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Objectives: This opinion paper aims to provide an overview of the current evidence base supporting the use of music therapy in mental health care. It also aims to offer critique on the issue of access to music therapy in Australia. Conclusions: There is a strong evidence base for music therapy to provide symptomatic relief and improve quality of life for people living with mental illness. However, music therapy is underfunded and framed as a supplementary service within mental health services in Australia, which limits its access to consumers. Funding music therapy as an evidence-based treatment option would fill an existing service gap and provide equitable access to a cost-effective and often consumer preferred treatment option for mental health consumers. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a major cause of morbidity and mortality, contributing to approximately 20 000 deaths in 2021 in Australia. Importantly, progression of CKD can be substantially reduced if it is detected and treated early. Here we present the perspectives of a general practitioner (primary care physician), a nephrologist and a patient advocate on how the diagnosis and management of CKD in primary care could be improved. Early detection and treatment of CKD are impeded by limited patient awareness and knowledge, communication challenges between patients and doctors, and psychosocial issues, with these factors also interacting with, and exacerbating, each other. We make the following recommendations to help improve outcomes in patients with CKD: (1) identifying people at increased risk of CKD and ensuring they have a complete kidney health check (including estimated glomerular filtration rate, urine albumin-creatinine ratio and a blood pressure check) every 1−2 years; (2) using simple, nonconfrontational language and supportive resources to communicate with patients about kidney health; (3) implementing early treatment to slow the progression of CKD and avoid adverse cardiovascular disease outcomes; and (4) asking patient-orientated questions to support shared decision-making and empower patients to be active partners in their healthcare. We acknowledge that limited time is a major barrier to implementing these recommendations in primary care. Utilizing the expertise of the whole practice team, and adopting supportive technology to introduce efficiencies, are likely to be of benefit. By adopting these recommendations, we believe general practitioners have the opportunity to drive improved outcomes and quality of life for people living with CKD in Australia. [ABSTRACT FROM AUTHOR]

Introduction: We aim to report on the feasibility of establishment of the first paediatric cohort as part of the longitudinal database of the Australian Lupus Registry and Biobank (ALRB) and to describe the enrolment data with a focus on clinical characteristics, serological data, treatment strategies and patient/parent-reported outcome measures. Methods: All patients under the age of 18 years with a diagnosis of systemic lupus erythematosus (SLE) attending the paediatric rheumatology service of a single, tertiary hospital were identified. Patients were enrolled in the ALRB if they met ≥4/11 of the American College of Rheumatology (ACR) 1997 SLE classification criteria or the Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria. Enrolment data including demographics, clinical characteristics, serological profiles, disease activity and damage assessments were recorded. Peds-QL Rheumatology and General Modules were used to assess patient and parent-reported outcomes. Results: Twenty-seven patients were eligible for inclusion, with 26 patients (96%) consenting for enrolment. Twenty-five patients (92%) consented for biobanking. Twenty patients (77%) were female. The median age at enrolment was 16 years (interquartile range (IQR) 13.7, 17.4). The median disease duration from diagnosis was 3.2 years (IQR 1.4, 5.3). Sixteen patients (62%) had synovitis, 16 (62%) had cutaneous involvement, 4 (15%) had serositis, 17 (65%) had haematological involvement and 7 (27%) had renal involvement at enrolment. Nineteen patients (73%) were prescribed at least two disease-modifying anti-rheumatic medications (DMARDs). Hydroxychloroquine (n = 22, 85%) and mycophenolate mofetil (n = 9, 35%) were the most commonly prescribed DMARDs. The median SLEDAI-2K score was 2 (IQR 2, 4). Six patients (23%) had active disease (SLEDAI-2K ≥6) at enrolment. Three patients (11.5%) had reported damage using the SLICC/ACR Damage Index. Twenty-three children (88%) and eighteen parents (69%) completed the Paediatric Quality of Life Inventory. Quality of life scores reported across domains of physical, emotional, social and school functioning at enrolment were comparable to previously studied paediatric cohorts with SLE and other chronic diseases. Conclusion: We have established our centre as the first paediatric participating site of the ALRB, providing contemporary data on the clinical characteristics, serological profile and health-related quality of life outcomes of Australian children with SLE. Paediatric involvement with this national registry will provide a unique perspective for future clinical and scientific research. Collection of Australian-specific paediatric longitudinal data will also enable a broader understanding of SLE within a multicultural Australian population. [ABSTRACT FROM AUTHOR]

