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Australia is a land of opportunity, where hard work can bring a better life. Most immigrants come to Australia to establish a new life and fulfil hopes and dreams for better life opportunities. Like many immigrants to Australia, I came to establish a new better life for myself and for family. In this paper, I share my challenges of being different, and of being black and the experiences of black Africans in Australia. The paper invites more conversations on finding ways forward to change the system that favours some and disadvantages others. It indicates the need to humanise the Other and make Australia a more inclusive and liveable multicultural environment. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to determine how baby boomers define healthy ageing and quality of life, and if late life university study could have a beneficial impact for future health-promoting initiatives.Design/methodology/approach Qualitative data were collected from Australian baby boomers. Data were inductively categorised to identify and report emergent themes.Findings The majority of respondents believed healthy ageing meant being mentally and physically active, with later life university study contributing to mental health, which improves their quality of life.Social implications Later life university study can have positive health outcomes for baby boomers and may contribute to the quality of their life.Originality/value This study suggests that baby boomers are quite clear about how they define healthy ageing and quality of life: maintaining good health and retaining their independence. Some baby boomers stated that intellectual stimulation was critical for their overall health and wellbeing. Baby boomers identified as belonging to this group engagement in an educational (i.e. university) programme could be considered as a health-promoting intervention. [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]

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This paper contributes to the advancement of quality-of-life research in tourism by examining complex relationships involving direct, mediated, moderated and moderated mediation relationships among the antecedents to quality-of-life. Using a sample of 222 repeat visitors in an Australian national park, the findings indicate positive significant effects of (1) place satisfaction on quality-of-life; (2) place satisfaction on place attachment; (3) place attachment on quality-of-life; (4) park citizenship on place attachment. The findings further support that (5) place attachment mediates the relationship between place satisfaction and quality-of-life; (6) social involvement moderates the relationship between place satisfaction and place attachment; (7) park citizenship moderates the relationship between place satisfaction and place attachment; (8) social involvement moderates the relationship between place attachment and quality-of-life; (9) social involvement moderates the indirect effect of place satisfaction on quality-of-life. Theoretical and practical implications are discussed. Park managers, for example, need to promote on-site marketing and post-visit communication/interpretation, encouraging repeat visits and behavioural change. Message delivery needs to promote a sense of belonging to the park with personal meaning, creating place distinctiveness. Personal actions to promote include signing petitions supporting the park's biodiversity, and other resources, and volunteering to participate in meetings and other direct actions. [ABSTRACT FROM AUTHOR]

Chronic diseases, such as hypertension and diabetes, account for 60% of global mortality. These conditions are directly related to unhealthy lifestyle habits, which are considered to be preventable risk factors, making it important to establish and maintain healthy habits. Several countries, including South Korea, have organized medical-based expert committees in order to develop and release lifestyle management guidelines. In this study, committees in the United States, United Kingdom, Netherlands, and Australia, and how they have developed guidelines, are scrutinized as benchmark policy cases. Physicians comprise most of the members of those committees, and most of the committees are operated independently from the government. All members of each committee are transparently listed on the committee's website, and the committees develop guidelines in a systematic and well-organized way. In comparison with these international committees, the relevant Korean committees (the Medical Guideline Committee and the Korean Preventive Services Task Force), have a number of things to change in terms of independence, expertise, and the process of developing guidelines. First, both of these committees are directly related to a governmental agency, the Korea Centers for Disease Control and Prevention. The proportion of physicians on the Medical Guideline Committee and the Korean Preventive Services Task Force is lower than that of other committees. Moreover, the focus of the current process of developing guidelines is limited to development itself, rather than the broader process, including re-assessment and feedback loops. This paper provides suggestions for the current lifestyle guideline committee based on case studies, with the ultimate goal of improving quality of life. [ABSTRACT FROM AUTHOR]

This paper explored the psychological mechanisms by which leisure enhances well-being by using sentence-by-sentence coding of the best-possible-selves text produced by 112 participants. Of the 1097 sentences, 41% were coded as leisure indicating that leisure is an important component of optimal well-being. The data showed that Australians have significantly less leisure in their daily lives than our sample desired; older and wealthier individuals placed a greater emphasis on leisure but there were no significant differences based on gender. Application of the Detachment-Recovery, Autonomy, Mastery, Meaning, Affiliation (DRAMMA) framework showed the following allocation of sentences to psychological mechanisms: Detachment-Recovery-21%, Autonomy-23%, Mastery-12%, Meaning-11% and Affiliation-33%. In their ideal future, participants imagined that they have the time and money to do what they want, particularly, to travel. We showed leisure is not solely associated with ‘having fun’; 59% of participants wanted to use their leisure time to learn, improve, or contribute to society. [ABSTRACT FROM PUBLISHER]

Falls are common among older people and a leading cause of injury-related hospitalisation. The immediate post-hospitalisation period is a risky time for further falls. This paper explores discharge strategies from the perspectives of older people hospitalised for a fall and liaison nurses assisting people to return home. Exploratory mixed methods were used. Semi-structured interviews with older people were conducted regarding their experience of the fall and discharge strategies. Quality of life, falls risk and functional capacity were measured by questionnaire. Liaison nurses were also interviewed. Interviews were audio-recorded, transcribed and thematically analysed. Mixed-method synthesis occurred using role-orderedmatrix analysis. Older people (n = 13) and liaison nurses (n = 6) participated. Older persons' quality of lifewas average and falls risk high. Thematic analysis revealed three key themes: 'falls are not a priority', 'information not given, or given and not retained' and 'reduction in confidence and independence'. Role-orderedmatrix analysis identified differences between acute and rehabilitative hospital stays. Older people hospitalised for a fall present a unique opportunity for implementation of falls prevention strategies. However, hospitalisation is often a time of crisis with competing priorities. Timing and relevance are crucial for optimal uptake of falls prevention strategies, with the primary care setting well-placed for their implementation. [ABSTRACT FROM AUTHOR]

