Overweight or obesity increases the risk of cardiovascular disease among older Australian adults, even in the absence of cardiometabolic risk factors: a Bayesian survival analysis from the Hunter Community Study.

OBJECTIVE: To estimate the risk of cardiovascular disease (CVD) in older adults with overweight or obesity without metabolic risk factors using a Bayesian survival analysis. DESIGN: Prospective cohort study with median follow-up of 9.7 years. SETTING: Newcastle, New South Wales, Australia. PARTICIPANTS: A total of 2313 community-dwelling older men and women. INTERVENTION/EXPOSURE: Participants without known CVD and with a body mass index (BMI) ≥ 18.5 kg m2 were stratified by BMI and metabolic risk to create six BMI-metabolic health categories. Metabolic risk was defined according to the International Diabetes Federation criteria for metabolic syndrome. 'Metabolically healthy' was defined as absence of metabolic risk factors. Bayesian survival analysis, incorporating prior information from a previously published meta-analysis was used to assess the effect of BMI-metabolic health categories on time from recruitment to CVD. MAIN OUTCOME: Incident physician-diagnosed CVD, defined as fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, angina, or coronary revascularisation procedure, was determined by linkage to hospital admissions records and Medicare Australia data. Secondary outcomes were cardiovascular mortality and all-cause mortality. RESULTS: From 2313 adults with complete metabolic health data over a median follow-up of 9.7 years, 283 incident CVD events, 58 CVD related deaths and 277 deaths from any cause occurred. In an adjusted Bayesian survival model of complete cases with informative prior and metabolically healthy normal weight as the reference group, the risk of CVD was increased in metabolically healthy overweight (HR = 1.52, 95% credible interval 0.96-2.36), and in metabolically healthy obesity (HR = 1.86, 95% credible interval 1.14-3.08). Imputation of missing metabolic health and confounding data did not change the results. CONCLUSION: There was increased risk of CVD in older adults with overweight or obesity, even in the absence of any metabolic abnormality. This argues against the notion of 'metabolically healthy' overweight or obesity.

Rehabilitation Support via Postcard (RSVP): A Randomised Controlled Trial of a Postcard to Promote Uptake of Cardiac Rehabilitation.

PURPOSE: The aim was to increase cardiac rehabilitation (CR) uptake using a novel intervention, Rehabilitation Support Via Postcard (RSVP), among patients with acute myocardial infarction discharged from two major hospitals in Hunter New England Local Health District (HNELHD), New South Wales, Australia. METHODS: The RSVP trial was evaluated using a two-armed randomised controlled trial design. Participants (N=430) were recruited from the two main hospitals in HNELHD, and enrolled and randomised to either the intervention (n=216) or control (n=214) group over a six-month period. All participants received usual care; however, the intervention group received postcards promoting CR attendance between January and July 2020. The postcard was ostensibly written as an invitation from the patient's admitting medical officer to promote timely and early uptake of CR. The primary outcome was CR attendance at outpatient HNELHD CR services in the 30-days post-discharge. RESULTS: Fifty-four percent (54%) of participants who received RSVP attended CR, compared to 46% in the control group; however this difference was not statistically significant (odds ratio [OR]=1.4, 95% confidence interval [CI]=0.9-2.0, p=0.11). Exploratory post-hoc analysis among four sub-groups (i.e., Indigeneity, gender, age and rurality), found that the intervention significantly increased attendance in males (OR=1.6, 95%CI=1.0-2.6, p=0.03) but had no significant impact on attendance for other sub-groups. CONCLUSIONS: While not statistically significant, postcards increased overall CR attendance by 8%. This strategy may be useful to increase attendance, particularly in men. Alternative strategies are necessary to increase CR uptake among women, Indigenous people, older people and people from regional and remote locations.

Community perspectives of barriers indigenous women face in accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh.

