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Background: There is currently an incomplete picture of the long‐term impact of homelessness on youth with mental health issues. There are also questions regarding homelessness as a predictor of mental health re‐admissions. Aims: To examine the mental health service presentation profile of young people affected by homelessness and mental health issues. Methods: A retrospective analysis was conducted of the medical records of homeless (n = 29) and non‐homeless (n = 32) youth who attended the YouthLink specialist mental health service in 2010. We tracked their pattern of mental health service admissions at five time points during a total period of 10 years, including 2 years prior to, and up to 8 years following the YouthLink presentation. A regression analysis was used to examine factors hypothesized to contribute to mental health re‐admissions. Results: Homeless youth had significantly more frequent presentations to inpatient and outpatient mental health services, and emergency departments for mental health reasons. They were 11 times more likely to be re‐admitted to a mental health inpatient ward than non‐homeless youth. Prior hospital admission was an independent predictor, increasing by a factor of 2.2 for every inpatient admission. Conclusion: The impact of homelessness on mental health issues is enduring, and is a long‐term predictor of hospital re‐admission. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of physical activity on asthma in middle-aged adults, in one longitudinal analysis, and one multi-centre cross-sectional analysis. Methods: The Respiratory Health in Northern Europe (RHINE) is a population-based postal questionnaire cohort study. Physical activity, height and weight were self-reported in Bergen, Norway, at RHINE II (1999–2001) and all centres at RHINE III (2010–2012). A longitudinal analysis of Bergen data investigated the association of baseline physical activity with follow-up asthma, incident asthma and symptoms, using logistic and zero-inflated Poisson regression (n = 1782). A cross-sectional analysis of all RHINE III centres investigated the association of physical activity with concurrent asthma and symptoms (n = 13,542) using mixed-effects models. Body mass index (BMI) was categorised (<20, 20–24.99, 25–29.99, 30+ kg/m2) and physical activity grouped by amount and frequency of lighter (no sweating/heavy breathing) and vigorous (sweating/heavy breathing) activity. Results: In the Bergen longitudinal analysis, undertaking light activity 3+ times/week at baseline was associated with less follow-up asthma (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.22, 0.89), whilst an effect from undertaking vigorous activity 3+ times/week was not detected (OR 1.22, 95% CI 0.44, 2.76). The associations were attenuated with BMI adjustment. In the all-centre cross-sectional analysis an interaction was found, with the association between physical activity and asthma varying across BMI categories. Conclusion: These findings suggest potential longer-term benefit from lighter physical activity, whilst improvement in asthma outcomes from increasing activity intensity was not evident. Additionally, it appears the benefit from physical activity may differ according to BMI. [ABSTRACT FROM AUTHOR]

Professionals, celebrities, and media frequently suggest to parents the possible treatment options for their children with autism. Some treatment recommendations advocate for scientifically supported treatments whereas others suggest novel, untested interventions, or potentially ineffective or harmful treatments. The current study examined the print media's coverage of applied behavior analysis (ABA) and non-scientifically supported autism treatments. Over the last 10 years, print media have increasingly published articles referring to autism treatments with little scientific support and a decreased coverage of ABA. Print media's positive statements about non-scientifically supported treatments also increased over the last decade, whereas positive statements about ABA decreased. ABA received two times as many positive comments as negative; however, non-scientifically supported treatments as a group received four times as many positive comments as negative. These results could contribute to parents' decisions to implement treatments for their children with autism. To contribute to future positive perception of ABA, we provided suggestions for the dissemination of information to increase positive reporting of ABA in print media. