlled trial in adults with symptoms of FA. The aim was to evaluate dietary intake, sleep and physical activity resulting from a dietitian‐led telehealth intervention at 3 months. Methods: Adults with ≥3 symptoms of FA and a body mass index > 18.5 kg/m2 were recruited. Dietary intake including energy, nutrients and diet quality were assessed by a validated food frequency questionnaire in addition to sleep quality and physical activity (total min) and compared between groups and over time. Personalised dietary goals set by participants were examined to determine whether improvements in percent energy from core and non‐core foods were reported. Results: The active intervention group was superior compared to the passive intervention and control groups for improvements in percent energy from core (6.4%/day [95% confidence interval (CI) −0.0 to 12.9], p = 0.049), non‐core foods (−6.4%/day [95% CI −12.9 to 0.0], p = 0.049), sweetened drinks (−1.7%/day [95% CI −2.9 to −0.4], p = 0.013), takeaway foods (−2.3%/day [95% CI −4.5 to −0.1], p = 0.045) and sodium (−478 mg/day [95% CI −765 to −191 mg], p = 0.001). Conclusions: A dietitian‐led telehealth intervention for Australian adults with FA found significant improvements in dietary intake variables. Setting personalised goals around nutrition and eating behaviours was beneficial for lifestyle change. Highlights: A full range of dietary intake variables, eating behaviours, sleep quality and physical activity was evaluated.There was a significant negative relationship between change in diet quality and change food addiction (FA) symptoms at 3 months compared to baseline, indicating that, as FA symptoms decreased, diet quality increased.Participants allocated to the active intervention group reported statistically significant improvements in a range of dietary intake variables compared to the participants allocated to the passive intervention or control groups. [ABSTRACT FROM AUTHOR]

Objective: People with mental health conditions have high rates of chronic physical diseases, partially attributable to lifestyle risks factors. This study examined risk prevalence among community mental health service clients, their readiness and confidence to change, and associations with participant characteristics. Methods: Cross-sectional survey of adult clients from 12 community mental health services across 3 local health districts in New South Wales, Australia, collected from 2021 to 2022. Participants (n = 486) completed a telephone interview determining five risk factors, and readiness and confidence to change these. Multiple binary logistic regression models determined associations between readiness and confidence (for each risk), and participant characteristics (demographics and diagnosis). Results: Participants most commonly reported a diagnosis of schizophrenia (36.7%) or depression (21.1%). Risk factors were prevalent: ranging from 26% (harmful alcohol use) to 97% (poor nutrition). High readiness was greatest for smoking (68%), weight (66%) and physical inactivity (63%), while confidence was highest for changing alcohol use (67%). Two significant associations were identified; females were more likely than males to have high readiness to change nutrition (odds ratio = 1.14, confidence interval = [1.13, 2.34], p = 0.0092), with males more likely to have high confidence to change physical activity (odds ratio = 0.91, confidence interval = [0.45, 0.99], p = 0.0109). Conclusions: Many participants were ready and confident to change risk factors. Gender influenced readiness to change nutrition and physical activity confidence. Training to upskill mental health clinicians in provision of preventive care that builds confidence and readiness levels may aid in supporting positive behaviour change. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence and demographic, social and health characteristics associated with co-occurring psychological distress symptoms, risky alcohol and/or substance use among a national sample of Aboriginal and Torres Strait Islander people aged 15 years or older. Methods: This study uses secondary cross-sectional data from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS). Data were collected via face-to-face interviews with those living in private dwellings across Australia. Participants were Aboriginal and Torres Strait Islander people (n = 10,579) aged 15 years or older. Data pertaining to psychological distress, alcohol and substance use were obtained and weighted to represent the total population of Aboriginal and Torres Strait Islander people in Australia. Results: A total of 20.3% participants were found to have co-occurring psychological distress, risky alcohol use and/or substance use, and 4.0% reported co-occurrence of all three conditions. Female participants in a registered marriage and fully engaged in study or employment had lower rates of co-occurring conditions. Poorer self-rated health, one or more chronic conditions and increased experiences of unfair treatment and physical harm in the past 12 months were associated with increased rates of co-occurring conditions. Conclusion: A range of potential risk and protective factors were identified for co-occurring psychological distress, risky alcohol and/or substance use among Aboriginal and Torres Strait Islander people. This information is critical for planning effective holistic strategies to decrease the burden of suffering imposed upon the individual, family and community members impacted by co-occurring conditions. [ABSTRACT FROM AUTHOR]

