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Background: Dysarthria, aphasia and executive processes have been examined for their role in producing impaired communicative competence post traumatic brain injury (TBI). Less understood is the role of emotional dysregulation, that is, apathy and disinhibition, and social cognition, that is, reading and interpreting social cues. Methods & Procedures: In this study, we examined 49 adults with moderate to severe TBI and 18 neurologically healthy adults. We hypothesised that apathy and disinhibition would predict communication outcomes as would social cognition. We also predicted that apathy and disinhibition would influence social cognition. Communication outcomes were measured by the La Trobe Communication Questionnaire (LCQ) and the Social Skills Questionnaire‐TBI (SSQ‐TBI). Apathy and disinhibition were measured by the Frontal Systems Behavior Scale (FrSBe). We measured four aspects of social cognition: emotion perception and theory of mind using The Awareness of Social Inference Test (TASIT) and the Complex Audio‐Visual Evaluation of Affect Test (CAVEAT), empathy using the Questionnaire of Cognitive and Affective Empathy (QCAE) and the Balanced Emotional Empathy Scale (BEES), and alexithymia using the Toronto Alexithymia Scale (TAS‐20) and the Bermond–Vorst Alexithymia Questionnaire. Outcomes & Results: Consistent with predictions, the LCQ and SSQ‐TBI were associated with disinhibition and the LCQ was also associated with apathy. The LCQ was associated with the full range of social cognition constructs although the SSQ‐TBI was not. Finally, apathy and disinhibition predicted a number of social cognition measures. Conclusions and Implications: These results are discussed in relation to understanding the nature of communication disorders following TBI and how they are measured, as well as the interrelation between emotion dysregulation and social cognition. What this study adds: What is already known on this subject: The role of emotional dysregulation and social cognition in producing impaired communicative competence post traumatic brain injury (TBI) is not well understood. Although most adults with severe TBI have minimal or possibly no language impairment, they often struggle with functional communication in everyday situations. Many have been reported to be overtalkative, insensitive, childish and self‐centred, displaying an inappropriate level of self‐disclosure and making tangential and irrelevant comments. Conversely, some speakers with TBI have been noted to have impoverished communication, producing little language either spontaneously or in response to the speaker's questions and prompts. What this paper adds to existing knowledge: We found that both apathy and disinhibition were strongly associated with the Latrobe Communication Questionnaire both empirically and conceptually, despite the LCQ being developed from a different, pragmatic orientation. Disinhibition was also associated with the Social Skills Questionnaire for TBI. We also found that poor social cognition scores predicted communication difficulties. Finally, we found that behavioural dysregulation itself, i.e., both apathy and disinhibition, predicted poor social cognition. What are the potential or actual clinical implications of this work?: Our findings highlight the central role that apathy and disinhibition play in both communication and social cognition. These insights point to the importance of remediation to target behavioural and autonomic dysregulation as a means to improve everyday social function. [ABSTRACT FROM AUTHOR]

• Innovative phenotype-genotype association analysis for categorical genomic data having non-ignorable missing values. • Statistical learning method of random forest is used for variable selection in the analysis. • Weighted logistic ridge regression with EM algorithm is used for missing data imputation in the analysis. • Linear statistical hypothesis testing is used for determining the missingness mechanism in the analysis. • An application to analyzing real data from Australia breast cancer genome-wide association study (GWAS). Genomic data arising from a genome-wide association study (GWAS) are often not only of large-scale, but also incomplete. A specific form of their incompleteness is missing values with non-ignorable missingness mechanism. The intrinsic complications of genomic data present significant challenges in developing an effective and efficient procedure of phenotype-genotype association analysis by a statistical variable selection approach. In this paper we develop a coherent procedure of categorical phenotype-genotype association analysis, in the presence of missing values with non-ignorable missingness mechanism in genomic data. It is developed by integrating the statistical learning methods of random forest for variable selection, joint weighted logistic ridge regression with EM algorithm for missing data imputation, and linear statistical hypothesis testing for determining the missingness mechanism. Two simulated genomic datasets are used to undertake the phenotype-genotype association analysis by the proposed procedure, with the performance validated. The proposed procedure is then applied to analyze a real data set from breast cancer GWAS. [ABSTRACT FROM AUTHOR]

Purpose: Both Rapid Syllable Transition Treatment (ReST) and ultrasound biofeedback are effective approaches to treating childhood apraxia of speech (CAS). The purpose of the study was to compare outcomes from these two motor-based treatment approaches for school-age children with CAS. Method: In a single site, single blind randomized control trial, 14 children with CAS ages 6–13 years were randomly assigned to 12 sessions over 6 weeks of either of ultrasound biofeedback treatment (with a speech motor chaining practice structure) or ReST. Treatment was delivered at The University of Sydney by students trained and supervised by certified speech-language pathologists. Transcriptions from blinded assessors were used to compare the two groups on speech sound accuracy (percent phonemes correct) and prosodic severity (lexical stress errors and syllable segregation) in untreated words and sentences at three time points: pretreatment, immediately posttreatment, and 1-month posttreatment (i.e., retention). Results: Both groups showed significant improvement on treated items indicating a treatment effect. At no time was there a difference between groups. Both groups showed a significant improvement in speech sound accuracy on untreated words and sentences from pre to post and neither group showed an improvement in prosody pre–post. Changes to speech sound accuracy were retained by both groups at 1-month follow-up. Significant improvement in prosodic accuracy was reported at the 1-month follow-up. Conclusions: ReST and ultrasound biofeedback were equally effective. Either ReST or ultrasound biofeedback may be viable treatment options for school-age children with CAS. [ABSTRACT FROM AUTHOR]

Australians fail to meet the daily recommended two and five serves of fruit and vegetable respectively, which increases mortality risk for non‐communicable diseases such as cardiovascular disease and type 2 diabetes. This study aimed to evaluate the effectiveness of an online intervention delivered through social media on food literacy and fruit and vegetable consumption in Australian adults. In a pre‐post single group experimental study, 29 participants completed the "online MedDiet challenge", a four‐week intervention delivered via Facebook. Infographics, recipes and informational videos aligned with food literacy concepts related to the Mediterranean Diet were shared with participants. Outcome measures included a validated food literacy questionnaire with two questions from the National Nutrition Survey to record fruit and vegetable consumption. The mean age of participants was 52 years (range: 25–67 years). Post intervention, food literacy improved between 21%–45% across each survey component. Participants also reported an increase in fruit and vegetable consumption by 0.6 and 1.3 serves per day (p < 0.05) respectively. Social media holds potential for increasing fruit and vegetable consumption in adults through food literacy. Future research should focus on longer studies and larger cohorts to confirm that food literacy plays a key component to maintain sustainability of such interventions. [ABSTRACT FROM AUTHOR]

Background and Hypothesis Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, yet a significant proportion of individuals on clozapine continue to experience disabling symptoms, despite being treated with an adequate dose. There is a need for adjunct treatments to augment clozapine, notably for negative and cognitive symptoms. One such potential agent is the glutathione precursor N -acetylcysteine (NAC). Study Design A randomized double-blind, multi-center, placebo-controlled trial for clozapine patients with enduring psychotic symptoms (n = 84) was undertaken to investigate the efficacy of adjunctive NAC (2 g daily) for negative symptoms, cognition and quality of life (QoL). Efficacy was assessed at 8, 24, and 52 weeks. Study Results NAC did not significantly improve negative symptoms (P =.62), overall cognition (P =.71) or quality of life (Manchester quality of life: P =.11; Assessment of quality of life: P =.57) at any time point over a 1-year period of treatment. There were no differences in reported side effects between the groups (P =.26). Conclusions NAC did not significantly improve schizophrenia symptoms, cognition, or quality of life in treatment-resistant patients taking clozapine. This trial was registered with "Australian and New Zealand Clinical Trials" on the 30 May, 2016 (Registration Number: ACTRN12615001273572). [ABSTRACT FROM AUTHOR]

The study aimed to compare nutrient content of 822 and 924 fast-food items at two-time points 2015 and 2019, respectively. Nutrient profiles for most of the fast-food items did not change significantly between 2015 and 2019. In 2019, 97% of the fast-food items (per 100 g) did not meet at least one of the reference criteria. Pizza (median serve 649.3 g) items had the highest median energy (5860 kJ), total fat (56.5 g), saturated fat (24 g) and sodium (3168 mg). Shakes (median serve 401 ml) had the highest median total sugar (44.5 g). Firmer legislations on fast-food outlets may be required to support availability of healthier food options. [ABSTRACT FROM AUTHOR]