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Universities are increasingly recognised as institutions where health and wellbeing can be promoted to maximise academic outcomes, career transitions, and lifelong positive health behaviours. There is concern about the mental health of university students and other factors which affect academic outcomes particularly for subgroups such as international students. There are few cohort studies of the breadth of issues that can impact on mental health and academic outcomes for both local and international students. We conducted a baseline prevalence survey of students at a large Australian university covering health, academic, and social determinants of wellbeing. The purpose was to inform the university's new student health and wellbeing framework with a view to follow-up to determine predictors of mental ill-health and academic outcomes in the subsequent year. In this paper we present the baseline prevalence data and report on selected mental health and health care access issues for local and international students. Methods: The entire university population as of April 2019 of over 56,375 students aged 18 or above were invited to complete the online survey. Questions explored eight domains: demographic characteristics, general health and wellbeing, mental health, risk taking behaviours, psychosocial stressors, learning and academic factors, social and cultural environment, and awareness of and access to health and wellbeing services. Records of academic results were also accessed and matched with survey data for a large subset of students providing consent. Results: Fourteen thousand eight hundred eighty (26.4%) students commenced our survey and were representative of the entire student population on demographic characteristics. Three quarters were aged between 18 to 25 years and one third were international students. Eighty-five percent consented to access of their academic records. Similar proportions of local and international students experienced symptoms of a depression or anxiety disorder, however international students were less aware of and less likely to access available health services both inside and external to the university. We also reported on the prevalence of: general lifestyle factors (diet, exercise, amount of daily sleep); risk-taking behaviours (including alcohol, tobacco and other drug use; unprotected sexual activity); psychosocial stressors (financial, intimate partner violence, discrimination, academic stressors, acculturative stress); subjects failed; resilience; social supports; social media use; and health services accessed online. Conclusions: This rigorous and comprehensive examination of the health status of local and international students in an Australian university student population establishes the prevalence of mental health issues and other psychosocial determinants of health and wellbeing, along with academic performance. This study will inform a university-wide student wellbeing framework to guide health and wellbeing promotion and is a baseline for a 12-month follow-up of the cohort in 2020 during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Universities are increasingly recognised as institutions where health and wellbeing can be promoted to maximise academic outcomes, career transitions, and lifelong positive health behaviours. There is concern about the mental health of university students and other factors which affect academic outcomes particularly for subgroups such as international students. There are few cohort studies of the breadth of issues that can impact on mental health and academic outcomes for both local and international students. We conducted a baseline prevalence survey of students at a large Australian university covering health, academic, and social determinants of wellbeing. The purpose was to inform the university's new student health and wellbeing framework with a view to follow-up to determine predictors of mental ill-health and academic outcomes in the subsequent year. In this paper we present the baseline prevalence data and report on selected mental health and health care access issues for local and international students. Methods: The entire university population as of April 2019 of over 56,375 students aged 18 or above were invited to complete the online survey. Questions explored eight domains: demographic characteristics, general health and wellbeing, mental health, risk taking behaviours, psychosocial stressors, learning and academic factors, social and cultural environment, and awareness of and access to health and wellbeing services. Records of academic results were also accessed and matched with survey data for a large subset of students providing consent. Results: Fourteen thousand eight hundred eighty (26.4%) students commenced our survey and were representative of the entire student population on demographic characteristics. Three quarters were aged between 18 to 25 years and one third were international students. Eighty-five percent consented to access of their academic records. Similar proportions of local and international students experienced symptoms of a depression or anxiety disorder, however international students were less aware of and less likely to access available health services both inside and external to the university. We also reported on the prevalence of: general lifestyle factors (diet, exercise, amount of daily sleep); risk-taking behaviours (including alcohol, tobacco and other drug use; unprotected sexual activity); psychosocial stressors (financial, intimate partner