Background: Although guidelines recommend guideline‐directed medical therapy (GDMT) for patients with acute coronary syndrome (ACS), implementation is limited in clinical practice. Aim: To assess the level of GDMT in ACS patients after discharge who attended cardiac rehabilitation (CR) programs and association with clinical outcomes. Method: A cross‐sectional study was conducted in 13 rural and 10 metropolitan CR programs via all modes of delivery (face‐to‐face, telephone, or general practice‐hybrid) operating in South Australia, Australia. ACS patients were included if they were ≥18 years of age and were referred and attended CR programs with medication details recorded in their hospital discharge summary. GDMT was assessed according to the Australian clinical guidelines for the management of acute coronary syndromes 2016. Prescription of all the four recommended medication classes was considered optimal. Logistic regression and χ2 test were used for association. Ethical approval was granted by the South Australian Department for Health and Wellbeing Human Research Ethics Committee (Reference No. HREC/15/SAH/63) and the Northern Territory Department of Health Human Research Ethics Committee (Reference No. HREC 2015‐2484) which included a waiver of consent per the National Statement on Ethical Conduct in Human Research and the study conforms with the Good Clinical Practice Guidelines. Results: Of the 1229 patients included, 74.6% were male and 41.1% had acute myocardial infarction. Only 39.7% of patients received optimal prescription. Prescription of any three or two medication class combinations occurred for 78.3% and 94.1% of patients, respectively. Optimal GDMT was associated with fewer hospital admissions (odds ratio = 0.647, 95% confidence interval 0.424–0.987, p = 0.043) with no significant gender association. Women were less likely to be prescribed angiotensin converting enzyme inhibitors (p = 0.003), angiotensin receptor blockers (p = 0.007), statins (p = 0.005), and any two (p < 0.001) and three combinations (p = 0.023) of medication classes. Conclusion: GDMT prescription was suboptimal in patients with ACS before attendance at CR. Primary care and CR clinicians have missed an opportunity to implement best practice guideline recommendations, particularly for women. [ABSTRACT FROM AUTHOR]

The efficacy and availability of contraception have changed in the last several decades; however, unintended pregnancies continue to be an issue in Australia. This study aimed to describe trends in contraception in women attending a sexual health service over 9 years. Repeated cross-sectional study. Women aged 16–49 years attending Melbourne Sexual Health Centre between 2011 and 2020 were included. Women were asked what methods of contraception they currently use. Contraception were categorised into long-acting reversible contraception (LARC; e.g. intrauterine devices and implants classified as highly effective), moderately effective contraception (e.g. oral contraception pill), less effective contraception (e.g. condom and withdrawal) and no contraception, as defined by US Centers for Disease Control and Prevention guidelines. Multivariable logistic regression was used to examine the factors associated with the use of moderate-high-efficacy contraception. A total of 38,288 women were included with a median age of 25 (interquartile range: 22–29). Between 2011 and 2020, there was a decreasing trend in condom (63.3%–56.1%; P trend <0.001) and oral contraception (27.2%–20.5%; P trend <0.001) use, whilst there was an increasing trend in the use of LARCs: implant (4.6%–6.0%; P trend = 0.002) and intrauterine device (2.8%–11.8%; P trend <0.001). Increasing age was associated with decreased odds of using moderate-high-efficacy contraception (P trend <0.001). Compared with Oceanian-born women, Asian (adjusted odds ratios [aOR] = 0.63, 95% confidence interval [CI]: 0.56–0.72) and Middle Eastern-born women (aOR = 0.60, 95% CI: 0.48–0.74) had lower odds of using moderate-high-efficacy contraception, whilst European (aOR = 1.23, 95% CI:1.07–1.41) and North American-born women (aOR = 1.51, 95% CI: 1.22–1.87) had higher odds of using moderate-high-efficacy contraception. Between 2011 and 2020, LARC use has increased, whilst less effective contraceptives, such as condom and oral contraception, have decreased among women at Melbourne Sexual Health Centre. Further research is required to understand age and ethnic disparities in contraception methods for future family planning programmes. [ABSTRACT FROM AUTHOR]

