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Background: Non‐communicable diseases (NCDs), also known as chronic diseases, now constitute a major proportion of ill‐health across most adult and older populations including in people with intellectual disability. The current paper is a comparative analysis of prevalence of NCDs across mid‐aged and older‐aged people with mild intellectual disability. Method: Comparative data comes from two cross‐sectional surveys using similar methodology and timeframes. The analysis sample comprises mid‐aged group (30–50 years, N = 291) and older‐aged group (≥60 years, N = 391). Results: People with mild intellectual disability start developing NCDs in early to mid‐adulthood and increases with age. The mean number of NCDs in mid‐aged group was 0.86 (SD, 0.84) compared to 3.82 in older group (SD, 2.67). Conclusion: There needs to be early identification and management of NCDs using relevant health promotion and preventative measures at optimal intervention points. The training of healthcare professionals needs improvement. [ABSTRACT FROM AUTHOR]

There is little research comparatively assessing prevalence of pain between older people either with or without intellectual disability. This paper explores health and social factors associated with chronic pain in these two groups. A cross-sectional survey was undertaken in New South Wales and Queensland, Australia. Inclusion criteria were adults either with or without intellectual disability, aged 60 years and older, and currently living in community-settings. Univariate and multivariable analyses were undertaken on a sample of 391 adults with intellectual disability and 920 adults without intellectual disability. Key findings included higher prevalence of pain in the intellectual disability group, along with higher rates of osteoarthritis, falls, oral health problems, and mood disorders. Mitigating risk factors for conditions that cause chronic pain in older adults is crucial. As longevity increases, the healthcare sector needs to prioritise chronic pain management for people with intellectual disabilities through appropriate treatment strategies. [ABSTRACT FROM AUTHOR]

Data specifically comparing outcomes for people with and without intellectual disability is limited. This paper reports perceived health and wellbeing of older Australians resident in metropolitan and rural locations in New South Wales and Queensland. Respondents were community-residing individuals with intellectual disability and mainstream age peers [age ≥ 60]. Measures included SF12; Cummings well-being scales; DSSI; Adverse Life Events; and financial hardship status. The sample was composed of 391 adults with intellectual disability and 920 age peers. Adults with intellectual disability were significantly more likely to note adverse life events, worse mental health, and lower levels of social support, but reported higher mean wellbeing scores and had higher scores for physical health. Results indicated higher likelihood of adults with intellectual disability reporting comparative disadvantage across multiple key areas when compared to age peers. [ABSTRACT FROM AUTHOR]

Changing disease patterns and improved life expectancy have resulted in a growing cohort of older Australians with an intellectual disability, with the provision of end-of-life care to this group only recently emerging as a priority area. Particularly in rural settings, where the availability of both specialist and general local services may be limited, end-of-life care support remains under-explored. The current project aimed to specifically examine end-of-life care provision in rural areas, the focus of this article being individual quality-of-life during the end-of-life stage. The study used a focus group interview model with 22 rural disability support workers from either New South Wales or Queensland, who had direct experience in providing end-of-life care. An advisory committee, composed of people with intellectual disabilities, carers, and service providers, offered overall project guidance. Participants elaborated on factors that contributed to quality-of-life during end-of-life care. Verbatim transcripts of the focus groups were thematically analysed by the team, and three thematic categories identified: availability of services; individual needs; and untreated pain. Specifically, participants noted concerns about the unavailability of health services, inflexibility of funding support, artificial government barriers, and a widespread lack of pain relief for individuals. We conclude that end-of-life support people with intellectual disabilities in rural areas has to trade off the ongoing delivery of quality-of-life activities against the increasing need for health care, which itself is subject to accessibility issues, and which is exacerbated by the more general funding challenges seen across all locations with the National Disability Health Insurance implementation. [ABSTRACT FROM AUTHOR]

Background: Although a 'person‐centred focus' is a legislated objective for both aged‐care and disability services sectors in Australia, evidence suggests limited translation into systems and practices due to entrenched silos. This paper proposes a Best Practice Framework to mitigate these silos. Methods: Mixed‐methods research comprising key informant interviews with major stakeholders across both sectors; a survey of people with/without intellectual disability aged 60+ years; qualitative in‐depth interviews; and survey of health professionals. Results: There is an urgent need to develop inter‐sectoral 'integrated care systems'. Key components include choice in accommodation; regular assessment of health and well‐being indicators; development and adoption of nationally consistent policies/standards across integrated aged‐ and disability‐care sectors; improved strategies for workforce planning; and upskilling of existing staff including place‐based collaboration. Conclusions: An integrated service model requires collaboration on broader public policy instruments, appropriate planning and resourcing. A strategic shift is required to ensure better quality person‐centred support systems. [ABSTRACT FROM AUTHOR]

The article by Andrea Grindrod on "Dying with disability: A disability and palliative care intersectoral partnership framework" provides a good opportunity to focus on some of the key underlying issues associated more broadly with death and dying within the gerontological and medical literature before focussing on policy and implementation perspectives on end-of-life care for people with intellectual disabilities. As outlined in the article by Grindrod ([6]), there is a lack of clinical expertise in the disability care sector with the near-disappearance of developmental disability as a speciality in nursing. Dying with disability: A disability and palliative care intersectoral partnership framework. [Extracted from the article]

Australia's Intergenerational Reports (2010, 2015) make a case for restraining public expenditure on an ageing population given the sizeable post-WWII baby boom cohort, increasing longevity, and uncertain economic prospects for younger generations. There also is concern for major disparities within older and younger generations resulting from cumulative advantages or disadvantages over the life course. Drawing on national survey data from the Attitudes to Ageing in Australia study, this article investigates perceptions of inequity between age cohorts at two time points (2009–10, 2015–17) focusing on variations by age and gender around lifelong opportunities for baby boomers compared to other groups, share of government benefits, and support for increasing pension age eligibility. The findings indicate a shift in attitudes between 2009–10 and 2015–17 with more in the younger cohorts in 2015–17 reporting better lifelong opportunities for baby boomers; and baby boomers receiving a fair share/more than a fair share of government benefits. With pension age eligibility, there is a small but significant shift in attitudes supporting the increase and a corresponding drop in those opposing it, however opposition is highly gendered with more women in each of the age cohorts opposing it at both time points. While there is a perceptible shift in younger cohorts' attitudes towards baby boomers' perceived advantages, overall attitudes are not totally supportive of government arguments for expenditure restraint; although a more overt public discourse on intergenerational inequity is emerging as the declining life prospects of younger cohorts are juxtaposed with tax-advantaged housing and retirement wealth of many older age Australians. [ABSTRACT FROM AUTHOR]