violence, discrimination, academic stressors, acculturative stress); subjects failed; resilience; social supports; social media use; and health services accessed online. Conclusions: This rigorous and comprehensive examination of the health status of local and international students in an Australian university student population establishes the prevalence of mental health issues and other psychosocial determinants of health and wellbeing, along with academic performance. This study will inform a university-wide student wellbeing framework to guide health and wellbeing promotion and is a baseline for a 12-month follow-up of the cohort in 2020 during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Summary Background Puberty is characterized by increases in growth hormone (GH) and insulin-like growth factor-1 (IGF-1) and the pubertal growth spurt. Bone formation and resorption also increase, consistent with increased bone metabolism. Objective To determine the relationship between pubertal bone metabolism, GH and IGF-1. We hypothesized that bone turnover peaks at the time of greatest pubertal GH secretion. Design and Subjects Subjects included 86 girls and boys, 9-17 years-old (BMI 10th-90th percentiles). Because higher endogenous GH secretion is associated with a higher nadir following oral glucose, we used the GH nadir following a 2-h OGTT as indicative of GH status. Fasting serum IGF-1, aminoterminal propeptide of type 1 procollagen (P1NP) and carboxy-terminal collagen crosslinks (CTX) were obtained. Subjects were grouped per expected timing of peak growth. Group 1: Tanner 1 girls and Tanner 1-2 boys (period preceding peak growth), Group 2: Tanner 2-3 girls and Tanner 3-4 boys (period of peak growth) and Group 3: Tanner 4-5 girls and Tanner 5 boys (period following peak growth). Results GH peaked at mid-puberty (Group 2) and IGF-1 in late puberty (Group 3). P1NP and CTX were highest in mid-puberty compared with early and late puberty ( P = 0·0009 and 0·006 in girls and P = 0·005 and 0·04 in boys). GH, but not IGF-1, correlated with P1NP ( r = 0·46 in both genders, P ≤ 0·008) and CTX ( r = 0·37 and 0·38, P = 0·04 and 0·02 in girls and boys, respectively). Similarly, on regression modelling, GH (but not IGF-1) predicted both bone turnover markers in both genders. Conclusion GH is strongly associated with pubertal bone metabolism, independent of systemic IGF-1 in girls and boys. [ABSTRACT FROM AUTHOR]

To investigate the effect of a referral-based targeted multifactorial falls prevention intervention on the occurrence of recurrent falls and injuries in older people presenting to an emergency department (ED) after a fall and discharged directly home from the ED. Randomized controlled trial. Assessors of outcomes were unaware of group allocation. Seven EDs in metropolitan Melbourne, Australia. Inclusion criteria were community dwelling, aged 60 and older, presenting to an ED after a fall, and discharged directly home. Exclusion criteria were unable to follow simple instructions or walk independently. Targeted referrals to existing community services and health promotion recommendations, based on the falls risk factors found in a baseline assessment. Primary outcome measures were falls and resultant injuries occurring over the 12-month follow-up period. Falls and injury data were collected using falls calendars supported by medical record reviews. Three hundred sixty-one participants were randomized to the standard care group and 351 to the intervention group. No significant difference was found between the two groups over the 12-month follow-up period in number of fallers (relative risk (RR)=1.11, 95% confidence interval (CI)=0.95-1.31] or number of participants sustaining an injury from a fall (RR=1.06, 95% CI=0.86-1.29). This study does not support the use of a referral-based targeted multifactorial intervention program to reduce subsequent falls or fall injuries in older people who present to an ED after a fall. [ABSTRACT FROM AUTHOR]

Abstract: Background: Bone mineral density (BMD) is lower in amenorrheic athletes (AA) compared with eumenorrheic athletes (EA). Decreased energy availability and altered levels of appetite regulating hormones (ghrelin and leptin) in AA contribute to hypogonadism, an important cause of low BMD. The role of other nutritionally regulated hormones such as peptide YY (PYY) and adiponectin in mediating gonadal status and bone metabolism remains to be determined. Objectives: Our objective was to determine whether PYY and adiponectin are higher in AA compared with EA and contribute to hypogonadism and impaired bone metabolism in AA. Methods: We determined PYY and adiponectin in 16 AA, 15 EA and 16 non-athletic controls 12–18 years old, and other nutritionally dependent hormones including ghrelin, leptin and IGF-1. We also measured testosterone, estradiol, PINP and NTX (markers of bone formation and resorption) and BMD. Results: PYY was higher in AA than EA (111±52 vs. 61±29 pg/ml, p <0.05), whereas adiponectin did not differ between groups. Although activity scores did not differ, BMI was lower in AA than EA and a larger proportion (62.5% vs. 6.7%) reported disordered eating, indicating lower energy availability. PYY and adiponectin were independent predictors of testosterone in a regression model (p =0.01 and 0.04), but did not predict estradiol. PYY, but not adiponectin, was an independent and negative predictor of PINP (p =0.002) and lumbar bone mineral apparent density Z-scores (p =0.045) in this model. Conclusion: High PYY levels (but not adiponectin) differentiate AA from EA, and may be an important factor contributing to low bone density in athletes. [Copyright &y& Elsevier]