Aim: THD SphinKeeper® is an emerging surgical technique for faecal incontinence (FI). The safety, indications and efficacy of the procedure are still being investigated. The aim of this study is to present the first experience of SphinKeeper® in Australia. Method: This was a prospective single‐centre observational study of patients undergoing SphinKeeper® implantation between February 2018 and September 2019. Baseline demographics, intraoperative and postoperative complications, Cleveland Clinic Faecal Incontinence Score, St Mark's Incontinence Score, Faecal Incontinence Quality of Life score (FIQOL), anorectal manometry and endo‐anal ultrasound were assessed preoperatively and 3 and 12 months after implantation. Results: Thirteen patients (2 male, 11 female) underwent implantation during the study period. Anal sphincter defects were present in 13 (76.9%) patients [external anal sphincter (EAS) defect, 2 (15.4%); internal anal sphincter (IAS) defect 4 (30.8%); EAS + IAS defect, 4 (30.8%)]. Median follow‐up was 32 months (range 18–37 months). There were four complications: one intraoperative (rectal perforation) and three postoperative (one implant extrusion, two implants that required removal due to malposition). At 12 months, an average of 9/10 implants remained ideally placed in each patient. THD SphinKeeper® insertion was associated with an improvement in coping/behaviour as measured using FIQOL (p = 0.047). However, the procedure did not improve FI scores or anorectal manometry parameters. Conclusion: In this study, SphinKeeper® marginally improved symptoms of FI but there was no significant impact on anorectal manometric measurements. Larger‐scale studies are needed to determine the patient cohort most likely to benefit from this procedure. [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]

Objectives: Patient reported experience measures (PREMs) are tools often utilised in hospitals to support quality improvements and to provide objective feedback on care experiences. Less commonly PREMs can be used to support consumers choices in their hospital care. Little is known about the experience and views of the Australian consumer regarding PREMs nor the considerations these consumers have when they need to make decisions about attending hospital. This study aimed to explore consumer awareness of PREMs, consumer attitudes towards PREMs and the utility of PREMs as a decision-making tool in accessing hospital care. Methods: Qualitative study involving semi-structured interviews conducted over the phone. Participants (n = 40) were recruited from across Australia and purposively sampled according to key characteristics: holding private health insurance, > 30-years of age, may have accessed private hospital care in the past year, variety of educational and cultural backgrounds, and if urban or rural residing. Interviews were audio-recorded, transcribed, and analysed thematically. Results: Four overarching themes and six subthemes were identified from the data. Major findings were that prior awareness of PREMs was limited; however, many had filled in a PREM either for themselves or for someone they cared for following a hospital stay. Most respondents preferred to listen to experience of self or family/friends or the recommendation of their physician when choosing a hospital to attend. Participants appeared to be more interested in the treating clinician than the hospital with this clinician often dictating the hospital or hospital options. If provided choice in hospital, issues of additional costs, timeliness of treatment and location were important factors. Conclusion: While PREMs were considered a possible tool to assist in hospital decision-making process, previous hospital experiences, the doctor and knowing up-front cost are an overriding consideration for consumers when choosing their hospital. Consideration to format and presentation of PREMs data is needed to facilitate understanding and allow meaningful comparisons. Future research could examine the considerations of those consumers who primarily access public healthcare facilities and how to improve the utility of PREMs. [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]

Background: There is little long-term causal evidence on the effect of physical activity on health-related quality of life. This study aimed to examine the associations between longitudinal patterns of physical activity over 15 years and health-related quality of life in both the physical and mental health domains, in a cohort of middle-aged Australian women. Methods and findings: We used data collected at 3-year intervals (1998 to 2019) from 11,336 participants in the Australian Longitudinal Study on Women's Health (ALSWH) (1946 to 1951 birth cohort). Primary outcomes were the physical (PCS) and mental health component summary (MCS) scores (range from 0 to 100; higher scores indicate higher perceived physical/mental health) from the SF-36 in 2019 (when women aged 68 to 73 years). Using target trial emulation to imitate a randomized controlled trial (RCT), we tested 2 interventions: (1) meeting the World Health Organization (WHO) physical activity guidelines consistently throughout the 15-year "exposure period" (2001 to 2016; when women aged 50–55 to 65–70 years; physical activity assessed every 3 years); and (2) not meeting the guidelines at the beginning of the exposure period but starting to first meet the guidelines at age 55, 60, or 65; against the control of not meeting the guidelines throughout the exposure period. Analysis controlled for confounding using marginal structural models which were adjusted for sociodemographic and health variables and conditions. Consistent adherence to guidelines during the exposure period (PCS: 46.93 [99.5% confidence interval [CI]: 46.32, 47.54]) and first starting to meet the guidelines at age 55 (PCS: 46.96 [99.5% CI: 45.53, 48.40]) were associated with three-point higher PCS (mean score difference: 3.0 [99.5% CI: 1.8, 4.1] and 3.0 [99.5% CI:1.2, 4.8]) than consistent non-adherence (PCS: 43.90 [99.5% CI: 42.79, 45.01]). We found a similar pattern for most SF-36 subscales but no significant effects of the interventions on MCS. The main limitations of the study were that it may not account for all underlying health conditions and/or other unmeasured or insufficiently measured confounders, the use of self-reported physical activity and that findings may not be generalizable to all mid-age women. Conclusions: Results from the emulated RCT suggest women should be active throughout mid-age, ideally increasing activity levels to meet the guidelines by age 55, to gain the most benefits for physical health in later life. Binh Nguyen and colleagues, use longitudinally collected data and target trial emulation methods to explore the impact of mid-life physical activity on the health outcomes of Australian women later in life. Author summary: Why was this study done?: ○ The evidence for an association between physical activity and health-related quality of life has been based primarily on cross-sectional studies and randomized controlled trials (RCTs) with short-term outcomes. ○ To date, few longitudinal studies have examined the associations between long-term patterns of physical activity and health-related quality of life, measured physical activity at more than one time point, and examined the causal effects of physical activity. What did the researchers do and find?: ○ We leveraged data on >11,000 women enrolled in the Australian Longitudinal Study on Women's Health (ALSWH) and applied targeted maximum likelihood estimation (TMLE) to emulate various target trials of physical adherence regimes and explore how physical activity in midlife impacts health outcomes in later life. ○ We found that consistent adherence to physical activity guidelines over 15 years was associated with better health-related quality of life in the physical health domain, especially physical functioning. ○ Meeting physical activity guidelines earlier in midlife and especially by age 55 resulted in better physical health-related quality of life outcomes in later life but the same impact on mental health domain outcomes was less evident. What do these findings mean?: ○ This study provides insights into the long-term effects of different patterns of physical activity during mid-age on later health-related quality of life in Australian women. ○ Combined with existing evidence, it contributes to the growing evidence concerning the benefits of maintaining or adopting an active lifestyle in mid-age. ○ The study presents an important message for public health which encourages women to be active throughout mid-age, even if they start meeting physical activity guidelines in their mid-50s, to gain the most benefits for physical health-related quality of life latterly. ○ Limitations of the study included reliance on self-reported physical activity, an inability to account for all contributing factors and findings may not be generalizable to all mid-age Australian women or to women outside of Australia. [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]