Background: There is paucity of research from Australia about comorbidity in older people with intellectual disability (PwID). This paper examines the burden of chronic diseases and associated sociodemographic correlates in a cohort of PwID aged 60+. Methods: A cross‐sectional survey was used with community‐dwelling older PwID in urban/rural regions of two Australian states. Recruitment was undertaken via a multi‐prong approach and each subject (N = 391; 236 urban/155 rural) personally interviewed. Results: Findings show older PwID experience considerable multimorbidity (X = 3.8; 53.5% had 2–6 conditions). Conditions included arthritis (40%), diabetes (26%), cardiovascular diseases (23.6%), asthma (16.1%), carcinomas (10.0%) and mental health disorders (34.5%). Conclusions: There was significant multimorbidity in older PwID, with evolution of life trajectories of select conditions associated with socioeconomic disadvantage and heath facility access barriers. Greater scrutiny of progressive health debilitation leading into older age and increased engagement by healthcare systems is required earlier in the lives of PwID. [ABSTRACT FROM AUTHOR]

Accessible Summary: In the past 30 years, many people with (intellectual) learning disabilities have been moved out of large "institutions" and into their own home in their local communityThese people are now often between 30 and 50 years oldWe asked people with learning disabilities aged between 30 and 50 and who are living in their local community what things, including work, that they enjoyed doingWe asked people with learning disabilities aged between 30 and 50 and who are living in their local community whether they felt that they could make decisions about their lifeWe found out the things that make their life good, and also what might stop people enjoying their lifeWe learnt that people with learning disabilities should receive more support to assist them before they retireWe learnt that people with learning disabilities still need more support and choice around who they live with Background: This study investigated perceived quality of life (QoL) of community‐dwelling middle‐aged adults (30–50 years) with an intellectual disability and/or developmental disability living in rural or urban areas in New South Wales and Queensland, Australia. The specific aim of the current paper was to provide a descriptive evidence base of QoL and its specific domains by various key demographic characteristics of middle‐aged individuals. This cohort is likely to have either experienced or reached adulthood during and after large‐scale deinstitutionalisation in Australia. Methods and procedures: A cross‐sectional design was utilised, based on the QoL‐Q survey, testing domains of satisfaction; Competence/Productivity; Empowerment/Independence; and social belonging/community integration. The survey included demographic questions and was distributed to participants through disability support agencies across two states. The final sample included 291 respondents. Results: The overall QoL‐Q scores ranged from 3.0 to 29.5 (Mean = 20.4, SD, 4.1), with considerable variation in mean scores both across and within domains. The two demographic areas that showed greatest predictive value for QoL were work status and accommodation issues. The loss of agency and control in choice of co‐residents influenced perceived QoL for empowerment and independence domain of QoL‐Q. Conclusions: The findings highlight QoL issues associated with policy decisions and support programmes for middle‐aged adults. The two key recommendations arising from the project are that future planning for post‐retirement or reduced working hours needs to commence at a much younger age than currently expected, and more attention needs to focus on facilitating individual decision‐making and choice within shared accommodation options. [ABSTRACT FROM AUTHOR]

Attitudes to ageing can predispose decision-making as governments, interest groups and electorates negotiate competing demands in the context of economic constraints and social change. This paper, based on national survey data, investigates change and stability in Australian attitudes to intergenerational equity from 2009–2010 to 2015–2017, alongside concurrent socio-economic and policy change as well as cohort succession. The emphasis is on the baby-boom cohort who are viewed as significant beneficiaries of social change relative to opportunities of younger and older cohorts. Views of older people as a needy group may be changing slightly as more enter later life with substantial wealth and resources. Our results show that there is little perception of intergenerational conflict with the exception of the Millennial cohort whose life chances are compromised by economic and expenditure constraint over the past decade. Overall, attitudes remain sympathetic to older people, especially among women and people rendered vulnerable by poor health, non-home-ownership and low socio-economic positions. The findings do not align with government portrayals of intergenerational inequalities notwithstanding many having negative views of the future and ongoing expenditure restraint strategies. At what appears to be a critical turning point in the life chances of successive cohorts, the findings indicate the interplay between attitudes and social and policy change, as well as implications for social equity and processes of attitudinal change. [ABSTRACT FROM AUTHOR]

Aims: Life expectancy for both sexes in Australia exceeds 80 years, with individuals with intellectual disability also increasingly living into older age. This research aimed to comparatively examine perceptions of staff supporting either older adults or age peers with lifelong intellectual disability. Methods: This project asked 420 medical, health, and support workers about training adequacy, health services access, and trigger points for premature institutionalisation. This paper is based on a subsample of 196 respondents who provided quantitative and qualitative responses. Results: There was considerable variation in confidence in supporting ageing individuals, while only 23.7% of doctors reported their training was adequate to support adults ageing with intellectual disability. A lack of services and poor carer health were identified as triggers for premature institutionalisation. Conclusions: The study revealed key differences in staff perceptions of support provision and training adequacy when comparing ageing individuals with intellectual disability to the general ageing population. [ABSTRACT FROM AUTHOR]