Aims and context: This paper reports the evaluation of the Doorway program (2015-18) in Melbourne, Australia. Doorway extends the original Housing First (HF) model in providing housing support to people with precarious housing at-risk of homelessness with Serious and Persistent Mental Illnesses (SPMIs) receiving care within Victoria's public mental health system. Doorway participants source and choose properties through the open rental market, and receive rental subsidies, assistance, advocacy and brokerage support through their Housing and Recovery Worker (HRW). The aim of this study is to estimate Doorway's impact on participants' housing, quality of life and mental health service use. Methodology: The study employed a a quasi-experimental study design with a comparison group, adjusted for ten potential confounders. The primary outcome measure was days of secure housing per participant. Secure housing status, health service usage and quality of life (HoNOS) data were extracted from participants' electronic hospital and Doorway records in deidentified, non-reidentifiable form. Analysis for continuous outcome variables was based on multivariate GLM modelling. Results: Doorway housed 89 (57%) of 157 accepted participants. The 157 Doorway participants overall were also housed for significantly more days (119.4 extra days per participant) than control participants, albeit after some delay in locating and moving into housing (mean 14 weeks). There was a significant, positive Doorway effect on health outcomes (all and one dimension of the HoNOS). Doorway participants had significantly reduced length of stay during acute and community hospital admissions (7.4 fewer days per participant) compared with the control group. Conclusion: The Doorway model represents a new and substantial opportunity to house, enhance health outcomes and reduce mental health service use for people with SPMIs from the public mental health sector and at-risk of homelessness. [ABSTRACT FROM AUTHOR]

Objective: Paliperidone palmitate is now available as a three-month depot injection. This paper will review the pharmacokinetics, pharmacodynamics, efficacy and tolerability, as well as practical issues and pitfalls for clinicians with this innovative treatment for schizophrenia.Conclusion: The three-month depot formulation of paliperidone for the treatment of schizophrenia is not a new compound. The nanocrystalline structure of the three-month formulation is larger and takes longer to disperse than the one-month formulation, hence its extended depot action. As expected, it is non-inferior to one-month depot paliperidone, and superior to placebo, for the treatment of schizophrenia. The side effect profile of three-month paliperidone is identical to the one-month formulation. The relapse rate on treatment is low, and the median time to relapse after ceasing the drug is 395 days. An understanding of half-life and kinetics is crucial for clinicians using this compound, and the loading strategy is important to ensure effectiveness. There are significant challenges: ensuring timely administration and switching a three-month depot treatment to another antipsychotic may be problematic. Paliperidone palmitate three-month depot injection represents an advance for both convenience and effectiveness in the long term psychopharmacological treatment of schizophrenia. [ABSTRACT FROM AUTHOR]

Many autistic adults are likely to experience poor financial wellbeing and hardship due to unemployment and under-employment. Research in the general population demonstrates that subjective financial wellbeing—how people perceive their financial situation—influences quality of life. There is no research, however, examining the subjective financial wellbeing of autistic people. This study therefore aimed to (1) understand the subjective financial wellbeing of a sample of autistic adults living in Australia compared to a general Australian population sample and (2) identify the predictors of subjective financial wellbeing in this sample of autistic adults. To this end, 191 autistic adults aged 18–83 years (mean = 39.28, standard deviation = 11.74) completed an online survey about their economic status, financial wellbeing, financial behaviors, confidence in money management skills, and anxiety and depression symptoms. Almost half of our sample felt it was a struggle to make ends meet, whereas only one-third of the general Australian population felt this way. Similar to the general population, autistic people's income and their financial behaviors (specifically, saving and not borrowing for everyday expenses) predicted their sense of financial wellbeing. Our findings have implications for both research and practice. Researchers have found the way people feel about their financial situation is related to their quality of life. We know that many autistic people find it hard to find a job. And for those autistic people who have a job, they are often underpaid. Not having a job or being underpaid often means having low income. Having low income is likely to influence how autistic people feel about their financial situation. However, no research has looked at these issues for autistic people. This is the first study that helps us learn more about what autistic adults think about their financial situation. We looked at autistic people's thoughts on this issue compared to people from the general Australian population. We also looked at what things might impact how autistic people feel about their financial situation—which might be how much money they earn, what they do with that money, and their mental health. Many autistic adults felt they were struggling with financial wellbeing and this was connected both to the level of their income and how they said they managed their money. Those who were able to save and not borrow for everyday expenses reported feeling a greater sense of financial wellbeing. Concrete changes might help to improve autistic people's financial wellbeing. We need to investigate how we can help autistic people find and keep well-paying jobs. And we need to work out the best ways of equipping autistic people with the skills they need in financial matters. [ABSTRACT FROM AUTHOR]