This paper examines the transformation of open space and how it compares to older residential development. A study has been conducted at the residential level because neighbourhoods have been a basic unit of city design throughout the recent history of urban settlements. Furthermore, the neighbourhood is a more humanly relevant scale of urban development. The method adopted for this research was a comparative urbanism by comparing old and new residential areas. This study found that incremental redevelopment of old residential areas through both re-subdivision and intensification of development on existing allotments has resulted in a progressive loss of open space. However, the study also confirmed that the current supplies of open space across all the study areas (old and new residential areas) are relatively similar. The main difference between the open space supply in older and newer residential areas comes down to the ownership of land (i.e. the proportion of public versus private open space). The study demonstrated that older residential areas with large allotments have experienced a significant loss of private open space – originally from 50%, to current levels of 23–30%. The paper concludes that there is a need for a holistic approach to the provision of public and private open spaces to improve the quality of life at a residential level. [ABSTRACT FROM PUBLISHER]

As living renal donors face a unique decision of self-sacrifice that is not without risk, there is an ethical imperative for health professionals to understand the donors' perspective. The findings presented in this paper contribute to this area by documenting living renal donors' expectations of quality of life and longevity for the recipient, post-transplant. The longitudinal study involved an open-ended, explorative, qualitative, methodological approach, involving interviews with 20 (n=20) living kidney donors at four points in time over two years. The findings in this paper are from the first interview prior to the donation surgery. The findings on the donors' expectations for the recipients' future were predominantly characterised by a tension between an enthusiastic optimism and a realistic awareness of the medical problems associated with the kidney disease and transplantation. In terms of the immediacy of the transplant operation, the donors expressed high hopes of success combined with an informed understanding of the possibility of rejection. The donors interviewed expressed an acceptance of such risks. The important longitudinal finding is that the cohort demonstrated an ongoing high level of satisfaction with their decision making. Consequently, the findings on the living renal donors' perception about the recipients' quality of life and longevity can be viewed as reflecting an appropriately screened and satisfied group of donors. [ABSTRACT FROM AUTHOR]

Rural communities represent a large proportion of Australia's most disadvantaged areas, with a growing percentage of older people concentrated in these locations. Older people residing in these communities are subject to both the disadvantages of rural living, as well as the health and mobility issues associated with ageing. This paper reviews the literature relating to rural disadvantage, and find that the issues are far more complex than previously thought. As well as disadvantages, there are also benefits to rural living, which can alleviate disadvantage for many older people. However, these same socio-cultural and structural factors are inter-related, and can also mask or increase rural disadvantage in certain circumstances or for particular groups. These factors are dynamic, interactive, and often invisible, and can impact on quality of life. Findings suggest a need for research into the relationship between disadvantage, the experience of rural living and the concept of healthy ageing. [ABSTRACT FROM AUTHOR]

In Australia we have become preoccupied with the potential adverse impact of our ageing population on our health and social systems. The projected cost of having increasing proportions of our population in the over 70s, retired, chronically ill category of the demographic profile is emerging as a major challenge for governments and private insurers: so much so in fact that the government is now urging older people to stay at work longer. In America, new approaches to the management and self-management of chronic diseases have been invoked to encourage and support older people to improve their quality of life and reduce their recourse to and dependence upon health care technologies, clinical interventions and health care management systems. Unless this is achieved, it is argued, the cost of looking after this emerging ‘bubble’ of elderly people will become increasingly unsustainable as fewer and fewer (proportionately) younger people work to pay the taxes that support ageing, retired, sick and dependent populations. This paper argues that we are at real risk of having our economic wealth and productivity impeded and truncated by the financial burden of looking after high demand and high cost dependants at the aged end of the social demographic. This paper offers an alternative view of our ageing population, as well as highlighting some of the assets we have in our elderly populations, and providing suggestions as to an alternative view of the phenomenon of ageing that incorporates elements such as flexible working arrangements and the application of new, enabling technologies. This approach to our ageing population dilemma is predicated on a concept of lifelong learning and social participation along with better preventive and early intervention systems of health care. [ABSTRACT FROM AUTHOR]

In modern times when we speak of a mobile lifestyle we think of backpackers, fruit pickers, tourists, bikies or people living in caravans. Some people, of course, deliberately choose such a lifestyle. In the context of the historical past, of the people who moved in and out of this place - Kalgoorlie (our conference venue) - one group in particular had a very mobile lifestyle, though not by choice. I refer to the Afghan camel drivers who came to Australia for economic reasons. They mostly arrived as single men and assisted the explorers in their expeditions, and contributed to the development of the infrastructure of the Australian outback. The camel drivers steered the camels, 'the ships of the desert', that carried water tanks out to the mining areas such as Kalgoorlie and Coolgardie and other areas where water was scarce. The camels also carried wool bales and boxes of merchandize from one part of Australia to another. And they carted sleepers for the construction of railway lines from Perth to Coolgardie, and materials for the development of the Overland Telegraph Line in South Australia back in 1870-1872. The mobile nature of the lives of the Afghan camel drivers never permitted them to stay in one place for long. The Afghans were predominantly Muslims. They retained their culture and religion in such a harsh lifestyle. In this paper I examine the pattern of their mobile lifestyle from 1860 to 1930 and discuss their identity when they were with other ethnic groups, conflict when they faced resistance and their outspoken nature when they were regarded as the 'other'. Finally, I consider their loyalty to their Australian employers (and explorers). This paper relies on both primary and secondary sources, including oral testimonies. [ABSTRACT FROM AUTHOR]

This paper reports our experiences with the application of a number of alternative approaches to a study of women's economic circumstances and quality of life in a typical western city. The important work of, especially, Martha Nussbaum on the capabilities approach to evaluations of “quality of life” has highlighted pitfalls associated with the use of a narrow informational base in studies of women's lives and has emphasized the value of qualitative methods in these evaluations. However, to date, most discussions of the relevance of plural approaches to studies of women's lives have been conducted in the context of developing countries. This paper contributes a practical, current example of the relevance of such approaches to assessments of the lives of women in western countries as well. The research findings reported in the paper also cast further light on the importance of several, related themes in the literature on the capabilities approach, namely the importance of understanding how women's aspirations and expectations change with their economic and social experiences; and the importance of appreciating the social uses of language and how this affects the way in which women describe their lives. [ABSTRACT FROM AUTHOR]