PURPOSE Regulatory agencies have sought to speed up the review of new cancer medicines and reduce delays in approval between countries. We examined trends in regulatory review times and association with clinical benefit for new cancer medicines in six jurisdictions: United States (Food and Drug Administration [FDA]), European Union (European Medicines Agency [EMA]), Switzerland (Swissmedic), Japan (Pharmaceuticals and Medical Devices Agency [PMDA]), Canada (Health Canada), and Australia (Therapeutic Goods Administration). METHODS We studied all new cancer drugs approved in the six aforementioned jurisdictions from 2007 to 2020. We extracted all applicable expedited programs, total regulatory review times, and, for drugs first approved by the FDA, times to subsequent regulatory approval. Clinical benefit was assessed using the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale value framework and ASCO-Cancer Research Committee's targets. Nonparametric Kruskal-Wallis test was used to compare total review times for high versus low clinical benefit drugs. RESULTS One hundred and twenty eight drugs received initial approval in at least one of the six included jurisdictions. Most drugs approved by the FDA (91%) and Health Canada (59%) qualified for at least one expedited program within those jurisdictions, compared with 46% of EMA approvals and 18% of PMDA approvals. The FDA was the first regulator to approve 102 (80%) drugs. Delays in submission accounted for a median of 20.2% (EMA) to 83.8% (PMDA) of the time to subsequent approval. There was no association between high clinical benefit and shorter total review times. CONCLUSION Most new cancer therapies were approved first by the FDA, and delays in submission of regulatory applications accounted for substantial delays in approving cancer drugs in other countries. Regulators should prioritize faster review for drugs with high clinical benefit. [ABSTRACT FROM AUTHOR]

Clinical learning experiences are known to exacerbate nursing student anxiety, causing them to present to clinical placement in distressed, meaning anxious, states. Students already living with anxiety are also more likely to suffer setbacks at this time. Supervising Registered Nurses (RNs), in the clinical settings, struggle to support this student cohort. A professional development activity was designed to introduce RNs to higher education and nursing students' known mental health concerns (such as anxiety) and to arm them with strategies for working with distressed students. A research approach that enabled researchers to collaborate with participants was employed to design the intervention. A study evaluated the impact of the educational intervention with 45 Australian RN supervisors. Two tailed T‐tests were chosen to explore the statistical difference between pre‐ and post‐test mean results across the survey items. A 95% confidence interval was used. Statistical significance was set at <0.05. The evaluation indicated the activity could be useful for improving supervising RNs' mental health literacy, thus enhancing their understanding of how to work with distressed students. Participants recommended the activity be offered to any staff supporting student clinical learning. Collaboration between nursing researchers and nursing clinical staff produced a meaningful professional development activity and motivated the participants to increase their mental health literacy and understanding of strategies to support distressed students. Future projects should adopt similar approaches that would support both RNs' ability to support students' during clinical learning and students in distress would also benefit. [ABSTRACT FROM AUTHOR]

This study investigates rainfall and drought characteristics in southeastern Australia (New South Wales and Victoria) using data from 45 rainfall stations. Four homogeneity tests are adopted to determine inhomogeneities in the annual total rainfall (ATR) and monthly rainfall data, namely The Pettitt test, the SNHT, the Buishand range test and the Von Neumann ratio test at significance levels of 1%, 5%, and 10%. Temporal trends in rainfall (ATR, monthly, and seasonal) and droughts are examined using autocorrelated Mann–Kendall (A-MK) trend test at 1%, 5%, and 10% significance levels. We also assess meteorological droughts by using multiple drought indices (3-, 6-, 9-, 12-, 24-, and 36-month Standardized Precipitation Index (SPI) and Effective Drought Index (EDI)). Furthermore, spatial variability of temporal trends in rainfall and drought are investigated through interpolation of Sen's slope estimator. The results represent an increasing trend in ATR between 1920 and 2019. However, southeast Australia is highly dominated by a significant negative trend in the medium term between 1970 and 2019. Winter is found to be dominated by a significantly negative trend, whereas summer and spring seasons are dominated by a positive trend. April is detected as the driest month according to magnitude of Sen's slope and the A-MK test result. Positive trends on droughts are observed at inner parts of the study area, whereas a negative trend is detected in the south, southeast, and northeast of the study area based on SPIs and EDI. The findings of this study help to understand changes in rainfall and droughts in southeastern Australia. [ABSTRACT FROM AUTHOR]

Aim: Evidence‐based guideline translation to practice can improve outcomes but is often impaired by poor implementation. This project aimed to evaluate the implementation of the Evidence‐based guidelines for the nutritional management of adult patients with head and neck cancer among Australian dietitians providing clinical care to this population. Methods: A questionnaire was developed, with face and content validity confirmed by an expert panel (n = 13), to gauge participant perceptions of the guidelines against an implementation evaluation framework. Dietitians were identified through Dietitians Australia and by contacting experts in the field. Eligibility was determined by questionnaire completion and prior guideline awareness. Responses were provided using a 5‐point Likert scale. Results were analysed using descriptive statistics; with inferential analysis to determine if demographic information could reveal trends in guideline use and perception. Results: Of the 43 initial respondents, n = 28 completed the questionnaire, with n = 24/28 (86%) meeting full eligibility criteria for analysis. Median (range) scores for all four domains were high: awareness (4.0 [3.2‐4.8]), agreement (4.4 [4.1‐4.7]), adoption (3.5 [3.1‐3.9]), and adherence (4.3 [4.1‐4.9]). However, perception of guideline awareness and use among multidisciplinary team colleagues was low (mean 3.2/5.0 and 3.1/5.0, respectively). Dietitians with <10 years' experience had significantly higher perceptions of the guidelines' ability to positively influence practice; support evidence‐based practice; and enhance dietitian credibility (P = 0.04) vs dietitians with ≥10 years' experience. Conclusion: Dietitians demonstrated high rates of guideline implementation and positive perceptions for its use in clinical practice. Future implementation strategies and evaluation should expand to engage the wider multidisciplinary team and more experienced clinicians. [ABSTRACT FROM AUTHOR]

Trend analysis and change point detection in a time series are frequent analysis tools. Change point detection is the identification of abrupt variation in the process behaviour due to natural or artificial changes, whereas trend can be defined as estimation of gradual departure from past norms. We analyze the time series data in the presence of trend, using Cox-Stuart methods together with the change point algorithms. We applied the methods to the near-surface wind speed time series for Australia as an example. The trends in near-surface wind speeds for Australia have been investigated based upon our newly developed wind speed datasets, which were constructed by blending observational data collected at various heights using local surface roughness information. The trend in wind speed at 10 m is generally increasing while at 2 m it tends to be decreasing. Significance testing, change point analysis and manual inspection of records indicate several factors may be contributing to the discrepancy, such as systematic biases accompanying instrument changes, random data errors (e.g. accumulation day error) and data sampling issues. Homogenization technique and multiple-period trend analysis based upon change point detections have thus been employed to clarify the source of the inconsistencies in wind speed trends. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore the current practices and training requirements for supporting clients experiencing psychosocial concerns in the audiology setting, from the perspectives of audiology clinicians, managers, and reception staff. Method: Convenience sampling was used to recruit audiologists, reception staff, and clinic managers (N =13, Mage = 32.2 ± 8.1, range: 25--47 years, 11 female) through a large hearing services provider in Western Australia. A semistructured focus group was used to elicit participant views regarding current experiences relating to clients who express psychosocial concerns in the audiology setting, familiarity with psychosocial interventions, and training requirements for delivery of psychosocial interventions in the audiological setting. Results: Twenty-four subthemes were identified across six themes: (1) awareness of psychosocial well-being, (2) the role of others, (3) identifying client's psychosocial needs, (4) managing client's psychosocial needs, (5) barriers to providing psychosocial support, and (6) broadening audiological services to include psychosocial support. Conclusions: Participants reported an awareness of their clients' psychosocial challenges within the audiology setting, yet they described uncertainty in how best to respond in providing support and whether this was within their scope of practice. A majority of audiology staff expressed desire and motivation to broaden the scope of their service in order to better address their clients' hearing loss--related psychosocial needs. [ABSTRACT FROM AUTHOR]