Objective: Clarifying the distinctions between art-based creative activities in the domains of occupational therapy and art therapy in the context of stroke rehabilitation, while also describing the effects of art-based creative activities on stroke rehabilitation. Design: Scoping review. Data source: A systematic search was performed in nine databases (Web of Science, PubMed, EMBASE, Cochrane Library, CINAHL and four Chinese database) from their inception to December 2023. Review methods: The study included randomized and non-randomized controlled trials involving art-based creative activities, as well as qualitative research providing detailed intervention measures. The study focused on stroke patients, with primary outcomes related to patients' physiological recovery, psychological well-being, ADL, etc. Data extraction included information on intervention strategies and study results. Results: Seventeen studies were included, extracting six similarities and differences in creative activity between two domains. Creative activities were observed to have positive impacts on daily living activities, limb motor function, fine motor ability, and emotional well-being in stroke patients. Conclusion: Creative activities, whether in occupational therapy or art therapy, involve providing participants with tangible crafting materials for the creation of artistic works. Future stroke rehabilitation practices should tailor activities and intervention focus based on patients' rehabilitation needs, preferences, and cultural background. The current comprehensive analysis provides initial support for the potential positive role of creative activities in stroke rehabilitation, but further in-depth research is needed to confirm their effectiveness. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists can improve the quality of life of people receiving palliative care through the management of communication and swallowing difficulties (dysphagia). However, their role in this domain is poorly defined and little is understood about the current international professional practice in this field. Aims: To examine how speech and language therapists perceive their role in the delivery of palliative care to clients, to discover current international speech and language therapist practices and to explore the similarities and differences in speech and language therapists’ practice in palliative care internationally. This will inform professional clinical guidelines and practice in this area.Design:Anonymous, non-experimental, cross-sectional survey design.Participants:Speech and language therapists working with adult and paediatric palliative care populations in Republic of Ireland, United Kingdom, United States, Canada, Australia and New Zealand where the speech and language therapist profession is well established. Method: Purposive and snowball sampling were used to recruit participants internationally using gatekeepers. An online survey was disseminated using Survey Monkey (http://www.surveymonkey.com). Results: A total of 322 speech and language therapists responded to the survey. Speech and language therapist practices in palliative care were similar across continents. Current speech and language therapist practices along with barriers and facilitators to practice were identified. The need for a speech and language therapist professional position paper on this topic was emphasised by respondents. Conclusion: Internationally, speech and language therapists believe they have a role in palliative care. The speech and language therapist respondents highlighted that this area of practice is under-resourced, under-acknowledged and poorly developed. They highlighted the need for additional research as well as specialist training and education for speech and language therapists and other multidisciplinary team members in the area of palliative care. [ABSTRACT FROM AUTHOR]

This paper characterises the health and wellbeing of people living with HIV/AIDS (PLWHA) in Australia. The HIV Futures 4 Survey is a self-complete anonymous questionnaire distributed through multiple sites. Data were collected on health, clinical and social variables. There were 1059 responses, approximately 8% of the estimated HIV-positive population. Respondents were aged between 18 and 92 years and 77% were homosexual men. In total, 60% reported a viral load of <500 copies/mL and 83% a CD4 count of over 250 cells/μL. A total of 44% reported another major health condition and 35% a mental health condition. A total of 71% were using antiretroviral therapy. More than half of the respondents had stopped working because of HIV and 25% were living in poverty. In conclusion, adequate planning for the future of our response to HIV/AIDS relies in no small part on our access to detailed information about how the epidemic affects those with the virus. [ABSTRACT FROM AUTHOR]

FOOD ALLERGY IMPAIRS THE health-related quality of life of both the affected children and their families. In particular, parents and children become anxious about the potential risks and consequences of food allergy, including disruptions in families' aid children's social activities, the need for constant vigilance, children's safety, and the daily management of children's health and illnesses. These anxieties tend to increase during children's transition to school because of the increased risks outside the home, as outlined in the review of literature in the present paper. However, there is a gap in research on the concerns and support needs of families and children when starting school. Attention to parents' and children's needs and concerns is vital to ease their smooth transition to school. [ABSTRACT FROM AUTHOR]

This paper examines processes of social cohesion across sexual difference in 'queer-friendly neighbourhoods' - localities that have a heterosexual majority in residential and commercial terms, but where a significant presence of gay and lesbian residents, businesses, and organisations are welcomed. This investigation advances a lineage of work on the development and maintenance of gay and lesbian neighbourhoods, and their role in residents' well-being. The findings also extend understandings of social cohesion, a key theme in neighbourhood and policy research across the West. The context of this study is Australia, where recent projects on social cohesion have focused on public order, economic benefits, and race tensions. However, given that gay men and lesbians are present in Australian social and political debates, sexuality should be integrated into studies about neighbourhood cohesion. To analyse processes of cohesion between heterosexual and same-sex- attracted people, we draw on data from case studies of two queer-friendly neighbourhoods in Australia - the inner-city suburb of Newtown, NSW, and the regional town of Daylesford, Victoria. We discuss the findings in three analytical categories to highlight common processes and characteristics of queer-friendly neighbourhoods: diversity and difference; symbolic landscapes; combating homophobia. [ABSTRACT FROM AUTHOR]