The aim of this paper was to evaluate the effectiveness of an online self-management program in improving health outcomes and well-being for gay men living with HIV in Australia. The online Positive Outlook Program was based on self-efficacy theory and used a self-management approach to enhance HIV-positive gay men's skills, confidence and abilities to manage the psychosocial issues associated with HIV in daily life. The 7-week program was delivered in closed groups and comprised information modules, action-planning activities, moderated discussion boards, and weekly peer-facilitated 'live chats'. A randomised controlled trial was conducted to establish the effectiveness of the Positive Outlook program compared to a 'usual care' control. Participants were HIV-positive gay men 18 years or older living in Australia. Primary outcomes were evaluated at three time-points (baseline, post-intervention and 12-week's post-intervention follow-up) and included HIV-related quality of life (PROQOL-HIV), outcomes of health education (HeiQ) and HIV specific self-efficacy (Positive Outlook Self-Efficacy Scale). A total of 132 gay men with HIV in Australia were randomly allocated to the intervention (n = 68) or usual care control (n = 64) groups. Maximum likelihood marginal-linear modelling indicated significant improvement in the intervention group on the PROQOL-HIV subscales of body change (p = 0.036), social relationships (p = 0.035) and emotional distress (p = 0.031); the HeiQ subscales of health-directed activity (p = 0.048); constructive attitudes and approaches (p = 0.015); skill and technique acquisition (p = 0.046) and health service navigation (p = 0.008); and the Positive Outlook Self-Efficacy Scale on the subscales of relationships (p = 0.019); social participation (p = 0.006); and emotions (p = 0.041). Online delivery of self-management programs is feasible and has the potential to improve quality of life, self-management skills and domain specific self-efficacy for gay men with HIV.

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

Food allergy is an increasing phenomenon in Australia, with most recent reports of food allergy occurring in 1 in 12 children. A number of studies have demonstrated that children and adolescents with food allergies experience a decreased quality of life across a number of domains. More recent evidence suggests that this population also experiences an increased occurrence of bullying compared to similar school-aged children. Some individuals have reported being bullied because of their allergies, whilst others have reported specific allergy-related-bullying, such as being touched with foods that they are allergic to or having their food being intentionally contaminated with an allergen. Where there may be a risk of severe anaphylaxis, this is of great concern. This article reviews the current literature on bullying in populations of children and adolescents with food allergies. Several papers worldwide have investigated this, providing evidence of its occurrence in North America, Canada, Italy and Japan. [ABSTRACT FROM AUTHOR]

Purpose Quality of care in the residential aged sector has changed over the past decade. The purpose of this paper is to examine these changes from the perspectives of staff to identify factors influencing quality of residential aged care, and the role and influence of an aged care accreditation programme.Design/methodology/approach Focus groups were held with 66 aged care staff from 11 Australian aged care facilities. Data from semi-structured interviews were analysed to capture categories representing participant views.Findings Participants reported two factors stimulating change: developments in the aged care regulatory and policy framework, and rising consumer expectations. Four corresponding effects on service quality were identified: increasing complexity of resident care, renewed built environments of aged care facilities, growing focus on resident-centred care and the influence of accreditation on resident quality of life. The accreditation programme was viewed as maintaining minimum standards of quality throughout regulatory and social change, yet was considered to lack capacity of itself to explicitly promote or improve resident quality of life.Research limitations/implications For an increasingly complex aged care population, regulatory and societal change has led to a shift in service provision from institutional care models to one that is becoming more responsive to consumer expectations. The capacity of long-established and relatively static accreditation standards to better accommodate changing consumer needs comes into question.Originality/value This is the first study to examine the relationship between accreditation and residential aged care service quality from the perspectives of staff, and offers a nuanced view of “quality” in this setting. [ABSTRACT FROM AUTHOR]

Background: The Pediatric Quality of Life Inventory™ 4.0 Short Form 15 Generic Core Scales (hereafter the PedsQL) and the Child Health Utility-9 Dimensions (CHU9D) are two generic instruments designed to measure health-related quality of life in children and adolescents in the general population and paediatric patient groups living with specific health conditions. Although the PedsQL is widely used among paediatric patient populations, presently it is not possible to directly use the scores from the instrument to calculate quality-adjusted life-years (QALYs) for application in economic evaluation because it produces summary scores which are not preference-based.Objective: This paper examines different econometric mapping techniques for estimating CHU9D utility scores from the PedsQL for the purpose of calculating QALYs for cost-utility analysis.Methods: The PedsQL and the CHU9D were completed by a community sample of 755 Australian adolescents aged 15-17 years. Seven regression models were estimated: ordinary least squares estimator, generalised linear model, robust MM estimator, multivariate factorial polynomial estimator, beta-binomial estimator, finite mixture model and multinomial logistic model. The mean absolute error (MAE) and the mean squared error (MSE) were used to assess predictive ability of the models.Results: The MM estimator with stepwise-selected PedsQL dimension scores as explanatory variables had the best predictive accuracy using MAE and the equivalent beta-binomial model had the best predictive accuracy using MSE.Conclusions: Our mapping algorithm facilitates the estimation of health-state utilities for use within economic evaluations where only PedsQL data is available and is suitable for use in community-based adolescents aged 15-17 years. Applicability of the algorithm in younger populations should be assessed in further research. [ABSTRACT FROM AUTHOR]

Beginning in 2013, the Australian Royal Commission into Institutional Responses to Child Sexual Abuse (referred to as the Royal Commission) bought to public consciousness a history of child sexual exploitation that contradicts dearly held values of the preciousness and innocence of childhood and the trust of public organizations. The Royal Commission has publically validated the trauma that victims have experienced across institutions. It has also identified and raised the issue of a symptomatology ofcultural traumaat work in community and public life. Using the work of contemporary trauma theorists and applying it to one hearing held in Victoria in May 2015, this paper suggests that collective trauma can shape cultural identity and influence the quality of communal life. [ABSTRACT FROM PUBLISHER]

Background/aim The first evidence-based Clinical Practice Guidelines and Principles of Care for People with Dementia in Australia have been released. The Guidelines detail a number of important evidence-based recommendations for occupational therapists. The aim of this paper is (1) to provide an overview of Guideline development, and (2) to describe the evidence supporting a recommendation for occupational therapy. Common characteristics of effective occupational therapy programmes for people with dementia are described. Methods Guideline development involved adaptation of existing high-quality guidelines developed overseas and 17 systematic reviews to ensure that the most recent high-quality evidence was included. One of the systematic reviews involved examining the evidence for interventions to promote independence in people with dementia. Specifically, we looked at the evidence for occupational therapy and its effect on activities of daily living, quality of life and carer impact. Results A total of 109 recommendations are included in the Guidelines. Occupational therapy was found to significantly increase independence in activities of daily living and improve quality of life. Effective occupational therapy programmes involve: environmental assessment, problem solving strategies, carer education and interactive carer skills training. Conclusion Occupational therapists working with people with dementia in community settings should ensure that their time is spent on those aspects of intervention that are shown to be effective. [ABSTRACT FROM AUTHOR]

