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We used a retrospective cohort study to measure the impact of caring for children on female Australian researchers. Our aim was to see whether caring for children was associated with reduced outputs and collaboration. Women were randomly selected for inclusion if they published a first author paper in one of three Australian journals during 2007 to 2015, women who did not publish during this time were not included. One-hundred and sixty women were approached and 95 (59%) completed a survey on their history of caring for children. Two key outcomes were the women's publication and citation counts, which were accessed from Scopus. We also examined the number of authors, affiliations and countries on their published papers, as a reduction in these numbers could indicate an impaired ability to collaborate. We examined the probability of being first or last author as a measure of esteem. There was a small increase in publication counts after the first child that was reversed after the second child. Average citations counts declined after children, particularly after the second child. There was some evidence of a reduced collaboration with overseas collaborators after the first child. The probability of being the last author increased after the second child. Three women were identified as statistically influential and all three had children and were in the top 10% of overall publications and citations. After removing these women the estimated changes in outcomes were noticeably different for most of the outcomes. The repeated presence of statistically influential women shows that it may be impossible to find an "average impact" of caring for children when considering research output. Adjustments may need to be made individually, with women explaining how caring for children has altered their career. [ABSTRACT FROM AUTHOR]

Background: Middle ear disease (otitis media) is endemic among Aboriginal and Torres Strait Islander children in Australia and represents an important cause of hearing loss. The disease is the result of a mix of biological, environmental and host risk factors that interact in complex, non-linear ways along a dynamic continuum. As such, it is generally recognised that a holistic, systems approach is required to reverse the high rates of otitis media in Aboriginal and Torres Strait Islander children. The objective of this paper is to examine the alignment between efforts designed to address otitis media in Aboriginal and Torres Strait Islander children in Queensland, Australia and core concepts of systems thinking. This paper’s overall purpose is to identify which combination of activities, and at which level, hold the potential to facilitate systems changes to better support ear health among Aboriginal and Torres Strait Islander children. Methods: We began with a review of documents identified in consultation with stakeholders and an online search. In addition, key informants were invited to participate in an online survey and a face-to-face or phone interview. Qualitative interviews using a semi-structured interview guide were used to explore survey responses in more depth. We also undertook interviews at the community level to elicit a diverse range of views. Ideas, statements or activities reported in the documents and interviews as being performed under the Intervention Level Framework were identified using qualitative thematic and content analysis. A quantitative descriptive analysis was also undertaken, whereby data was extracted into an Excel spreadsheet and coded under the relevant strategic directions and performance indicators of the Framework. Subsequently, we coded activities against the five-level intervention framework developed by Malhi and colleagues, that is: 1) paradigm; 2) goals; 3) system structure; 4) feedback and delays; and 5) structural elements. Results: Overall, twenty documents were reviewed. We examined surveys and interviews with six key informants. Twenty-four individual and 3 group interviews were conducted across central and community level informants. One hundred and four items were coded from the 20 documents and 156 items from interview data. For both data sets, the majority of activities were coded at the structural elements level. The results suggested three key areas where further work is needed to drive sustained improvements: 1) build the governance structures needed for paradigm shift to achieve a multi-sectoral approach; 2) develop shared system level goals; 3) develop system-wide feedback processes. Conclusions: Sustained progress in improving ear health within Aboriginal and Torres Strait Islander children requires a holistic, system-wide approach. To advance such work, governance structures for multi-sectoral collaboration including the development of joint goals and monitoring and feedback are required. Intervening at these higher leverage points could have a profound effect on persistent public health issues. [ABSTRACT FROM AUTHOR]

In terms of public health, childhood vaccination programs have benefits that far outweigh risks. However, some parents decide not to vaccinate their children. This paper explores the ways in which such parents talked about the perceived risks and benefits incurred by vaccinating (or not vaccinating) their children. Between 2013–2016 we undertook 29 in-depth interviews with non-vaccinating and/or ‘vaccine hesitant’ parents in Australia. Interviews were conducted in an open and non-judgmental manner, akin to empathic neutrality. Interviews focused on parents talking about the factors that shaped their decisions not to (or partially) vaccinate their children. All interviews were transcribed and analysed using both inductive and deductive processes. The main themes focus on parental perceptions of: 1. their capacity to reason; 2. their rejection of Western medical epistemology; and 3. their participation in labour intensive parenting practices (which we term salutogenic parenting). Parents engaged in an ongoing search for information about how best to parent their children (capacity to reason), which for many led to questioning/distrust of traditional scientific knowledge (rejection of Western medical epistemology). Salutogenic parenting spontaneously arose in interviews, whereby parents practised health promoting activities which they saw as boosting the natural immunity of their children and protecting them from illness (reducing or negating the perceived need for vaccinations). Salutogenic parenting practices included breastfeeding, eating organic and/or home-grown food, cooking from scratch to reduce preservative consumption and reducing exposure to toxins. We interpret our data as a ‘logic of care’, which is seen by parents as internally consistent, logically inter-related and inter-dependent. Whilst not necessarily sharing the parents’ reasoning, we argue that an understanding of their attitudes towards health and well-being is imperative for any efforts to engage with their vaccine refusal at a policy level. [ABSTRACT FROM AUTHOR]