Objective: This paper reports on a study designed within the framework of the National Survey of Mental Health and Wellbeing to: estimate the prevalence of psychoses in urban areas of Australia; identify profiles of symptomatology, impairments and disabilities; collect information on services received and needed; and explore quality of life issues in a broadly representative sample of people with psychotic illnesses. Method: The study was conducted over four areas in the Australian Capital Territory, Queensland, Victoria and Western Australia, as a two-phase survey: (i) a census and screening for psychosis of all individuals who made contacts with mental health services during a period of 1 month in 1997; and (ii) interviews with a stratified random sample (n = 980) of the screen-positive individuals (n = 3800) using a standardised instrument. Results: The point prevalence (1 month) of psychotic disorders in the urban population aged 18–64 is in the range of 4–7 per 1000 with a weighted mean of 4.7 per 1000. People with psychotic disorders experience high rates of functional impairments and disability, decreased quality of life, persistent symptoms, substance-use comorbidity and frequent side effects of medication. Although the utilisation of hospital-based and community mental health services, as well as of public and non-governmental helping agencies, is high, the majority live in extreme social isolation and adverse socioeconomic circumstances. Among the many unmet needs, the limited availability of community-based rehabilitation, supported accommodation and employment opportunities is particularly prominent. Conclusions: The so-called ‘low-prevalence’ psychotic disorders represent a major and complex public health problem, associated with heavy personal and social costs. There is a need for a broad programmatic approach, involving various sectors of the community, to tackle the multiple dimensions of clinical disorder, personal... [ABSTRACT FROM AUTHOR]

Introduction: Migrant care workers are a growing portion of the aged care workforce in high-income countries. This study investigated the impacts of acculturation stress on the well-being of migrant care workers. Method: A cross-sectional national survey was conducted among migrant care workers (n = 272) across five Australian states and one territory using the Riverside Acculturation Stress Inventory (RASI) and Depression Anxiety Stress Scale (DASS 21). Results: Acculturation stress was high (M = 38.4; SD = 14.1; 38.9% scored ≥40 out of 75), but respondents scored in the normal to mild ranges (85% to 93%) on the DASS 21 scale. Enrolled and registered nurses had the highest acculturation stress levels when compared with other occupational roles. Ethnicity, F (4, 254) = 11.0, p <.001; occupational roles, F (3, 254) = 3.0, p =.03; and self-reported English proficiency, F (1, 254) = 4.17, p =.04, were statistically significant. Conclusions: Addressing acculturation stress may improve job satisfaction and retention among migrant care workers. [ABSTRACT FROM AUTHOR]

Objective: Psychosocial trauma was associated with developing conversion disorder (also known as functional neurological disorder) before Freud, though why a particular symptom should arise is unknown. We aimed to determine if there was a relationship between trauma type and symptom.Methods: We retrospectively reviewed the medical records of patients attending Australia's first functional neurology clinic, including referral, clinic letters and a clinic questionnaire.Results: There were 106 females, 43 males and five transgender patients. Sensory (51%), motor (47%) and seizures (39%) were the commonest functional symptoms. Most patients (92%) reported stressors associated with symptom onset. Multiple trauma/symptom type associations were found: patients with in-law problems experienced more cognitive symptoms (p = .036), for example, while expressive speech problems more commonly followed relationship difficulties (p = .021).Conclusion: Associations were found between type of traumatic events and type of symptoms in conversion disorder. This will require verification in a larger sample. [ABSTRACT FROM AUTHOR]

Background: Family meetings facilitate the exploration of issues and goals of care however, there has been minimal research to determine the benefits and cost implications. Aims: To determine: (1) if family caregivers of hospitalised patients referred to palliative care who receive a structured family meeting report lower psychological distress (primary outcome), fewer unmet needs, improved quality of life; feel more prepared for the caregiving role; and receive better quality of end-of-life care; (2) if outcomes vary dependant upon site of care and; (3) the cost-benefit of implementing meetings into routine practice. Design: Pragmatic cluster randomised trial involving palliative care patients and their primary family caregivers at three Australian hospitals. Participants completed measures upon admission (Time 1); 10 days later (Time 2) and two months after the patient died (Time 3). Regression analyses, health utilisation and process evaluation were conducted. Results: 297 dyads recruited; control (n = 153) and intervention (n = 144). The intervention group demonstrated significantly lower psychological distress (Diff: –1.68, p < 0.01) and higher preparedness (Diff: 3.48, p = 0.001) at Time 2. No differences were identified based on quality of end of life care or health utilisation measures. Conclusions: Family meetings may be helpful in reducing family caregiver distress and enhancing their preparedness for the caregiving role and it appears they may be conducted without increased hospital health utilisation impacts; although opportunity costs need to be considered in order to routinely offer these as a standardised intervention. Additional health economic examination is also advocated to comprehensively understand the cost-benefit implications. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12615000200583 [ABSTRACT FROM AUTHOR]

Approximately 33% of those with bipolar disorder (BD) have a comorbid eating disorder (ED). However, the trajectory of these conditions has received little research attention. Nine participants who met criteria for BD and an ED participated in qualitative interviews exploring experiences of illness onset, the interaction of these conditions, and service provision. Almost all participants in the sample reported minimal to no screening of ED problems, despite their health professionals' frequent discussion of obesity. Findings suggested that ED features were diverse and evolved over time. Mania and depression were connected to ED features such as overeating and restricting, but this differed between and within participants. Most participants disclosed historic trauma which they considered central to their mental health concerns. This clinical group appears to be underserviced. Clinicians and researchers should routinely screen for ED features when treating and diagnosing BD to inform their physical and mental health interventions. [ABSTRACT FROM AUTHOR]