Background: Life expectancy for persons with intellectual disability has increased dramatically over the past decade, which has seen an associated rise in the need for end-of-life care. However, little is known regarding how end-of-life affects the individual's personal relationships with family, friends and staff.Methods: Focus group interviews were undertaken with 35 disability support workers from four rural and two metropolitan locations in NSW and Queensland, Australia. A semi-structured interview guide was used, with a focus on the gaining an understanding of the impact that end-of-life has on personal relationships for persons with intellectual disability.Results: The thematic analysis identified three key thematic areas: Relationships with Family, Relationships with Friends and Staff Roles. Relationships with Family had three sub-themes of 'Active and Ongoing', 'Active but Limited' and 'After Death'. Relationships with Friends had two sub-themes of 'Positive Experiences' and 'Negative Experiences', and Staff Roles had two sub-themes of 'Loss of Contact' and 'Default Decision Making'.Discussion: The frequency of family contact was not reported as increasing or decreasing following the diagnosis of a life-ending illness and during an individual's end-of-life. A lack of counselling support was noted as potentially impairing the individual's friends' ability to cope with death. Staff also reported a number of concerns regarding how their relationships with the individual changed, particularly when end-of-life entailed potential movement of the individual with intellectual disability to a new residential setting. [ABSTRACT FROM AUTHOR]

Background Increasing life expectancy for people with intellectual disability is resulting in greater need for end-of-life care services. However, limited knowledge is available regarding what barriers to accessing end-of-life care support are evident, particularly comparatively across rural and metropolitan locations. Methods Focus group interviews were undertaken with 35 direct-care staff from four rural and two metropolitan locations. A semistructured interview guide was used, with a focus on health service access. All focus group data were independently transcribed, with thematic analysis then performed. Results Frequency analysis identified 262 statements relating to health services access. Thematic analysis identified four key areas of 'isolation,' 'support from doctors,' 'general health support access' and 'internal staffing issues.' Conclusions Improved access to end-of-life services is urgently required across both rural and metropolitan areas. Development of specialist training and support models for both disability and general healthcare staff may assist to reduce some identified barriers. [ABSTRACT FROM AUTHOR]

Australian education service provision includes the delivery of quality educational programmes to rural and remote living children. However, according to their parents, many children with developmental disabilities (such as Down Syndrome and Autism Spectrum Disorders) who are living in rural country areas in New South Wales (NSW) still do not have access to an acceptable education programme. This study aimed to use quality of life factors via a family quality of life scale to explore 51 parents’ experience of educational service provision for their children with developmental disabilities in rural NSW. The results indicated that successful engagement with the school system is strongly affected by the views, assumptions, expertise and prejudices of teaching and care professionals. Further research into how local educational service providers may assist rural Australian families with a child with IDD in rural and remote locations is warranted. [ABSTRACT FROM PUBLISHER]

Precision medicine approaches to depression argue for the assessment of individual client profiles of the two major diagnostic criteria of depressed mood and anhedonia. To explore this suggestion, 1,513 males and 1,348 females aged between 55 and 87 years from Newcastle, Australia, completed the Center for Epidemiological Studies-Depression Scale (CESD). Total CESD score and the two sets of scores gradually increased with age; females had significantly higher scores on total CESD and the two subsets of scores. Anhedonia showed greater prevalence than depressed mood and also increased from age 70 years, whereas depressed mood remained fairly stable until age 80 years. Treatment efficacy for depression may benefit from consideration of individual client profiles on these two aspects of depression. [ABSTRACT FROM PUBLISHER]

Objective: Investigations around ageing with an intellectual disability have increased substantially in the past three decades. A research gap continued to exist regarding the detection of ageing issues in this cohort of people, particularly in rural areas where access to specialist support continued to be limited. The purpose of this study was to identify the main signs of ageing in rural people with intellectual disabilities. Design: A multi-round Delphi design was used to examine what signs of ageing were observed by disability support staff, who assisted people with intellectual disability. Setting: The project was conducted across nine of the ten rural regions (as defined by the government funding body) in New South Wales (NSW). Participants: There were 31 participants representing 14 non-government organisations. The group was composed of 26 women and 5 men, with a mean age of 47 years, who averaged 10-year experience with people with intellectual disabilities. Main Outcome Measures: The objective was to gain the direct input of rurally based disability workers to identify the main signs of ageing in people with intellectual disabilities. Results: Thirty-two specific signs of ageing, including emerging mental health issues, grief, loss of identity and aggression, were identified. A thematic analysis indicated two main categories: mental/emotional functioning and physical functioning. Conclusions: When carers have the information and skills needed to identify the main signs of ageing, they can more accurately recognise and address potential problems in a timely manner. Such understandings have the potential to reduce premature admissions to residential aged-care. [ABSTRACT FROM AUTHOR]

Data from a national, population-based longitudinal study of Australian women (26-34 years) were analyzed to investigate the association between domestic relocation and multiple explanatory factors, namely intimate partner violence (IPV), metropolitan versus non-metropolitan residence, education, income, housing tenure, number of children, and changes in relationship status. Experience of IPV in the past 12 months was significantly associated with increased odds of domestic relocation. This association remained significant after controlling for age, social support, area of residence, income, number of children, education, and housing situation. Change in relationship status attenuated the association between recent IPV and domestic relocation. Metropolitan versus non-metropolitan residence had no major influence on these results. [ABSTRACT FROM AUTHOR]

Objective: To investigate differences in self-reported health among Australian women with a history of intimate partner violence (IPV) in relation to rurality of residence. Methods: Data were drawn from six survey waves of the Australian Longitudinal Study on Women’s Health 1973–78 birth cohort. Self-reported general and mental health scores derived from the SF-36 scale were compared for women with a history of IPV living in metropolitan, regional and rural areas. Multivariable generalised estimating equations were constructed adjusting for income hardship, number of children, education, social support, age and marital status. Results: Women with a history of IPV living in regional and rural areas had no significant differences in self-reported general health scores compared to their metropolitan counterparts. Rural women affected by IPV had slightly better self-reported mental health than equivalent women living in metropolitan or regional areas. The socio-demographic factors with the strongest association with self-reported health were income, education, social support, and number of children. Conclusions: Women in regional and rural areas were no more disadvantaged, in terms of self-reported general health or mental health, than IPV affected women living in major cities in Australia. [ABSTRACT FROM AUTHOR]