Simple Summary: The mortality of hepatocellular carcinoma (HCC) is rising globally, against the trend of other cancers. People with liver cirrhosis, even after hepatitis C treatment still face a high risk of HCC, requiring ongoing enrolment in HCC surveillance, and new technologies to improve diagnostic sensitivity are being explored. However, their impact on HCC survival remains uncertain relative to improving adherence to existing surveillance methods. This study uses mathematical modeling to assess how different strategies can reduce deaths from liver cancer in people with cirrhosis after being cured of hepatitis C. We compared the impact of improved adherence to ultrasound screening with increased HCC imaging sensitivity on HCC survival. Notably, we found that even modest enhancements in surveillance adherence (5–10 percentage point increases) exhibited significant survival benefits for people with hepatitis C-related cirrhosis, outperforming improvements in diagnostic sensitivity. Background & Aims: Hepatocellular carcinoma (HCC) presents a significant global health challenge, particularly among individuals with liver cirrhosis, with hepatitis C (HCV) a major cause. In people with HCV-related cirrhosis, an increased risk of HCC remains after cure. HCC surveillance with six monthly ultrasounds has been shown to improve survival. However, adherence to biannual screening is currently suboptimal. This study aimed to evaluate the effect of increased HCC surveillance uptake and improved ultrasound sensitivity on mortality among people with HCV-related cirrhosis post HCV cure. Methods: This study utilized mathematical modelling to assess HCC progression, surveillance, diagnosis, and treatment among individuals with cirrhosis who had successfully been treated for HCV. The deterministic compartmental model incorporated Barcelona Clinic Liver Cancer (BCLC) stages to simulate disease progression and diagnosis probabilities in 100 people with cirrhosis who had successfully been treated for hepatitis C over 10 years. Four interventions were modelled to assess their potential for improving life expectancy: realistic improvements to surveillance adherence, optimistic improvements to surveillance adherence, diagnosis sensitivity enhancements, and improved treatment efficacy Results: Realistic adherence improvements resulted in 9.8 (95% CI 7.9, 11.6) life years gained per cohort of 100 over a 10-year intervention period; 17.2 (13.9, 20.3) life years were achieved in optimistic adherence improvements. Diagnosis sensitivity improvements led to a 7.0 (3.6, 13.8) year gain in life years, and treatment improvements improved life years by 9.0 (7.5, 10.3) years. Conclusions: Regular HCC ultrasound surveillance remains crucial to reduce mortality among people with cured hepatitis C and cirrhosis. Our study highlights that even minor enhancements to adherence to ultrasound surveillance can significantly boost life expectancy across populations more effectively than strategies that increase surveillance sensitivity or treatment efficacy. [ABSTRACT FROM AUTHOR]