Risk prediction is an important part of the management of emergency laparotomy (EL) patients. This study aims to investigate the current use of and future directions for EL risk prediction scores. New Zealand members of the Royal Australasian College of Surgery (RACS), Australian and New Zealand College of Anaesthetists (ANZCA) and College of Intensive Care Medicine (CICM) were invited to participate in an anonymous online survey. Responses were received from 316 clinicians (45 RACS, 253 ANZCA and 19 CICM), with 73% of them having >10 years' experience as a consultant. Risk assessment scores were utilised by respondents for approximately 30% of EL cases. The most common EL risk scores used were Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality (P-POSSUM) and American College of Surgeons National Surgical Quality Improvement Programs (ACS-NSQIP). When used, respondents used risk assessment mostly preoperatively (RACS 100%, ANZCA 98% and CICM 78%), although P-POSSUM and ACS-NSQIP scores require intraoperative data (which can only be estimated crudely preoperatively by the clinician). Respondents on average 'somewhat agreed' that risk assessment scores should only include preoperative variables. The most common reasons for using P-POSSUM and ACS-NSQIP scores were familiarity and ease of use and availability of online/app calculators. The most important outcomes that the respondents would like to predict were quality of life and 30-day mortality rather than long-term impact from EL. These findings suggest that developing a new score may be required to improve utilisation and help in decision-making. This may require tailoring risk scores specifically for EL, and designing them to predict what is preferred by the clinicians making the decisions. [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]

Introduction: Parents of children with disabilities experience long-term loss of occupations and increased caregiving responsibilities, which affect their individual and family quality of life. There is limited knowledge about the factors that influence the family quality of life of families when their child with disability is at school. This study examined the relationships between family quality of life, disability-related supports provided and parental occupations, and identified factors influencing family quality of life. Method: A mixed-methods approach was utilised using the Beach Center Family Quality of Life Survey, a demographic questionnaire (n = 50) and 12 qualitative interviews. Descriptive analyses and Spearman's Rho correlations were conducted. Both sets of data were analysed and triangulated. Findings: Participants reported high satisfaction with their family quality of life, with strong associations between parental occupations and family quality of life. Four qualitative themes highlighted that their family quality of life was hard, challenging and fluctuating; however, there were positives about having a child with disability, and receiving services and supports (formal and informal) for their child with disability helped family quality of life. In spite of this, caregiving was long-term and impacted their everyday occupations, challenging their family quality of life. Conclusion: This study concludes that even though parents of a school-aged child with disability are happy to adopt the caregiver role and appreciate the positives of having a child with disability, lack of support within the mainstream schooling system and prolonged caregiving has a detrimental impact on the parents' occupations, their health and wellbeing, and consequently on their family quality of life. Inadequate opportunities for recreation and lack of resources to manage persistent behaviours of concern highlight unequal participation opportunities for school-aged children with disabilities. [ABSTRACT FROM AUTHOR]

Background: There is a lack of studies examining the prevalence and severity of psychosocial distress in parents caring for a child with life-limiting condition. More research is also needed to better understand the experience, support needs and quality-of-life of this population. Aim: To describe the experience and support needs of caring for children with life-limiting conditions and examine the level of distress and quality-of-life experienced by parents. Design: Cross-sectional, prospective, quantitative study guided by an advisory group. Participants completed a survey that included demographics and self-report outcome measures of unmet support needs, appraisal of caregiving, psychological distress and quality-of-life. Bivariate correlation analyses were performed to examine for associations between measures. Setting/participants: Parents currently caring for one or more children (⩽18 years) with a life-limiting condition and registered with a paediatric palliative care service (Australia). Results: In total, 143 parents (88% female) completed the questionnaire (36% RR). Compared with population norms, participants reported low quality-of-life, high carer burden and high psychological distress. Almost half (47%) of the sample met the criteria for one or more diagnoses of clinically elevated stress, anxiety or depression. There were significant associations between the psychosocial outcome variables; carer strain and depression had the strongest correlations with quality-of-life (r = –.63, p <.001, for both). Participants also reported multiple unmet needs related to emotional and practical support. Conclusions: This study contributes to the growing body of evidence on paediatric palliative care, specifically that parents caring for a child with a life-limiting condition report high levels of distress and burden, low quality-of-life and need more emotional and practical support targeted at their unmet needs. Paediatric palliative care services should routinely assess parent mental health and provide appropriate support. [ABSTRACT FROM AUTHOR]

New or adapted methods and tools are needed to ensure the voices of older people with cognitive impairment and dementia are included in evaluations of care services which aim to support their quality of life (QoL). In this study, cognitive interviewing practices were used with a group of 26 older service users with cognitive impairment from two service providers in New South Wales, Australia, to test and modify the Adult Social Care Outcomes Toolkit Easy Read (ER) survey to improve its suitability for this cohort. We used Antonovsky's "sense of coherence" framework to describe our research approach and how it was adapted to provide a manageable, meaningful, and comprehensible experience for our participants. While the modified ER format made the survey more comprehensible and meaningful, it was the techniques of cognitive interviewing that made the research approach manageable. We argue that while ER does support the research process for older service users with cognitive impairment, combining ER pictorials with the qualitative interactions with the researcher, in particular cognitive interviewing strategies, is needed to support a cohesive approach to assess care-related QoL in this vulnerable group. [ABSTRACT FROM AUTHOR]