Background: the aim of this study was to develop a brief screening tool for use in the emergency department (ED), to identify people who require further assessment and management. Methods: this prospective study included 344 community-dwelling older people presenting to an ED after a fall. After direct discharge participants had a home-based assessment performed that included the Falls Risk for Older People in the Community (PROP-Com), a comprehensive, yet simple, multifactorial falls risk assessment tool. They were then monitored for falls for 12 months. The items from the PROP-Com assessment tool predictive of falls in a multifactorial logistic regression were used to develop the FROP-Com screen. Results: the items significantly predictive of falls and combined to form the PROP-Com screen were: falls in the previous 12 months, observation of the person's balance and the need for assistance to perform domestic activities of daily living. At the cut-off with the highest Youden index sensitivity was 67.1% (95% CI 59.9-74.3) and specificity was 66.7% (95% CI 59.8-73.6). Conclusion: the FROP-Com screen has a relatively good capacity to predict falls. It can be used in time-limited situations to classify those at high risk of falls who require more detailed assessment and management. [ABSTRACT FROM AUTHOR]

Background. There is currently no standard approach to falls risk assessment and management lot older fallers presenting to the emergency department (ED) who are discharged directly home. Hence, this study was conducted to describe the prevalence of falls risk factors associated with older fallers presenting to the ED and to identify the factors associated with postdischarge decline in function in this group. Methods. This cross-sectional study was performed with 300 community-dwelling individuals, aged 60 years or older admitted to the ED following a fall, and discharged directly home. A home-based assessment after ED discharge was performed, which included the prevalence of falls risk factors, identification of functional decline, and objective measurements of balance, gait, depression, and falls efficacy. Results. Fall-related injuries were sustained by 91% (95% confidence interval [CI], 87.2%-94.0%) of participants presenting to the ED. The most common falls risk factors identified in the home assessment were polypharmacy (79.0%, 95% CI, 73.9%-83.5%), home hazards (76.0%, 95% CI, 70.8%-80.7%), decreased balance (61.3%, 95% CI, 55.6%-66.9%), and arthritis (61.3%, 95% CI, 55.6%-66.9%). A decline in function was reported by 35% of participants (95% CI, 29.6%-40.7%). Sustaining a fracture, functional independence before the fall, being female, depression, and slower Timed Up and Go (TUG) scores were associated with a decline in function (p < .05). Conclusion. Older fallers discharged directly from the ED have a high prevalence of falls risk factors and are at risk of functional decline. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsThe ‘two-hit’ hypothesis theorizes that early life allergic sensitization and respiratory infection interact to increase asthma risk.We sought to determine in a high allergy risk birth cohort whether interactions between early life allergic sensitization and respiratory infection were associated with increased risk for asthma at ages 6–7 years and 18 years. Allergic sensitization was assessed at 6, 12, and 24 months by skin prick testing to 3 food and 3 aeroallergens. Respiratory infection was defined as reported “cough, rattle, or wheeze” and assessed 4-weekly for 15 months, at 18 months, and age 2 years. Regression analysis was undertaken with parent-reported asthma at age 6–7 years and doctor diagnosed asthma at 18 years as distinct outcomes. Interactions between allergic sensitization and respiratory infection were explored with adjustment made for potential confounders.Odds of asthma were higher in sensitized compared to nonsensitized children at age 6–7 years (OR = 14.46; 95% CI 3.99–52.4), There was no evidence for interactions between allergic sensitization and early life respiratory infection, with a greater frequency of respiratory infection up to 2 years of age associated with increased odds for asthma at age 6–7 years in both sensitized (OR = 1.13; 95% CI 1.02–1.25, n = 199) and nonsensitized children (OR = 1.31; 1.11–1.53, n = 211) (p interaction = 0.089). At age 18 years, these associations were weaker.Our findings do not support ‘two-hit’ interactions between early life allergic sensitization and respiratory infection on asthma risk. Both early life respiratory infections and allergic sensitization were risk factors and children with either should be monitored closely for development of asthma. [ABSTRACT FROM AUTHOR]