OBJECTIVES: Bangladesh has achieved notable success in improving maternal health by increasing women's access to good quality and low-cost maternal health care (MHC) services. However, the health system of Bangladesh has earned criticism for not ensuring equitable MHC access for all women, particularly for Indigenous women in the Chittagong Hill Tracts (CHT). Little is known about Indigenous communities' perspectives on these inequalities in MHC service access in the CHT. Therefore, this study aimed to explore Indigenous communities' perspectives on challenges and opportunities for improving MHC service access in the CHT. DESIGN: This qualitative descriptive study was conducted in two sub-districts of Khagrachhari between September 2017 and February 2018. Eight Indigenous key informants from three Indigenous communities (Chakma, Marma and Tripura) were recruited via snowballing and purposive techniques and participated in face-to-face, semi-structured interviews. Key informants comprised community leaders and health care providers. Data were analysed thematically using Nvivo12 software. RESULTS: Findings suggest that distance, poor availability of resources and infrastructure, lack of community engagement in the design of health interventions, Indigenous cultural beliefs, misconceptions about MHC services, and maltreatment from health care providers were the key barriers to accessing MHC services; all are interconnected. Indigenous women faced humiliation and maltreatment from MHC staff. Failure to provide a culturally-safe environment suggests a lack of cultural competency among health staff, including Indigenous staff. CONCLUSION: Findings suggest that cultural competency training for all health care providers is needed to improve cultural appropriateness and accessibility of services. Refresher training and undisrupted supply of basic MHC services for front-line care providers will benefit the entire community and will likely be cost-effective for the government. Designing health programmes through extensive community consultation is essential.

Documented nursing practices of pain assessment and management when communicating about pain in dementia care.

AIM: To evaluate nurses' documented practice when communicating about pain for people with dementia in hospital. DESIGN: Retrospective medical record review. METHOD: Medical records were retrieved from four inpatient units in a district and a tertiary teaching hospital of people aged 65 years and over with documented dementia. Data were extracted on nurses' documented pain assessment and management. Pain frequency and association between patient self-report, pain scores, cognition levels and analgesics used during hospitalization were analysed using descriptive and inferential statistics. Multivariate regression examined patient characteristics, pain characteristics and length of hospital stay. RESULTS: One-hundred patient records met the inclusion criteria between 1 January and 31 August 2017. Sixty-six percent of patients with dementia had pain documented at least once during hospitalization with 58% reported as moderate to severe pain intensity. Patients' pain severity during admission was associated with their length of hospital stay. Ninety-three percent of nurses used a self-reporting pain tool and 7% used an observational pain tool. Pain scores were not associated with patients' cognition level, nurses' pain reports or analgesic management. CONCLUSION: Pain frequently occurs in people with dementia during hospitalization. Fragmented pain reporting influences the translation of pain messages. Disproportionate pain tool application and non-association between pain scores and analgesic management suggest a potential knowledge gap among nurses about the practical use of pain tools and practice gap between pain assessment and management in dementia care. IMPACT: Pain was regularly assessed by nurses and implemented as a fifth vital sign for people with dementia in hospitals. However, the high frequency of pain affects care outcomes. Areas for improvement include nursing practice of pain assessment and management in dementia care in hospitals. Further understanding of the usefulness of pain tools and the efficacy of pain scores when communicating about pain in dementia care in hospitals is required.

A scoping review of outpatient interventions to support the reduction of prescription opioid medication for chronic non cancer pain.

BACKGROUND: Prescription opioid use is a global health issue. Previous systematic reviews have not identified that any specific intervention supports prescription opioid reduction effectively. In keeping with the nature of a scoping review, this review details an overview of the existing literature on this topic, with quality of evidence being discussed rather than formally analysed. AIM: This review aimed to examine and describe outpatient interventions that support the reduction of prescription opioid medication for chronic non cancer pain. ELIGIBILITY CRITERIA: Abstracts were reviewed against the inclusion criteria of outpatient clinical interventions, for the purpose of prescription opioid dose reduction, offered to adults with CNCP. SOURCES OF EVIDENCE: Following a structured review approach an electronic database search, of Medline, Embase, Cochrane, Cinahl, and Proquest and grey literature was undertaken. Search results were screened by title for relevance. CHARTING METHODS: Two reviewers adhering to the PRISMA-ScR checklist charted and assessed studies for quality using Critical Appraisal Skills Programme checklist assessment tools. Extracted data were collated and synthesised for presentation as a tabular and narrative review. RESULTS: From the initial search of 5089 papers, 19 underwent full-text review and quality appraisal. A variety of interventions were described to support reduction in prescription opioid use, however only one study of at least fair quality was able to demonstrate a demonstrated a statistically significant benefit in reducing measured opioid dose compared with a control group. Interventions were implemented in both specialist pain services and in primary care with multidisciplinary and interdisciplinary clinician care. Barriers and facilitators were observed in both settings. CONCLUSION AND IMPLICATIONS FOR CLINICAL PRACTICE: Further rigorous research needs to be conducted to conclusively answer the question of what outpatient interventions support opioid reduction in chronic non cancer pain. This scoping review is the first step of inquiry in the development of a nursing intervention to support reduction of prescription opioids.