Introduction: Pressure injuries are a preventable yet highly prevalent health concern. Wheelchair cushion prescription can have significant implications for wheelchair users' risk of pressure injury development, which can impact functional abilities and quality of life. The efficacy of a wheelchair cushion to redistribute pressure has been well‐researched, but the efficacy to manage the microclimate is less clear, particularly in warm‐hot environments. The aim of this study was to systematically review studies examining the effect of wheelchair cushions on temperature, moisture and thermal perception to determine which cushions are superior to improve these responses. Method: A systematic review with meta‐analyses of randomised cross‐over and randomised control trials of wheelchair cushion interventions on measures of temperature, moisture, and thermal perception was conducted. Results: Eight studies were identified that met the eligibility criteria and six meta‐analyses were conducted. Pooled analyses identified a significantly lower temperature on foam‐gel cushions compared to air cushions (MD = 0.80, 95% CI: 0.31, 1.29; p = 0.002) and a significantly lower temperature on foam‐gel cushions compared to foam cushions (SMD = 0.76, 95%CI; 0.45, 1.06; p < 0.00001). Pooled analyses also demonstrated significantly lower relative humidity (i.e., moisture) on foam cushions compared to foam‐gel cushions (p = 0.02). Differences in thermal perception were inconclusive due to limited data found. Conclusion: It is clear that not one cushion is ideal in managing all aspects of microclimate, as foam‐gel cushions were the superior cushion to manage temperature and foam cushions were the superior cushion to manage moisture. This article provides occupational therapists and other health professionals with evidence‐based information to assist with wheelchair cushion prescription that minimises the temperature and moisture accumulation, and associated risk of pressure injury for wheelchair users. [ABSTRACT FROM AUTHOR]

Introduction: This study assessed the prevalence and associations of musculoskeletal pain and dysfunction in electrical utility workers, with the aim of applying the findings to better prevent and rehabilitate workplace musculoskeletal disorders. Methods: Employees completed an online survey recording their musculoskeletal symptoms across nine anatomical locations for the preceding 12 months. A total of 565 employees, working across eight different electrical utility organisational work units, completed the survey. Consumer and Community Involvement: The study was collaborative and conducted in Australia's largest, wholly government owned electricity company. The study originated from the participating organisation wanting to better understand their musculoskeletal disorder (MSD) risks. Results: Employees who experienced high job stress were 4.06 times (95% confidence interval [CI] = 1.78–9.29) more likely to report musculoskeletal symptoms in the shoulder compared with employees with lower reported job stress. Employees that perceived their work to have high physical demands report lower back musculoskeletal symptoms at 2.64 times the rate of those perceiving their job to be of low physical demand (95% CI = 1.44–4.84). There were significant differences in the lower back musculoskeletal symptoms according to work unit membership. Conclusions: Understanding the prevalence of MSDs is critical to implementing practical prevention and rehabilitation strategies in the workplace. This anonymous survey highlighted that a large proportion of electrical utility workers reported that musculoskeletal symptoms had impacted their ability to perform their job, housework and/or hobbies in the preceding 12 months. Early access to rehabilitation services is essential. However, many workers report barriers to disclosing MSDs; therefore, workplace rehabilitation services may need to be broadened to account for these barriers. [ABSTRACT FROM AUTHOR]

Introduction: Direct current cardioversion (DCCV) remains one of the recommended management strategies for symptomatic atrial fibrillation (AF). Antiarrhythmic drugs (AAD) are prescribed post procedure to maintain sinus rhythm (SR). Limited literature exists on the AAD prescribing practices and their efficacy, post‐DCCV in rural Australia. Objective: The primary aim was to determine the preferred AAD post‐DCCV and the factors affecting AAD prescribing practices. The secondary aim was to assess the efficacy of the AAD in maintaining SR. Design: A retrospective observational audit of patients with non‐valvular AF who underwent successful elective DCCV for symptomatic AF, during 2015–2020 at a regional hospital in New South Wales (NSW) (Dubbo Base Hospital). Patients were followed up for a duration of 12 months post‐DCCV. Results: 233 patients underwent successful DCCV during the study duration. Amiodarone was the preferred AAD of choice post‐DCCV followed by sotalol and flecainide, respectively (36.5% vs. 27.8% vs. 1.3%). 35.2% patients were not prescribed AAD. Amiodarone and sotalol had similar but modest efficacies and neither were superior to no AAD, in maintaining SR 12 months post‐DCCV (AF recurrence rate 61.5% vs. 68.2% vs. 71.6% respectively, p = 0.37). Antecedent cerebrovascular accident (CVA), pulmonary disease, smoking, prior treatment with digoxin, diuretics and left ventricular (LV) dysfunction were factors that influenced AAD prescribing practices. Conclusion: The study demonstrates equal efficacies of amiodarone, sotalol and no AAD in maintaining SR 12 months post‐DCCV. Prescribing practices post‐DCCV at Dubbo Base Hospital differ from observed national trends and guidelines. AAD prescription requires a multifaceted approach with a key consideration to prioritise safety over efficacy, being mindful of challenges in delivering optimal healthcare in a rural setting. [ABSTRACT FROM AUTHOR]