Rationale: The effectiveness of clinician-focused interventions to improve stroke care is uncertain. Aims: To determine whether an organizational intervention can improve the quality of stroke care over usual care. Sample size estimates: To detect an absolute 10% difference in overall performance (composite outcome), a minimum of 21 hospitals and 843 patients per group was determined. Methods and design: Before and after controlled design in hospitals in Queensland, Australia. Intervention: Externally facilitated program (StrokeLink) using outreach workshops incorporating clinical performance feedback, patient outcomes (survival, quality of life at 90-180 days), local barrier assessments to best practice care, action planning, and ongoing support. Descriptive and multivariable analyses adjusted for patient correlations by hospital (intention-to-treat method). Context: Concurrent implementation of financial incentives to increase stroke unit access and use of the Australian Stroke Clinical Registry for performance monitoring. Study outcome(s): Primary outcome: net change in composite score (i.e. total number of process indicators achieved divided by the sum of eligible indicators for each cohort). Secondary outcomes: change in individual indicators, change in composite score comparing hospitals that did or did not develop action plans (per-protocol analysis), impact on 90-180-day health outcomes. Sensitivity analyses: hospital self-rated status, alternate cross-sectional audit data (Stroke Foundation). To account for temporal effects, comparison of Queensland hospital performance relative to other Australian hospitals will also be undertaken. Discussion: Twenty-one hospitals were recruited; however, one was unable to participate within the study time frame. Workshops were held between 11 March 2014 and 7 November 2014. Data are ready for analysis. [ABSTRACT FROM AUTHOR]

Introduction Wellbeing is an important goal and outcome measure for people living with Parkinson’s disease. Previous wellbeing studies have used standardised measures and not explored the individual understandings of wellbeing and how it is affected by engagement in meaningful occupations. The aim of this study was to explore individual definitions of wellbeing and perceived associations between engagement in daily occupations and wellbeing for people living at home with Parkinson’s disease. Method A qualitative descriptive design was used. Participants completed 24-hour time diaries prior to completing semi-structured interviews which explored participants’ individual definitions of wellbeing and perceptions of associations between wellbeing and engagement in occupation. Transcribed interviews were analysed using thematic analysis. Results Seventeen participants were recruited and 11 completed interviews. Participants defined wellbeing in terms of independence and satisfaction in being able to contribute to others’ lives. Participants identified engagement in meaningful occupation as supporting their wellbeing and maintaining relationships and identity. Conclusion This study expands what is known about wellbeing for people living with Parkinson’s disease. Understanding the individual meaning of wellbeing and facilitating engagement in the occupations individuals with Parkinson’s disease identify as meaningful may assist them to maintain wellbeing despite the presence of disease. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute stroke patients and reduce adverse events. Design: Controlled before-after pilot study. Setting: An acute stroke unit in a regional Australian hospital. Participants: Acute stroke patients admitted during (a) initial usual care control period, (b) an enriched environment period and (c) a sustainability period. Intervention: Usual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing and daily group activities. Change management strategies were used to implement an enriched environment within existing staffing levels. Main Measures: Behavioural mapping was used to estimate patient activity levels across groups. Participants were observed every 10 minutes between 7.30 am and 7.30 pm within the first 10 days after stroke. Adverse and serious adverse events were recorded using a clinical registry. Results: The enriched environment group (n = 30, mean age 76.7 ± 12.1) spent a significantly higher proportion of their day engaged in 'any' activity (71% vs. 58%, P = 0.005) compared to the usual care group (n = 30, mean age 76.0 ± 12.8). They were more active in physical (33% vs. 22%, P < 0.001), social (40% vs. 29%, P = 0.007) and cognitive domains (59% vs. 45%, P = 0.002) and changes were sustained six months post implementation. The enriched group experienced significantly fewer adverse events (0.4 ± 0.7 vs.1.3 ± 1.6, P = 0.001), with no differences found in serious adverse events (0.5 ± 1.6 vs.1.0 ± 2.0, P = 0.309). Conclusions: Embedding an enriched environment in an acute stroke unit increased activity in stroke patients. [ABSTRACT FROM AUTHOR]