Social support is proposed as a coping mechanism against anxiety and depression amongst older persons, but few data have examined how this occurs. This study assessed the contributions of two sub-components of social support as mediators against psychological distress--broadly defined as anxiety and depression. 1,560 men and 1,758 women from the Hunter Community Study (Australia) completed the Duke Social Support Scale and the Kessler Psychological Distress Scale. The Duke Social Support Scale examined the amount of social interaction and satisfaction with social interactions. Significant mediating effects of social support were found in the Kessler Psychological Distress Scale items measuring depression but not anxiety. Satisfaction with social support was a significant predictor of Kessler Psychological Distress Scale total score and Sadness items, but the amount of social support was not a predictor of stress. Social support may assist with symptoms of depression, i.e., specific sadness/depressed mood, but not necessarily with anxiety. Implications for policy and service delivery were discussed. [ABSTRACT FROM AUTHOR]

Objective This paper aims to contribute to the development of a more sustainable Australian rural community mental health workforce by comparing the findings from a literature search investigating impacting factors on retention with the experiences of community mental health service managers running services in rural Australia. Design Semi-structured interviews. Setting Public health sector, rural New South Wales. Participants Five community mental health managers, running services in rural Australia. Main outcome measures Interviews were undertaken as a pilot for a broader qualitative study investigating factors influencing the decision to stay or leave among community mental health professionals working in rural positions. The purpose of undertaking this pilot study was to test for validity and relevance of the retention phenomena and help inform the research design for the main study. Results Three key retention focussed themes were identified: (i) Staffing is a persistent challenge; (ii) Small remote towns pose the biggest challenge; and (iii) The decision to stay or leave is complex and multifactorial. Conclusions The findings of this pilot study support previous research and contribute to the understanding of influences on retention among health professionals working in rural community mental health services. Importantly, those who have worked for several years in rural positions hold important information through which to explore factors that impact retention in rural and remote regions. [ABSTRACT FROM AUTHOR]

Purpose – While ageing with an intellectual (learning) disability has been subject to increased research in recent years, there remains little knowledge regarding the daily practice issues that disability workers struggle most to support in this cohort. The purpose of this paper is to gain feedback directly from staff regarding the problems they experience in daily work, and to evaluate whether any changes to legislation or practice could potentially alleviate identified areas of concern. Design/methodology/approach – A Delphi project was conducted over three rounds with participants from rural areas of New South Wales (NSW). The panel was composed of support workers who assist people ageing with a learning disability. Participants were asked their perceptions of the main practice issues facing them while they provide support. Findings – The panel identified 29 issues that were considered problematic in the provision of support to people ageing with a learning disability. A thematic analysis indicated three main themes of access to services; time constraints; and funding. Research limitations/implications – The participants in this study were all disability workers employed by non-government organisations in rural NSW, and as such, many of the issues identified may be specific to this population cohort and geographic setting. Any generalisation of these results to other locations or populations must be considered within these limitations. Originality/value – Identification of the issues facing disability staff may facilitate government, health care providers and disability organisations to proactively plan to address current and future problem areas. The consequent effect of improving practices can assist individuals to receive better support and lead to a corresponding improvement in their quality of life. The current implementation of the National Disability Insurance Scheme in Australia is an ideal opportunity for cross-sectoral collaboration to change practice to facilitate better support for a highly vulnerable group of the community. [ABSTRACT FROM AUTHOR]

Purpose: Rural Australians comprise a third of the population. However, there are relatively few research studies that have focused on issues for children with developmental disabilities in rural regions. In particular, there is very limited research that gives voice to parents regarding challenges faced by them due to their location in rural regions. Methods: This article is based on the qualitative component of a mixed-methods study undertaken in rural settings. In-depth, face-to-face interviews were conducted with 17 parents yielding 30 h of information rich taped data. Thematic analysis techniques were used to identify major issues. Results: Three core themes emerged from analysis of the qualitative data regarding information and support needs: an ongoing lack of timely and relevant information about disabilities and support services; inadequacies in interactions with service providers particularly doctors and allied health staff; and considerable challenges and barriers to access and use of health services. Conclusions: Within the constraints of limited rural service provision, there are still opportunities for considerable improvements, through focussed in-service training to narrow the information gap, improve provider-client interaction around attitudinal issues and uptake of tele-health to minimise the long waiting times and the need to regularly travel long distances to access services and setting up online support groups. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is known to be linked to significant negative physical and mental health outcomes. This study addresses a gap in the Australian IPV literature by investigating lifetime IPV prevalence by rurality of residence, using data from a populationbased sample of young women. The overall lifetime IPV prevalence rate in the sample was 21.6%, but there were significant differences in IPV rates from major cities (19.6%), inner regional areas (24.4%) and other rural areas (26.1%). After adjusting for demographic variables, multivariable analysis revealed that there were still significantly raised odds of women from inner regional (OR 1.16, 95% CI 1.01-1.33) and other rural areas (OR 1.31, 95% CI 1.11-1.56) reporting lifetime IPV compared to women from major cities. Multivariable analysis also showed that a history of IPV was significantly associated with women being separated/divorced/widowed, having lower levels of education, income hardship and limited available social support. [ABSTRACT FROM AUTHOR]

Background: As research focuses on the concept of resilience, evidence suggests that greater levels of personal hope may have a mitigating effect on the mental health impact of adversity. In view of the adversity affecting rural communities, a better understanding of factors influencing personal hope may help identify foci for mental health promotion and mental illness prevention research and interventions. Aim: To explore the relationship between demographic, socioeconomic and mental health factors and personal hopefulness, including the influence of locality and remoteness. Method: Using data from two community-based longitudinal cohorts from New SouthWales - one urban and one rural - we analysed cross-sectional relationships between a range of factors and personal hopefulness using logistic regression techniques, as part of a common follow-up. Personal hopefulness was measured using a 12-item scale and scores were categorised as low (<2.5), medium (2.5-3.4) and high (≥3.5). Results: Of 2774 participants (53% female, mean age 69.1 years [SD 7.3, range 58-91 years], 36% living outside metropolitan areas) 32% had low, 51% had medium and 17% had high personal hopefulness scores. Several factors displayed univariate associations with personal hopefulness. In the multivariate model, five factors were independently associated with lower personal hopefulness: being older, having lower perceived prosperity, less frequent socialisation, experiencing high psychological distress or psychological impairment. Hopefulness was not associated with geographical location. Conclusion: The impact of current psychological distress and aspects of adversity on personal hopefulness over time should be further investigated in longitudinal research. Personal hopefulness did not differ across geographical location. [ABSTRACT FROM AUTHOR]