* OBJECTIVE: To determine the independent associations of potential clinical, symptom, physical activity, and psychological factors with chronic plantar heel pain. * DESIGN: Case-control. * METHODS: We investigated associations by comparing 220 participants with chronic (more than 3 months in duration) plantar heel pain to 100 age- and sex-matched controls, who were recruited randomly from the electoral roll. Exposures measured were waist girth, body mass index, body composition, clinical measures of foot and leg function, physical activity via accelerometry, systemdepression and pain catastrophizing, symptoms of prolonged morning stiffness anywhere in the body, and multisite pain. Data were analyzed using multivariable conditional logistic regression. * RESULTS: Waist girth (centimeters) (odds ratio [OR] = 1.06; 95% confidence interval ICI]: 1.03, 1.09), ankle plantar flexor strength (kilograms) (OR - 0.98; 95% Cl: 0.97,0.99), pain at multiple sites (pain at 1 other site : OR = 2.76 ; 95 % Cl : 1. 29, 591; pain at 4 or more other sites: OR = 10.45; 95% Cl: 3.66, 29.81), and pain catastrophizing status (none, some, or catastrophizer) (some: OR = 2.91: 95% Cl: 1.33, 6.37: catastrophizer OR = 6.79; 95% Cl: 1.91,24.11) were independently associated with chronic plantar heel pair. There were univariable but not independent associations with morning stiffness, first metatarsophalangeal joint extension range of motion, depression, and body mass index. There were no significant associations with physical activity or body composition (bioelectrical impedance analysis) * CONCLUSION: Waist girth, ankle plantar flexor strength, multisite pain, and pain catasheel trophizing, but not foot-specific factors, were independently associated with chronic plantar heel pain. Of these 4 factors, 3 (waist girth, multisite pain, and pain catastrophizing) were central or systemic associations. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated associations between weather conditions, physical activity, and sedentary time in primary school-aged children in Australia and Canada. Methods: Cross-sectional data on 9-11-year-old children from the Australian (n = 491 ) and Canadian (n = 524) sites of the International Study of Childhood Obesity, Lifestyle and the Environment were used. Minutes of daily moderate-to-vigorous-physical-activity (MVPA) and sedentary time were determined from 7-day, 24-h accelerometry (Actigraph GT3X+ triaxial accelerometer). Day-matched weather data (temperature, rainfall, snowfall, relative humidity, wind speed) were obtained from the closest weather station to participants' schools. Covariates included parental highest education level, day type, sex, and BMI z-scores. Generalized mixed model analyses allowing for clustering of participants within schools were completed. Scatterplots with Loess curves were created for maximum temperature, MVPA, and sedentary time. Results: Daily maximum temperature was significantly associated with MVPA and sedentary time in Australia (MVPA p = .05, sedentary p = .01) and Canada (p < .001, p = .001). Rainfall was negatively associated with MVPA in Australia (p < .001) and positively associated with sedentary time in Canada (p = .02). Conclusions: MVPA and sedentary time appear to be optimal when the maximum temperature ranges between 20°C and 25°C in both countries. The findings have implications for study design and interpretation for surveillance and intervention studies. [ABSTRACT FROM AUTHOR]

Objectives: Single sex after-school physical activity programs show potential to prevent unhealthy weight gain. The aim of this study was to assess the acceptability and potential efficacy of single-sex after-school physical activity programs for overweight and at-risk children from low-income communities. Design: 7-month, 2-arm parallel-group, RCT, conducted at an elementary school in a disadvantaged area in Wollongong, Australia (March-November 2010). Methods: 20 boys and 17 girls were randomized to intervention (PA) or active comparison groups (HL). Primary outcomes included implementation, acceptability, percentage body fat and BMI z-score. Results: The PA programs were acceptable with high implementation and enjoyment rates. At 7 months postintervention girls in the PA group displayed greater changes in percentage body fat (adjust diff. = -1.70, [95% CI -3.25, -0.14]; d = -0.83) and BMI z-score (-0.19 [-0.36, -0.03]; d= -1.00). At 7 months boys in the PA group showed greater changes in waist circumference (-3.87 cm [-7.80, 0.15]; d= -0.90) and waist circumference z-score (-0.33 [-0.64, -0.03]; d= -0.98). For both boys' and girls' PA groups, changes in adiposity were not maintained at 12-month follow-up. Conclusions: Single-sex after-school physical activity programs are acceptable and potentially efficacious in preventing unhealthy weight gain among overweight and at-risk children. However improvements are hard to sustain once programs finish operating. [ABSTRACT FROM AUTHOR]

The current study examined the effects of 10-h northbound air travel across l time zone on sleep quantity, together with subjective jet lag and wellness ratings, in 16 male professional Australian football (soccer) players. Player wellness was measured throughout the week before (home training week) and the week of (away travel week) travel from Australia to Japan for a preseason tour. Sleep quantity and subjective jet lag were measured 2 d before (Pre 1 and 2), the day of, and for 5 d alter travel (Post 1-5). Sleep duration was significantly reduced during the night before travel (Pre 1: 4.9 [4.2-5.6] h) and night of competition (Post 2; 4.2 [3.7-4.7] h) compared with every other night (P< .01, d> 0.90). Moreover, compared with the day before travel, subjective jet lag was significantly greater for the 5 d after travel (P < .05, d > 0.90), and player wellness was significantly lower 1 d post-match (Post 3) than at all other time points (P < .05, d > 0.90). Results from the current study suggest that sleep disruption, as a result of an early travel departure time (8 PM) and evening match (7:30 PM), and fatigue induced by competition had a greater effect on wellness ratings than long-haul air travel with a minimal time-zone change. Furthermore, subjective jet lag may have been misinterpreted as fatigue from sleep disruption and competition, especially by the less experienced players. Therefore, northbound air travel across 1 time zone from Australia to Asia appears to have negligible effects on player preparedness for subsequent training and competition. [ABSTRACT FROM AUTHOR]

Objective: This cost-analysis study explored Pharmaceutical Benefits Scheme (PBS) data to determine the financial patient contribution (PC) towards dispensed medications prescribed by dentists and temporal trends in cost contributions. Methods: For this study we used the PBS online dataset and only included concessional data in the analysis. Data on dental medications dispensed under the PBS from 2006 to 2018 were accessed. For all medicines aggregated to different pharmacological categories (antibiotics, analgesics and opiates, anti-inflammatories, antifungals, benzodiazepines, anticonvulsants and anti-emetics, and emergency medications), a temporal trend was generated using annual PC data. Cumulative patient and mean annual PC data were also generated in a similar manner. Results: Cumulative PC over the study period for dental PBS prescriptions was A$28 783 361 (A$5.55 per dispensing). The mean annual PC for dental PBS was A$2 214 105 (for the entire concessional population from 2006 to 2018), with a statistically significant and strong correlation between year and PC (Dental PBS, A$59 756 per year; r = 0.98: P < 0.0001). Antibiotics represented the highest proportion of PC (87.8%), whereas the lowest proportion of PC was for emergency medications (e.g. adrenaline, atropine, glucagon, naloxone), which amounted to 0.003%. Conclusions: This study highlights the increasing contributions made by patients towards antibiotic prescriptions. What is known about the topic?: Australian dentists can independently prescribe subsidised medications as per a set scope for general and specialist dentists, regulated under the PBS with requisite adherence to specific legal requirements. What does this paper add?: This is the first study highlighting the increased level of patient financial contributions towards dental medicines, according to different pharmacological categories, dispensed by pharmacists in Australia. What are the implications for practitioners?: This study creates a base for future research assessing the appropriateness of the PBS subsidy and the PBS Safety Net threshold, possibly reassessing the out-of-pocket pricing on brand substitution and appropriately reassessing the current dental PBS schedule. [ABSTRACT FROM AUTHOR]

Purpose To examine the effect that a test set from 1 region of the world has on the performance of expert breast radiologists from that region and from a distant region. Methods Forty-seven Australian and 15 Singaporean breast radiologists interpreted the same test set (ie, 60 mammograms of Australian women consisting of 40 typical and 20 atypical cases) in their respective locations. The radiologists assigned each case a confidence score of 1 to 5, where 1 was typical, 2 was benign, and 3 to 5 indicated identifiable cancer. Localization-response operating characteristic area under the curve (AUC), receiver operating characteristic AUC, location sensitivity, case sensitivity, and specificity were calculated for each radiologist and compared between Australian and Singaporean readers using nonparametric 2-tailed Mann-Whitney U tests. Results Australian readers performed better than did their Singaporean counterparts with respect to localization-response operating characteristic AUC (.738 vs .642, P = .0395) and location sensitivity (.775 vs .660, P = .0185). Discussion Technological advancement has made possible telereporting, in which radiologists report on mammograms originating from other countries. However, those readers' levels of performance might be affected by interpreting images from populations that are different from those with which they are familiar. Conclusion Radiologist performance differed between the groups when localization of lesions was taken into account. This difference might be because of the Australians' reading mammograms from populations with which they were familiar, in contrast to the Singaporeans. [ABSTRACT FROM AUTHOR]