Background: Employment status and working conditions are strong determinants of male health, and are therefore an important focus in the Australian Longitudinal Study on Male Health (Ten to Men). In this paper, we describe key work variables included in Ten to Men, and present analyses relating psychosocial job quality to mental health and subjective wellbeing at baseline.Methods: A national sample of males aged 10 to 55 years residing in private dwellings was drawn using a stratified multi-stage cluster random sample design. Data were collected between October 2013 and July 2014 for a cohort of 15,988 males, representing a response fraction of 35 %. This analysis was restricted to 18-55 year old working age participants (n = 13,456). Work-related measures included employment status, and, for those who were employed, a number of working conditions including an ordinal scale of psychosocial job quality (presence of low job control, high demand and complexity, high job insecurity, and low fairness of pay), and working time-related stressors such as long working hours and night shift work. Associations between psychosocial job quality and two outcome measures, mental ill-health and subjective wellbeing, were assessed using multiple linear regression.Results: The majority of participants aged 18-55 years were employed at baseline (85.6 %), with 8.4 % unemployed and looking for work, and 6.1 % not in the labour force. Among employed participants, there was a high prevalence of long working hours (49.9 % reported working more than 40 h/week) and night shift work (23.4 %). Psychosocial job quality (exposure to 0/1/2/3+ job stressors) prevalence was 36 %/ 37 %/ 20 %/ and 7 % of the working respondents. There was a dose-response relationship between psychosocial job quality and each of the two outcome measures of mental health and subjective wellbeing after adjusting for potential confounders, with higher magnitude associations between psychosocial job quality and subjective wellbeing.Conclusions: These results extend the study of psychosocial job quality to demonstrate associations with a global measure of subjective wellbeing. Ten to Men represents a valuable new resource for the longitudinal and life course study of work and health in the Australian male population. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the relationship between the quality of reflective practice groups and nurses' professional quality of life. Background: Previous nursing research has indicated that reflective practice groups are positively associated with personal resources, job resources, and professional quality of life for nurses. The specific impact of the groups however, has not been distinguished from the impact of personal and job resources, and the explanatory mechanisms for the associations are unclear. Design/Methods: This study utilised a cross-sectional, quantitative research methodology with 184 Australian nurses from a regional teaching hospital who attended reflective practice groups (88.5% female). Surveys captured demographics, personal resources (i.e. self-efficacy), job resources (i.e. job autonomy, skill discretion, job social support, and group cohesion) and perceived quality of reflective practice groups, as measured by the Clinical Supervision Evaluation Questionnaire, alongside professional quality of life outcomes. Results: Participants who rated reflective practice groups as 'high quality' or more effective were associated with significantly higher scores for personal and job resources of self-efficacy, autonomy, skill discretion, social support, and group cohesion. These resources, in turn, correlated with more positive professional quality of life scores; in particular compassion satisfaction and burnout. Discussion: While the study used cross-sectional data and causality cannot be inferred, the findings do indicate a clear association between attending effectively facilitated reflective practice groups and greater personal and job resources. This may indicate that the groups provide nurses with an opportunity to build or enhance these resources. Furthermore, it is proposed that this could explain a mechanism by which reflective practice groups can indirectly impact positively on professional quality of life for nurses by building resources. Future research should explore causality longitudinally. Conclusion: This study provides evidence that nurses who perceive the groups favorably have greater social support, enhanced self-efficacy, more autonomy, and increased skill discretion. These factors also align with the restorative and formative benefits of supervision. Greater personal and job resources, in turn, can enhance professional quality of life. Whilst mediating pathways have been identified, it is still not possible to definitively attribute the development of these resources to group participation. Implications for Research, Policy, and Practice: There is growing evidence to support reflective practice groups as a viable form of group clinical supervision for nurses. It is important to ensure reflective practice groups are effectively facilitated. What is already known about the topic? Correlational data indicates that high quality reflective practice groups may offer a cost-effective form of group clinical supervision, for nurses; providing support and helping them deal with what can be a challenging professional environment. Reflective practice groups have been linked to a range of benefits across individual and organisational levels, including; 1) increased job satisfaction, 2) higher quality of patient care, less critical incidents, 3) higher rates of staff retainment and reduced leave, and 4) enhancing the integrity of the nursing profession through accountability and skill development. What this paper adds Despite these claims, little is known regarding the mechanisms underpinning these documented benefits. This study provides a theoretically driven explanation; that reflective practice groups provide an opportunity for job crafting, in which nurses actively build resources (i.e. skills development critical thinking and social support), mitigating some of the negative psychological consequences associated with nursing. This information can help guide policy, practice, and the development of effective interventions to provide support and supervision for nurses. [ABSTRACT FROM AUTHOR]

Introduction: High-grade glioma (HGG) is a rapidly progressive and debilitating disease. Primary carers experience significant levels of distress which impacts on their experience of caregiving, the quality of care received and the community in terms of the increased reliance on healthcare due to the potential development of complicated grief. This paper describes the protocol for testing the efficacy and feasibility of an intervention for primary carers of patients with HGG in order to improve preparedness to care and reduce carer distress., Methods: Randomised controlled trial. The target population is carers of patients with HGG who are undergoing combined chemoradiotherapy. The intervention consists of 4 components: (1) initial telephone assessment of unmet needs of the carer, (2) tailoring of a personalised resource folder, (3) home visit, (4) ongoing monthly telephone contact and support for 12 months. The control arm will receive usual care., Primary Hypothesis: This intervention will improve preparedness for caring and reduce carer psychological distress., Secondary Hypothesis: This intervention will reduce carer unmet needs. The longer term aim of the intervention is to reduce patient healthcare resource utilisation and, by doing so, reduce costs. Assessments will be obtained at baseline, 8 weeks post intervention, then 4, 6 and 12 months. Participants will also complete a healthcare utilisation checklist and proxy performance status which will be assessed at baseline and monthly. 240 carers will be recruited. The sample size is 180. Multilevel mixed effects regression models will be applied to test the effect of the intervention., Ethics: Ethics approval has been gained from Curtin University and the participating sites., Dissemination: Results will be reported in international peer-reviewed journals., Trial Registration Number: Australian and New Zealand Clinical Trials Registration (ACTRN)12612001147875., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Dementia is a chronic illness without cure or effective treatment, which results in declining mental and physical function and assistance from others to manage activities of daily living. Many people with dementia live in long term care facilities, yet research into their quality of life (QoL) was rare until the last decade. Previous studies failed to incorporate important variables related to the facility and care provision or to look closely at the daily lives of residents. This paper presents a protocol for a comprehensive, multi-perspective assessment of QoL of residents with dementia living in long term care in Australia. A secondary aim is investigating the effectiveness of self-report instruments for measuring QoL., Methods: The study utilizes a descriptive, mixed methods design to examine how facility, care staff, and resident factors impact QoL. Over 500 residents with dementia from a stratified, random sample of 53 facilities are being recruited. A sub-sample of 12 residents is also taking part in qualitative interviews and observations., Conclusions: This national study will provide a broad understanding of factors underlying QoL for residents with dementia in long term care. The present study uses a similar methodology to the US-based Collaborative Studies of Long Term Care (CS-LTC) Dementia Care Study, applying it to the Australian setting.