Background: Home visiting programs are implemented in high income countries to improve outcomes for families with young children. Significant resources are invested in such programs and high quality evaluations are important. In the context of research trials, implementation quality is often poorly reported and, when reported, is variable. This paper presents the quality of implementation of the right@home program, a sustained nurse home visiting intervention trialled in Australia, and delivered in a ‘real world’ context through usual child and family health services. right@home is structured around the core Maternal Early Childhood Sustained Home-visiting (MECSH) program, which is a salutogenic, child focused prevention model. Method: At each visit right@home practitioners completed a checklist detailing the client unique identifier, date of contact and activities undertaken. These checklists were collated to provide data on intervention dose, retention to program completion at child age 2 years, and visit content, which were compared with the program schedule. Quality of family-provider relationship was measured using the Session Rating Scale. Exploratory factor analysis was conducted to identify clusters of activities and allow qualitative assessment of concordance between program aims and program delivery. Results: Of 363 intervention families offered the program, 352 (97·0%) commenced the program and 304 (87·3%) completed the program to child age 2 years. 253 of 352 (71·9%) families who commenced the program received more than 75 percent of scheduled visits including at least one antenatal visit. Families rated the participant-practitioner relationship highly (mean 39.4/40). The factor analysis identified six antenatal and six postnatal components which were concordant with the program aims. Conclusions: The right@home program was delivered with higher adherence to program dose, schedule and content, and retention than usually reported in other home visiting research. Program compliance may have resulted from program design (visit schedule, dose, content and delivery flexibility) that was consistent with family aims. [ABSTRACT FROM AUTHOR]

Mental health can affect young people’s sense of wellbeing and life satisfaction, their ability to participate in employment and education, and their onward opportunities in life. This paper offers a rare opportunity to longitudinally examine mental health in a population-representative study of children aged 4–5 years to 14–15 years. Using data from the Longitudinal Study of Australian Children (LSAC), this study examined maternally-reported child mental health over a 10 year period, in order to understand their initial mental health status early in life and its change over time, as measured by the Strengths and Difficulties Questionnaire. Longitudinal models were fitted from ages 4–5 to 14–15 years. Results showed that child sex, maternal mental health, socio-economic status (family income, maternal education, neighbourhood disadvantage), maternal hostility, and child temperament (persistence, sociability, reactivity) are all independent contributors to child mental health at age 4. These effects largely persist over time, with the effects of maternal mental health increasing slightly over time. Persistence of these effects suggests the need for early intervention and supports. The independent contribution of these factors to child mental health suggests that multi-faceted approaches to child and maternal mental health are needed. [ABSTRACT FROM AUTHOR]

Risk exposures and predictions of child development outcomes typically estimate the independent effects of individual exposures. As a rule though, children are not exposed piecemeal to individual or single risks but, rather, they are exposed to clusters of risk. Many of these clusters of risks are better thought of as comprising a developmental “circumstance” with a substantial duration, over which period, additional risk exposures also accumulate. In this paper we examined the distribution of 16 single risk exposures for low language ability using latent class analysis across a sample of approximately 4000 children from the Longitudinal Study of Australian Children. The best fitting model identified six distinct classes. 46% of children were in a Developmentally Enabled group, 20% were in a group typified as Working Poor families, 10% of children were in group typified as Overwhelmed group, 9% of children were in a group defined by Child Developmental Delay, 8% of children were in a group defined by Low Human Capital, and 7% of children were in a group defined by Resource Poor non-English Speaking background families. These groups had quantitatively and qualitatively distinct patterns of risk factors and showed different onward trajectories of receptive vocabulary. Our results demonstrate a range of multiple risk profiles in a population-representative sample of Australian children and highlight the mix of risk factors faced by children. Children with distinct patterns of risk factors have different onward trajectories of receptive vocabulary development. [ABSTRACT FROM AUTHOR]