Objectives. MePACS is a triage and support-based personal alarm emergency response system designed to assist older and/or disabled people to live safely in their homes. The aim of this study was to estimate avoidable ambulance attendances and transports to emergency departments and quantify the cost savings attributed to MePACS compared with a comparison cohort without a personal alarm system. Methods. Alarm activation and demographic data for clients registered in the program from June 2016 to May 2017 and funded through the Personal Alert Victoria program were extracted from routinely collected MePACS electronic data. Information on alarm use, event outcomes and ambulance attendances was extracted. Using published Ambulance Victoria data, a comparison cohort was simulated to model the experience of a similar cohort without access to a personal alarm system who experienced a health emergency and called Australia's emergency call service number. The incremental management cost, incorporating the operation cost of MePACS and ambulance fees, was calculated to compare the potential cost savings of MePACS with the comparison cohort. Results. Among 18 421 eligible clients, there were 7856 emergency alarm activations due to falls or medical events from 4275 clients (79.5% female; 81.1% aged .75 years; 91.8% living alone). MePACS resulted in approximately onethird of ambulance attendances being avoided. Potential annual cost savings of A$1 414 732.8 (A$76.8 per person per year; 95% confidence interval A$60.0-93.6 per person per year; P, 0.001) were attributed to avoidable ambulance utilisations for 18 421 MePACS clients. Conclusion. Triage-based personal alarm systems, such as MePACS, provide a cost-saving strategy because of fewer ambulance attendances and transports to emergency departments for older and/or disabled people living in the community. [ABSTRACT FROM AUTHOR]

Many Aboriginal and Torres Strait Islander children are affected by chronic middle ear infection or otitis media from infancy that has a negative impact on development of listening and communication skills. Deficits in these skills are often not detected until school-age when the opportunity for early intervention is lost. Primary health and early childhood workers need screening tools to assist them with detecting the problem early, but there is a scarcity of tools. This study reports the development and validation of a screening tool for detecting communication problems in young Aboriginal and Torres Strait Islander children. The tool, called the Hearing and Talking Scale (HATS), relies on a systematic use of parent observations of communication behaviours of their children in everyday situations. Developed by using a co-design approach, the HATS is culturally and linguistically appropriate for use with parents/carers of young children by front-line workers not trained in speech-language pathology. We validated the HATS by comparing the HATS score of 68 children (46 Indigenous and 22 non-Indigenous children) with their performance in standardised assessments. The accuracy of the HATS was 80% and 81% when compared to the ASQ-TRAK and the Expressive Vocabulary Test respectively. The HATS takes 5 minutes to administer, and is easy to score and interpret. It can be used as part of a standard ear and hearing health check for young children to support early detection so that those with problems can be referred for specialist diagnosis and treatment at a young age. [ABSTRACT FROM AUTHOR]

Objective. Emergency general surgery (EGS) patients experience superior outcomes when cared for within an acute surgical unit (ASU) model. EGS structures in most Australian hospitals remain unknown. This study aimed to describe the national spectrum of EGS models. Methods. Across-sectional study was performed of allAustralian public hospitals of medium or greater peer group (.2000 patient separations per annum). The primary outcome was the incidence of each EGS model. Secondary outcomes were the relationship of the EGS model to objective hospital variables, and qualitative reasons for the choice of model. Results. Of the 120 eligible hospitals, 119 (99%) participated. Sixty-four hospitals reported using an ASU (28%) or hybrid EGS model (26%), whereas the remaining 55 (46%) used a traditional model. ASU implementation was significantly more common among hospitals of greater peer group, bed number, surgeon pool and trauma service sophistication. Leading drivers for ASU commencement were aims to improve patient care and decrease after-hours operating, whereas common barriers against uptake were insufficient EGS patient load or surgeon on-call pool. Conclusions. ASU or hybrid models of care may be more widespread than currently reported. The introduction of such structures is heavily dependent on hospital and staff size, trauma subspecialisation and EGS patient throughput. [ABSTRACT FROM AUTHOR]

From 1 December 2017, the National Cervical Screening Program was renewed in Australia, with updated national cervical screening guidelines released. This study was performed to determine clinicians' familiarity with the updated guidelines and explore their views and attitudes towards the renewed program. Clinicians providing cervical screening in New South Wales, Australia, were invited to complete an online survey in 2018. Of the 241 clinicians who responded, 91.5% supported the change to 5-yearly human papillomavirus screening from the age of 25 years. However, nearly 13% indicated they did not know where to access the renewed guidelines and 37% had never or rarely accessed them. Open-ended responses highlighted clinicians' concerns about missed cancers and missed opportunities for health checks. Those raising these concerns accessed the guidelines less frequently. The findings highlight important areas for additional education and support for clinicians in translating guidelines into practice to ensure successful delivery of the renewed program. In 2017, the Australian National Cervical Screening Program was renewed. This study assessed New South Wales clinicians' views and attitudes towards the changes to the program. We identified some gaps in familiarity with the guidelines and clinician concerns that, if not addressed, may undermine the success of the program. [ABSTRACT FROM AUTHOR]

Autistic adults experience a higher rate of physical and mental health conditions and lower rates of employment and post-secondary education participation than their non-autistic counterparts, which may affect negatively quality of life. Limited information exists on predictors of quality of life for autistic individuals, or how quality of life compares to non-autistic individuals. Our aims were to (a) examine and compare indicators of physical (e.g. sleep quality) and mental health (e.g. anxiety) on quality of life among a sample of 244 autistic and 165 non-autistic individuals aged 15–80 years and (b) examine factors contributing to quality of life 2 years later among the autistic sample (n = 93). Participants were from two Australian longitudinal studies. The pattern of results for quality of life was similar across the autistic and non-autistic groups, with depression symptomatology, psychological well-being, sleep quality and autonomic symptoms all significantly predicting quality of life. In addition, among the autistic group, baseline quality of life had the greatest influence on quality of life 2 years later. These findings have implications for support services for autistic individuals, implying that in order to improve quality of life, mental health, particularly depression, needs addressing. Given known relationships between sleep and mental health, an intervention addressing these may have greatest clinical impact on quality of life among autistic individuals. Research shows that autistic adults are at risk of a range of physical (e.g. sleep difficulties) and mental health (e.g. anxiety) conditions, as well as lower employment and post-secondary education participation; these all can affect one's quality of life. However, we have little information about what affects quality of life for autistic individuals across the lifespan and whether this differs from non-autistic people. We determined what factors (e.g. mental or physical health challenges) affected quality of life in a large group of autistic individuals aged 15–80 years compared with similar age non-autistic individuals. We also examined what factors affected quality of life of the autistic group 2 years later. We found a similar pattern of results for the autistic and non-autistic groups; depression symptoms, psychological well-being, sleep quality and autonomic symptoms (e.g. sweating) were all significant predictors of quality of life. In addition, among the autistic group, baseline quality of life had the most influence on quality of life 2 years later. These results have implications for support services, as they highlight the relationship between mental health (especially depression) and quality of life. Given that sleep challenges (e.g. insomnia) are related to mental health, an intervention addressing both insomnia and mental health may be most useful in helping autistic individuals improve their quality of life. [ABSTRACT FROM AUTHOR]

Limiting ultraviolet radiation exposure during early childhood can significantly reduce the risk of developing skin cancer, making early childhood a critical time for sun protection strategies. This study aimed to measure sun protection practices utilized in Australian early-childhood services over the past decade and evaluate the impact of Cancer Council Australia's SunSmart Early-Childhood Program. Results are presented from cross-sectional and repeated-measures survey data, completed by directors or other staff at randomly sampled early-childhood services in 2008, 2013 and 2018 (N  =   3243). Most sun protection practices were used by a significantly greater proportion of services in 2018 relative to earlier years, such as requiring the use of sunscreen (98.4%), and sun-protective hats (99.7%) and clothing (88.8%). However, only a small and declining proportion of services (16.3%–22.4%) required the use of specific items of sun-protective clothing. SunSmart program members reported enacting significantly more sun protection practices compared to non-members, while new members showed an increase in the use of those practices relative to services whose status did not change (d  =   0.48). The results demonstrate improvements in sun protection in Australian early-childhood settings, and highlight the benefits and limitations of the SunSmart program. [ABSTRACT FROM AUTHOR]

Background: Junior physiotherapists require satisfactory clinical skills to work effectively within the acute hospital setting for service quality and consistency. Objective: To investigate the effects of stream-specific clinical training on junior physiotherapist self-efficacy, self-rated confidence, and self-rated ability to work independently during weekend shifts. Design: Prospective cohort study. Participants: Eighteen junior physiotherapists. Methods: Physiotherapists undertook 8 h of stream-specific education in: pediatrics, women's health, neuro-medical, musculoskeletal, cardiorespiratory, and critical care over 8 weeks. Learning objectives were evaluated using a self-efficacy (0–100) scale and self-rated confidence was measured with a 4-point Likert scale (not confident to independent). Self-rated ability to independently work weekend shifts was measured dichotomously (yes/no). Results: Participants completed an average of three stream-specific programs in the study period. Post-training, mean improvement in self-efficacy across objectives ranged from 2.9 (95% CI −8.7 to 14.5) to 43.3 (95% CI 4.8–81.8) points, p < 0.05 for 80% of objectives. Self-rated confidence scores improved for 45.6% of stream-specific learning objectives; 52.8% were unchanged and 1.7% reported a decrease in confidence. Self-rated ability to work stream-specific weekend shifts increased from 56–70%, but no stream achieved a significant increase in staff able to independently work weekend shifts (p range 0.10 to 1.0). Conclusions: A stream-specific education program increased junior physiotherapists' self-efficacy and self-rated confidence but not perceived ability to work independently on weekends. Results were non-randomized and actual practice change was not assessed. Future studies could investigate different educational structures in a blinded, randomized manner on clinical practice change. [ABSTRACT FROM AUTHOR]