Background: The ability to save the life of an extremely premature baby has increased substantially over the last decade. This survival, however, can be associated with unfavourable outcomes for both baby and family. Questions are now being asked about quality of life for survivors of extreme prematurity. Quality of life is rightly deemed to be an important consideration in high technology neonatal care; yet, it is notoriously difficult to determine or predict. How does one define and operationalise what is considered to be in the best interest of a surviving extremely premature baby, especially when the full extent of the outcomes might not be known for several years? Research question: The research investigates the caregiving dilemmas often faced by neonatal nurses when caring for extremely premature babies. This article explores the issues arising for neonatal nurses when they considered the philosophical and ethical questions about quality of life in babies ≤24 weeks gestation. Participants: Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia. Ethical considerations: Ethical processes and procedures have been adhered to by the researchers. Findings: A qualitative approach was used to analyse the data. The theme 'difficult choices' was generated which comprised three sub-themes: 'damaged through survival', 'the importance of the brain' and 'families are important'. The results show that neonatal nurses believed that quality of life was an important consideration; yet they experienced significant inner conflict and uncertainty when asked to define or suggest specific elements of quality of life, or to suggest how it might be determined. It was even moredifficult for the nurses to say when an extremely premature baby's life possessed quality. Their previous clinical and personal experiences led the nurses to believe that the quality of the family's life was important, and possibly more so than the quality of life of the surviving baby. This finding contrasts markedly with much of the existing literature in this field. Conclusion: Quality of life for extremely premature babies was an important consideration for neonatal nurses; however, they experienced difficulty deciding how to operationalise such considerations in their everyday clinical practice. [ABSTRACT FROM AUTHOR]

We evaluated a cognitive behaviour therapy–based programme to improve glycaemic control and psychosocial wellbeing in adolescents with type 1 diabetes. A total of 147 adolescents aged 13–16 years were randomized to the intervention (n = 73) or standard care (n = 74). The primary outcome was glycaemic control at 3 and 12 months post randomization, and secondary measures were stress, self-efficacy and quality of life. Mixed-effects regression models were used to assess differences in means between groups at each time point. There was little evidence of differences in glycaemic control between groups. However, psychosocial wellbeing improved in the intervention group compared to the control group. Recommendations for future programmes are discussed. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12608000368336). [ABSTRACT FROM AUTHOR]

This study examines different types and sources of social support in relation to psychological distress levels among older Australian gay men. A national community-based survey was conducted involving 242 gay-identified men aged 50 years and older. In univariable regressions, psychological distress was less likely if men were receiving emotional support, practical support, or had a sense of belonging, and also if they had a greater number of close friends and received some or a lot of support from family and gay friends but not from straight friends. Of all these factors, a multivariable regression showed that receiving emotional support was the only significant independent factor. Emotional support appears to play a greater role in the mental health of older gay men than many other types and sources of support. Ensuring access to emotional support may need to be considered when promoting healthier aging among gay men. [ABSTRACT FROM AUTHOR]

The article discusses a pre-test and post-test study of the physical and psychological impact of out-of home respite care on caregivers of children with life-threatening illnesses. The study included a consecutive sample of 58 parental caregivers of children who were admitted to a children's hospice for out-of-home respite. Results showed the effectiveness of out-of-home respite care in improving physical and psychological adjustment of caregivers.

The article presents information on a study on the role of doctors in helping dying cancer patients to achieve peace. The study aimed at understanding the features of a peaceful patient and preferences of patients about the role of the doctor in facilitating peace. The study was conducted on 15 dying cancer patients. It is concluded that communication from doctors on prognosis can promote spiritual well-being in cancer patients.

The article presents a study to explore the experiences of stroke survivors with urinary incontinence (UI) or post-stroke urinary incontinence (PSUI). It mentions that UI was well after the discharge of patient from the hospital but it is characterized with distress. The study concludes that occupational therapists are encouraged to get engaged in the treatment of UI.

The article discusses a study on the assessment of the impacts of multiple sclerosis (MS) in the lives of the MS disease carriers in Australia. The study uses a cost-effective assessment strategy by conducting surveys from the volunteer members of an MS registry. It says that the strategy may exhibit different outcomes resulting to the prevalence of volunteer bias. It adds that the Australian Multiple Sclerosis Longitudinal Study (AMSLS) was determined essential in the country's MS population.

Objectives: Identify factors associated with changes to health-related quality of life (HRQoL) in baby boomers. Methods: Panel data were collected on baby boomers at two time points, 2000-2002 and 2004-2006. A fixed-effects model was used to identify associations between changes in the dependent variable (SF-36 summary scales) and changes in independent variables (health indicators/employment status). Results: Mental health problems, being out of labor force, sedentary behavior, and severe lung disease were associated with deterioration in physical and mental HRQoL. Obesity was associated with deterioration in physical HRQoL whereas cardiovascular disease was associated with deterioration in mental HRQoL. Unemployment, full-time employment, and absence of lung disease symptoms were associated with improvements in physical and mental HRQoL. Discussion: If we are to maximize the future labor participation, and HRQoL, of this cohort, it will be necessary to reduce obesity and sedentary behavior and to further investigate the association between health and employment. [ABSTRACT FROM AUTHOR]