Youth alcohol consumption has been steadily declining in Australia, as in other countries; fewer young people are drinking and the age of initiation is increasing. However, young people, their parents and others in their communities continue to believe that adolescent (excessive) drinking is the norm. This perception, and the concurrent misperception that the majority of parents are happy to provide their underage children with alcohol, creates a perceived culture of acceptance of youth alcohol consumption. Young people believe that it is accepted, and even expected, that they will drink; and parents perceive that not providing their adolescent children with alcohol will lead to social exclusion. There is evidence that shifting social norms can have an immediate and lasting effect adolescents’ (and adults’) alcohol related attitudes and behaviors. This paper reports on a novel, community based social marketing intervention designed to correct misperceptions of alcohol related social norms in an Australian community. The project utilized a social marketing approach, informed by the full complement of Andreasen’s social marketing benchmarking criteria, and concurrently targeted adolescents, parents of adolescents and the broader community. Using extensive formative research and multiple evaluation techniques, the study demonstrates that shifts in community social norms are possible and suggests that this approach could be used more widely to support the positive trends in youth alcohol consumption and parental supply. [ABSTRACT FROM AUTHOR]

Background: Non-AIDS-related mortality rates among HIV-infected patients still exceed those of their uninfected peers. A major driver of this excess mortality is a higher risk of non-infectious comorbidities, including cardiovascular disease, chronic kidney disease, type 2 diabetes mellitus, osteoporosis and cancer. The prevalence of mental illness and other chronic non-infectious comorbidities is identified as a primary concern of antiretroviral prescribers in Australia. Methods: We conducted a cross-sectional, observational study using data from MedicineInsight, a large-scale Australian primary care database comprising longitudinal data from electronic clinical information systems. The HIV-infected cohort included all men with a recorded diagnosis of HIV. The non-HIV-infected cohort comprised all other men from the same practices. The prevalence and risk of cardiovascular disease, chronic kidney disease, type 2 diabetes mellitus, osteoporosis, cancer, anxiety and depression were compared between the groups. Results: We included 2,406 HIV-infected males and 648,205 males with no record of HIV diagnosis attending primary care in this study. HIV-infected men were less socioeconomically disadvantaged and more urban-dwelling than men in the primary care cohort. We found that HIV-infected men attending primary care in Australia are at increased risk of chronic kidney disease, cancer, osteoporosis, anxiety and depression. There appears to be a risk of premature onset of cardiovascular disease, osteoporosis and cancer among younger HIV-infected patients. There is a high prevalence of anxiety and depression among HIV-infected men. Conclusions: Increased prevalence of non-infectious comorbidities among HIV-infected men has broad implications for the effective management of those with these chronic conditions. Education to raise awareness among both HIV-infected men and their care providers, together with a greater focus on risk reduction, monitoring and preventive care, may be effective strategies in primary healthcare settings to further narrow the gap in health outcomes between people living with HIV and their uninfected counterparts. [ABSTRACT FROM AUTHOR]

Purpose: Ageing in place is one of the greatest desires of elderly people. Assistive digital technologies could potentially delay the institutionalization of the elderly people and allow them ageing in place. This study develops a population-wide cost estimating framework for adopting digital technologies that can improve the quality of life of elderly people through examining an Australian region. Methods: We developed a five-stage cost estimation framework, which involved progressive forecasting of elderly population and direct cost estimation methods. The forecasting and cost estimation models have been set for a 10-year period because the prediction accuracy from cross-sectional data is better in the short to medium term compared to the long-term. For cost estimation, we categorised the ageing population on the basis of the number of chronic diseases that they have contracted. Costs of assistive technologies were collected from open sources. The model has been tested in the Fitzroy and Central West, a regional area of Queensland in Australia. A stakeholder panel discussion in a workshop format was used to validate the appropriateness of the proposed framework and the study findings. Results: This study identified eight common chronic diseases with different comorbidity patterns in Australia. We also identified the required assistive technologies to assist patients with chronic diseases. This study estimated that annual per capita cost for technological intervention could range from AUD 4,169 to AUD 7,551 on the basis of different price margins of the technologies. Conclusion: The approach of categorising the aged cohorts on the basis of the number of chronic diseases helps estimate population-wide costs compared to using single technology intervention costs for a particular chronic disease cohort. The cost estimation framework and the method developed in this study can assist the government to estimate costs for ageing-in-place programs. [ABSTRACT FROM AUTHOR]