Australia's rural communities rely heavily on public-sector provided community mental health services and these services face major recruitment and retention challenges, with many longterm unfilled positions and high staff turnover. This paper aims, by undertaking a comprehensive literature review of Australian peer-reviewed studies, to identify the impacting factors on retention among community mental health clinicians working in rural Australia. Thirteen studies were found and thematic analysis identified three key main categories (1) the nature of the work; (2) the multidisciplinary team; and (3) the attractors and detractors of working rurally. This literature identifies that community mental health workers have demanding and stressful roles and carry heavy workloads. Clinicians working in rural positions experience additional challenges arising from extra work demands and workplace stresses. The impacts of the interdisciplinary generic casework approach and rurality within community mental health have not yet been well investigated. The studies exploring impacting factors on retention have, so far, mostly focused on work and professional considerations with less research conducted exploring personal and community factors. Future retention focused studies are needed that are multidisciplinary, rural focused and take a multifactor approach. [ABSTRACT FROM AUTHOR]

The past century has seen a dramatic improvement in the life expectancy of people with Down syndrome. However, research has shown that individuals with Down syndrome now have an increased likelihood of early onset dementia. They are more likely than their mainstream peers to experience other significant co-morbidities including mental health issues such as depression. This case study reports a phenomenon in which three individuals with Down syndrome and dementia are described as experiencing a rebound in their functioning after a clear and sustained period of decline. It is hypothesized that this phenomenon is not actually a reversal of the expected dementia trajectory but is an undiagnosed depression exaggerating the true level of functional decline associated with the dementia. The proactive identification and treatment of depressive symptoms may therefore increase the quality of life of some people with Down syndrome and dementia. [ABSTRACT FROM AUTHOR]

The emerging phenomenon of ageing with an intellectual disability has become subject to an increasing research focus in recent years. However, there remains little knowledge regarding the specific impediments that community workers face in supporting this cohort. The aims of the current study were to identify the major factors that, direct care staff believe, have most impact upon individuals ageing with an intellectual disability in the community. A three-round Delphi project was conducted across rural areas of New South Wales in Australia with 31 disability support workers to gain their perspectives on the main impediments facing a person ageing with intellectual disability. The 2010 study identified that the issue of ageing with an intellectual disability was presenting significant problems for community-based service delivery to this group of people. The panel identified 25 different impediments to the provision of support. A thematic analysis of the items indicated three main themes of 'funding', 'training' and 'access to services'. By identifying these impediments to supporting people ageing with an intellectual disability in the community, both services and government funding bodies have the ability to plan to overcome both current and future problem areas. This identification of impediments may facilitate individuals to receive more appropriate assistance, which in turn may lead to an improved quality of life and maintenance of a communitybased placement rather than premature admission to the congregate-care system. This study is particularly timely, given that Australia is in the midst of implementing a National Disability Insurance Scheme, and is an opportunity for all levels of government to agree on the mechanisms to appropriately assist individuals with an intellectual disability to continue to be supported in the community as they age. [ABSTRACT FROM AUTHOR]

An editorial is presented on protecting people in resource-poor regions and reducing the risk of new viral mutations. Topics include have a globally-equitable vaccination program for many policy makers and the big pharma industry; and mitigating the physical and mental health impact of limited mobility, severe curtailment of social interactions, and short- and long-term impact for people with intellectual disability.

Background The issue of ageing within the cohort of people with intellectual disabilities has been an increasing focus for research. However, the training needs of the staff who support them has not been subject of extensive examination. Materials and Methods A multiround Delphi project was conducted focusing upon the impact ageing issues have on the support provided by disability workers, and what training is required to address the identified areas. Results Three rounds of the Delphi identified twenty-six separate important issues. A thematic analysis identified five main themes including Generic Training Issues; Medical Issues; Emerging Ageing Issues Requiring Changing Support; Mental Health Issues; and Quality of Life. Conclusions The study identified a series of training priorities for staff assisting people ageing with an intellectual disability. It would appear possible for many training programmes to be developed and delivered with minimal cost impacts even within rural localities. [ABSTRACT FROM AUTHOR]

Dementia is one of the major causes of disability and dependence amongst older people and previous research has highlighted how the well-being of people with dementia is inherently connected to the quality of their relationships with their informal carers. In turn, these carers can experience significant levels of emotional stress and physical burden from the demands of caring for a family member with dementia, yet their uptake of formal services tends to be lower than in other conditions related to ageing. This paper is based on a qualitative study undertaken in the Australian state of Queensland and explores issues of access to and use of formal services in dementia care from the perspective of the informal family carers. It identifies three critical points at which changes in policy and practice in the formal care system could improve the capability of informal carers to continue to care for their family member with dementia: when symptoms first become apparent and a diagnosis is sought; when the condition of the person with dementia changes resulting in a change to their support needs; and when the burden of informal care being experienced by the carer is so great that some form of transition appears to be immanent in the care arrangement [ABSTRACT FROM AUTHOR]