Personality pathology is associated with emotional problems that are potentially attributable to problematic emotion regulation strategy patterns. We evaluated the emotion regulation strategies associated with the pathological personality traits in the Alternative Model of Personality Disorders (AMPD). A total of 504 participants completed measures of AMPD traits and strategy usage, which were analyzed using hierarchical regressions and latent profile analysis (LPA). Regression results demonstrated that each trait was associated with a unique strategy pattern: negative affect with emotional overengagement, detachment with socialemotional avoidance, antagonism with emotional externalization/avoidance, disinhibition with emotional avoidance and overengagement, and psychoticism with strategies linked to psychotic/dissociative experiences. The LPA identified three profiles with heightened AMPD traits: an internalizing/distressed profile, an externalizing/distressed profile, and a schizoid-schizotypal profile; each had a unique strategy pattern that varied depending on trait composition. This research highlights the relevance of emotion regulation strategy patterns in the assessment, conceptualization, and treatment of personality pathology. [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]

Purpose: It is unclear whether common maternal infections during pregnancy are risk factors for adverse birth outcomes. We assessed the association between self-reported infections during pregnancy with preterm birth and small-for-gestational-age (SGA) in an international cohort consortium. Methods: Data on 120,507 pregnant women were obtained from six population-based birth cohorts in Australia, Denmark, Israel, Norway, the UK and the USA. Self-reported common infections during pregnancy included influenza-like illness, common cold, any respiratory tract infection, vaginal thrush, vaginal infections, cystitis, urinary tract infection, and the symptoms fever and diarrhoea. Birth outcomes included preterm birth, low birth weight and SGA. Associations between maternal infections and birth outcomes were first assessed using Poisson regression in each cohort and then pooled using random-effect meta-analysis. Risk ratios (RR) and 95% confidence intervals (CI) were calculated, adjusted for potential confounders. Results: Vaginal infections (pooled RR, 1.10; 95% CI, 1.02–1.20) and urinary tract infections (pooled RR, 1.17; 95% CI, 1.09–1.26) during pregnancy were associated with higher risk of preterm birth. Similar associations with low birth weight were also observed for these two infections. Fever during pregnancy was associated with higher risk of SGA (pooled RR, 1.07; 95% CI, 1.02–1.12). No other significant associations were observed between maternal infections/symptoms and birth outcomes. Conclusion: Vaginal infections and urinary infections during pregnancy were associated with a small increased risk of preterm birth and low birth weight, whereas fever was associated with SGA. These findings require confirmation in future studies with laboratory-confirmed infection diagnosis. [ABSTRACT FROM AUTHOR]