Despite their widespread use, typical visual observation practices are not evidence‐based and adverse events – such as self‐harm and absconding – still occur even under the most intense forms of observation. This study aimed to (i) develop and implement an engagement‐focused systematized model of clinical risk management in an adult acute psychiatric inpatient unit; and (ii) prospectively evaluate its effect on rates of violence, self‐harm, absconding, sexually inappropriate behaviour, and seclusion. A new model of engagement‐focused clinical risk management was developed using a participatory action research framework and implemented in an adult acute psychiatric inpatient unit. Using a mirror‐image design, rates of violence/aggression, self‐harm, absconding, sexually inappropriate behaviour, and seclusion were compared before and after implementation, and staff satisfaction levels were measured. The clinical engagement‐based model was introduced, and 1087 admissions before implementation (24 months) were compared with 965 admissions post‐implementation (18 months). The new model was associated with significantly reduced rates of absconding (pre: 10.5/1000 occupied bed days, 95% CI [9.0, 12.1] compared with post: 6.5/1000 occupied bed days [5.2, 8.1], P < 0.001) and seclusion (pre: 43.7/1000 occupied bed days, 95% CI [40.6, 46.9] compared with post: 30.9/1000 occupied bed days [27.9, 34.1], P < 0.0001). Rates of aggression, deliberate self‐harm, and sexually inappropriate behaviour were non‐significantly decreased. Findings suggest that this engagement‐focused model of clinical risk management in an adult psychiatric inpatient unit significantly reduced adverse patient events and was preferred by staff over current practice. Other psychiatric inpatient facilities may see a reduction in adverse events following the introduction of this well‐tolerated risk management model. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to map end-of-life care in acute hospital settings against Elements 1–5 of the Australian Commission on Safety and Quality in Health Care's (ACSQHC) Essential Elements for Safe and High-Quality End-of-Life Care. Methods: A retrospective medical record audit of deceased in-patients was conducted from 2016 at one public (n = 320) and one private (n = 132) hospital in Melbourne, Australia. Ten variables, key to end-of-life care according to the ACSQHC's Elements 1–5 were used to evaluate end-of-life care. Results: Most patients (87.2%) had a limitation of medical treatment. In 91.97% (P < 0.0001) of cases, a written entry indicating poor prognosis preceded a documented decision to provide end-of-life care, with a documented decision noted in 81.1% of cases (P < 0.0001). Evidence of pastoral care involvement was found in 41.6% of cases (P < 0.0001), with only 33.1% of non-palliative care patients referred to specialist palliative care personnel (P = 0.059). An end-of-life care pathway was used in 51.1% of cases (P < 0.0001). Conclusion: There is clear scope for improvement in end-of-life care provision. Health services need to mandate and operationalise Elements 1–5 of the ACSQHC's Essential Elements into care systems and processes, and ensure nationally consistent, high-quality end-of-life care. What is known about the topic?: Acute care settings provide the majority of end-of-life care. Despite the ACSQHC's Ten Essential Elements, little is known about whether current end-of-life care practices align with recommendations. What does this paper add?: There is room for improvement in providing patient-centred care, increasing family involvement and teamwork, describing and enacting goals of care and using triggers to prompt care. Differences between public and private hospitals may be the result of differences in standard practice or policy and differences in cultural diversity. What are the implications for practitioners?: The Essential Elements need to be mandated and operationalised into mainstream care systems and processes as a way of ensuring safe and high-quality end-of-life care. [ABSTRACT FROM AUTHOR]

Background: Non steroidal anti-inflammatory agents (NSAIDS) are among the most commonly prescribed analgesics despite their adverse effect profile. The main objective of this pilot study is to assess the prescribing patterns of NSAIDs in an Australian hospital and to examine predictors for prescribing patterns. Method: A retrospective cross sectional study was conducted. Patients' gastrointestinal and cardiovascular comorbidities were recorded for stratifications according to international guidelines. Pharmacist input was recorded to examine its effect on NSAIDs' prescribing patterns. Appropriateness of prescribing patterns was determined according to published international prescribing guidelines for NSAIDs. Univariate and multivariate regression analyses were conducted to determine predictors of patients' variables on prescribing patterns. Results: A total of 300 patients were eligible to be included in the study. Fifty-five percentage of patients audited were prescribed NSAIDs according to the guidelines. There was an association between the type of NSAIDs prescribed and patients' gastrointestinal and cardiovascular risks, P less than 0.01. Multiple logistic regression analysis has shown: age more than 75 years, a history of peptic ulcer disease or a moderate gastrointestinal risk were all predictors for receiving a NSAID with a gastroprotectant agent [odds ratio (OR) = 3.54, 95% confidence interval (CI) (1.10-11.79), P < 0.05; OR = 9.51, 95% CI (3.70-26.72), P < 0.01; and OR = 5.04, 95% CI (51.72-15.54), P < 0.01, respectively]. Naproxen was more likely to be prescribed in patients with moderate-to-high gastrointestinal risk [OR = 16.24, 95% CI (2.70-132.70) and OR = 81.47 95% CI (3.38-2436.53), P < 0.01, respectively]. Patients who had their medications reviewed by a pharmacist were prescribed cyclo-oxygenase-2 inhibitors more frequently [OR = 3.36, 95% CI (1.05-15.34), P < 0.05] than any other agent. Conclusion: About half of the patients audited were prescribed NSAIDs appropriately. Factors affecting the prescribing of NSAIDs included: older age, patients' gastrointestinal risks as well as pharmacist input. This pilot study presents an opportunity for pharmacists to promote adherence to NSAIDs prescribing guidelines. What is known about the topic? * Inappropriate prescribing contributes to patients' morbidity and mortality. * Nonsteroidal agents are associated with multiple adverse effects. * Compliance with various evidence-based prescribing guidelines is variable and is dependent on prescriber's knowledge and experience. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate how health consumer organisations manage their relationships with the pharmaceutical industry in Australia. Methods: We identified 230 health consumer organisations that received pharmaceutical industry support from 2013 to 2016 according to reports published by Medicines Australia, the industry trade association. A random sample of 133 organisations was selected and their websites assessed for financial transparency, policies governing corporate sponsorship and evidence of potential industry influence. Results: In all, 130 of the 133 organisations evaluated received industry funding. Of these 130, 68 (52.3%; 95% confidence interval (CI) 43.4–61.1%) disclosed this funding. Nearly all (67; 98.5%) reported the identity of their industry donors, followed by uses (52.9%), amount (13.2%) and proportion of income from industry (4.4%). Less than one-fifth (24/133; 18.0%; 95% CI 11.9–25.6%) had publicly available policies on corporate sponsorship. Six organisations (7.2%; 95% CI 2.7–15.1%) had board members that were currently or previously employed by pharmaceutical companies, and 49 (36.8%; 95% CI 28.6–45.6%) had company logos, web links or advertisements on their websites. Conclusion: Industry-funded health consumer organisations in Australia have low transparency when reporting industry funding and few have policies governing corporate sponsorship. Relationships between health consumer organisations and the industry require effective actions to minimise the risks of undue influence. What is known about this topic?: Pharmaceutical industry funding of health consumer organisations is common in the US and Europe, yet only a minority of such organisations publicly disclose this funding and have policies regulating their relationships with industry. What does this paper add?: Industry-funded health consumer organisations in Australia have inadequate financial transparency and rarely have policies addressing corporate funding. Organisations that have received more industry funding are more likely to report it publicly. What are the implications for practitioners?: Robust policies addressing corporate sponsorship and increased transparency are needed to maintain the independence of health consumer organisations. Governments may also consider regulating non-profit organisations to ensure public reporting of funding sources. [ABSTRACT FROM AUTHOR]