Dementia is one of the major causes of disability and dependence amongst older people and previous research has highlighted how the well-being of people with dementia is inherently connected to the quality of their relationships with their informal carers. In turn, these carers can experience significant levels of emotional stress and physical burden from the demands of caring for a family member with dementia, yet their uptake of formal services tends to be lower than in other conditions related to ageing. This paper is based on a qualitative study undertaken in the Australian state of Queensland and explores issues of access to and use of formal services in dementia care from the perspective of the informal family carers. It identifies three critical points at which changes in policy and practice in the formal care system could improve the capability of informal carers to continue to care for their family member with dementia: when symptoms first become apparent and a diagnosis is sought; when the condition of the person with dementia changes resulting in a change to their support needs; and when the burden of informal care being experienced by the carer is so great that some form of transition appears to be immanent in the care arrangement [ABSTRACT FROM AUTHOR]

Background: University students are often perceived to have a privileged position in society and considered immune to ill-health and disability. There is growing evidence that a sizeable proportion experience poor physical health, and that the prevalence of psychological disorders is higher in university students than their community peers. This study examined the physical and mental health issues for first year Australian rural university students and their perception of access to available health and support services. Methods: Cross-sectional study design using an online survey form based on the Adolescent Screening Questionnaire modeled on the internationally recognised HEADSS survey tool. The target audience was all first-year undergraduate students enrolled in an on-campus degree program. The response rate was 41% comprising 355 students (244 females, 111 males). Data was analysed using standard statistical techniques including descriptive and inferential statistics; and thematic analysis of the open-ended responses. Results: The mean age of the respondents was 20.2 years (SD 4.8). The majority of the students lived in on-campus residential college style accommodation, and a third combined part-time paid work with full-time study. Most students reported being in good physical health. However, on average two health conditions were reported over the past six months, with the most common being fatigue (56%), frequent headaches (26%) and allergies (24%). Mental health problems included anxiety (25%), coping difficulties (19.7%) and diagnosed depression (8%). Most respondents reported adequate access to medical doctors and support services for themselves (82%) and friends (78%). However the qualitative comments highlighted concerns about stigma, privacy and anonymity in seeking counselling. Conclusions: The present study adds to the limited literature of physical and mental health issues as well as barriers to service utilization by rural university students. It provides useful baseline data for the development of customised support programs at rural campuses. Future research using a longitudinal research design and multi-site studies are recommended to facilitate a deeper understanding of health issues affecting rural university students. [ABSTRACT FROM AUTHOR]

Iranian-American womens' perceptions of their sexual-selves and gender roles are influenced both by the cultural context of their life experience in Iran and their acculturation in the USA. In a qualitative study, using narrative as methodology and a feminist theoretical framework, individual interviews were conducted with 24 first-generation Iranian-American women in southern California. The narratives revealed that these Iranian-American women felt attached to their home culture while also having a desire to distinguish themselves from it. In so doing, they realised that their individual sexual-selves and gender roles stemmed from their life experiences, such as home culture memories and new cultural exposures. The degrees of adjustment during the acculturation process provided women with challenges in dealing with the consequences of new experiences and the shame and guilt of shedding old cultural norms. Acculturation offered these Iranian-American women a fuller understanding of their gender role and sexual-self perceptions. An understanding of cultural impact on women's life experiences may assist healthcare professionals in their efforts to assist women in determining innovative intervention where the needs of gender role and sexual-self-concept are concerned. [ABSTRACT FROM AUTHOR]

Iranian-American womens' perceptions of their sexual-selves and gender roles are influenced both by the cultural context of their life experience in Iran and their acculturation in the USA. In a qualitative study, using narrative as methodology and a feminist theoretical framework, individual interviews were conducted with 24 first-generation Iranian-American women in southern California. The narratives revealed that these Iranian-American women felt attached to their home culture while also having a desire to distinguish themselves from it. In so doing, they realised that their individual sexual-selves and gender roles stemmed from their life experiences, such as home culture memories and new cultural exposures. The degrees of adjustment during the acculturation process provided women with challenges in dealing with the consequences of new experiences and the shame and guilt of shedding old cultural norms. Acculturation offered these Iranian-American women a fuller understanding of their gender role and sexual-self perceptions. An understanding of cultural impact on women's life experiences may assist healthcare professionals in their efforts to assist women in determining innovative intervention where the needs of gender role and sexual-self-concept are concerned. [ABSTRACT FROM AUTHOR]

In recent years, a combination of factors has seen life expectancies for people with intellectual disabilities increase dramatically. The majority of research so far has focused upon metropolitan areas, but little information is available regarding the impact of this relatively new phenomenon within rural localities. The authors examine the issues surrounding aging with an intellectual disability within rural areas and identify possible areas of change to policy and practice that may better support the individual living in nonmetropolitan locations. A three-round Delphi research model was utilized over a period of 12 months to examine the views of disability support workers from rural organizations regarding issues associated with aging. This study detailed a large number of items rated as important by direct care staff. A thematic analysis identified specific areas of concern including funding, training challenges and options, and access to relevant generic and specialist services. The findings of this study have implications for the delivery of rural services and training of staff. The results point to the need for changes to initial training and professional development options to support staff to work successfully with people with intellectual disabilities who are aging in rural areas. [ABSTRACT FROM AUTHOR]

Associations between intimate partner violence (IPV) and poor physical and mental health of women have been demonstrated in the international and national literature across numerous studies. This paper presents a review of the literature on this topic. The 75 papers included in this review cover both original research studies and those which undertook secondary analyses of primary data sources. The reviewed research papers published from 2006 to 2012 include quantitative and qualitative studies from Western and developing countries. The results show that while there is variation in prevalence of IPV across various cultural settings, IPV was associated with a range of mental health issues including depression, PTSD, anxiety, self-harm, and sleep disorders. In most studies, these effects were observed using validated measurement tools. IPV was also found to be associated with poor physical health including poor functional health, somatic disorders, chronic disorders and chronic pain, gynaecological problems, and increased risk of STIs. An increased risk of HIV was reported to be associated with a history of sexual abuse and violence. The implications of the study findings in relation to methodological issues, clinical significance, and future research direction are discussed. [ABSTRACT FROM AUTHOR]

