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Background Induction of labor, an increasingly common intervention, is often preceded by the application of an agent to 'prime' or 'ripen' the cervix. We conducted a randomized controlled trial to compare clinical, economic, and psychosocial outcomes of inpatient and outpatient cervical priming before induction of labor. In this paper we present the psychosocial outcomes. Methods Women participating in a randomized controlled trial in two Australian metropolitan teaching hospitals completed questionnaires to measure anxiety and depression at enrollment, and to examine satisfaction, experiences, depression, and infant feeding 7 weeks after giving birth. Data analysis was by intention to treat and by having received the intervention as intended (approximately 50% in each group). Results Of 1,004 eligible women, 85 percent consented ( n = 407, outpatient; n = 414 inpatient). No statistically significant or clinically relevant differences were found in immediate anxiety, depression, or infant feeding. Small, statistically significant differences favoring outpatient priming were found in seven of the nine subscales in the 7-week postpartum questionnaire. The direction of the effect was maintained, mostly with a larger effect size in women who received the intervention. Conclusion Women allocated to outpatient priming were more satisfied with their priming experience than women allocated to inpatient priming. Being informed that they could go home after cervical priming did not increase women's anxiety. [ABSTRACT FROM AUTHOR]

Issue addressed: This study used the Transtheoretical Model of Behaviour Change (TTM) to describe reparticipation in colorectal cancer (CRC) screening according to social cognitive and background variables. Methods: A random sample of men and women aged 50-74 years living in South Australia completed a questionnaire measuring TTM stage and attitudes toward screening using a faecal occult blood test (FOBT). Participants were categorised according to four stages of readiness to rescreen: action, maintenance, relapse and inconsistent. Multivariate techniques were used to determine predictors of lower readiness stages compared with maintenance. Results: Of the 849 study participants, 29.9% were either non-adherent or had no intentions to maintain adherence (inconsistent and relapse). Compared with maintenance rescreeners, relapse participants reported less: social influences to screen (RR=0.86, p<0.001); satisfaction with prior screening (RR=0.87, p=0.03), self-efficacy (RR=0.96, p=0.01); and screening benefits (RR=0.84, p<0.001). Relapse participants were also more likely to not have private health insurance (RR=1.33, p=0.04) and be unaware of the need to repeat screening (RR=1.41, p=0.02). Inconsistent screeners were less likely to have planned when they will next rescreen (RR= 0.84, p=0.04) and reported greater barriers to rescreening (RR=1.05, p=0.05). Action participants were younger (RR= 0.98, p=<0.001), reported less social influences to screen (RR=0.94, p<0.001) and were less likely to have known someone who has had CRC (RR=0.82, p=0.01). Conclusions: Social cognitive, demographic and background variables significantly differentiated screening maintenance from lower readiness stages. [ABSTRACT FROM AUTHOR]

To examine the effects of social support and sense of community on rural men's subjective well-being, considering the main effects and stress-buffer models. Cross-sectional population-based survey, non-probability sampling frame primarily convenience sampling. Community-based setting. A total of 185 men aged 18+ years from rural South Australia. Subjective well-being, measured by the Satisfaction With Life Scale. Two-step hierarchical multiple regression analysis was conducted, with subjective well-being as the dependent variable, controlling for independent variables of age, living alone and farm employment. Social support was the most effective predictor of well-being, followed by stress, and only a very modest contribution from sense of community; total variance explained was 56% (F(6,178) = 37.77, P < 0.001, R = 0.56, adjusted R = 0.55, R change = 0.07, P < 0.001). Stress partially mediated both the social support/well-being and sense of community/well-being relationships (mediation analysis). Results demonstrated the benefits of social support on well-being using the stress-buffer and main effects models, within a sample of rural men, and explored the relatively unexamined relationship between sense of community and well-being. Rural men have considerable stress impacting their well-being. This study identifies that it is critical for individuals, organisations and policy makers to be aware of the capacity of both social supports and sense of community to buffer stress and promote well-being within rural men. Furthermore, structural, community-based approaches might have greater capacity to cost-effectively provide this support, contrasting with the growing trend towards individual-based approaches for mental health. [ABSTRACT FROM AUTHOR]