Psychometric properties of Brief Coping Orientation to Problems Experienced in patients with multiple chronic conditions: A preliminary study.

BACKGROUND: Multiple chronic conditions (MCCs) are highly prevalent in primary care. Coping is an important psychological factor that influences patients' ability to adapt physically and mentally to MCCs. Testing a reliable and valid psychometric inventory is necessary to identify coping strategies before developing coping-oriented interventions. PURPOSE: The purpose of this study is to examine the psychometric properties of the Chinese version of the Brief Coping Orientation to Problems Experienced (Brief COPE-CN) inventory in patients with MCCs. METHOD: This study adopted a cross-sectional design. A convenience sample of 290 Chinese patients with MCCs was recruited from a tertiary hospital in East China. The Brief COPE-CN, sociodemographic characteristics and clinical data were collected using a self-reported questionnaire from November 2017 to May 2018. Factor analysis and reliability analysis were performed. RESULTS: The mean age of the participants was 58.5 years (range from 23 to 95 years), and approximately half of the participants were female (49.3%). Most participants had two chronic conditions (82.1%) and reported having had MCCs for more than 2 years. The explanatory factor analysis (EFA) identified five factors in the Brief COPE-CN that explained 58.4% of the total variance. The Cronbach's α coefficients ranged from .65 to .85 for the five subscales. CONCLUSIONS: The psychometric properties of the Brief COPE-CN were acceptable for use with Chinese patients with MCCs. With further evaluation, this instrument may help health-care professionals understand patients' coping and develop coping-based interventions to promote coping in this population.

The effectiveness of interventions to improve pain assessment and management in people living with dementia: A systematic review and meta-analyses.

AIMS: To synthesize and evaluate the effectiveness of interventions for nurses to improve the assessment and management of pain in people living with dementia. DESIGN: Systematic review and meta-analyses of randomized controlled trials. DATA SOURCES: CINAHL, Joanna Briggs Institute (JBI) EBP, Cochrane Library, PubMed, and Scopus databases were searched for all journal articles published between 2009 -2019. REVIEW METHODS: Papers were included under population intervention comparator outcome (PICO) framework for: (a) people living with dementia aged 65 years and over; (b) interventions developed for nurses or other health professionals; (c) comparison group of standard care or control; and (d) outcome that measures the intervention effects on nurses and people living with dementia. Independent reviewers undertook critical appraisal, data abstraction, and synthesis. Meta-analyses were performed to determine the effectiveness of interventions. RESULTS: Of 2099 titles and abstracts screened, six interventions with low-to-moderate risk of bias met inclusion criteria. Studies that implemented a routine pain assessment tool showed no effect on nurses' analgesic management. Studies that developed a comprehensive pain model involving multidisciplinary health professionals showed overall effects on pain assessment and management in dementia care. Physician involvement had an impact on analgesic management. CONCLUSION: Comprehensive pain models improve nurses' pain assessment and management. A lack of balance between analgesia use and non-pharmacological pain management in dementia care is evident. Multidisciplinary health professionals' involvement is essential for effective intervention design for pain management in dementia. IMPACT: Various pain assessment tools have been considered to assist identification and management of pain in people living with dementia. Nevertheless, challenges exist when caring for people living with dementia in pain. These findings support the development of a comprehensive pain model, which may be a more effective strategy than routine use of a pain tool alone for nurses to improve pain management in dementia care.

Contemporary trends in stroke complicating cardiac catheterisation.