Objective: To investigate the differential effects of aerobic graded exercise and progressive resistance training on exercise tolerance, fatigue and quality of life in adolescent patients with chronic fatigue syndrome (CFS).Design: Single-blind, randomized controlled pilot trial.Setting: A major metropolitan hospital in Melbourne, Australia.Subjects: Twenty-two adolescents aged 13—18 years diagnosed with CFS and admitted to the inpatient chronic fatigue rehabilitation programme.Intervention: Patients were randomized to either graded aerobic exercise training or a progressive resistance training programme, for five days/week for four weeks. The graded aerobic training consisted of 20—40 minutes of stationary cycling and treadmill exercise. The progressive resistance training involved 16 exercises performed with single set, moderate load and high repetitions.Main measures: Exercise tolerance (time to fatigue) measured on a graded sub-maximal treadmill test, metabolic equivalents and quality of life, along with muscular strength (maximium push-ups) and endurance (sit-to-stand) and questionnaires evaluating depressive symptoms and fatigue severity.Results: No intervention was significantly better than the other for any outcome. However, physical capacity and quality of life significantly improved in both groups, while fatigue severity and symptoms of depression improved only with aerobic training.Conclusions: Resistance and aerobic training resulted in similar changes to physical capacity, quality of life and fatigue severity. Generally, patients who completed resistance training or aerobic training experienced significant improvements in outcomes from baseline when they entered the programme. Whether these improvements can be attributed to the treatment is unknown. [ABSTRACT FROM PUBLISHER]

Objectives: A series of studies has proposed that hearing loss has adverse effects for other aspects of health. This article examines the health effects associated with self-reported hearing disability on older people. Methods: The study utilized the 2003 Australian Survey of Disability, Ageing, and Carers (n = 43,233), a weighted population-based survey providing data on self-reported disability and quality of life, to examine hearing disability among older Australians (55 years plus). Results: Of the estimated 654,113 people reporting hearing disability, 71% experienced limited communication and 60% used hearing aids. Compared with population norms, hearing disability at all levels was associated with poorer physical and mental health scores on the SF-12 measure, especially for people with severe or profound hearing loss, thus suggesting a threshold effect at advanced levels of disability. Discussion: Data support emerging literature suggesting a causal relationship between hearing disability and quality of life. Prospective studies to further examine this relationship are indicated. [ABSTRACT FROM AUTHOR]

This article reports on findings of a study designed to develop and test measures suitable to assessing the perceived comparative contribution of Australian community banks and other more conventional banks to communities served, and the perceived impact of these banks on the well-being and quality of life of individuals who reside in those communities. Findings reveal that perceptions of the contribution of community banks to the sense of community and individual well being are significantly more favorable than those of more conventional banks. [ABSTRACT FROM AUTHOR]

Home-based palliative care services are facing increasing challenges in servicing the needs of clients who live alone and without a primary caregiver. The findings from the analysis of 721 services' records from three Australian states, and feedback from health professionals in interviews and postal surveys, demonstrated that there were aspects of being on one's own with a terminal illness and living at home that require a specialised approach and support. This study explored the issues of palliative care patients living alone, from a service provider perspective, and provided evidence-based information to assist with service planning. The study made recommendations to the Australian Department of Health and Ageing about services considered important in developing support structures for this growing population. [ABSTRACT FROM AUTHOR]

Objective: There is continued uncertainty regarding the strength of association between performance-based and self-report measures of physical functioning, and of their relationship to self-efficacy and health-related quality of life (HRQoL). This study assessed the inter-relationships between such measures, and the predictors of 'physical' aspects of HRQoL in frail older patients. Design: We used statistical models to determine the predictors of 'physical' HRQoL, according to the physical component summary score and the physical functioning domain of the 36-item short form (SF-36) questionnaire. Setting: Patients were recruited from hospitals in Australia and New Zealand and followed up in their homes. Subjects: Two hundred and forty-three frail older patients. Main measures: Physical functioning was assessed using three performance-based measures (Timed Up and Go Test, gait speed and the Berg Balance Scale) and five self-report measures, including the modified falls self-efficacy scale, at three and six months after registration. Results: A moderate association (r = 0.48–0.55) was found between each of the performance-based and self-report measures, including the SF-36 physical component summary score. Multiple linear regression analyses showed that the performance-based measures and falls self-efficacy predicted 33% of the SF-36 physical component summary score. Falls self-efficacy was the single highest predictor of both the SF-36 physical component summary score and SF-36 physical functioning domain. A curvilinear relationship was found between the SF-36 physical functioning domain and two variables: falls self-efficacy and the Berg Balance Scale. Conclusions: Although performance-based and self-report measures provide complementary but distinct measures of physical function, psychosocial factors such as self-efficacy have a strong influence on the HRQoL of frail older people. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess whether the lives of Australian people living with HIV/AIDS (PLWHA) have improved to the extent hoped for following the introduction of new antiretroviral (ARV) drugs for HIV. In 1997, 925 Australian PLWHA completed the first national survey of the social impacts of HIV/AIDS. In 1999, 924 Australian PLWHA were recruited for a repeat of the survey. Study participants completed an anonymous self-administered questionnaire. The data revealed that although new ARV drugs have improved the clinical profiles of many PLWHA, there have not been corresponding improvements in the physical well-being, levels of employment, or financial circumstances of many PLWHA. Nevertheless, PLWHA express favourable attitudes toward ARV drugs. Australian PLWHA have a complex relationship with their ARV medication that is likely to change over time as their HIV disease progresses and new treatments become available. [ABSTRACT FROM AUTHOR]