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The article focuses on the application of participation-focused therapy in children with cerebral palsy for improvement in physical activity goal performance, satisfaction, and confidence.

Abstract School refusal (SR) can result in decreased academic achievement, impaired social connections, and family stress. Current interventions for SR include behavioral and cognitive-behavioral treatments that are not always effective. Incorporating multidisciplinary work that includes therapeutic and educational interventions may enhance outcomes for youth displaying SR. The In2School program fosters a working partnership between mental health clinicians and teachers. It was designed to meet the needs of young people missing more than 50% of school in the previous 6 weeks due to mental health disorders, including anxiety or depression. This paper reports on an action research study in which the In2School program was piloted. Over a 14-week period, therapeutic and educational interventions were integrated into the learning environment via a transitional classroom to support youths' return to school. Outcomes of this program are reported for the first cohort of 7 youth. Of these youth, 6 returned to mainstream schooling with attendance levels being maintained for 6 months after completing the intervention. Progress was observed in mental health recovery, quality of life reports, increased social interactions with peers, and positive experiences at school. The preliminary results presented in this paper suggest that a multidisciplinary, home-school-clinic intervention holds promise for helping school-refusing youth to return to school. Highlights • School refusal is a complex issue which requires multidisciplinary approaches. • Wraparound models of care may address the complex range of factors linked to school refusal. • In2School is a wraparound model involving mental health and education staff in a 'transitional' classroom. • Improved school attendance, mental health and quality of life suggest In2School is a promising model of care. [ABSTRACT FROM AUTHOR]

Objective: This paper aimed to investigate whether distinct sleep quality subtypes predicted health-related quality of life in a nonclinical sample of children.Methods: This paper utilized data from two waves of the Longitudinal Study of Australian Children, a cohort study that follows a representative population of children in Australia. This paper examined data from Waves 4 and 5 of the LSAC (covering the period 2010-2012) and included 3974 children aged 10-11 years at Wave 4 (51.4% male). Multiple dimensions of sleep quality were assessed using a combination of child- and parent-reported measures. Health-related quality of life (HRQOL) was assessed through the Pediatric Quality of Life Inventory.Results: Latent class analysis indicated six distinct sleep quality classes in children, namely good sleep, moderate sleep quality, mild sleep disturbances, short sleep, long sleep, and disordered sleep. In general, the disordered sleep and minor sleep disturbance classes had poorer HRQOL, which worsened over time. The long sleep and moderate sleep quality classes also showed some decreases in HRQOL over time.Conclusions: This study demonstrates that there are distinct sleep quality subtypes in children that could have implications for HRQOL. These findings may inform future strategies to promote improved sleep and HRQOL in children. [ABSTRACT FROM AUTHOR]

Background: Minimally adequate treatment (MAT) is intended to represent treatment minimally sufficient for common mental health problems. For children, MAT has been defined over a twelve-month period as either eight or more mental health visits, or four to seven visits plus relevant medication. MAT is used to identify those missing out on adequate care, but it is unknown whether MAT improves children's outcomes.Methods: This paper examines whether MAT is associated with improved outcomes for children. It uses survey data from the nationally representative Longitudinal Study of Australian children on 596 children with mental health problems based on the Strengths and Difficulties Questionnaire at ages 8-15 years, linked to health service administrative data from 2012 to 2016. Statistical analysis examines the association of MAT with later quality of life (Pediatric Quality of Life Inventory), using a lagged dependent variable model to account for time-varying unobserved confounding.Results: Compared to children with lower levels of treatment, those who received MAT between baseline and follow up had no statistically significant improvement in either quality of life or mental health symptoms.Limitations: The observational data provide insight into real-world practice but require statistical methods to account for selection into treatment.Conclusions: While clinical trials show mental health treatments can be efficacious, this study shows no evidence that children receiving MAT in routine practice have better outcomes. These findings demonstrate the need for better understanding of the nature and impact of children's mental health care as it is delivered and received in routine practice. [ABSTRACT FROM AUTHOR]