BACKGROUND: Stroke remains an important complication of diagnostic cardiac catheterisation and percutaneous coronary intervention and is associated with high rates of in-hospital mortality. AIMS: To evaluate the incidence of stroke over a 10-year period and assess the long-term influence of stroke following cardiac catheterisation and PCI on functional outcomes, based on modified Rankin score and mortality. METHODS: The study was performed using a case-control design in a single tertiary referral centre. Patients were identified by correlating those patients undergoing cardiac catheterisation between October 2006 and December 2016 with patients who underwent neuroimaging within 7 days to identify possible cases of suspected stroke or transient ischaemic attack. RESULTS: A total of 21 510 patients underwent cardiac catheterisation during the study period. Sixty (0.28%) patients experienced stroke or transient ischaemic attack. Compared to control patients, those who did experience cerebral ischaemic events were older (70.5 vs 64 years; P < 0.001), with higher rates of atrial fibrillation, hypertension and diabetes mellitus. Stroke complicating cardiac catheterisation was associated with an increased risk of readmission, with a significantly higher hazard of readmission for stroke noted. Despite minimal functional impairment based on modified Rankin score, stroke was associated with a significant risk of early and cumulative mortality. Stroke incidence remained stable over the study period despite changes in procedural practice. CONCLUSIONS: The incidence and functional severity of stroke remains low despite evolving procedural practice with a stable incidence over time despite changes in procedural practice; however, post-procedural stroke confirms an increased mortality hazard.

Illness Perceptions, Coping Strategies, and Quality of Life in People With Multiple Chronic Conditions.

PURPOSE: To determine whether illness perceptions, coping strategies, and sociodemographic and clinical variables are related to the quality of life (QoL) in adults with multiple chronic conditions (MCCs) living in China. DESIGN: By employing a cross-sectional design based on the transactional stress and coping theory, a convenience sample of adults with MCCs were recruited from a university-affiliated hospital between November 2017 and May 2018 in Northern Anhui, China. METHODS: A self-reported questionnaire, including the Brief Illness Perceptions Questionnaire, the Brief Coping Orientation to Problems Experienced inventory, and the Short Form Survey version 2, was administered. Sociodemographic and clinical data regarding MCCs were also collected. Descriptive statistics including frequencies, means, standard deviations, and correlation coefficients were calculated to examine the relationship between illness perceptions, coping, and QoL. Hierarchical multiple regression models were used to identify variables associated with physical and mental QoL. FINDINGS: A total of 351 participants (50% male) were recruited, with a mean age of 58.9 years (SD = 14.6). Of the participants, 83% had two chronic conditions. Participants reported impaired physical and mental QoL when compared with the general population in China. Poorer QoL was correlated with stronger illness perceptions of consequences and timeline and increased use of denial and disengagement and self-blame. Increasing age and more chronic conditions were associated with worse QoL. A higher education level was significantly associated with better physical and mental QoL. CONCLUSIONS: This study found that adults with MCCs living in China experienced impaired QoL. The strong relationship found between the participants' perceptions of MCCs, coping strategies, and QoL suggested that healthcare professionals should recognize the physical and psychological impacts of MCCs and address the significance of adaptations to MCCs in future treatment programs. The findings will help healthcare professionals design more specific interventions to modify illness perceptions and enhance certain coping strategies to improve the QoL of people with MCCs. Healthcare professionals can mobilize available resources from healthcare and social systems to enhance people's coping and adaptation to MCCs. CLINICAL RELEVANCE: With an understanding of the illness perceptions of people with MCCs, healthcare professionals could offer information related to consequences, timeline, and personal control to enable better alignment between people's expectations and their actual situations. By knowing people's coping strategies, healthcare professionals can offer additional support to people who prefer strategies of denial and disengagement and self-blame.

Exploring academics beliefs about the meaning of life to inform mental health clinical practice.

The aim of this research was to understand academic's beliefs about the meaning of life to gain knowledge to inform mental health clinical practice and research. Qualitative research was conducted using descriptive text and interviews from a sample of Australian midlife academic staff from one university who described their beliefs about the meaning of life. Their beliefs included that: life is a journey of self-development, is about religious or non-religious beliefs, is about living well, is about family, love and relationships, and is about making a difference. These findings may be used by mental health clinicians to help clients explore their beliefs about the meaning of life. Consumers with depression may suffer from meaninglessness, existential crises, severe depression and risk suicide. Working on understanding their beliefs about the meaning of life may result in better mental health outcomes for these people.

Coping with multiple chronic conditions: An integrative review.