Introduction: Adult male and female mortality declines in Japan have been slower than in most high-income countries since the early 1990s. This study compares Japan’s recent life expectancy trends with the more favourable trends in Australia, measures the contribution of age groups and causes of death to differences in these trends, and places the findings in the context of the countries’ risk factor transitions. Methods: The study utilises data on deaths by age, sex and cause in Australia and Japan from 1950–2016 from the Global Burden of Disease Study. A decomposition method measures the contributions of various ages and causes to the male and female life expectancy gap and changes over four distinct phases during this period. Mortality differences by cohort are also assessed. Findings: Japan’s two-year male life expectancy advantage over Australia in the 1980s closed in the following 20 years. The trend was driven by ages 45–64 and then 65–79 years, and the cohort born in the late 1940s. Over half of Australia’s gains were from declines in ischaemic heart disease (IHD) mortality, with lung cancer, chronic respiratory disease and self-harm also contributing substantially. Since 2011 the trend has reversed again, and in 2016 Japan had a slightly higher male life expectancy. The advantage in Japanese female life expectancy widened over the period to 2.3 years in 2016. The 2016 gap was mostly from differential mortality at ages 65 years and over from IHD, chronic respiratory disease and cancers. Conclusions: The considerable gains in Australian male life expectancy from declining non-communicable disease mortality are attributable to a range of risk factors, including declining smoking prevalence due to strong public health interventions. A recent reversal in life expectancy trends could continue because Japan has greater scope for further falls in smoking and far lower levels of obesity. Japan’s substantial female life expectancy advantage however could diminish in future because it is primarily due to lower mortality at old ages. [ABSTRACT FROM AUTHOR]

Bullying in schools is associated with an extensive public health burden. Bullying is intentional and goal oriented aggressive behavior in which the perpetrator exploits an imbalance of power to repeatedly dominate the victim. To differentiate bullying from aggressive behavior, assessment must include a valid measure of power imbalance as perceived by the victim. And yet, to date, there remains no agreement as to how to most accurately measure power imbalance among preadolescent children. This qualitative study explored children’s (age 9 to 11) understanding of power imbalance through thematic analysis of focus group discussions. Subthemes that emerged as influencing power imbalance include: age of victim, peer valued characteristics, and group membership and position. Subthemes of empathy and peer valued characteristics emerged as protecting against the negative impact of power imbalance. [ABSTRACT FROM AUTHOR]

Background: In recent decades, there has been a shift to later childbearing in high-income countries. There is limited large-scale evidence of the relationship between maternal age and child outcomes beyond the perinatal period. The objective of this study is to quantify a child's risk of developmental vulnerability at age five, according to their mother's age at childbirth.Methods and Findings: Linkage of population-level perinatal, hospital, and birth registration datasets to data from the Australian Early Development Census (AEDC) and school enrolments in Australia's most populous state, New South Wales (NSW), enabled us to follow a cohort of 99,530 children from birth to their first year of school in 2009 or 2012. The study outcome was teacher-reported child development on five domains measured by the AEDC, including physical health and well-being, emotional maturity, social competence, language and cognitive skills, and communication skills and general knowledge. Developmental vulnerability was defined as domain scores below the 2009 AEDC 10th percentile cut point. The mean maternal age at childbirth was 29.6 years (standard deviation [SD], 5.7), with 4,382 children (4.4%) born to mothers aged <20 years and 20,026 children (20.1%) born to mothers aged ≥35 years. The proportion vulnerable on ≥1 domains was 21% overall and followed a reverse J-shaped distribution according to maternal age: it was highest in children born to mothers aged ≤15 years, at 40% (95% CI, 32-49), and was lowest in children born to mothers aged between 30 years and ≤35 years, at 17%-18%. For maternal ages 36 years to ≥45 years, the proportion vulnerable on ≥1 domains increased to 17%-24%. Adjustment for sociodemographic characteristics significantly attenuated vulnerability risk in children born to younger mothers, while adjustment for potentially modifiable factors, such as antenatal visits, had little additional impact across all ages. Although the multi-agency linkage yielded a broad range of sociodemographic, perinatal, health, and developmental variables at the child's birth and school entry, the study was necessarily limited to variables available in the source data, which were mostly recorded for administrative purposes.Conclusions: Increasing maternal age was associated with a lesser risk of developmental vulnerability for children born to mothers aged 15 years to about 30 years. In contrast, increasing maternal age beyond 35 years was generally associated with increasing vulnerability, broadly equivalent to the risk for children born to mothers in their early twenties, which is highly relevant in the international context of later childbearing. That socioeconomic disadvantage explained approximately half of the increased risk of developmental vulnerability associated with younger motherhood suggests there may be scope to improve population-level child development through policies and programs that support disadvantaged mothers and children. [ABSTRACT FROM AUTHOR]