Objective: The ability to determine the location of the sound source is often important for effective communication. However, it is not clear how the localisation is affected by background noise. In the current study, localisation in quiet versus noise was evaluated in adults both behaviourally, and using MMN and P3b. Design: The speech token/da/was presented in a multi-deviant oddball paradigm in quiet and in presence of speech babble at +5 dB SNR. The deviants were presented at locations that differed from the standard by 30°, 60° and 90°. Study sample: Sixteen normal hearing adults between the age range of 18–35 years participated in the study. Results: The results showed that participants were significantly faster and more accurate at identifying deviants presented at 60° and 90° as compared to 30°. Neither reaction times nor electrophysiological measures (MMN/P3b) were affected by the background noise. The deviance magnitude (30°, 60° and 90°) did not affect the MMN amplitude, but the smaller deviant (30°) generated P3b with smaller amplitude. Conclusions: Under the stimulus paradigm and measures employed in this study, localisation ability as effectively sampled appeared resistant to speech babble interference. [ABSTRACT FROM AUTHOR]

Evidence-based standardised diabetes care is difficult to achieve in the community due to resource limitations, and lack of equitable access to specialist care leads to poor clinical outcomes. This study reports a quality improvement program in diabetes health care across a large health district challenged with significant rural and remote geography and limited specialist workforce. An integrated diabetes care model was implemented, linking specialist teams with primary care teams through capacity enhancing case-conferencing in general practice supported by comprehensive performance feedback with regular educational sessions. Initially, 20 practices were recruited and 456 patients were seen over 14 months, with significant improvements in clinical parameters. To date 80 practices, 307 general practitioners, 100 practice nurses and 1400 patients have participated in the Diabetes Alliance program and the program envisages enrolling 40 new practices per year, with a view to engage all 314 practices in the health district over time. Diabetes care in general practice appears suboptimal with significant variation in process measures. An integrated care model where specialist teams are engaged collaboratively with primary care teams in providing education, capacity enhancing case-conferences and performance monitoring may achieve improved health outcomes for people with diabetes. [ABSTRACT FROM AUTHOR]

Background: Recent guidelines suggest screening high‐risk women in early pregnancy for gestational diabetes (GDM); however, there is little evidence to support this. Aims: To compare pregnancy outcomes associated with diabetes for women with risk factors for GDM according to gestation of diagnosis. Early GDM was defined as a positive test before 20 weeks gestation, late GDM as a positive test at 20 or more weeks and no GDM when both tests were negative. Materials and methods: Retrospective analysis in an Australian tertiary hospital of women who underwent a glucose tolerance test in pregnancy prior to 20 weeks gestation, and a repeat test after 20 weeks gestation if the initial test was negative. Results were adjusted for maternal demographics. Results: Women with early GDM (n = 170) were no more likely to experience the obstetric composite outcome than women with late GDM (n = 171) or no GDM (n = 547) (early odds ratio (OR) 1.16, 95%CI 0.79–1.71; late OR 0.78, 95%CI 0.53–1.12). Infants of women with early GDM, but not late GDM, were more likely (early OR 1.8, 95%CI 1.15–2.92; late OR 1.4, 95%CI 0.90–2.23) to have the neonatal composite outcome than infants of women without GDM, predominantly due to an increase in neonatal hypoglycaemia. Conclusions: This result may be due to careful management of GDM, or because, after adjustment for maternal demographics, the early diagnosis of GDM does not substantially increase rates of adverse outcomes compared to GDM diagnosed in later pregnancy or no GDM in women with risk factors for GDM. [ABSTRACT FROM AUTHOR]

Objective: Limited international evidence suggests general practice registrars' emergency department (ED) referral rates exceed those of established general practitioners (GPs). The aim of the present study was to fill an evidence gap by establishing the prevalence, nature and associations of Australian GP registrar ED referrals. Methods: A cross-sectional analysis was performed of the Registrar Clinical Encounters in Training (ReCEnT) cohort study of GP registrars' consultation experiences, between 2010 and 2015. The outcome factor in logistic regression analysis was referral to an ED. Independent variables included patient-level, registrar-level, practice-level and consultation-level factors. Results: In all, 1161 GP registrars (response rate 95.5%) contributed data from 166 966 consultations, comprising 258 381 individual problems. Based on responses, 0.5% of problems resulted in ED referral, of which nearly 25% comprised chest pain, abdominal pain and fractures. Significant (P < 0.05) associations of ED referral included patient age <15 and >34 years, the patient being new to the registrar, one particular regional training provider (RTP), in-consultation information or assistance being sought and learning goals being generated. Outer regional-, remote- or very remote-based registrars made significantly fewer ED referrals than more urban registrars. Of the problems referred to the ED, 45.5% involved the seeking of in-consultation information or assistance, predominantly from supervisors. Conclusions: Registrars' ED referral rates are nearly twice those of established GPs. The findings of the present study suggest acute illnesses or injuries present registrars with clinical challenges and real learning opportunities, and highlight the importance of continuity of care, even for acute presentations. What is known about the topic?: A GP's decision concerning continued community- versus hospital-based management of acute presentations demands careful consideration of a suite of factors, including implications for patient care and resource expenditure. General practice vocational training is a critical period for the development of GP registrars' long-term patterns of practice. Although limited international evidence suggests GP registrars and early career GPs refer patients to the ED at a higher rate than their more experienced peers, these studies involved small subject numbers and did not investigate associations of registrars making an ED referral. Relevant Australian studies focusing on GP registrars' ED referral patterns are lacking. What does this paper add?: The present ongoing cohort study is the first to establish the patterns of ED referrals made by Australian GP registrars, encompassing five general practice RTPs across five states, with participating registrars practising in urban, rural, remote and very remote practices. Several significant associations were found with GP registrars making ED referrals, including patient age, continuity of care, the registrar's RTP, assistance sought by the registrar and rurality of the registrar's practice. What are the implications for practitioners?: The higher likelihood of GP registrars seeing acute presentations than their more established practice colleagues, coupled with a demonstrated association of registrars seeking in-consultation assistance for such presentations, highlights the importance of GP supervisor accessibility in facilitating ED referral appropriateness and in the development of registrars' safe clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to describe and compare the confidence and knowledge of health professionals (HPs) with and without specialized speech-language training for communicating with people with aphasia (PWA) in a metropolitan hospital setting.Methods: Ninety HPs from multidisciplinary teams completed a customized survey to identify their demographic information, knowledge of aphasia, current use of supported conversation strategies and overall communication confidence when interacting with PWA using a 100 mm visual analogue scale (VAS) to rate open-ended questions. Conventional descriptive statistics were used to examine the demographic information. Descriptive statistics and the Mann-Whitney U test were used to analyse VAS confidence rating data. The responses to the open-ended survey questions were grouped into four previously identified key categories.Results: The HPs consisted of 22 (24.4%) participants who were speech-language pathologists and 68 (75.6%) participants from other disciplines (non-speech-language pathology HPs, non-SLP HPs). The non-SLP HPs reported significantly lower confidence levels (U = 159.0, p < 0.001, two-tailed) and identified fewer strategies for communicating effectively with PWA than the trained speech-language pathologists. The non-SLP HPs identified a median of two strategies identified [interquartile range (IQR) 1-3] in contrast to the speech-language pathologists who identified a median of eight strategies (IQR 7-12).Conclusion: These findings suggest that HPs, particularly those without specialized communication education, are likely to benefit from formal training to enhance their confidence, skills and ability to successfully communicate with PWA in their work environment. This may in turn increase the involvement of PWA in their health care decisions. Implications for Rehabilitation Interventions to remediate health professional’s (particularly non-speech-language pathology health professionals) lower levels of confidence and ability to communicate with PWA may ultimately help ensure equal access for PWA.Promote informed collaborative decision-making, and foster patient-centred care within the health care setting. [ABSTRACT FROM AUTHOR]

Background: Individuals with impaired fat taste (FT) sensitivity have reduced satiety responses after consuming fatty foods, leading to increased dietary fat intake. Habitual consumption of dietary fat may modulate sensitivity to FT, with high consumption decreasing sensitivity [increasing fatty acid taste threshold (FATT)] and low consumption increasing sensitivity (decreasing FATT). However, some individuals may be less susceptible to diet-mediated changes in FATT due to variations in gene expression. Objective: The objective of this study was to determine the effect of an 8-wk low-fat or high-fat diet on FATT while maintaining baseline weight (<2.0 kg variation) to assess heritability and to explore the effect of genetics on diet-mediated changes in FATT. Design: A co-twin randomized controlled trial including 44 pairs (mean ± SD age: 43.7 ± 15.4 y; 34 monozygotic, 10 dizygotic; 33 women, 10 men, 1 gender-discordant) was conducted. Twins within a pair were randomly allocated to an 8-wk low-fat (<20% of energy from fat) or high-fat (>35% of energy from fat) diet. FATT was assessed by a 3-alternate forced choice methodology and transformed to an ordinal scale (FT rank) at baseline and at 4 and 8 wk. Linear mixed models were fit to assess diet effect on FT rank and diet effect modification due to zygosity. A variance components model was fit to calculate baseline heritability. Results: There was a significant time x diet interaction for FT rank after the 8-wk trial (P < 0.001), with the same conclusions for the subset of participants maintaining baseline weight (low-fat; n = 32; high-fat: n = 35). There was no evidence of zygosity effect modification (interaction of time x diet x zygosity: P = 0.892). Heritability of baseline FT rank was 8%. Conclusions: There appears to be little to no genetic contribution on heritability of FATT or diet-mediated changes to FATT. Rather, environment, specifically dietary fat intake, is the main influencer of FT sensitivity, regardless of body weight. [ABSTRACT FROM AUTHOR]