There is a paucity of summarized evidence concerning coping with multiple chronic conditions. An integrative review approach was used to synthesize current evidence on: (i) coping in forms of perceptions and strategies, (ii) relationship between coping and health-related outcomes, and (iii) factors related to coping. Five electronic databases were searched without time limitation. Thirty-two studies met inclusion criteria and were included for full-text review: 24 qualitative, seven quantitative, and one mixed-methods study. Studies were assessed for quality using an appraisal system of rigor and relevance. A constant comparison method was used to synthesize findings from eligible studies. This review synthesized perceptions of multiple chronic conditions involving negative moods and physical limitations, and strategies of coping with multiple chronic conditions including problem- and emotion-focused strategies. Findings suggested that coping is a promising path to manage multiple chronic conditions and emphasized that appropriate coping might have positive impacts on health-related outcomes. Five impact factors including age, gender, clusters of multiple chronic conditions, social support, and ethnicity and culture were associated with people's coping. Future healthcare plans should address the physical and psychological needs of people with multiple chronic conditions and highlight the importance of modifying their illness perceptions and enhancing appropriate coping strategies.

The role of the peer support worker in increasing rural mental health help-seeking.

OBJECTIVE: Mental health peer support workers draw on lived experience to provide benefit to people experiencing mental distress. People living in rural areas are less likely than their urban counterparts to seek professional help for psychological distress. The aim of this study was to explore the perceived value of rural peer support workers as facilitators to rural mental health help-seeking. DESIGN: Data were gathered through a cross-sectional survey distributed by a social media boosted post. SETTING: A total of 349 "small" rural towns in New South Wales as defined by the Modified Monash Model classification system as MMM5. PARTICIPANTS: A total of 765 adult, rural residents completed the survey. MAIN OUTCOME MEASURE(S): Participants were asked to select, from a list of potential facilitators, those which they felt would make mental health help-seeking easier or harder. RESULTS: Study participants felt that a help provider with lived experience of mental illness or distress would make mental health help-seeking easier. Similarly, rural life experience in a help provider was thought to facilitate help-seeking. Participants also believed that flexible and informal meeting settings would make it easier to seek help for mental distress. CONCLUSIONS: Engaging rural mental health peer support workers in a flexible/informal setting, as a complement to conventional health service provision, may increase rural help-seeking for mental distress. Increased mental health help-seeking is likely to have a positive impact on instances of serious mental illness.

Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study.

OBJECTIVE: To explore the experiences of how Chinese adults cope with multiple chronic conditions in everyday life. BACKGROUND: Having multiple chronic conditions is stressful, requiring people to make physical and mental adaptations. There is little evidence exploring how people cope with multiple chronic conditions, especially in an Asian context. DESIGN: A qualitative descriptive design was employed. The Consolidated criteria for reporting qualitative research (COREQ) was used to report this study. METHODS: This study was conducted in a tertiary referral and teaching hospital in Bengbu, Anhui, China, between August and October 2018. A purposive sample of 14 people with multiple chronic conditions, aged between 32 and 75 years, completed a demographic questionnaire and semi-structured face-to-face interviews. The interviews were digitally recorded and transcribed verbatim. Qualitative content analysis guided data analysis. RESULTS: Four distinctive themes comprising subthemes were developed from participants' narratives pertaining to coping with multiple chronic conditions: (a) appraising multiple chronic conditions, (b) addressing multiple chronic conditions management, (c) maintaining psychological well-being and (d) fulfilling a social role. Illustrative quotations were cited to support each theme. CONCLUSIONS: This study underscores that people cope with multiple chronic conditions in everyday life by using a compendium of coping strategies. As one of the influencing factors, culture dominates the ways of coping at different levels among people with multiple chronic conditions. These findings expand the current literature on coping based on an Asian perspective and inform further cross-culture research on this topic. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should understand peoples' experiences of coping with multiple chronic conditions to provide more holistic and dynamic health care to address their actual needs. Healthcare professionals should be acquainted with how culture impacts individuals' coping and develops culture-tailored supportive programmes such as family-based interventions, to promote the health of people with multiple chronic conditions.

Education on invasive mechanical ventilation involving intensive care nurses: a systematic review.