Purpose: Human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) commonly affects people of working age, yet there is limited data regarding the return-to-work experience in this cohort. This study aimed to investigate the proportion of survivors currently working after completion of radiation therapy and to explore potential facilitators and barriers to working after treatment.Methods: A cross-sectional, single-institutional study was undertaken at the Peter MacCallum Cancer Centre, a comprehensive cancer center in Melbourne, Victoria, Australia. Eligible participants were 18 to 65 years old at diagnosis, were employed at or within the 3 months before diagnosis, and had completed curative treatment for HPV-associated OPC ≥4 months before enrollment. Participants completed a paper-based survey to assess baseline demographics, employment status, and quality of life (QOL; Functional Assessment of Cancer Therapy Head and Neck). Open-ended questions explored factors affecting return to work. Associations between current employment status and various disease, treatment, and demographic variables and with QOL were examined. Free-text items were analyzed by summarizing content analysis.Results: Of 93 participants approached, 68 responded (73.1%). Mean age was 54.1 years (range, 39-64 years), and 89.7% were male. Most participants (67.6%) had stage II disease and were treated with chemoradiation (85.3%). Mean time after treatment was 2.6 years (range, 0.3-9.1 years). Fifty-eight of 68 participants (85.3%) were working at enrollment; median time to return to work was 6.0 months (interquartile range, 4-10 months); 45 (77.6%) were in the same role and 35 (60.3%) worked the same number of hours. Ten participants were not working, 3 had retired, 5 reported persistent and significant treatment toxicity preventing employment. Survivors currently working reported higher physical, functional, and global QOL scores. Access to leave and support from treating doctors were facilitators for return to work, whereas fatigue was frequently reported as a barrier to returning to work.Conclusion: With time, the majority of participants with HPV-associated OPC will return to work after radiation therapy. Attention to symptom management and support from the workplace may enable more successful return to work. [ABSTRACT FROM AUTHOR]

Abstract: In this paper we describe (i) the protocol for a cluster controlled clinical trial of nurse led care coordination in residential aged care facilities (RACF); and (ii) the development and content of a best practice resource guide to be implemented as part of this trial. We used published systematic reviews of quantitative studies, existing resources and multidisciplinary expert opinion to develop an intervention for testing in a cluster controlled trial (Australian and New Zealand Clinical Trials Registry Number 12611000933954). The trial will determine whether care coordination of multiple evidenced based strategies can improve quality of life and reduce hospitalization rates amongst people living in RACF. Central to the intervention arm of the trial are two components: (i) experienced nurse practitioners responsible for resident care and (ii) a best practice guide for the care processes being delivered and coordinated by those nurses. In this paper we outline how this practice guide, which is published herein, was refined through consultative processes and practitioner testing. [Copyright &y& Elsevier]

Systematic differences in the ways that people use and interpret response categories (differential item functioning, DIF ) can introduce bias when using self-assessments to compare health or quality of life across heterogeneous groups. This paper reports on an exploratory analysis involving the use of anchoring vignettes to identify DIF in a commonly used measure for assessing health-related quality of life - namely the EQ-5D. Using data from a bespoke (i.e. custom) survey that recruited a representative sample of 4300 respondents from the general Australian population in 2014 and 2015, we find that the assumptions of response consistency (RC) and vignette equivalence (VE) hold in a sub-sample of respondents aged 55–65 years (n = 914), which demonstrates that vignettes can appropriately identify DIF in EQ-5D reporting for this age group. We find that the EQ-5D is indeed subject to DIF, and that failure to account for DIF can lead to conclusions that are misleading when using the instrument to compare health or quality of life across heterogeneous groups. We also provide several important insights in terms of the identifying assumptions of RC and VE. We conclude that the implications of DIF could be of considerable importance, not only for outcomes research, but for funding decisions in healthcare more broadly given the strong reliance on patient-reported outcome measures in economic evaluations for health technology assessment. [ABSTRACT FROM AUTHOR]