This study investigated factors involved in sexual information processing when alcohol is involved. Seventy-two male and 90 female participants viewed one of four videos of a heterosexual dyad interacting where the females’ clothing (sexualized/non-sexualized) and drink consumed (alcohol/water) was manipulated, and completed personality questionnaires. It was hypothesized the condition containing sexualized clothing, alcohol consumption and a male participant viewing the video would infer the greatest level of perceived sexual intent. Results yielded support for an effect of clothing. Also, men, compared to women, were significantly more socio-sexually inept, sexually pre-occupied, adopted a masculine sex role orientation and held conservative attitudes toward women. However, the feminine sex role orientation was not adopted significantly more by females when compared to males. The results of this study re-affirm the strong link between sexualized clothing and misperception, reinstating the need for clear verbal communication of sexual/platonic intentions. Recommendations are made for future research. [ABSTRACT FROM PUBLISHER]

This study examined levels of, and relationships between, self-care ability, self-compassion, and compassion among palliative care nurses and doctors. Methods: A total of 369 participants across Australia completed a cross-sectional survey comprising a demographic questionnaire and outcome measures for each variable. Descriptive and inferential statistics were analysed, controlling for potential social-desirability bias. Results: Levels of compassion, self-compassion and self-care ability varied, with some individuals scoring high or low in each. Self-compassion and self-care ability were positively correlated (r = .412, p<.001), whereas a negative correlation was observed between compassion and self-compassion (r = -.122, p<.05). Linear regression further indicated that: increased compassion was associated with a decrease in self-compassion, and increased self-care ability was associated with an increase in self-compassion. Conclusion: These results suggest important implications for self-care in the palliative care workforce. Moreover, this study contributes an empirical basis to inform future research and education to promote balanced compassion and compassion literacy in palliative care practice. [ABSTRACT FROM AUTHOR]

Aim Research conducted by dietitians is encouraged by national and international organisations, yet research output remains low. The attitudes towards and experiences with research and research methods course work of students and practitioners in Australia and the United States were examined. Methods A cross-sectional online survey was conducted. Participants were contacted by email; 173 Australian (N = 50 students; 123 practitioners) and 499 US (N = 231 students; 268 practitioners) respondents completed the survey. Results A smaller proportion of American students (74%) indicated that they would consider conducting research in the future compared to Australian students (84%) ( P < 0.001). More Australian than American practitioners indicated interest in conducting research in their current position (87% vs 66%; P < 0.001). Research training did not increase future research plans, but respondents who had conducted research either as a student or at work responded more favourably to conducting research in the future ( P < 0.001). In general, Australian respondents were more supportive of and more experienced with research. Conclusions Unlike classroom training, past research experiences supported plans for future research. Further work needs to investigate how the culture of the profession can be changed to support more dietitian-conducted research. [ABSTRACT FROM AUTHOR]

Inappropriate prescribing of antibiotics for the management of respiratory tract infections (RTIs) has contributed to increased prevalence of antibiotic resistance, and this remains a challenge. The aim of this study was to evaluate the effect of general practitioners' (GPs) participation in the Antibiotics: Clinical e-Audit, a quality-improvement activity, on GP self-reported knowledge and practice change, and explored barriers encountered in the management of respiratory tract infections (RTIs). Participants completed a survey at the end of the activity to assess the usefulness of the audit, any reported changes made and barriers encountered to their clinical practice. More than half of the 872 participants reported the audit assisted them in reviewing patients with RTIs. The majority of GP registrars (48.2%, N= 66) indicated that the clinical e-Audit had changed their practice in terms of identifying patients for whom an antibiotic was recommended. GPs identified several barriers to achieving best practice in the management of RTIs, including patient or carer expectations for an antibiotic prescription and non-adherence to symptomatic management by patients. Empowering GPs to overcome these barriers should be the aim of future education and behaviour change programs. [ABSTRACT FROM AUTHOR]

Objective This study investigated whether lifetime and recent methamphetamine use (including crystal methamphetamine) differed among city, regional and rural residents and whether particular subpopulations were more at-risk. Design Secondary analyses of the last three National Drug Strategy Household Surveys and corresponding Alcohol and Other Drug Treatment Services National Minimum Data Sets ( AODTS NMDS). Setting Australian general population. Participants Australians who completed the 2007 ( n = 22 519), 2010 ( n = 25 786) and 2013 ( n = 23 512) NDSHS (aged 14 + ); and treatment episodes where the principal drug of concern was recorded in the 2006/2007 ( n = 139 808), 2009/2010 ( n = 139 608) and 2012/2013 ( n = 154 489) AODTS NMDS. Main outcome measure(s) To determine whether rural Australians were more likely to use methamphetamine than non-rural counterparts. Results Lifetime and recent methamphetamine and recent crystal methamphetamine use were significantly higher among rural than other Australians. Significantly more rural men and employed rural Australians used methamphetamine than their city, regional or Australian counterparts. Rural Australians aged 18-24 and 25-29 years were significantly more likely to have used methamphetamine in their lifetime than city or Australian residents. Rural Australians aged 18-24 years were significantly more likely to have recently used crystal methamphetamine. Conclusions Interventions tailored to address the specific and unique circumstances of rural settings are required to reduce and prevent methamphetamine use, particularly crystal methamphetamine. Scope exists to focus prevention efforts on rural workplaces and primary care settings. Greater understanding of the higher prevalence of methamphetamine use in rural areas is required, plus implementation of comprehensive strategies and optimised treatment utilisation. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) screening participation remains unacceptably low. This study investigated the emotion of disgust as a potential deterrent to intention to screen for CRC. The study utilised a convenience sample of individuals' 40-70 years of age to complete an online survey. Participants included 30 men and 118 women recruited between December 1, 2013 and March 31, 2014. Data on socio-demographics, health status, screening intentions and emotional barriers to bowel screening were collected via an on-line survey. Logistic regression analysis was utilised to investigate predictors of screening intention. Individuals were more likely to report intention to screen if they had prior screening experience, and reported fewer emotional concerns to screening for CRC. Results implicate disgust as a predictor of screening avoidance among participants. Specifically, higher reported faecal disgust was predictive of a 3% decrease in screening intention. This study was the first to empirically position disgust alongside other negative emotional states as an affective barrier to screening for CRC. Trait disgust sensitivity was not a reliable predictor of screening intention. This research suggests that anticipated faecal disgust may contribute to avoidance of screening for CRC. [ABSTRACT FROM AUTHOR]

Undulatory underwater swimming (UUS) is one of the major skills contributing to performance in competitive swimming. UUS has two phases- the upbeat is performed by hip extension and knee flexion, and the downbeat is the converse action. The purpose of this study was to determine which kinematic variables of the upbeat and downbeat are associated with prone UUS performance in an elite sample. Ten elite participants were filmed performing three prone 20 m UUS trials. Seven landmarks were manually digitised to calculate eighteen kinematic variables, plus the performance variable- horizontal centre of mass velocity (VCOM). Mean VCOM was significantly correlated with body wave velocity (upbeat r = 0.81, downbeat r = 0.72), vertical toe velocity (upbeat r = 0.71, downbeat r = 0.86), phase duration (upbeat r = -0.79), peak hip angular velocity (upbeat r = 0.73) and mean knee angular velocity (upbeat r = -0.63), all significant at P < 0.05. A multiple stepwise regression model explained 78% of variance in mean VCOM. Peak toe velocity explained 72% of the variance, and mean body wave velocity explained an additional 6%. Elite swimmers should strive for a high peak toe velocity and a fast caudal transfer of momentum to optimise underwater undulatory swimming performance. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the present study was to describe trends in and age and gender distributions of presentations of older people to Australian emergency departments (EDs) from July 2006 to June 2011, and to develop ED utilisation projections to 2050. Methods. A retrospective analysis of data collected in the National Non-admitted Patient Emergency Department Care Database was undertaken to assess trends in ED presentations. Three standard Australian Bureau of Statistics population growth models, with and without adjustment for current trends in ED presentation growth and effects of climate change, were examined with projections of ED presentations across three age groups (0-64, 65-84 and ⩾85 years) to 2050. Results. From 2006-07 to 2010-11, ED presentations increased by 12.63%, whereas the Australian population over this time increased by only 7.26%. Rates of presentation per head of population were greatest among those aged ⩾85 years. Projections of ED presentations to 2050 revealed that overall ED presentations are forecast to increase markedly, with the rate of increase being most marked for older people. Conclusion. Growth in Australian ED presentations from 2006-07 to 2010-11 was greater than that expected from population growth alone. The predicted changes in demand for ED care will only be able to be optimally managed if Australian health policy, ED funding instruments and ED models of care are adjusted to take into account the specific care and resource needs of older people. [ABSTRACT FROM AUTHOR]