Background: Acute gastroenteritis illness is a common illness that causes considerable morbidity, but current estimates of the cost to the Australian healthcare system are unknown. Objective: To estimate the current healthcare utilisation and direct public healthcare system costs attributable to acute gastroenteritis illness in Australia. Methods: This is an incidence-based cost-of-illness study focused on quantifying direct health care costs using a bottom-up approach. Data on general practitioner consultations, prescribed medications, diagnostic tests, specialist consultations, emergency department visits and hospital admissions were collected from national reports. Results: Using 2016 prices, the estimated annual direct per capita cost of acute gastroenteritis illness was AUD$14.87 (USD$10.71), equating to AUD$20.27 (USD$14.59) per case. The estimated overall economic burden in Australia was AUD$359 million (USD$258 million; AUD$1.5 million per 100,000 people). The major contributors to this cost were hospital admissions (57.1%), emergency department visits (17.7%), and general practitioner consultations (14.0%). Children under five years of age have the highest per capita rates of acute gastroenteritis illness; however, service utilisation rates vary by age group and both young children and older adults accounted for a substantial proportion of the overall economic burden attributable to acute gastroenteritis illness. Conclusions: Although chronic diseases comprise a large cost burden on the healthcare system, acute illnesses, including acute gastroenteritis illness, also impose substantial direct healthcare system costs. Providing data on current cost estimates is useful for prioritizing public health interventions, with our findings suggesting that it would be ideal if targeted interventions to reduce hospitalisation rates among young children and older adults were available. [ABSTRACT FROM AUTHOR]

There are few published studies describing the unique management practices, farm design and housing characteristics of commercial meat chicken and layer farms in Australia. In particular, there has been a large expansion of free range poultry production in Australia in recent years, but limited information about this enterprise exists. This study aimed to describe features of Australian commercial chicken farms, with particular interest in free range farms, by conducting on-farm interviews of 25 free range layer farms, nine cage layer farms, nine barn layer farms, six free range meat chicken farms and 15 barn meat chicken farms in the Sydney basin bioregion and South East Queensland. Comparisons between the different enterprises (cage, barn and free range) were explored, including stocking densities, depopulation procedures, environmental control methods and sources of information for farmers. Additional information collected for free range farms include range size, range characteristics and range access. The median number of chickens per shed was greatest in free range meat chicken farms (31,058), followed by barn meat chicken (20,817), free range layer (10,713), barn layer (9,300) and cage layer farms (9,000). Sheds had cooling pads and tunnel ventilation in just over half of both barn and free range meat chicken farms (53%, n = 8) and was least common in free range layer farms (16%, n = 4). Range access in free range meat chicken farms was from sunrise to dark in the majority (93%, n = 14) of free range meat chicken farms. Over half of free range layer farms (56%, n = 14) granted range access at a set time each morning; most commonly between 9:00 to 10.00am (86%, n = 12), and chickens were placed back inside sheds when it was dusk. [ABSTRACT FROM AUTHOR]

Objectives: The importance of adolescent engagement in health decisions and public health programs such as immunisation is becoming increasingly recognised. Understanding adolescent preferences and further identifying barriers and facilitators for immunisation acceptance is critical to the success of adolescent immunisation programs. This study applied a discrete choice experiment (DCE) to assess vaccination preferences in adolescents. Methods: This study was conducted as a cross-sectional, national online survey in Australian adolescents. The DCE survey evaluated adolescent vaccination preferences. Six attributes were assessed including disease severity, target for protection, price, location of vaccination provision, potential side effects and vaccine delivery method. A mixed logit model was used to analyse DCE data. Results: This survey was conducted between December 2014 and January 2015. Of 800 adolescents aged 15 to 19 years, stronger preferences were observed overall for: vaccination in the case of a life threatening illness (p<0.001), lower price vaccinations (p<0.001), mild but common side effects (p = 0.004), delivery via a skin patch (p<0.001) and being administered by a family practitioner (p<0.001). Participants suggested that they and their families would be willing to pay AU$394.28 (95%CI: AU$348.40 to AU$446.92) more for a vaccine targeting a life threatening illness than a mild-moderate illness, AU$37.94 (95%CI: AU$19.22 to AU$57.39) more for being vaccinated at a family practitioner clinic than a council immunisation clinic, AU$23.01 (95%CI: AU$7.12 to AU$39.24) more for common but mild and resolving side effects compared to rare but serious side effects, and AU$51.80 (95%CI: AU$30.42 to AU$73.70) more for delivery via a skin patch than injection. Conclusions: Consideration of adolescent preferences may result in improved acceptance of, engagement in and uptake of immunisation programs targeted for this age group. [ABSTRACT FROM AUTHOR]