Objective: Despite the availability of palliative care in many countries, legalization of euthanasia and physician-assisted suicide (EAS) continues to be debated-particularly around ethical and legal issues--and the surrounding controversy shows no signs of abating. Responding to EAS requests is considered one of the most difficult healthcare responsibilities. In the present paper, we highlight some of the less frequently discussed practical implications for palliative care provision if EAS were to be legalized. Our aim was not to take an explicit anti-EAS stance or expand on findings from systematic reviews or philosophical and ethico-legal treatises, but rather to offer clinical perspectives and the potential pragmatic implications of legalized EAS for palliative care provision, patients and families, healthcare professionals, and the broader community., Method: We provide insights from our multidisciplinary clinical experience, coupled with those from various jurisdictions where EAS is, or has been, legalized., Results: We believe that these issues, many of which are encountered at the bedside, must be considered in detail so that the pragmatic implications of EAS can be comprehensively considered., Significance of Results: Increased resources and effort must be directed toward training, research, community engagement, and ensuring adequate resourcing for palliative care before further consideration is given to allocating resources for legalizing euthanasia and physician-assisted suicide.

Chronic pain is associated with significant costs to individuals directly affected by this condition, their families, the healthcare system, and the society as a whole. This paper investigates the relationship between chronic pain and life satisfaction using a sample of around 90,000 observations from the first ten waves of the Household, Income and Labour Dynamics of Australia Survey (HILDA), which is a representative survey of the Australian population that started in 2000. We estimate the negative impact on life satisfaction and examine the persistence of the effect over multiple years. Chronic pain is associated with poor health conditions, disability, decreased participation in the labour market and lower quality of life. We calculate the compensating income variation of chronic pain, based on the measurement of chronic pain, the life satisfaction of individuals and the income of households. Panel data models with random and fixed effects are used to control for characteristics of individuals that do not vary over time. Further, we investigate whether individuals who experience chronic pain exhibit adaptation and recovery in life satisfaction after 3 years. Overall, we find that chronic pain has a large negative association with life satisfaction, and that the compensating income variation is substantial (around 640 US$ per day)., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: The exploratory research seeks to describe the community of Brazilian entrepreneurs in Perth, Australia, regarding their aspirations, migratory trajectories and aspects of entrepreneurship. Method: an exploratory qualitative research was carried out, through the analysis of 21 in-depth interviews with Brazilian entrepreneurs from the most diverse sectors, established in the city of Perth, Western Australia. Main results: Among the reported reasons for emigrating, stand out, discontent with Brazil and the search for a better quality of life. Among the reasons for undertaking, the identification of opportunities, the search for freedom and help to colleagues and family members are reported. The Brazilian community is seen by entrepreneurs as crucial to the establishment of several businesses whose target audience is the community itself, but is also viewed with a certain suspicion, evidenced by the occurrence of false complaints, denoting a distorted business ethics. Cultural and linguistic barriers to entrepreneurship and work are highlighted. Relevance / originality: Brazilian immigrants' entrepreneurship overseas is scarcely researched, particularly in Australia. The paper evidences the sociodemographic profile of the entrepreneurs, their behavioral traits, a description of their businesses, and the relationships between entrepreneurs and between them and their community. Theoretical contributions: to understand the inception of Brazilian immigrants business, related factors and constraints. Contributions to management: help Brazilian immigrant entrepreneurs envision paths, based on the cases reported, for them to act with greater assertiveness while managing their businesses. [ABSTRACT FROM AUTHOR]

Obesity can increase the risk of postoperative complications. Despite increased demand for patients living with obesity to lose weight prior to common surgical procedures, the impact of intentional weight loss on surgical outcomes is largely unknown. We aimed to conduct a pilot study to assess the feasibility of a full-scale randomised controlled trial (RCT) to examine the effect of preoperative dietitian-led Very Low Calorie Diet (VLCD) Clinic on surgical outcomes in gynaecology and general surgeries. Between August 2021 and January 2023, a convenience sample of adults living with obesity (BMI ≥ 30 kg/m2) awaiting gynaecology, laparoscopic cholecystectomy and ventral hernia repair procedures were randomised to dietitian-led VLCD (800–1000 kcal using meal replacements and allowed foods), or control (no dietary intervention), 2–12 weeks preoperatively. Primary outcome was feasibility (recruitment, adherence, safety, attendance, acceptability and quality of life (QoL)). Secondary outcomes were anthropometry and 30-d postoperative outcomes. Outcomes were analysed as intention-to-treat. Fifty-one participants were recruited (n 23 VLCD, n 28 control), mean 48 (sd 13) years, 86 % female, and mean BMI 35·8 (sd 4·6) kg/m2. Recruitment was disrupted by COVID-19, but other thresholds for feasibility were met for VLCD group: high adherence without unfavourable body composition change, high acceptability, improved pre/post QoL (22·1 ± 15 points, < 0·001), with greater reductions in weight (–5·5 kg VLCD v. −0·9 kg control, P < 0·05) waist circumference (–6·6 cm VLCD v. +0·6 control, P < 0·05) and fewer 30-d complications (n 4/21) than controls (n 8/22) (P > 0·05). The RCT study design was deemed feasible in a public hospital setting. The dietitian-led VLCD resulted in significant weight loss and waist circumference reduction compared with a control group, without unfavourable body composition change and improved QoL. [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]

Structured health system-based programs, such as cardiac rehabilitation, may reduce the risk of recurrent stroke. This study aimed to co-design and evaluate a structured program of rehabilitation, developed based on insights from focus groups involving stroke survivors and health professionals. Conducted in Tasmania, Australia in 2019, the 7-week program comprised one hour of group exercise and one hour of education each week. Functional capacity (6 min walk test), fatigue, symptoms of depression (Patient Health Questionnaire), and lifestyle were assessed pre- and post-program, with a historical control group for comparison. Propensity score matching determined the average treatment effect (ATE) of the program. Key themes from the co-design focus groups included the need for coordinated care, improved psychosocial management, and including carers and peers in programs. Of the 23 people approached, 10 participants (70% men, mean age 67.4 ± 8.6 years) completed the program without adverse events. ATE analysis revealed improvements in functional capacity (139 m, 95% CI 44, 234) and fatigue (−5 units, 95% CI −9, −1), with a small improvement in symptoms of depression (−0.8 units, 95% CI −1.8, 0.2) compared to controls. The co-designed program demonstrated feasibility, acceptability, and positive outcomes, suggesting its potential to support stroke survivors. [ABSTRACT FROM AUTHOR]