Background Disability research data often exist in the form of individual records located within discrete registers that may extend across sensitive political boundaries. Method This paper discusses the opportunities and challenges associated with using linked health and administrative data for disability research, with examples from research projects conducted both in Australia and overseas. Results Linked data offer distinct value in providing a comprehensive profile for a range of health issues, such as morbidity, mortality, assessing health care costs and/or quality of service provision. Conclusions While the use of record linkage in health research is not a novel concept, recent advances in technology and electronic data management plus improved data linkage protocols have markedly increased the feasibility and opportunity for successfully utilising data linkage for the purposes of research, while at the same time protecting the privacy of the individual. An awareness and appropriate management of the associated challenges is required to maximise the outcomes of disability research using linked data. [ABSTRACT FROM AUTHOR]

Accessible summary • People with learning disability are just as likely as people in the general population to get cancer. • In this study we have looked at how often clients who get cancer are admitted to hospital. • We found that clients who get cancer are admitted to hospital much more often than clients who do not get cancer. • We also looked at the experiences of two clients to show what clients have to go through when they get cancer. • This research could help parents/carers and clients to know what to expect when people with learning disability need treatment and care for cancer. In Australia, general health and medical services are subsidised by the government. This includes care for people with disabilities, screening and diagnostic services for common diseases, including cancer, and care and treatment for various medical conditions. In Western Australia, the majority of state-provided health services are well documented in linkable databases. We have examined data from a large cohort of people receiving services for learning disability from the state and linked this with the state cancer registry and hospital records. While people with learning disability appear to be at similar risk for cancer, they may have poorer treatment outcomes as they already experience a range of health conditions which can exacerbate medical complications associated with treatment and/or other primary or secondary co-morbid conditions. Our results show that the mean number of hospital admissions were higher for the cancer group, even when adjustments were made for conditions such as childhood leukaemia and renal dialysis both of which often require frequent hospitalisations. Multivariate regression analyses showed that younger age, female sex and severe or unspecified level of disability were significant contributors to the frequency of hospital admissions. Qualitative information gleaned from detailed chart reviews showed that in addition to considerable morbidity, some patients were admitted repeatedly either because of lack of supportive environments and/or lack of compliance with treatment. Issues in providing appropriate support services for individuals and their carers are discussed. [ABSTRACT FROM AUTHOR]

The article discusses the perception and experiences on domestic violence particularly of women in Pakistan. The international non-government organizations (NGO) and the Human Rights Commission reveal that domestic violence is one of the greatest threats to women's security, health and well being in the country. Moreover, the discussion explores the study on domestic violence particularly on the issues of cultural beliefs and perceptions, such as discriminatory civil and criminal laws and an overall climate of structural disadvantages. Furthermore, it shows the result of the comprehensive interviews on women who personally experienced some form of domestic violence.

In this article we explore women's perceptions and experiences of sexual violence in marital relationships and its effects on reproductive health. We conducted a qualitative study composed of key informant interviews, focus group discussions, and in-depth interviews in two low- to middle-income areas of Karachi, Pakistan. Results show sexual coercion and nonconsensual sex were common and not limited to abusive relationships. Difficulties in negotiating safe sex resulted in unwanted pregnancies, some leading to unsafe abortions. The women reported escalation of violence during pregnancy to be common. Social norms prevented disclosure of sexual violence leading to limited support or intervention or both. The link between women's social status, marital violence, and reproductive health is discussed. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to determine the extent and nature of consanguinity in the Qatari population and its effects on common adult diseases. Subjects and Methods: The study was conducted in urban and semi-urban areas of Qatar between October 2004 and May 2005. The total sample of 1,050 married Qatari females 15 years of age and over were approached for study. The degree of consanguinity between each female and her spouse and the degree of consanguinity between their parents were recorded. Results: Of 1,050 married Qatari females who were approached, 876 agreed to participate in the study, giving an 83.4% response. The rate of consanguinity in the present generation was 51% (95% confidence interval = 47.7–54.4) with a coefficient of inbreeding of 0.023724. The consanguinity rate and coefficient of inbreeding in the current generation were significantly higher than the maternal rate (51.0 vs. 40.3%; p < 0.001; 0.023724 vs. 0.016410 maternal). All types of consanguineous marriages were higher in this generation, particularly first cousins (26.7 vs. 21.4% paternal and 23.1% maternal) and double first cousins (4.3 vs. 2.9% paternal and 0.8% maternal). The current generation of consanguineous parents had a slightly higher risk for most diseases: cancer, mental disorders, heart diseases, gastro-intestinal disorders, hypertension, hearing deficit and diabetes mellitus. All reported diseases were more frequent in consanguineous marriages. Conclusion: The study showed that in a population with a high rate of consanguinity, there is a significant increase in the prevalence of common adult diseases like cancer, mental disorders, heart diseases, gastro-intestinal disorders, hypertension and hearing deficit. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aim of the study was to estimate the prevalence and sociodemographic predictors of consanguineous unions in the State of Qatar and to assess the association between consanguinity, fertility and child health. A representative sample of 1800 Qatari women aged ≥15 years was approached for the study. Of these, 1515 (84.2%) women agreed to participate. The consanguineous marriage rate was 54.0% with estimated population confidence limits of 52.3–55.7%. First cousin unions were the most common form of cousin marriage. The level of parental consanguinity (both in the respondent’s parents and her parents-in-law) was quite high. In a multivariable analysis, both education of the respondent and her husband as well as parental consanguinity were found to be strong predictors of consanguineous unions in the index generation. Although fertility was high in both groups, the mean number of pregnancies was somewhat higher in respondents with first cousin unions. Concomitantly they also had a slighter higher rate of livebirths than women in non-consanguineous unions. The occurrence of asthma, mental retardation, epilepsy and diabetes was significantly more common in offspring of all consanguineous than non-consanguineous couples. [ABSTRACT FROM AUTHOR]

Current psychosocial and health behavioural covariates of past cosmetic surgery were assessed in a population-based sample (n = 14,100) aged 45-50 years, from the baseline survey of the Women's Health Australia study. Seven percent (n = 982) reported having ever had cosmetic surgery. Multivariate analysis found that self-reported dieting frequency in the past year and body mass index were highly significant covariates of cosmetic surgery; perception about body weight was moderately significant, and satisfaction with body weight was unrelated. A higher likelihood of cosmetic surgery was also found for women who had ever been in a violent relationship, who had been verbally abused recently, smokers, those taking medication for sleep or nerves and those with private hospital insurance. There were moderate associations between cosmetic surgery and state of residence, higher occupational status, alcohol use, higher stress and poorer mental health. Life satisfaction, social support, recent life events, physical health, area of residence, country of birth and marital status, though all significant at the univariate level, were unrelated in multivariate analyses. The psychological and health implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

An editorial is presented in which editor discusses the World Health Organization that formally declared COVID-19 infections to be a global pandemic on March 11, 2020. Topics include examines the intractable aspects that have been brought into sharper focus deserve repeating and considered inequality and inequity of health and social services for vulnerable groups that are so entrenched that have come to accept them with varying degrees of reluctance.