Background: Globally, trachoma is the leading cause of infectious blindness and Australia is the only developed country with endemic trachoma. It is found in remote Indigenous communities burdened with poverty, overcrowding and poor hygiene. Lack of culturally appropriate health promotion, a small trachoma workforce and lack of awareness and support for trachoma elimination in general, were early barriers. Methods: A cross-sectional pre-post study using a convenience sample, was conducted in clinics, schools and community work-settings from 63 of the 82 remote Aboriginal communities identified as being at risk of trachoma in the Northern Territory (NT). The study assessed the effect of a multi-component health promotion strategy aimed at increasing knowledge, attitude and practice amongst health, education and community support settings staff. Data were collected between 2010 and 2012. The health promotion initiatives were introduced in communities in staggered delivery over a one-year period; 272 participants were surveyed at baseline and 261 at follow-up. Results: Trachoma related knowledge, attitudes and practice increased across all settings and for all primary outcome measures. Across all settings, there was a significant increase in the proportion of participants reporting the most important thing to do if a child has a ‘dirty’ face is to ‘wash it every time its dirty’ (61.6% cf 69.7%; X2p = 0.047), a significant reduction in the proportion of respondents answering ‘no’ to the question “Is it normal for kids to have dirty faces in your community’ (40.5% cf 29.6%; X2p = 0.009) and a significant increase in reported capacity to teach others about trachoma prevention (70.8% cf 83.3%; X2p <0.001). Conclusion: Health promotion was associated with increased trachoma knowledge, attitude and practice amongst health, education and community support staff working with children and in remote NT communities. In the early stages of the trachoma health promotion program, this increased trachoma awareness and improved local workforce capacity and support for trachoma elimination in three health promotion settings in remote communities in the NT. [ABSTRACT FROM AUTHOR]

Background: In Australia, there is limited evidence on the impact of antenatal depression on perinatal outcomes. This study investigates the association between maternal depressive symptoms during pregnancy and key perinatal outcomes, including birth weight, gestational age at birth, breastfeeding indicators and postnatal depressive symptoms. Method: A retrospective cohort of mothers (N = 17,564) of all infants born in public health facilities within South Western Sydney Local Health District and Sydney Local Health District in 2014, in the state of New South Wales (NSW), Australia, was enumerated from routinely collected antenatal data to investigate the risk of adverse perinatal outcomes associated with maternal depressive symptoms during pregnancy. Antenatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression models that adjusted for confounders were conducted to determine associations between antenatal depressive symptoms and low birth weight, early gestational age at birth (<37 weeks), breast feeding indicators and postnatal depressive symptoms. Results: The prevalence of maternal depressive symptoms during pregnancy was 7.0% in the cohort, and was significantly associated with postnatal depressive symptoms [Adjusted Odd Ratios (AOR) = 6.4, 95% CI: 4.8–8.7, P<0.001]. Antenatal depressive symptoms was associated with a higher odds of low birth weight [AOR = 1.7, 95% CI: 1.2–2.3, P = 0.003] and a gestational age at birth of <37 weeks [AOR = 1.3, 95% CI: 1.1–1.7, P = 0.018] compared to women who reported lower EPDS scores in antenatal period. Antenatal depressive symptoms were not strongly associated with non-exclusive breast feeding in the early postnatal period. Conclusion: Maternal depressive symptoms in the antenatal period are strongly associated with postnatal depressive symptoms and adverse perinatal outcomes in Australian infants. Early identification of antenatal and postnatal depressive symptoms, and referral for appropriate management could benefit not only the mother’s mental health, but also the infant’s health and development. [ABSTRACT FROM AUTHOR]

Salmonella is a key cause of foodborne gastroenteritis in Australia and case numbers are increasing. We used negative binomial regression to analyze national surveillance data for 2000–2013, for Salmonella Typhimurium and non-Typhimurium Salmonella serovars. We estimated incidence rate ratios adjusted for sex and age to show trends over time. Almost all states and territories had significantly increasing trends of reported infection for S. Typhimurium, with states and territories reporting annual increases as high as 12% (95% confidence interval 10–14%) for S. Typhimurium in the Australian Capital Territory and 6% (95% CI 5–7%) for non-Typhimurium Salmonella in Victoria. S. Typhimurium notification rates were higher than non-Typhimurium Salmonella rates in most age groups in the south eastern states of Australia, while non-Typhimurium rates were higher in most age groups elsewhere. The S. Typhimurium notification rate peaked at 12–23 months of age and the non-Typhimurium Salmonella notification rate peaked at 0–11 months of age. The age-specific pattern of S. Typhimurium cases suggests a foodborne origin, while the age and geographic pattern for non-Typhimurium may indicate that other transmission routes play a key role for these serovars. [ABSTRACT FROM AUTHOR]