(1) Background: We aim to examine and improve phosphate prescribing as part of a quality assurance program by examining the change in the proportion of patients receiving phosphate with normal or high preceding serum phosphate concentrations before and after the introduction of the 24 h time limit to default phosphate prescription. (2) Methods: This was a quality assurance study conducted across three Australian adult intensive care units (ICUs). All adult patients with ICU lengths of stay greater than or equal to 48 h who had their serum phosphate concentrations measured were included. A 24 h time limit was introduced to the protocolised prescription in the electronic clinical information system for enteral and intravenous phosphate at participating ICUs. Patient characteristics, phosphate administration, and outcomes were compared before and after this time limit was introduced. The primary outcome was the proportion of patients to whom phosphate was prescribed after measurement of a normal or high serum phosphate level. Secondary outcomes were ICU length of stay, mortality, and discharge destination. (3) Results: A total of 1192 patients were included from three ICUs over the two periods. The proportion of patients with a normal or high measured phosphate level who then received phosphate supplementation was significantly lower in the second study period (30.3% vs. 9.9%; p < 0.001). This difference persisted when adjusted for potential confounders in a mixed-effects logistic regression model (an adjusted odds ratio for receiving phosphate with normal or high serum concentration 0.214, 95% confidence interval of 0.132–0.347; p < 0.001). No significant difference was seen in the typical ICU length of stay, in-hospital case–fatality rate, and hospital discharge destination between these groups. (4) Conclusions: This multicentre before–after study has demonstrated that the introduction of a 24 h limit on electronic phosphate prescriptions resulted in significantly fewer patients receiving phosphate when their serum phosphate concentration was normal or high, without any adverse impact on patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Developmental Dysplasia of the Hip (DDH) describes a spectrum of abnormalities that impact the normal function of the joint. These abnormalities are detectable during infancy using physical assessment, universal ultrasound, or a combination of both. In Australia, child health nurses predominantly screen for this disease using physical assessment. The aim of this study was to determine if child health nurses can accurately screen for DDH using physical assessment. Methods: This Australian study estimated the accuracy and utility of child health nurses using physical assessment to screen for DDH by comparing it to a handheld ultrasound device. Results: This study (N = 44) concluded that using a point prevalence study design, child health nurses in Australia are unable to accurately assess for DDH in infants using physical assessment; overall, clinicians had 50.5% sensitivity (95% CI, 15.7 to 84.3), a specificity of 75.0% (95% CI, 57.8 to 87.9), and 71.3% accuracy (95% CI, 55.6 to 83.9). Conclusion: This study suggests that child health nurses cannot screen for DDH using physical assessment. Understanding education, experience and what assessments are used suggests that the utility of nurses performing DDH screening requires further investigation. [ABSTRACT FROM AUTHOR]

Purpose: LGBTQ people are less likely to seek support and face significant barriers in accessing affirmative family violence support services. Efforts to improve family violence service access must be grounded in the preferences of LGBTQ people themselves. Method: Data from a large nationwide Australian survey of the health and wellbeing of LGBTQ adults were analysed. 4,148 participants expressed a preference for family violence service provision. Multivariable logistic regressions were used to identify factors associated with preferences for family violence service provision, comparing mainstream services that are not known to be inclusive, mainstream services that are known to be LGBTQ-inclusive, and LGBTQ-specific services. Results: In total, 8.8% (n = 363) of participants indicated a preference for mainstream services, 57.5% (n = 2,383) for mainstream services that are known to be LGBTQ-inclusive and 33.8% (n = 1,402) for LGBTQ-specific services. Trans and non-binary identified people were more likely to prefer LGBTQ-specific services than cisgender participants, while bisexual, pansexual and asexual people were more likely to prefer mainstream LGBTQ-inclusive services. Participants with a regular general practitioner were more likely to prefer LGBTQ-inclusive services. Participants who had not felt supported the most recent time they reported an experience of family violence were more likely to prefer LGBTQ-specific services. Conclusion: Family violence and healthcare services require training in LGBTQ issues to provide inclusive and affirming care. The findings have implications for policy and practice in family violence care and illustrate an urgent need to reform the current narrative of family violence, which frequently excludes LGBTQ communities. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B infection has been associated with the development of gestational diabetes but the underlying mechanism is not known. Objective: To examine associations between viral activity, gestational diabetes mellitus (GDM), and insulin resistance in pregnant people with chronic hepatitis B infection (HBV). Design: Prospective cohort study across three tertiary maternity centres in Melbourne, Australia, between May 2021 and April 2023. Methods: Participants were followed prospectively through pregnancy to evaluate subsequent GDM diagnosis. Demographics, pregnancy outcomes, and markers of viral activity were compared between those with GDM versus those without. Logistic regression analysis was performed pre- and post-adjustment for known confounders. Sub-group analysis of participants from South East Asia (SEA) was performed. Outcome measures included GDM diagnosis, insulin resistance (Homeostatic Model Assessment Insulin Resistance score (HOMA-IR) score), HBV activity as measured by liver function tests, HBV viral load, hepatitis B e antigen, and quantitative hepatitis B surface antigen (quantHBsAg). Results: A total of 113 women were recruited. One third (38/112, 33.9%) developed GDM, mostly diagnosed on isolated postprandial hyperglycaemia (25/38, 65.8%). Over half were born in SEA (66/113, 58.4%). Mean quantHBsAg was significantly lower in those with GDM (p = 0.044). No other associations were identified between GDM or HOMA-IR and markers of hepatic activity on multivariate logistic regression analysis and on sub-group analysis of those born in SEA. Conclusions: QuantHBsAg was significantly lower in those with GDM; otherwise, no association between GDM and measures of HBV viral activity was found. QuantHBsAg may be useful as an early pregnancy marker for GDM risk and warrants further research. [ABSTRACT FROM AUTHOR]