Background In Australia, the prevalence of chronic kidney disease (CKD) is increasing steadily, especially amongst older people. The extent to which dialysis prolongs life and its effect on quality of life (QoL) of elderly patients who are frail or disabled also remains unclear. Patients and methods We conducted a single-centre, prospective study to compare the trajectory of symptom burden and functional status in elderly patients (age >65 years) with stage 5 CKD receiving renal replacement therapy (RRT), n=12, versus those managed conservatively without dialysis, n=8. Dialysis patients were younger (mean age 73(7) versus 84(6) years, p=0.001). Groups were similar at baseline in functional status, nutrition, co-morbidity and frailty assessments. All patients were still alive after six months. Results Dialysis patients reported a greater improvement in overall symptom scores by six months and no dialysis patient reported severe or overwhelming symptoms while one (13%) conservatively managed patient reported severe pruritus. There was no change in functional status in both groups over a six-month follow-up period. Conclusion We have contributed unique prospective longitudinal data showing the symptom and functional trajectory of a small group of elderly patients with CKD who have just been commenced on dialysis or referred to the renal supportive care clinic. [ABSTRACT FROM AUTHOR]

Background High-quality, evidence-based guidelines can improve the quality of health care and facilitate standardisation of practice within and across healthcare organisations. Limited information is known regarding existing antenatal corticosteroid ( ACS) guideline practices within organisations across Australia and New Zealand. Aims To assess existing ACS clinical practice guidelines ( CPG). To describe current organisational practice related to the production, implementation and renewal of CPG. Design A cross-sectional survey of hospital practice using an online questionnaire. Methods Clinical Managers at 27 secondary and 25 tertiary maternity hospitals, that contribute data to the Australia and New Zealand Neonatal Network, were approached from May to September 2015 and completed the questionnaire on behalf of their organisation. Results Of the hospitals surveyed, 93% reported having a CPG or protocol. Of these, 89% of CPG included recommendations on a single course of ACS, 37% on the use of repeat course/s and 41% on use prior to elective caesarean section at term. Variation in the recommendations provided existed between countries and depending on the level of neonatal care provided. A guideline development group existed in 85% of hospitals. The preferred tools to facilitate implementation of a CPG include: email with a link to the hospital intranet, education sessions and an opinion leader. Only 28% of respondents reported auditing the use of ACS administration. Conclusions There is significant variation in the recommendations provided by current ACS CPGs. Utilisation of a single ACS CPG reflective of the current available evidence base may limit this variation. [ABSTRACT FROM AUTHOR]

Background: Tibial tubercle transfer (TTT) and medial patellofemoral ligament (MPFL) reconstruction have both shown, either in isolation or in combination, to provide improved patellofemoral joint (PFJ) stability. There are few studies that provide evidence that this remains true in the long term. Purpose: To compare the long-term results of patellar instability after TTT with and without MPFL reconstruction in 2 randomized groups. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 34 patients (36 knees) were randomized to 2 groups. The first group underwent lateral release (LR) and TTT for confirmed maltracking of the patella (control group). The second group underwent MPFL reconstruction in addition to TTT and LR (reconstruction group). Patients were followed up with validated questionnaires (Kujala score, Tegner activity score), a visual analog scale (VAS) assessing their insecurity, and a clinical assessment at a minimum of 5 years postoperatively. Participants also underwent quantitative computed tomography (CT) at 1 year for comparison. Two patients in the control group and 1 patient in the reconstruction group were lost to follow-up at 5 years. Results: There were no significant differences in the Kujala (P = .75), Tegner (P = .36), or VAS (P = .75) scores at any time period. One patient in the control group sustained a patellar redislocation at 3 years. Five patients in the control group and 2 in the reconstruction group had functional failures and required reoperations; however, this was not statistically significant (P = .30). There were no significant differences between groups in the time to return to school or work (P = .65) or sports (P = .38) after surgery. Overall patient satisfaction was higher in the reconstruction group compared with the control group (P = .04), and quantitative CT scans showed that the reconstruction group had a statistically significant improvement in the mean patellar tilt (6° vs -8°, respectively; P = .03) and mean congruence angle (13° vs -11°, respectively; P = .03) in the quadriceps-contracted state compared with the control group. Conclusion: Reconstruction of the MPFL in addition to TTT and LR resulted in improved alignment parameters (congruence angle, patellar tilt angle) as well as patient satisfaction. The Kujala and Tegner scores were no different between the 2 groups at any time period. There was insufficient evidence to conclude that the addition of MPFL reconstruction to TTT results in fewer redislocations or reoperations. This study concludes that MPFL reconstruction improves PFJ alignment and patient satisfaction; however, further studies with larger patient numbers are required to satisfy its significance with respect to redislocation rates and functional scores in the long term. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to explore the extent to which Australian child and family health nurses work with families with complex needs and how their practice responds to the needs of these families. Background Many families with young children face challenges to their parenting capacity, potentially placing their children at risk of poorer developmental outcomes. Nurses increasingly work with families with mental health problems, trauma histories and/or substance dependence. Universal child health services must respond effectively to these challenges, to address health inequalities and to promote the best outcomes for all children and families. Design The descriptive study used cross-sectional data from the first national survey of child and family health nurses in Australia, conducted during 2011. Methods Survey data reported how often, where and how child and family health nurses worked with families with complex needs and their confidence in nursing tasks. Findings Many, but not all, of the 679 respondents saw families with complex needs in their regular weekly caseload. Child and family health nurses with diverse and complex caseloads reported using varied approaches to support their clients. They often undertook additional professional development and leadership roles compared with nurses who reported less complex caseloads. Most respondents reported high levels of professional confidence. Conclusion For health services providing universal support and early intervention for families at risk, the findings underscore the importance of appropriate education, training and support for child and family health professionals. The findings can inform the organization and delivery of services for families in Australia and internationally. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of occipital bending (an occipital lobe crossing or twisting across the midline) in subjects with schizophrenia and matched healthy controls. Method: Occipital bending prevalence was investigated in 37 patients with schizophrenia and 44 healthy controls. Results: Ratings showed that prevalence was nearly three times higher among schizophrenia patients (13/37 [35.1%]) than in control subjects (6/44 [13.6%]). Furthermore, those with schizophrenia had greater normalized gray matter volume but less white matter volume and had larger brain-to-cranial ratio. Conclusion: The results suggest that occipital bending is more prevalent among schizophrenia patients than healthy subjects and that schizophrenia patients have different gray matter-white matter proportions. Although the cause and clinical ramifications of occipital bending are unclear, the results infer that occipital bending may be a marker of psychiatric illness. [ABSTRACT FROM AUTHOR]

Background: It has been widely recognized that parental dietary intake is an important and consistent factor influencing children's food intake. However, there are conflicting results with regard to the strength of the parental-child resemblance in dietary intake. Moreover, this association has rarely been investigated in young adult offspring. Objectives: The aims of this study were to describe the dietary intake and food consumption of middle-aged women and their female and male adult offspring (aged 18-23 y) and to examine the association in dietary intake between sex-specific mother-child dyads. Design: We used cross-sectional dietary data for 2017 mother-child pairs from the 21-y follow-up of the Mater-University of Queensland Study of Pregnancy, a birth cohort study. Dietary information was obtained with the use of a 74-item food-frequency questionnaire. We assessed multivariate-adjusted mother-offspring correlations in selected nutrients and food groups and performed correlational analysis while stratifying by living arrangements. Results: Both sons and daughters had a significantly lower percentage of energy from protein than did their mothers. Sons had a significantly higher percentage of energy from fat and a lower percentage of energy from carbohydrates than did their mothers, whereas there was no difference between daughters and mothers. The mother-offspring correlations were weak (r = 0.12-0.29) for most dietary factors and tended to be slightly higher in motherdaughter dyads than in mother-son dyads. Overall, correlations appeared to be stronger in offspring still living with their parents than with their counterparts not living at home, specifically the correlations for consumption of vegetables and rice. Conclusions: Mother-adult offspring dietary resemblance in this Australian cohort was only weak and varied by nutrients, food groups, and the offspring's sex and living arrangements. Factors other than parental dietary habits and home environment seem to have a stronger influence on the diets of young adults. [ABSTRACT FROM AUTHOR]