Objectives: Physical activity (PA) can reduce depressive symptoms but has not been tested amongst depressed older caregivers and their care‐recipients. The aim of this single‐blind randomized controlled trial was to investigate the effect of a 6‐month tailored PA program on depressive symptoms in older caregivers. Method: Caregivers were included if they had scores of ≥5 on the 15‐item geriatric depression scale (GDS‐15). Care‐recipients could have any type of physical, mental or cognitive condition requiring support. The PA intervention group completed an individualized program based on the Otago‐Plus Exercise Program. The primary outcome was improvement in depressive symptoms in caregivers measured at six and 12 months. Results: Two hundred and twelve participants (91 dyads and 30 caregivers only) were randomized using a 3:3:1 ratio to PA intervention, social‐control, and usual‐care control groups. There were no significant differences in depressive symptoms of the caregivers between the three groups at 6 months or 12 months. However, more than 50% of caregivers in all three groups no longer had a GDS‐15 score ≥5 at 6 months. Further analysis revealed that caregivers in the PA group caring for someone with a standardised mini‐mental state examination (SMMSE) score ≥24 had significantly less depressive symptoms than those caring for someone with a SMMSE score <24 compared with social‐control (p < 0.02) and usual‐care groups (p < 0.02). Conclusions: A PA intervention may be beneficial for some caregivers in reducing symptoms of depression but may not be as beneficial to caregivers of people living with cognitive impairment. Key points: Physical activity (PA) may help to reduce depression, stress and burden in caregivers.This study investigated the effects of an individually tailored, home‐based PA intervention for both caregivers and care‐recipients, of 6 months' duration, on improving depressive symptoms in older caregivers.A PA intervention may be beneficial for caregivers in reducing symptoms of depression but may not be as beneficial to caregivers of people living with cognitive impairment. [ABSTRACT FROM AUTHOR]

The long-term health effects of bushfires include the potential to trigger new and exacerbate existing mental health problems. This review aimed to determine the prevalence of long-term mental health issues in Australian populations exposed to bushfires. A systematic search was conducted in five databases (Embase, Medline, PsycINFO, Scopus, and Web of Science) to identify studies focusing on Australian populations impacted by bushfires with the prevalence of mental health issues reported at 2+ years after bushfire. The Joanna Briggs Institute prevalence critical appraisal tool was utilised. We conducted meta-analyses to determine the prevalence of general psychological distress in the general population, and a narrative synthesis. We included 21 articles based on 5 studies and conducted on 3 bushfire events. Meta-analyses showed a pooled prevalence of 14% (95% CI 12%-16%) for psychological distress in the general population at 2–4 years post bushfire. The overall prevalence of long-term psychological problems in firefighters at 2–7 years ranged from 28% to 47.6%. The prevalence of some psychological issues decreased with time and was directly proportional to the level of bushfire impact. As the magnitude of long-term bushfire-related mental health impacts in Australia is severe, it is important to monitor psychological problems and assist communities in future. Future research needs include: (a) more studies on the full range of long-term psychological impacts of bushfires, and (b) consensus on instruments and diagnostic criteria to define mental health issues. First systematic review of long-term bushfire mental health issues in Australia. Indicating substantial mental health problems among affected populations. Long-term issues were linked to bushfire impact and elevated among firefighters. Highlighting need for further rigorous research on long-term disaster sequalae. [ABSTRACT FROM AUTHOR]