Objectives: To investigate if women with a history of having experienced intimate partner violence (IPV) who undertook caregiving would experience worse mental and physical health compared to those without caregiving roles.Study Design and Main Outcome Measures: IPV, caregiving history and data on covariates were collected between 1996 and 2010 from 8453 participants in the Australian Longitudinal Study on Women's Health aged between 45 and 65 over the course of the study. Regression analyses were used to analyse the association of IPV and caregiving (categorised as IPV+caregiving, IPV+no caregiving, no IPV+caregiving, no IPV+no caregiving), with and without adjustment for covariates, on mental and physical health-related quality of life (HRQOL), depressive symptoms and perceived stress, measured in 2010.Results: Experiencing IPV and being a caregiver was associated with poor health outcomes on three of the four outcomes (depressive symptoms, OR 2.08, 95% CI 1.58, 2.75; stress, OR 2.11, 95% CI 1.55, 2.87; physical HRQOL β -2.39, 95% CI -3.34, -1.44; all p≤0.001, fully adjusted) compared with not experiencing IPV or caregiving. On these outcomes, IPV and caregiving combined had a stronger association than IPV or caregiving separately. For mental HRQOL, a weaker association was found (OR 1.41 95% CI 1.02, 1.95, fully adjusted, p=0.04).Conclusions: This paper provides evidence for the cumulative health impact of stressful life events, both those that are perpetrated against an individual (violence) and those undertaken with a degree of personal agency (caregiving). The findings underscore the need to understand the drivers of poor health, for clinicians to ask about life circumstances of patients experiencing poor health, and for the provision of referral pathways for complex cases. [ABSTRACT FROM AUTHOR]

Introduction: Incidence of Achilles tendon rupture (ATR) has increased over recent years, and debate regarding optimal management has been widely documented. Most papers have focused on surgical success, complications and short term region-specific outcomes. Inconsistent use of standardised outcome measures following surgical ATR repair has made it difficult to evaluate the impact of ATR on a patient's health status post-surgery, and to compare this to other injury types. This study aimed to report the frequency of surgical repairs of the Achilles tendon over a five-year period within an orthopaedic trauma registry, and to investigate return to work (RTW) status, health status and functional outcomes at 12 months post-surgical repair of the Achilles tendon.Methods: Two hundred and four adults registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who underwent surgical repair of the Achilles tendon between July 2009 and June 2014 were included in this prospective cohort study. The Extended Glasgow Outcome Scale (GOS-E), 3-level European Quality of Life 5 Dimension measure (EQ-5D-3L), and RTW status 12 months following surgical ATR repair were collected through structured telephone interviews conducted by trained interviewers.Results: At 12 months, 92% of patients were successfully followed up. Of those working prior to injury, 95% had returned to work. 42% of patients reported a full recovery on the GOS-E scale. The prevalence of problems on the EQ-5D-3L at 12 months was 0.5% for self-care, 11% for anxiety, 13% for mobility, 16% for activity, and 22% for pain. 16% of patients reported problems with more than one domain. The number of surgical repairs of the Achilles tendon within the VOTOR registry decreased by 68% over the five-year study period.Conclusions: Overall, patients recover well following surgical repair of the Achilles tendon. However, in this study, deficits in function persisted for over half of patients at 12 months post-injury. The decreased incidence of surgical Achilles tendon repair may reflect a change in practice at VOTOR hospitals whereby surgery may be becoming less favoured for initial ATR management. [ABSTRACT FROM AUTHOR]