The extent and course of psychological distress were examined in a representative sample of patients attending a primary health care practice in metropolitan Adelaide where general practitioner (GP) and clinical psychologist services are co-located. Scores for psychological distress were similar to national norms. Approximately one in six patients expressed a wish to discuss their feelings with a GP and/or psychologist, but the association between distress scores and wish to discuss feelings was only moderate. At follow-up 5 months later, average distress scores had fallen. Half of those who had expressed a wish for discussion had done so, and they had significantly lower scores for anxiety and stress. The results provide a context within which subsequent national mental health initiatives can be interpreted. [ABSTRACT FROM AUTHOR]

Prior to 1997, the University of Adelaide, Australia selected medical students according to matriculation marks alone. After extensive consultation with relevant stakeholders and examination of empirical evidence, the selection process is now based on a national written examination of reasoning and interaction skills, a structured oral assessment and a threshold matriculation score. This paper presents a series of 4 case studies examining the process related to the procedure and early interim outcomes, with the aim of adding to the evidence base for methods of medical student selection. Data were collected from a range of sources between 1996 and 2001, including the University's central administration system, the Faculty of Health Sciences, and purpose-designed oral assessment forms and self-report student questionnaires. The oral assessment process has shown itself to be characterised by a high level of interassessor reliability. Equity of access has been addressed and the number of schools represented in the student intake has increased from between 10 and 15 in the final years of the old selection process to over 30 statewide under the new process. There has been a corresponding increase in the proportion of students from rural backgrounds (from an original 4–12% to 20–22%). These investigations add to the evidence base for medical school selection in that they demonstrate that an oral assessment process can be reliable and lead to early positive results in relation to student outcomes and access. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast density is an independent risk factor for breast cancer and can impede detection of cancer by mammography. There is growing awareness of breast density in Australia and globally, but it is unclear whether this awareness is increasing knowledge of what breast density is and what it means to have dense breasts. This study was conducted to investigate South Australian women's knowledge of the common facts and misconceptions about breast density. This study reports that women who had previously heard the term breast density had increased knowledge compared to those who had not, suggesting that current efforts to raise awareness are leading to better knowledge. Despite this, the study shows that there are widespread misconceptions that must be actively dispelled, including the misunderstanding that breast density can be determined by touch. Background: There is growing awareness of breast density in women attending breast cancer screening; however, it is unclear whether this awareness is associated with increased knowledge. This study aims to evaluate breast density knowledge among Australian women attending breast cancer screening. Method: This cross-sectional study was conducted on women undergoing breast cancer screening at The Queen Elizabeth Hospital Breast/Endocrine outpatient department. Participants were provided with a questionnaire to assess knowledge, awareness, and desire to know their own breast density. Result: Of the 350 women who participated, 61% were familiar with 'breast density' and 57% had 'some knowledge'. Prior breast density notification (OR = 4.99, 95% CI = 2.76, 9.03; p = 0.004), awareness (OR = 4.05, 95% CI = 2.57, 6.39; p = 0.004), younger age (OR = 0.97, 95% CI = 0.96, 0.99; p = 0.02), and English as the language spoken at home (OR = 3.29, 95% CI = 1.23, 8.77; p = 0.02) were independent predictors of 'some knowledge' of breast density. A significant proportion of participants (82%) expressed desire to ascertain their individual breast density. Conclusions: While knowledge of breast density in this Australian cohort is generally quite low, we have identified factors associated with increased knowledge. Further research is required to determine optimal interventions to increase breast density knowledge. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted by Jodie M. Dodd and colleagues for the LIMIT Randomised Trial Group which aims to know whether antenatal lifestyle advice offered to overweight or obese pregnant women can improve the health outcomes of mother and child. Included in the article are the primary outcome, main results and the role of chance, and the summary result of the study. It offers information on the methodology of the study including design, and participants and setting.

Background: The continuum of resistance model contends that respondents lie at one end of a continuum and non-respondents at the other with respect to factors demonstrated to impact on screening participation. Purpose: The aim of this study was to explore the validity of this model for the prediction of participation in colorectal cancer screening. Method: People aged 50 to 74 years were asked to complete a survey ( n = 1,250). Eligible respondents ( n = 376, 30 %) were invited to complete a faecal occult blood test (FOBT). The cutoff period for the determination of participation rates was 12 weeks, with a reminder sent at 6 weeks. Results: FOBTs were returned by n = 196 people (132 within 6 weeks, 64 following a reminder). Participation was generally influenced by the same variables in both the first 6 weeks and the second 6 weeks, consistent with the continuum of resistance model. These variables were having known someonewith bowelcancer and the social cognitive factor, perceptions ofbarriers toscreening. There is a suggestion, however, that other factors may be differentially associated with early, late and non-participants. Conclusion: Participation in screening appears somewhat consistent with the continuum of resistance model in that early and late participants respond to some of the same factors. This suggests that the same messages are relevant to early, late and non-screeners, but further consideration of what other factors may be influencing discrete stages of readiness to participate is necessary. [ABSTRACT FROM AUTHOR]