Close consanguineous unions continue to be extremely common in much of West Asia, including Pakistan. However, the impact of inbreeding on offspring mortality, particularly perinatal mortality, remains poorly documented. This paper attempts to measure the mortality risks associated with consanguinity and inbreeding while controlling for the effects of other potential confounders. The study sample comprises a multi-ethnic population residing in selected squatter settlements of Karachi. The adjusted odds ratio for perinatal mortality in the offspring of women married to their first cousins was 2.0 [95% CI 1.5, 2.6]. When parental inbreeding was also taken into account, the adjusted odds ratio for perinatal mortality increased further. Analysis of a subsample of data limited to pregnancies to women aged 35 years or above (at the time of the survey) showed that, despite adjustment for important biological and socio-demographic factors, both consanguinity and inbreeding remained important predictors of perinatal mortality in the offspring. Implications of the present study for further research are highlighted. [ABSTRACT FROM AUTHOR]

Focuses on the second highest contributor to infant morbidity and mortality in Pakistan, childhood pneumonia. Information on the decline of study in Pakistan for the past two decades; Examination of findings in two main ethnic groups; Information on the need for quality care providers.

Backgrounds: The adenoma‐carcinoma and serrated pathways offer a window of opportunity for the removal of pre‐malignant polyps and prevention of colorectal cancer (CRC) through the use of colonoscopy. The aim of this study was to investigate variation in polyp incidence in different age groups, gender and indications for undertaking colonoscopy. We also address histological types of polyps found and where in the bowel they are located. Methods: This study is based on the colonoscopy data collected prospectively over a one‐year period in multiple South Australian rural centres, 24 general surgeons contributed to this study. All histopathology results were subsequently entered into the dataset. Results: A total of 3497 colonoscopies were performed, with a total of 2221 adenomatous and serrated polyps removed. Both serrated and adenomatous polyps were more common in the distal colon. Patients of male gender, aged 70 years and over and with an indication of polyp surveillance had higher adenoma and serrated polyp detection rates (ADR and SPDR). Patients aged 40–49 years old who underwent colonoscopy for positive faecal occult blood had an ADR and SPDR of 25.0% and 6.3%, respectively. Conclusions: This study has shown variation in ADR and SPDR depending on age, gender and indication for colonoscopy. This variation will help further develop key performance indicators in colonoscopy. The high ADR and SPDR in patients aged 40–49 years old whom underwent colonoscopy for positive faecal occult blood may support lowering the age of commencement of CRC screening in Australia. [ABSTRACT FROM AUTHOR]

Objective. The aim of the present study was to identify factors affecting the job satisfaction and subsequent retention of Aboriginal mental health workers (AMHWs). Methods. FiveAMHWs working in New South Wales (NSW) forNSWHealth in rural and remote community mental health (CMH) services participated in in-depth, semi-structured interviews to understand how employment and rural living factors affected workers' decisions to stay or leave their CMH positions. Results. Using a constructivist grounded theory analysis, three aspects negatively impacting the job satisfaction of AMHWs were identified: (1) difficulties being accepted into the team and organisation; (2) culturally specific work challenges; and (3) professional differences and inequality. Conclusions. Policy and procedural changes to theAMHWtraining program may address the lower remuneration and limited career opportunities identified with regard to the Bachelor Health Sciences (Mental Health) qualification. Delivering training to increase levels of understanding about the AMHW training program, and cultural awareness generally, to CMH staff and NSWHealth management may assist in addressing the negative team, organisational and cultural issues identified. [ABSTRACT FROM AUTHOR]

Background: University students are often perceived to have a privileged position in society and considered immune to ill-health and disability. There is growing evidence that a sizeable proportion experience poor physical health, and that the prevalence of psychological disorders is higher in university students than their community peers. This study examined the physical and mental health issues for first year Australian rural university students and their perception of access to available health and support services.Methods: Cross-sectional study design using an online survey form based on the Adolescent Screening Questionnaire modeled on the internationally recognised HEADSS survey tool. The target audience was all first-year undergraduate students enrolled in an on-campus degree program. The response rate was 41% comprising 355 students (244 females, 111 males). Data was analysed using standard statistical techniques including descriptive and inferential statistics; and thematic analysis of the open-ended responses.Results: The mean age of the respondents was 20.2 years (SD 4.8). The majority of the students lived in on-campus residential college style accommodation, and a third combined part-time paid work with full-time study. Most students reported being in good physical health. However, on average two health conditions were reported over the past six months, with the most common being fatigue (56%), frequent headaches (26%) and allergies (24%). Mental health problems included anxiety (25%), coping difficulties (19.7%) and diagnosed depression (8%). Most respondents reported adequate access to medical doctors and support services for themselves (82%) and friends (78%). However the qualitative comments highlighted concerns about stigma, privacy and anonymity in seeking counselling.Conclusions: The present study adds to the limited literature of physical and mental health issues as well as barriers to service utilization by rural university students. It provides useful baseline data for the development of customised support programs at rural campuses. Future research using a longitudinal research design and multi-site studies are recommended to facilitate a deeper understanding of health issues affecting rural university students. [ABSTRACT FROM AUTHOR]