Chronic pain is associated with significant costs to individuals directly affected by this condition, their families, the healthcare system, and the society as a whole. This paper investigates the relationship between chronic pain and life satisfaction using a sample of around 90,000 observations from the first ten waves of the Household, Income and Labour Dynamics of Australia Survey (HILDA), which is a representative survey of the Australian population that started in 2000. We estimate the negative impact on life satisfaction and examine the persistence of the effect over multiple years. Chronic pain is associated with poor health conditions, disability, decreased participation in the labour market and lower quality of life. We calculate the compensating income variation of chronic pain, based on the measurement of chronic pain, the life satisfaction of individuals and the income of households. Panel data models with random and fixed effects are used to control for characteristics of individuals that do not vary over time. Further, we investigate whether individuals who experience chronic pain exhibit adaptation and recovery in life satisfaction after 3 years. Overall, we find that chronic pain has a large negative association with life satisfaction, and that the compensating income variation is substantial (around 640 US$ per day). [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this paper was to identify factors associated with self-efficacy for managing recovery in the trauma intensive care population. Introduction: Injury accounts for 6.5% of disease burden in Australia, with similar levels being reported in other developed countries. While some studies regarding self-efficacy have identified a relationship to patient recovery post acute injury, others have been inconclusive. This study will identify factors associated with self-efficacy for managing recovery in the trauma intensive care population. Methods: A prospective cohort study of patients aged ≥18 years, admitted to a metropolitan tertiary hospital in South East Queensland between June 2008 and August 2010 for the acute treatment of injury. Demographic, injury, acute care and psychosocial factors were considered. The primary outcome was self-efficacy measured by the 6-item self-efficacy scale (SES) 1 and 6 months post hospital discharge. All factors significant (p <0.10) on univariate analysis were included in multivariable modelling where p <0.05 was considered significant. Results: A total of 88 patients were included. The mean self-efficacy score at 1 and 6 months was similar (6.8 vs 6.9 respectively). Self-efficacy at 1 month, psychological distress (K-10) Score and illness perception (K10) Score accounted for 68.4% (adjusted R 2) of the variance in 6 month self-efficacy (F 3,75)=57.17, p <0.001. Illness perception was the strongest contributor to 6 month self-efficacy (beta=−0.516), followed by psychological distress (beta=−0.243) and self-efficacy at 1 month (beta=0.205). Conclusion: Significant factors associated with self-efficacy for managing recovery at 6 months included 1 month self-efficacy, illness perception and psychological distress. To promote patient recovery, screening patients at 1 month in order to commence relevant interventions could be beneficial. [Copyright &y& Elsevier]

Abstract: Accompanying patients from active treatment towards specialist palliative care is a complex sphere of clinical practice that can be fraught with interpersonal and emotional challenges. While medical specialists are expected to break ‘bad news’ to their patients and ease their transitions to specialist palliative care if required, few have received formal training in such interpersonal complexities. Furthermore, there also often exists clinical ambiguity around whether to continue active treatment vis-à-vis refocusing on quality of life and palliation. In this paper we explore the experiences of twenty Australian medical specialists, focussing on issues such as: dilemmas around when and how to talk about dying and palliation; the art of referral and practices of representation; and, accounts of emotion and subjective influences on referral. The results illustrate how this transitional realm can be embedded in emotions, relationships and the allure of potentially life-prolonging intervention. We argue that the practice of referral should be understood as a relational and contextually-bound process. [Copyright &y& Elsevier]

Abstract: As a consequence of local population ageing, which is more pronounced in rural areas, the issue of maintaining a positive quality of life for rural older people is attracting significant attention. While environmental psychology theory has advocated the role of place identity in defining the self, there has been little applied research exploring how this occurs in later life. This exploratory, qualitative study (n =16) utilises Breakwell’s (1986, 1992) identity process theory to investigate how rural older Australians (retirement migrants and long-term residents) use place to sustain and build a sense of self at a time when many are susceptible to age-related loss. The paper draws on the concepts of distinctiveness, continuity, self-esteem and self-efficacy in order to explore how place identity is supported and maintained. Findings suggest that rural places are beneficial in terms of identity maintenance, with differences between long term and more recent rural residents. Furthermore, findings also highlight that place-related change or growth can potentially threaten older people’s identification as a ‘rural’ person. [Copyright &y& Elsevier]