Background Intussusception is the primary cause of acute bowel obstruction in infants. The majority of cases <2 years of age are classed as idiopathic, with viral infection implicated as one of the causes. Coronavirus disease 2019 (COVID-19) public health measures led to significant decreases in communicable disease prevalence. During these times, reductions in intussusception frequency were greater than would be expected with our previous understanding of its infectious etiology. Methods We conducted a retrospective, multistate, ecological study over a 12-year period. Monthly case numbers of "intussusception"-coded admissions (code K56.1; International Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification) were acquired from state-wide admissions data sets from New South Wales, Victoria, and Queensland, representing 77.62% of the eligible Australian population. These counts within differing jurisdictional lockdowns were compared with non-lockdown periods in order to investigate a correlation between intussusception frequency and lockdown periods. Results We found a negative association between intussusception frequency and lockdown periods in both eligible states. The largest reductions were seen in the <2-year age groups, with Victoria experiencing a 62.7% reduction (rate ratio, 0.37; P <.001) and New South Wales a 40.1% reduction (0.599; P =.006) during lockdown times. Controls for variations in lockdown restrictions between both regional and metropolitan areas also showed expected decreases. Conclusions Our ecological study demonstrates significant decreases in the frequency of pediatric intussusception admissions during the COVID-19 lockdown periods. The unexpected magnitude of the reductions suggests that the true proportion of infectious disease-caused idiopathic intussusception is greatly underestimated. [ABSTRACT FROM AUTHOR]