Timely adverse event following immunisation (AEFI) signal event detection is essential to minimise further vaccinees receiving unsafe vaccines. We explored the proportional reporting ratio (PRR) ability to detect two known signal events with influenza vaccines with the aim of providing a model for prospective routine signal detection and improving vaccine safety surveillance in Australia. Passive AEFI surveillance reports from 2008–2017 relating to influenza vaccines were accessed from the Australian SAEFVIC (Victoria) database. Proportional reporting ratios were calculated for two vaccine-event categories; fever and allergic AEFI. Signal detection sensitivity for two known signal events were determined using weekly data; cumulative data by individual year and; cumulative for all previous years. Signal event thresholds of PRR ≥2 and Chi-square ≥4 were applied. PRR provided sensitive signal detection when calculated cumulatively by individual year or by all previous years. Known signal events were detected 15 and 11 days earlier than traditional methods used at the time of the actual events. Utilising a single jurisdiction's data, PRR improved vaccine pharmacovigilance and showed the potential to detect important safety signals much earlier than previously. It has potential to maximise immunisation safety in Australia. This study progresses the necessary work to establish national cohesion for passive surveillance signal detection and strengthen routine Australian vaccine pharmacovigilance. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic Chinese international students were reported to experience racism, food security issues and social isolation. However, no study has investigated the prevalence of these issues and the potential for worsening mental health in this population group during the pandemic. Therefore, this study aimed to examine the effect of this pandemic on the mental health of Chinese international students living in Australia and China, and the protective effect of social support. Data were extracted from a survey of Australian university students (April–June 2019) and follow-up during the pandemic (Sept-Oct 2020). The prevalence of anxiety, major depression and pandemic-related stressors was reported. Multivariable logistic regression was used to assess the association between country of residence, social support (baseline/follow-up), and follow-up self-reported mental health. With the pandemic, there was a substantial increase in the prevalence of anxiety (24.7 % vs 45.7 %) and major depression (22.1 % vs 43.8 %). Major depression was less likely to be reported by international students in China (34.8 %) than in Australia (46.3 %). Students with high social support during the pandemic were less likely to report major depression (Adjusted OR:0.15 [95 % CI 0.06,0.34]), although this effect was not observed longitudinally (Adjusted OR:1.03 [95 % CI 0.58,1.83]). Post pandemic improvement in mental health cannot be assessed. The pandemic appeared to have had a strong negative effect on Chinese international university students' mental health. Those living in Australia were more likely to experience poorer mental health, highlighting the need for increased support to this group. • The pandemic impacted the health and wellbeing of Chinese international students. • Students living in Australia were more likely to experience poorer mental health. • Short-term social support strongly protective of mental health issues. • No benefit observed from pre-pandemic social support. [ABSTRACT FROM AUTHOR]

A letter to the editor about the debate surrounding single-factor versus multiple-factor falls prevention interventions is presented.

Introduction: Australia is traditionally an early adopter of vaccines, therefore comprehensive and effective post-licensure vaccine pharmacovigilance is critical to maintain confidence in immunisation, both nationally and internationally. With adverse event following immunisation (AEFI) surveillance the responsibility of Australian jurisdictions, Victoria operates an enhanced passive AEFI surveillance system integrated with clinical services, called 'SAEFVIC' (Surveillance of Adverse Events Following Vaccination In the Community).Objective: The aim of this study was to evaluate Victoria's current AEFI surveillance system 'SAEFVIC' and inform ongoing quality improvement of vaccine pharmacovigilance in Victoria and Australia.Methods: We conducted a retrospective structured desktop evaluation of AEFI reporting received by SAEFVIC from 2007 to 2014, to evaluate the system according to its stated objectives, i.e. to improve AEFI reporting; provide AEFI signal detection; and to maintain consumer confidence in vaccination.Results: AEFI reporting has tripled since SAEFVIC commenced (incidence risk ratio [IRR] 3.04, 95% confidence interval [CI] 2.35-3.93), raising Victoria to be the lead jurisdiction by AEFI reporting volume and to rank third by population reporting rate nationally. The largest increase was observed in children. Data were utilised to investigate potential signal events and inform vaccine policy. Signal detection required clinical suspicion by surveillance nurses, or prior vaccine-specific concerns. Subsequent vaccination post-AEFI was documented for 56.2% (95% CI 54.1-58.4) of reports, and the proportion of children due or overdue for vaccination was 2.3% higher for those reporting AEFI compared with the general population.Conclusion: SAEFVIC has improved AEFI surveillance, facilitates signal investigation and validation, and supports consumer confidence in immunisation. Expansion of the system nationally has the potential to improve capacity and capability of vaccine pharmacovigilance, particularly through data consistency and jurisdictional comparability in Australia. [ABSTRACT FROM AUTHOR]