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Background: The incidence of young stroke is increasing worldwide. However, young adults are inadequately supported in their recovery by a system of stroke care in which the older patient is the majority consumer. Purpose: To examine the unmet needs of younger stroke survivors in inpatient and outpatient healthcare settings and identify opportunities for improved service delivery. Materials and Methods: In-depth semi-structured interviews were undertaken with 19 participants aged 18–55 at the time of their first-ever stroke and inductively analysed using a rigorous qualitative descriptive approach. Results: Many unmet care needs were identified within three emergent themes: inadequately addressed psycho-emotional and cognitive needs after young stroke; isolation from lack of information and structured support; and failure to deliver age-relevant patient-centred care. These themes were further divided into sub-themes and the sub-themes were named in a manner to signpost the way forward for young stroke care. Conclusions: This study provides new insights into the experience of inpatient and outpatient stroke care by younger stroke survivors and outlines possible improvements for clinical practice. Future research should evaluate the effect of targeted strategies to support younger adults after stroke. Post-stroke rehabilitation might be improved by providing more support for the non-physical effects of stroke (e.g., psycho-emotional support, cognitive rehabilitation). Younger stroke survivors may also benefit from a long-term community care plan and longer-term rehabilitation. Patient-centered rehabilitation and education about self-management interventions appear to be important areas for further development. Future research is required to evaluate the effect of targeted strategies to support younger stroke survivors, as well as identify the needs of younger adults with post-stroke communication impairment. [ABSTRACT FROM AUTHOR]

Objectives: Contraceptive use is important for reproductive-aged women living with HIV to plan and optimise safety of pregnancies. Clinicians play a vital role in counselling patients about contraception and safe sexual activity. This study aimed to determine the frequency and predictors of discussions regarding sexual activity and contraceptive use.Methods: Retrospective clinical study of all reproductive-aged women (n=128) treated for HIV between 2010 and 2012 at two metropolitan hospitals. Evidence of discussion between treating doctors and patients regarding sexual activity and contraception and variables including patient age, gender of doctor, time since HIV diagnosis, previous pregnancy, country of birth and antiretroviral regimen were obtained from medical records.Results: Sexual activity status was documented for 54% of the women and discussion regarding contraception was recorded for less than one-third of the study participants. Contraceptive use was not recorded in 63% of the medical records. In the study cohort 27% of the women used contraception, 10% did not use contraception, and when a discussion regarding sexual activity was documented, contraception was 3.7 times more likely to also be discussed (p=0.04). Excluding women who were pregnant, women who were documented as using contraception were 1.8 times as likely to have had a discussion about contraception documented (p=0.05). After adjustment for other factors, previous pregnancy, gender of doctor and age of patient were not associated with discussions regarding sexual activity or contraception.Conclusions: Discussions regarding sexual activity and contraception between HIV-infected women of reproductive age and their clinicians were inconsistent and suboptimal. Mechanisms to facilitate regular discussion about sexual activity and contraception between clinicians and women with HIV warrant further investigation. [ABSTRACT FROM AUTHOR]

Abstract: In the context of high and rising rates of parental employment in Australia, we investigated whether poor quality jobs (without security, control, flexibility or paid family leave) could pose a health risk to employed parents’ children. We examined the extent to which both mothers’ and fathers’ jobs matter, and whether disadvantaged children are more vulnerable than others. Multiple regression modelling was used to analyse cross-sectional data for 2004 from the Growing Up in Australia study, a nationally representative sample of 4–5 year old children and their families (N = 2373 employed mothers; 3026 employed fathers). Results revealed that when parents held poor quality jobs their children showed more emotional and behavioural difficulties. The associations with child difficulties were independent of income, parent education, family structure and work hours, and were evident for both mothers’ and fathers’ jobs. Further, the associations tended to be stronger for children in low-income households and lone-mother families. Thus job quality may be another mechanism underlying the intergenerational transmission of health inequality. Our findings also support the argument that a truly family-friendly job must not erode children’s health. [Copyright &y& Elsevier]