BACKGROUND: Intensive care unit nurses are critical for managing mechanical ventilation. Continuing education is essential in building and maintaining nurses' knowledge and skills, potentially improving patient outcomes. AIMS: The aim of this study was to determine whether continuing education programmes on invasive mechanical ventilation involving intensive care unit nurses are effective in improving patient outcomes. METHODS: Five electronic databases were searched from 2001 to 2016 using keywords such as mechanical ventilation, nursing and education. Inclusion criteria were invasive mechanical ventilation continuing education programmes that involved nurses and measured patient outcomes. Primary outcomes were intensive care unit mortality and in-hospital mortality. Secondary outcomes included hospital and intensive care unit length of stay, length of intubation, failed weaning trials, re-intubation incidence, ventilation-associated pneumonia rate and lung-protective ventilator strategies. Studies were excluded if they excluded nurses, patients were ventilated for less than 24 h, the education content focused on protocol implementation or oral care exclusively or the outcomes were participant satisfaction. Quality was assessed by two reviewers using an education intervention critical appraisal worksheet and a risk of bias assessment tool. Data were extracted independently by two reviewers and analysed narratively due to heterogeneity. RESULTS: Twelve studies met the inclusion criteria for full review: 11 pre- and post-intervention observational and 1 quasi-experimental design. Studies reported statistically significant reductions in hospital length of stay, length of intubation, ventilator-associated pneumonia rates, failed weaning trials and improvements in lung-protective ventilation compliance. Non-statistically significant results were reported for in-hospital and intensive care unit mortality, re-intubation and intensive care unit length of stay. CONCLUSION: Limited evidence of the effectiveness of continuing education programmes on mechanical ventilation involving nurses in improving patient outcomes exists. Comprehensive continuing education is required. RELEVANCE TO CLINICAL PRACTICE: Well-designed trials are required to confirm that comprehensive continuing education involving intensive care nurses about mechanical ventilation improves patient outcomes.

An experiment in using open-text comments from the Australian Rural Mental Health Study on health service priorities.

INTRODUCTION: Conducting research in rural and remote areas is compounded by challenges associated with accessing relatively small populations spread over large geographical areas. Open-ended questions provided in a postal survey format are an advantageous way of including rural and remote residents in research studies. This method means that it is possible to ask for in-depth perspectives, from a large sample, in a relatively resource-efficient way. Such questions are frequently included in population-based surveys; however, they are rarely analysed. The aim of this article is to explore word cloud analysis, to evaluate the utility of automated programs to supplement the analysis of open-ended survey responses. METHODS: Participants from the Australian Rural Mental Health Study completed the open-ended question 'What health services would you like to see the local health district providing that are currently not available in your area?' A word cloud analysis was then undertaken using the program Wordle; the size of the word in the cloud illustrates how many times, in proportion to other words, a word has appeared in responses, and provides an easily interpretable visual illustration of research results. RESULTS: In total, 388 participants provided a response to the free-text question. Using the word cloud as a visual guide, key words were identified and used to locate relevant quotes from the full open-text responses. \'Mental health\' was the most frequent request, cited by 81 people (20.8%). Following mental health, requests for more \'specialists\' (n=59) and \'services\' (n=53) were the second and third most frequent responses respectively. Visiting specialists were requested by multiple respondents (n=14). Less frequent requests illustrated in the word cloud are important when considering representatives from smaller population groups such as those with specific health needs or conditions including \'maternity\' services (n=13), \'cancer\' (n=10), \'drug and alcohol\' services (n=8), and \'aged care\' (n=7) services are all core services even though they were being called for by fewer people. This lesser frequency may suggest that these services are already considered as available in some rural and remote communities. CONCLUSIONS: This research aimed to determine whether meaningful and informative data could be obtained from short responses from open-ended survey questions using an automated data analysis technique to supplement a more in-depth analysis. The findings showed that, while not as detailed as interview responses, the open-ended survey questions provided sufficient information to develop a broad overview of the health service priorities identified by this large rural sample. Such automated data analysis techniques are rarely employed; however, the current research provides valuable support for their utility in rural and remote health research. This research has implications for researchers interested in engaging rural and remote residents, demonstrating that meaningful information can be extracted from short survey response data, contributing a resource-efficient supplement to a more detailed analysis. Open-ended questions are often asked in population-based studies yet they are rarely analysed, posing both an opportunity and a challenge for researchers using such participant-driven responses. The lessons learned from the methodology applied can be transferred to other population-based survey studies more widely.

Alcohol consumption in the Australian coal mining industry.