Objective To compare the costs of inpatient (usual care) with outpatient (intervention) care for cervical priming for induction of labour in women with healthy, low-risk pregnancies who are being induced for prolonged pregnancies or for social reasons. Methods Data from a randomised controlled trial at two hospitals in South Australia were matched with hospital financial data. A cost analysis comparing women randomised to inpatient care with those randomised to outpatient care was performed, with an additional analysis focusing on those who received the intervention. Results Overall, 48% of women randomised into the trial did not receive the intervention. Women randomised to outpatient care had an overall cost saving of $319 per woman (95% CI -$104 to $742) as compared with women randomised to usual care. When restricted to women who actually received the intervention, in-hospital cost savings of $433 (95% CI -$282 to $1148) were demonstrated in the outpatient group. However, these savings were partially offset by the cost of an outpatient priming clinic, reducing the overall cost savings to $156 per woman. Conclusions Overall cost savings were not statistically significant in women who were randomised to or received the intervention. However, the trend in cost savings favoured outpatient priming. What is known about the topic? Induction of labour is a common obstetric intervention. For women with low-risk, prolonged pregnancies who require cervical priming there has been increased interest in whether this period of waiting for the cervix to 'ripen' can be achieved at home. Outpatient priming has been reported to reduce hospital costs and improve maternal satisfaction. However, few studies have actually examined the cost of outpatient priming for induction of labour. What does this paper add? This is the first paper in Australia to both assess the full cost of outpatient cervical priming and to compare it with usual (inpatient) care. This is the first costing paper from a randomised controlled trial directly comparing inpatient and outpatient priming with prostaglandin E[sub 2]. What are the implications for practitioners? For women with prolonged, low-risk pregnancies, a program of outpatient cervical priming can potentially reduce in-hospital costs and free up labour ward beds by avoiding an additional overnight hospitalisation. [ABSTRACT FROM AUTHOR]

Aim and objective. This study aimed to understand older people's perceptions of their and other older peoples' falls risk, to increase understanding of why older people might not believe falls are relevant to themselves. Background. One-third of the people aged ≥65 years (older people) fall yearly. Many older people do not participate in falls prevention programmes because they purport they are not personally vulnerable. Design. A qualitative study was conducted, guided by the tenets of grounded theory. Method. Semi-structured interviews were conducted with nine community-dwelling older people living in metropolitan Adelaide, South Australia. The interview explored participant's direct and indirect experience of falling, their perceived chance of falling in the next 12 months and that of others of the same age and sex to themselves and their reasons for this. Results. Participants carefully presented themselves as being 'not the type who fall', who they view negatively. They believed their or their friends past or future falls were (or could be) because of factors outside of their personal control or because they were not paying attention at that moment of falling, as opposed to being the type of person who falls. They used these explanations as strategies to maintain or protect their identity as being physically competent. Conclusions. Older people know that falling can be viewed negatively. Falling is a threat to their identity as the type of person who does not fall. This explanation is consistent with self-presentation theory, where people use accounting strategies in social interaction to create a desired impression. Relevance to clinical practice. Falls prevention messages are likely to be rejected if the target group associate the message with a negative identity. These findings can assist nurses to understand older people's reluctance to engage in falls prevention and can stimulate thinking regarding alternative engagement strategies. [ABSTRACT FROM AUTHOR]