Objective(s): Describe unintentional drowning deaths in rivers, creeks and streams (rivers) in Australia and identify risk factors to inform prevention. Design & Setting: This study is a cross-sectional, total population audit of all unintentional fatal drownings in Australian rivers between 1-July-2002 and 30-June-2012 using Australian coronial data. A modified Bonferroni test has been applied, deeming statistical significance p<0.03 and p<0.04 respectively. Results: Rivers (n = 770; 26.6%) were the leading location among the 2,892 people who died from unintentional fatal drowning. This is a rate of 0.37/100,000 people / annum. Within river drowning deaths common groups include; males (80.4%), adults (85.3%), adults who have consumed alcohol (25.5%), people who fell in (21.3%), people involved in non-aquatic transport incidents (18.2%) and locals (74.0%). Children were 1.75 times more likely than adults (p<0.04) to drown in rivers as a result of a fall and adults 1.50 times more likely to drown in rivers as a result of watercraft incidents when compared to children. When compared to males, females were 2.27 and 4.45 times respectively more likely to drown in rivers as a result of incidents involving non-aquatic transport (p<0.04) and being swept away by floodwaters (p<0.04). Males were 2.66 and 4.27 times respectively more likely to drown in rivers as a result of watercraft incidents (p<0.04) and as a result of jumping in (p<0.04) when compared to females. Conclusion(s): While rivers are the leading location for drowning in Australia, little is understood about the risks. This study has identified key groups (males, adults, locals) and activities. While males were more likely to drown, the risk profile for females differed. [ABSTRACT FROM AUTHOR]

Background: Herpes zoster (HZ) is a common condition that increases in incidence with older age but vaccines are available to prevent the disease. However, there are limited data estimating the health system burden attributable to herpes zoster by age. Methods: In this study, we quantified excess healthcare resource usage associated with HZ during the acute/sub-acute period of disease (21days before to 90 days after onset) in 5952 cases and an equal number of controls matched on age, sex, and prior healthcare resource usage. Estimates were adjusted for potential confounders in multivariable regression models. Using population-based estimates of HZ incidence, we calculated the age-specific excess number of health service usage events attributable to HZ in the population. Results: Per HZ case, there was an average of 0.06 (95% CI 0.04–0.08) excess hospitalisations, 1.61 (95% CI 1.51–1.69) excess general practitioner visits, 1.96 (95% CI 1.86–2.15) excess prescriptions filled and 0.11 (95% CI 0.09–0.13) excess emergency department visits. The average number of healthcare resource use events, and the estimated excess per 100,000 population increased with increasing age but were similar for men and women, except for higher rates of hospitalisation in men. The excess annual HZ associated burden of hospitalisations was highest in adults ≥80 years (N = 2244, 95%CI 1719–2767); GP visits was highest in those 60–69 years (N = 50567, 95%CI 39958–61105), prescriptions and ED visits were highest in 70–79 years (N = 50524, 95%CI 40634–60471 and N = 2891, 95%CI 2319–3449 respectively). Conclusions: This study provides important data to establish the healthcare utilisation associated with HZ against which detailed cost-effectiveness analyses of HZ immunisation in older adults can be conducted. [ABSTRACT FROM AUTHOR]

Background: People released from prison are at increased risk of death. However, no country has established a system for routine monitoring of mortality in this population. The aims of this study were to (a) evaluate a system for routine monitoring of deaths after release from prison in Australia and (b) estimate the number of deaths annually within 28 and 365 days of prison release from 2000 to 2013. Methods: Persons released from prison and deaths were identified in records held by Centrelink, Australia’s national provider of unemployment benefits. Estimates generated in this manner were compared with those from a study that probabilistically linked correctional records with the National Death Index (NDI), for each calendar year 2000 to 2007. Using Centrelink data, national estimates of mortality within 28 and 365 days of release were produced for each calendar year 2000 to 2013. Findings: Compared with estimates based on linkage with the NDI, the estimated crude mortality rate based on Centrelink records was on average 52% lower for deaths within 28 days of release and 24% lower for deaths within 365 days of release. Nationally, over the period 2000 to 2013, we identified an average of 32 deaths per year within 28 days of release and 188 deaths per year within 365 days of release. The crude mortality rate for deaths within both 28 and 365 days of release increased over this time. Conclusions: Using routinely collected unemployment benefits data we detected the majority of deaths in people recently released from prison in Australia. These data may be sufficient for routine monitoring purposes and it may be possible to adopt a similar approach in other countries. Routine surveillance of mortality in ex-prisoners serves to highlight their extreme vulnerability and provides a basis for evaluating policy reforms designed to reduce preventable deaths. [ABSTRACT FROM AUTHOR]