Abstract: People who stutter often report negative impacts on their wellbeing as a result of their chronic fluency disorder. The need for a comprehensive assessment of the wellbeing and experience of stuttering should be a prime consideration when measuring treatment outcomes. One such measure designed to evaluate wellbeing and aspects of the individual''s experience of his or her stuttering is the Overall Assessment of the Speaker''s Experience of Stuttering (OASES). Normative data for the OASES Adult version (OASES-A; and hereafter referred to simply as the OASES) has begun to be collected over the past 10 years, though none are available for an Australian population. This paper presents Australian normative data for the OASES for 200 adult males and females who stutter, aged between 18 and 85 years. Additionally, the influence of age, sex, and frequency of stuttering on the Australian OASES scores are also presented. No significant relationships between OASES scores were found for sex and age, which is in keeping with the USA original dataset. However, those participants who had more severe stuttering were more likely to have higher negative impacts for ‘General Information’, Communication in Daily Situations,’ and for the overall OASES score. Implications for further research are discussed. Educational objectives : The reader will be able to: (i) describe the purpose of the Overall Experience of the Speaker''s Experience of Stuttering for Adults (OASES), (ii) evaluate the relevance of the OASES to treatment planning and the evaluation of stuttering treatment outcomes in the adult population, and (iii) compare Australian normative dataset with the USA and Dutch normative datasets for the OASES. [Copyright &y& Elsevier]

Abstract: Information-rich environments in Canada, Australia, and the United Kingdom have been built using record linkage techniques with population-based health insurance systems and longitudinal administrative data. This paper discusses the issues in extending population-based administrative data from health to additional topics more generally connected with well being. The scope of work associated with a multi-faceted American survey, the Panel Study in Income Dynamics (PSID), is compared with that of the administrative data in Manitoba, Canada. Both the PSID and the Manitoba database go back over 30 years, include families, and have good information on residential location. The PSID has emphasized research design to maximize the opportunities associated with expensive primary data collection. Information-rich environments such as that in Manitoba depend on registries and record linkage to increase the range of variables available for analysis. Using new databases on education and income assistance to provide information on the whole Manitoba population has involved linking files while preserving privacy, scaling educational achievement, assessing exposure to a given neighborhood, and measuring family circumstances. Questions being studied concern the role of the socioeconomic gradient and infant health in child development, the comparative influence of family and neighborhood in later well being, and the long-term effects of poverty reduction. Issues of organization of research, gaps in the data, and productivity are discussed. [Copyright &y& Elsevier]

This paper summarises the findings of an empirical investigation of some of the technical and social assumptions on which the disability adjusted life year (DALY) is based. The objectives of the study were to examine the notion that the burden of disease is broadly similar without regard to country, environment, gender or socio-economic status and to develop detailed descriptions of the experiences of the burden of disease as they related to these contextual factors. The study was a multi-factorial exploratory study employing qualitative and quantitative techniques to obtain data on the effects of country (development), environment (urban versus rural), gender and socio-economic status on people with paraplegia. The data provided an extensive and detailed compilation of context rich descriptions of living with paraplegia. Striking features of the data were the differences between countries with respect to the impact of the health conditions on functioning and highlight a context in which paraplegia of like clinical severity can be fatal in one environment and not in another. While there has been some focus on the control of social determinants of disease, there has been little work on the social determinants of the severity of disease. The underlying assumptions of the DALY, which ignore context in the assessment of the burden of disease, risk exacerbating inequalities by undervaluing the burden of disease in less-developed countries. There is a need to continue to subject the development of indicators to rigorous debate to determine a balance between the assumption of a global “average social milieu” and the treatment of each individual as belonging to their own context in the assessment of population health in order for indicators to be meaningful cross-culturally. [Copyright &y& Elsevier]