Background: Population screening reduces mortality from colorectal cancer, yet factors associated with uptake of screening are incompletely understood. Purpose: The purpose of the study was to determine demographic and psychosocial factors associated with participation in faecal occult blood test (FOBT)-based colorectal cancer (CRC) screening in an average risk community programme in Adelaide, South Australia. Method: A questionnaire consistent with the Preventive Health Model was used to determine demographic and psychosocial differences between previous FOBT-based screening participants ( n = 413, response rate 93.2%) and non-participants ( n = 481, response rate 47.9%). Results were analysed by univariate and multivariate generalised linear modelling, and factors associated with participation were identified. Results: Factor analysis of psychosocial items revealed an optimal three-factor solution (knowledge, faecal aversion, belief in the value of screening). Following multivariate analyses, two psychosocial and two demographic factors remained as predictors of FOBT screening behaviour: (1) items related to faecal aversion (Aversion), relative risk (RR) = 0.61, CI = 0.55-0.69, (2) perceptions about the value of screening (Value), RR = 1.45, CI = 1.13-1.85, (3) age band 65-69 (Age, five age bands, relative to age 50-54), RR = 1.43, CI = 1.16-1.76 and FOBT type (Test; three tests, Hemoccult®, FlexSure®, InSure® randomly assigned, relative to Hemoccult®: FlexSure®: RR = 1.41, CI = 1.17-1.71, InSure®: RR = 1.76, CI = 1.47-2.11. Conclusions: The psychosocial factors associated with non-participation in FOBT-based CRC screening are amenable to interventions designed to improve participation. The small relative risks values associated with each predictor, however, raise the possibility that additional factors are likely to influence screening participation. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prognostic risk of incident delirium after cardiac surgery attributable to preoperative affective disorders and Type D personality. Methods: Patients awaiting elective coronary revascularization surgery (N = 158; 20.9% female; 11.4% concomitant valve surgery; age M = 64.7, SD = 10.6) underwent the structured MINI International Neuropsychiatric Interview and completed a measure of Type D personality. Postoperative incident delirium was established prior to discharge from the index hospitalization with structured psychiatric interview. Results: The prevalence of psychiatric disorders before cardiac surgery was 17.1% for major depression, 7.6% for panic disorder, 10.1% for generalized anxiety disorder, and 13.3% for Type D personality, while there were 49 (31% of total) cases of delirium after surgery. After adjustment for sex, older age, cross-clamp time, haemoglobin (Hb) and psychotropic drug use, major depression was significantly associated with delirium, odds ratio (OR) = 3.86 (95% confidence interval (CI) 1.42 to 10.52, p = 0.001). Adjustment for clinical covariates suggested that Type D personality was not significantly associated with delirium, OR = 2.85 (95%CI 0.97 to 8.38, p = 0.06). Conclusions: Major depression was significantly associated with incident delirium after cardiac surgery. These findings suggest that the risk of incident delirium attributable to major depression was not merely a reflection of common diagnostic features in prospectively examined cardiac surgery patients. [ABSTRACT FROM AUTHOR]

This study investigated barriers to help seeking for mental health concerns and explored the role of psychological mindedness using semistructured interviews with sixteen adults in a South Australian rural centre. Prior research-driven thematic analysis identified themes of stigma, self-reliance and lack of services. Additional emergent themes were awareness of mental illness and mental health services, the role of general practitioners and the need for change. Lack of psychological mindedness was related to reluctance to seek help. Campaigns, interventions and services promoting mental health in rural communities need to be compatible with rural cultural context, and presented in a way that is congruent with rural values. [ABSTRACT FROM AUTHOR]

Objective: To describe the distribution of a population in southern urban Adelaide in terms of readiness to screen for colorectal cancer (CRC) by Faecal Occult Blood Test (FOBT) or colonoscopy according to the stages in the Transtheoretical Model (TTM) of behaviour change and to compare the stages according to demographic variables. Methods: A random sample of 664 South Australians aged 50 to 74 were surveyed in June 2006. Chi-squared analyses were performed to determine if statistically significant differences on demographic variables existed between participants at different stages of readiness to screen. Results: The precontemplation and contemplation stages when combined equated to more than half of the total respondents. Several significant differences were identified between the stages. Those in both the precontemplation and contemplation stages were older than those in the remaining stages and also had a significantly higher proportion of women when compared to the action stage. In the precontemplation stage there were significantly more respondents for whom English was a second language, and low levels of private health insurance, whereas the contemplation stage had the highest proportion of Australian-born respondents. Interestingly, levels of private health insurance were also low among those who intended to screen with colonoscopy. Conclusions and implications: The majority of the population were not found to have progressed beyond contemplation. Certain demographic characteristics varied significantly between people at different stages of readiness to screen for CRC. [ABSTRACT FROM AUTHOR]