Background: Indigenous infants (infants aged under 12 months) have the highest hospital admission and emergency department presentation risks in Australia. However, there have been no recent reports comparing hospital utilisation between Indigenous and non-Indigenous infants. Methods: Our primary objective was to use a large prospective population-based linked dataset to assess the risk of all-cause hospital admission and emergency department presentation in Indigenous compared to non-Indigenous infants in Western Australia (WA). Secondary objectives were to assess the effect of socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD]) on hospital utilisation and to understand the causes of hospital utilisation. Findings: There were 3,382 (5.4%) Indigenous and 59,583 (94.6%) non-Indigenous live births in WA from 1 January 2010 to 31 December 2011. Indigenous infants had a greater risk of hospital admission (adjusted odds ratio [aOR] 1.90, 95% confidence interval [95% CI] 1.77–2.04, p = <0.001) and emergency department presentation (aOR 2.15, 95% CI 1.98–2.33, p = <0.001) compared to non-Indigenous infants. Fifty nine percent (59.0%) of admissions in Indigenous children were classified as preventable compared to 31.2% of admissions in non-Indigenous infants (aOR 2.12, 95% CI 1.88–2.39). The risk of hospital admission in the most disadvantaged (IRSD 1) infants in the total cohort (35.7%) was similar to the risk in the least disadvantaged (IRSD 5) infants (30.6%) (aOR 1.04, 95% CI 0.96–1.13, p = 0.356). Interpretation: WA Indigenous infants have much higher hospital utilisation than non Indigenous infants. WA health services should prioritise Indigenous infants regardless of their socio economic status or where they live. [ABSTRACT FROM AUTHOR]

Menopausal Hormone Therapy (MHT) use in Australia fell by 55% from 2001 to 2005, following the release of large-scale findings on its risks and benefits. Comprehensive national data, including information on overall prevalence of MHT use as well as information on duration of use in Australia have not been reported since the 2004–5 National Health Survey, when 11% of women aged 45+ years were estimated to be current MHT users. No national data are available on prevalence of use of “bioidentical” hormone therapy (BHT). The objective of this study was to determine recent prevalence of MHT and BHT use. A cross-sectional, national, age-stratified, population survey was conducted in 2013. Eligible women, aged 50–69 years, resident in Australia were randomly sampled in 5-year age groups from the Medicare enrolment database (Australia’s universal health scheme). The response rate was 22% based on return of completed questionnaires, and analyses were restricted to 4,389 women within the specified age range. The estimated population-weighted prevalence of current use of MHT was 13% (95%CI 12–14), which was broadly similar to the previously reported national figures in 2004–5, suggesting that the use of MHT in Australia has largely stabilised over the past decade. A total of 39% and 20% of current-users with an intact uterus reported use of oestrogen-progestagen MHT and oestrogen-only MHT, respectively, whereas 77% of hysterectomised current-users used oestrogen-only MHT. Almost three-quarters of current-users [population-weighted prevalence 9% (95%CI 8–10)] had used MHT for ≥5 years. In regard to BHT, estimated population-weighted prevalence of ever use was 6% (95%CI 6–7) and 2% (95%CI 2–3) for current use. The population-weighted prevalence of MHT and BHT combined, in current users in their fifties and sixties was 15% (95%CI 14–16). These data provide a recent national “snapshot” of Australian women’s use of both conventional MHT and of BHT. [ABSTRACT FROM AUTHOR]

Mobile telephone numbers are increasingly being included in household surveys samples. As approach letters cannot be sent because many do not have address details, alternatives approaches have been considered. This study assesses the effectiveness of sending a short message service (SMS) to a random sample of mobile telephone numbers to increase response rates. A simple random sample of 9000 Australian mobile telephone numbers: 4500 were randomly assigned to be sent a pre-notification SMS, and the remaining 4500 did not have a SMS sent. Adults aged 18 years and over, and currently in paid employment, were eligible to participate. American Association for Public Opinion Research formulas were used to calculated response cooperation and refusal rates. Response and cooperation rate were higher for the SMS groups (12.4% and 28.6% respectively) than the group with no SMS (7.7% and 16.0%). Refusal rates were lower for the SMS group (27.3%) than the group with no SMS (35.9%). When asked, 85.8% of the pre-notification group indicated they remembered receiving a SMS about the study. Sending a pre-notification SMS is effective in improving participation in population-based surveys. Response rates were increased by 60% and cooperation rates by 79%. [ABSTRACT FROM AUTHOR]