Background: Quality of life is an important quality indicator for health and aged care sectors. However, self-reporting of quality of life is not always possible given the relatively high prevalence of cognitive impairment amongst older people, hence proxy reporting is often utilised as the default option. Internationally, there is little evidence on the impact of proxy perspective on interrater agreement between self and proxy report. Objectives: To assess the impacts of (i) cognition level and (ii) proxy perspective on interrater agreement using a utility instrument, the Quality of Life-Aged Care Consumers (QOL-ACC). Methods: A cross-sectional study was undertaken with aged care residents and family member proxies. Residents completed the self-report QOL-ACC, while proxies completed two proxy versions: proxy-proxy perspective (their own opinion), and proxy-person perspective (how they believe the resident would respond). Interrater agreement was assessed using quadratic weighted kappas for dimension-level data and concordance correlation coefficients and Bland-Altman plots for utility scores. Results: Sixty-three residents (22, no cognitive impairment; 41, mild-to-moderate cognitive impairment) and proxies participated. In the full sample and in the mild-to-moderate impairment group, the mean self-reported QOL-ACC utility score was significantly higher than the means reported by proxies, regardless of perspective (p < 0.01). Agreement with self-reported QOL-ACC utility scores was higher when proxies adopted a proxy-person perspective. Conclusion: Regardless of cognition level and proxy perspective, proxies tend to rate quality of life lower than residents. Further research is needed to explore the impact of such divergences for quality assessment and economic evaluation in aged care. [ABSTRACT FROM AUTHOR]

Background: Music therapy interventions with informal carers of individuals with life-threatening illness at pre- and post-bereavement is an increasingly important clinical area. This systematic review is the first to synthesise and critically evaluate the international evidence associated with music therapy with adult informal carers pre- and post-bereavement. Specifically, the objectives were: i) to describe the characteristics and effectiveness of music therapy interventions which aim to improve health-related outcomes for adult informal carers of adults with life-threatening illness (pre- and post-bereavement), and ii) to describe the experience of music therapy for adult informal carers of adults with life-threatening illness (pre- and post-bereavement). Methods: Eligibility: adult informal carers of adults at end of life or bereaved; music therapy interventions for improving health-related outcomes; qualitative; mixed-method; and quantitative studies including comparators of any other intervention; published in English from 1998 onwards. Six databases were searched up to July 2022. A JBI mixed-methods systematic review approach was followed throughout, including quality appraisal, data extraction and a convergent segregated approach to synthesis and integration. Results: A total of 34 studies were included, published between 2003 and 2022. Most were conducted in North America (n = 13), Australia (n = 10), or Europe (n = 8). No studies were conducted in low- and middle-income countries or in the UK. The majority were qualitative (n = 17), followed by quasi-experimental (n = 8), mixed-methods (n = 7) and two RCTs. The majority focused on carers of individuals with dementia (n = 21) or advanced cancer (n = 7). Seventeen studies were purely quantitative or included a quantitative component. During meta-synthesis, findings were aligned to core outcomes for evaluating bereavement interventions in palliative care and previously identified risk factors for complicated grief. Commonly targeted outcomes in quantitative studies included quality of life and mental wellbeing, showing equivocal effectiveness of music therapy with significant and non-significant results. Twenty-two studies either purely qualitative or with a qualitative component underwent meta synthesis and suggested a diverse range of improved pre- and post-bereavement outcomes for informal carers across all core outcomes, and across all risk and protective factors, including psychological, spiritual, emotional, and social outcomes. Conclusions: Qualitative studies provide moderate to strong evidence for improved health-related outcomes for adult informal carers of adults with life-threatening illness pre-bereavement. Limited studies including those bereaved negates conclusions for the bereavement phase. Comparisons and explanations for effectiveness across quantitative and qualitative studies are equivocal, with a high risk of bias and small samples in the limited number of quantitative studies, demonstrating a need for high-quality RCTs. Systematic review pre-registration: PROSPERO [CRD42021244859]. [ABSTRACT FROM AUTHOR]

Background: Waiting lists for treatment are common in outpatient and community services, Existing methods for managing access and triage to these services can lead to inequities in service delivery, inefficiencies and divert resources from frontline care. Evidence from two controlled studies indicates that an alternative to the traditional "waitlist and triage" model known as STAT (Specific Timely Appointments for Triage) may be successful in reducing waiting times without adversely affecting other aspects of patient care. This trial aims to test whether the model is cost effective in reducing waiting time across multiple services, and to measure the impact on service provision, health-related quality of life and patient satisfaction.Methods/design: A stepped wedge cluster randomised controlled trial has been designed to evaluate the impact of the STAT model in 8 community health and outpatient services. The primary outcome will be waiting time from referral to first appointment. Secondary outcomes will be nature and quantity of service received (collected from all patients attending the service during the study period and health-related quality of life (AQOL-8D), patient satisfaction, health care utilisation and cost data (collected from a subgroup of patients at initial assessment and after 12 weeks). Data will be analysed with a multiple multi-level random-effects regression model that allows for cluster effects. An economic evaluation will be undertaken alongside the clinical trial.Discussion: This paper outlines the study protocol for a fully powered prospective stepped wedge cluster randomised controlled trial (SWCRCT) to establish whether the STAT model of access and triage can reduce waiting times applied across multiple settings, without increasing health service costs or adversely impacting on other aspects of patient care. If successful, it will provide evidence for the effectiveness of a practical model of access that can substantially reduce waiting time for outpatient and community services with subsequent benefits for both efficiency of health systems and patient care.Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12615001016527 . Approved 15/9/2015. [ABSTRACT FROM AUTHOR]

Background: Hereditary hemochromatosis (HH) is a common autosomal recessive disorder amongst persons of northern European heritage. If untreated, iron accumulates in parenchymal tissues causing morbidity and mortality. As diagnosis often follows irreversible organ damage, screening programs have been suggested to increase early diagnosis. A lack of economic evidence has been cited as a barrier to establishing such a program. Previous analyses used poorly estimated utility values. This study sought to measure utilities directly from people with HH in Australia.Methods: Volunteers with HH were recruited to complete a web-based survey. Utility was assessed using the Assessment of Quality of Life 4D (AQOL-4D) instrument. Severity of HH was graded into four categories. Multivariable regression analysis was performed to identify parameters associated with HSUV.Results: Between November 2013 and November 2014, 221 people completed the survey. Increasing severity of HH was negatively associated with utility. Mean (standard deviation) utilities were 0.76 (0.21), 0.81 (0.18), 0.60 (0.27), and 0.50 (0.27) for categories 1-4 HH respectively. Lower mean utility was found for symptomatic participants (categories 3 and 4) compared with asymptomatic participants (0.583 v. 0.796). Self-reported HH-related symptoms were negatively associated with HSUV (r = -0.685).Conclusions: Symptomatic stages of HH and presence of multiple self-reported symptoms were associated with decreasing utility. Previous economic analyses have used higher utilities which likely resulted in underestimates of the cost effectiveness of HH interventions. The utilities reported in this paper are the most robust available, and will contribute to improving the validity of future economic models for HH. [ABSTRACT FROM AUTHOR]