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

AbstractIndexes are useful for summarizing multivariate information into single metrics for monitoring, communicating, and decision-making. While most work has focused on defining new indexes for specific purposes, more attention needs to be directed toward making it possible to understand index behavior in different data conditions, and to determine how their structure affects their values and the variability therein. Here we discuss a modular data pipeline recommendation to assemble indexes. It is universally applicable to index computation and allows investigation of index behavior as part of the development procedure. One can compute indexes with different parameter choices, adjust steps in the index definition by adding, removing, and swapping them to experiment with various index designs, calculate uncertainty measures, and assess indexes’ robustness. The article presents three examples to illustrate the usage of the pipeline framework: comparison of two different indexes designed to monitor the spatio-temporal distribution of drought in Queensland, Australia; the effect of dimension reduction choices on the Global Gender Gap Index (GGGI) on countries’ ranking; and how to calculate bootstrap confidence intervals for the Standardized Precipitation Index (SPI). The methods are supported by a new R package, called tidyindex. Supplemental materials for the article are available online. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal pain while running is a concern to women during pregnancy and can lead to running cessation. To support women who wish to run during pregnancy, it is essential to understand the sites, severities and personal risk factors associated with musculoskeletal pain. Objective: The aim was to investigate prevalence and risk factors for musculoskeletal pain when running during pregnancy. Methods: An online survey was completed by women who had a child in the past 5 years and ran prior to and during pregnancy. Pain frequency informed prevalence rates by body site, and logistic regression odds ratios (ORs) and 95% confidence intervals were calculated. Results: A total of 3102 women of 23 ethnicities from 25 countries completed the survey. Women were 22–52 years old when they gave birth and ran 2–129 km/week during the 0.5–35 years before the birth of their youngest child. Women ran significantly less distance and less often during pregnancy than before pregnancy. Most women (86%) experienced pain while running during pregnancy (59% pelvis/sacroiliac joint, 52% lower back, 51% abdomen, 44% breast, 40% hip). The highest prevalence of severe-to-worst pain was at the pelvis/sacroiliac joint (9%). Women at greatest risk of pain while running during pregnancy had a previous injury (OR = 3.44) or were older (OR = 1.04). Women with a previous child were less likely to experience breast pain (OR = 0.76) than those running during their first pregnancy. Conclusion: Healthcare practices to reduce pain should focus on regions of greatest musculoskeletal change during pregnancy, specifically the pelvis, lower back and abdomen. Efforts to support women to run for longer throughout pregnancy should focus on pain at the pelvis and breasts. [ABSTRACT FROM AUTHOR]

Objective: This study focused on employees' perceived discrimination due to parenthood; and mental health, occupational stress and turnover intention. Methods: Survey (2016) of ati Australian convenience sample of employed parents: women (n = 2950) and men (n = 1318). Results: Forty-two percent profesof all mothers reported missing out on promotion (n = 1234/2950); one-third re- ported negative comments from managers (n = 805/2950,27%) or colleagues (n = 832/2950,28%). One in five fathers reported these forms ofdiscrimination. 1ti adjusted analyses, perceived discrimination was associated with poorer men- tal health (13 = 0.23, P < 0.001); higher occupational stress ([4 - 0.30, P< 0.001); and increased odds of turnover intention (adjusted odds ratio= 1.5, P < 0.001) for mothers; and poorer mental health (0 = 0.34, P < 0.001); stress (13 - 0.35, P < 0.001); and increased odds of turnover intention (adjusted odds ratio = 1.7, P < 0.001) for fathers. Conclusions: Experiences of negativity and hostility at work are common and link to employee health and well-being. [ABSTRACT FROM AUTHOR]

Increased therapy time and task-specific practice can improve functional recovery post stroke. This observational study aimed to determine whether the clinical implementation of circuit training increases therapy time and improves function in stroke rehabilitation. In a retrospective clinical audit, medical records of 110 people (mean age 78.7, standard deviation 13.0, 49.1% male, 57.3% severe stroke) admitted to a stroke inpatient rehabilitation ward were evaluated to determine the differences between pre (Individual Therapy (IT), n = 55) and post (Circuit Class Therapy (CCT), n = 55) service change implementation. The primary outcome was the amount of time spent in physiotherapy daily (minutes). Secondary outcomes included the Functional Independence Measure (FIM) score and length of stay (LOS). The CCT Group spent significantly more time in physiotherapy daily during their rehabilitation LOS compared to the IT Group (mean difference 8.45 (95% CI 5.99 to 10.90) mins, p < 0.001). No significant between-group differences were observed for FIM scores or LOS (p ≥ 0.066). This study suggests that the clinical implementation of CCT can significantly increase therapy time by close to 9 minutes per session, with functional gains that are equivalent to usual care. This was achieved with a patient-to-staff ratio of 3:1, compared to the 1:1 ratio in IT, concurring with existing evidence in support of CCT as an alternative service delivery model for inpatient stroke rehabilitation. [ABSTRACT FROM AUTHOR]