Purpose: The health inequalities experienced by Aboriginal and Torres Strait Islander Australians are well documented but there are few empirical data outlining the burden, consequences, experience and expression of depressive illness. This paper seeks to address the lack of accessible, culturally specific measures of psychosocial stress, depression or quality of life developed for, and validated within, this population.Methods: Building on an extensive qualitative phase of research, a psychosocial questionnaire comprising novel and adapted scales was developed and piloted with 189 Aboriginal men across urban and remote settings in central Australia. With a view to refining this tool for future use, its underlying structure was assessed using exploratory factor analysis, and the predictive ability of the emergent psychosocial constructs assessed with respect to depressive symptomatology.Results: The latent structure of the psychosocial questionnaire was conceptually aligned with the components of the a priori model on which the questionnaire was based. Regression modelling indicated that depressive symptoms were driven by a sense of injury and chronic stress and had a non-linear association with socioeconomic position.Conclusions: This represents the first community-based survey of psychosocial stress and depression in Aboriginal men. It provides both knowledge of, and an appropriate process for, the further development of psychometric tools, including quality of life, in this population. Further research with larger and more diverse samples of Aboriginal people is required to refine the measurement of key constructs such as chronic stress, socioeconomic position, social support and connectedness. The further refinement, validation against criterion-based methods and incorporation within primary care services is essential. [ABSTRACT FROM AUTHOR]

Background: This study contributes further research into the assessment and treatment of older psychiatric patients with medical comorbidities. Methods: A retrospective file audit was conducted at the acute inpatient psychogeriatric unit of St Vincent's Aged Mental Health Service, Melbourne, in order to determine the prevalence of certain medical comorbidities and the nature of medical interventions provided for psychogeriatric inpatients. Results: This study, investigating 165 admissions into an acute inpatient psychogeriatric unit, highlights that psychiatric and medical comorbidities are routine in this population: the vast majority (91.5%) of all inpatients had at least one medical comorbidity. Conclusions: As the population ages, psychogeriatric wards are likely to see more of the oldest‐olds, who are likely to have comorbid medical illnesses. Currently, appropriate detection, investigation, and management of these illnesses are often suboptimal and can affect quality of life, increase mortality, and complicate treatment. This paper adds to the literature about the need for integrating medical and psychiatric care to create a more comprehensive strategy for treating the older person with psychiatric illness. [ABSTRACT FROM AUTHOR]

The International Psycho-oncology Society (IPOS) has just celebrated its 30th anniversary. The growth of psychosocial oncology has been exponential, and this relatively new field is becoming a core service that focuses on prevention, reducing the burden of cancer, and enhancing the quality of life from time of diagnosis, through treatment, survivorship, and palliative care. Looking back over the past 30 years, we see that cancer care globally has evolved to a new and higher standard. Today, 'cancer care for the whole patient' is being accomplished with an evidence-based model that addresses psychosocial needs and integrates psycho-oncology into the treatment and care of patients. The President's Plenary Session in Lisbon, Portugal, highlighted the IPOS Mission of promoting global excellence in psychosocial care of people affected by cancer through our research, public policy, advocacy, and education. The internationally endorsed IPOS Standard of Quality Cancer Care, for example, clearly states the necessity of integrating the psychosocial domain into routine care, and that distress should be measured as the sixth vital sign after temperature, blood pressure, pulse, respiratory rate, and pain. The plenary paper also discussed the global progress being made in Europe, North America, and Australia in providing quality cancer care for the whole patient. Collaborative partnerships between IPOS and organizations such as the European Partnership Action Against Cancer and the World Health Organization are essential in building capacity for the delivery of high-quality psycho-oncology services in the future. [ABSTRACT FROM AUTHOR]

Background Improving staff performance is an issue in services for people with intellectual disability. Practice leadership, where the front line leader of a staff team focuses on service user outcomes in everything they do and provides coaching, modeling, supervision and organisation to the team, has been identified as important in improving staff performance. To date this finding is based only on self-report measures. Methods This paper describes and tests an observational measure of practice leadership based on an interview with the front-line manager, a review of paperwork and observations in 58 disability services in Australia. Results The measure showed good internal consistency and acceptable inter-rater reliability. Practice leadership was associated with staff practice and outcomes for service users. The observed measure of practice leadership appears to be a useful tool for assessing whether leadership within a service promotes enabling and empowering support by staff. It was found to discriminate higher and lower performing services in terms of active support. Conclusions The measure had good reliability and validity although some further testing is required to give a complete picture of the possible uses and Conclusions The measure had good reliability and validity although some further testing is required to give a complete picture of the possible uses and reliability of the measure. The measure is potentially useful in contexts of both research and service development. The confirmation of previous findings from self-report measures that practice leadership is related to the quality of staff practice and outcomes for service users has implications for policy and practice in terms of the training of managers and structures for organisational management. [ABSTRACT FROM AUTHOR]

Background: Physical and mental component summary scores (PCS and MCS, respectively) are often used to summarise SF-36 quality of life subscales. This paper investigates PCS and MCS across the life course and compares the trajectories obtained from two different methods of calculation., Methods: The Australian Longitudinal Study on Women's Health is a population-based study with three cohorts of women and SF-36 surveys taken at multiple time points. Scoring coefficients for each component score were determined using factor analysis with uncorrelated (orthogonal) and correlated (oblique) rotation at the baseline survey, which were then used to compute correlated and uncorrelated PCS and MCS scores at each survey (scaled to have mean of 50 and standard deviation of 10 at baseline)., Results: For both methods, PCS declined progressively across the lifespan, while MCS rose in young and mid-age women to a peak and subsequently declined in later life. Differences were apparent between correlated and uncorrelated scores, most notably for MCS in the older cohort, where correlated MCS reached 54.6 but still less than uncorrelated MCS, with a random effects model indicating 1.63 (95% confidence intervals 1.58-1.67) units difference; it then declined to a score of 51.2 by the last survey and the difference widened to 3.44 (3.38-3.50) units compared with the uncorrelated MCS., Conclusions: PCS and MCS have distinct trajectories through life, with differences in results from correlated and uncorrelated component summary scores. The divergence is most notable with MCS, especially for older women, suggesting that correlated MCS and PCS should be used when examining change in health over time in this age group.