OBJECTIVES: To investigate patterns of alcohol use within the coal mining industry, and associations with the personal, social, workplace and employment characteristics. DESIGN: 8 mine sites across 3 eastern Australian states were surveyed, selected to encompass key geographic characteristics (accessibility and remoteness) and mine type (open cut and underground). Problematic alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT) to determine: (1) overall risky or hazardous drinking behaviour; and (2) frequency of single-occasion drinking (6 or more drinks on 1 occasion). RESULTS: A total of 1457 employees completed the survey, of which 45.7% of male and 17.0% of female participants reported levels of alcohol use within the range considered as risky or hazardous, considerably higher than the national average. Hierarchical linear regression revealed a significant contribution of many individual level factors associated with AUDIT scores: younger age, male, current smoking status; illicit substance use; previous alcohol and other drug use (AOD) problems; and higher psychological distress. Workplace factors associated with alcohol use included working in mining primarily for the high remuneration, and the type of mining, with underground miners reporting higher alcohol use than open-cut miners. CONCLUSIONS: Our findings provide support for the need to address alcohol use in the coal mining industry over and above routine on-site testing for alcohol use.

Meaning in Life and Meaning of Life in Mental Health Care: An Integrative Literature Review.

The aim of this integrative literature review was to identify high quality empirical research and theoretical literature on the sources of meaning in life and people's beliefs regarding the meaning of life. This will inform current mental health clinical practice and research by providing a synthesis of empirical and theoretical literature. Failure to address meaninglessness or the existential crisis can lead to psychopathologies such as depression, anxiety, addiction, aggression, hopelessness, apathy, lower levels of well-being, physical illness, and suicide. Integrative literature reviews incorporate empirical research and theoretical literature. The inclusion criteria were primary research and theoretical papers and books by prominent theorists. Thirty-nine items underwent the critical appraisal process. Thirty-two papers or books were included. Overwhelmingly the results revealed that relationships, particularly relationships with family, are cited as the most important source of meaning in people's lives in all cultures and age groups. There was no consensus identified to answer the meaning of life question. These results and future research will allow mental health clinicians to help patients deepen their understanding of themselves, identify where they find meaning and understand their beliefs about meaning of life, contributing to a reduction in symptomatology and meaninglessness, and an increase in happiness, life satisfaction, positive affect, better coping, psychosocial health and well-being, and more meaningfulness in life.

Integrative Analysis of Subcellular Quantitative Proteomics Studies Reveals Functional Cytoskeleton Membrane-Lipid Raft Interactions in Cancer.

Lipid rafts are dynamic membrane microdomains that orchestrate molecular interactions and are implicated in cancer development. To understand the functions of lipid rafts in cancer, we performed an integrated analysis of quantitative lipid raft proteomics data sets modeling progression in breast cancer, melanoma, and renal cell carcinoma. This analysis revealed that cancer development is associated with increased membrane raft-cytoskeleton interactions, with ∼40% of elevated lipid raft proteins being cytoskeletal components. Previous studies suggest a potential functional role for the raft-cytoskeleton in the action of the putative tumor suppressors PTRF/Cavin-1 and Merlin. To extend the observation, we examined lipid raft proteome modulation by an unrelated tumor suppressor opioid binding protein cell-adhesion molecule (OPCML) in ovarian cancer SKOV3 cells. In agreement with the other model systems, quantitative proteomics revealed that 39% of OPCML-depleted lipid raft proteins are cytoskeletal components, with microfilaments and intermediate filaments specifically down-regulated. Furthermore, protein-protein interaction network and simulation analysis showed significantly higher interactions among cancer raft proteins compared with general human raft proteins. Collectively, these results suggest increased cytoskeleton-mediated stabilization of lipid raft domains with greater molecular interactions as a common, functional, and reversible feature of cancer cells.

Investigation of a Suicide Ideation Risk Profile in People With Co-occurring Depression and Substance Use Disorder.

Disengagement from services is common before suicide, hence identifying factors at treatment presentation that predict future suicidality is important. This article explores risk profiles for suicidal ideation among treatment seekers with depression and substance misuse. Participants completed assessments at baseline and 6 months. Baseline demographics, psychiatric history, and current symptoms were entered into a decision tree to predict suicidal ideation at follow-up. Sixty-three percent of participants at baseline and 43.5% at follow-up reported suicidal ideation. Baseline ideation most salient when psychiatric illness began before adulthood, increasing the rate of follow-up ideation by 16%. Among those without baseline ideation, dysfunctional attitudes were the most important risk factor, increasing rates of suicidal ideation by 35%. These findings provide evidence of factors beyond initial diagnoses that increase the likelihood of suicidal ideation and are worthy of clinical attention. In particular, providing suicide prevention resources to those with high dysfunctional attitudes may be beneficial.

The health and wellbeing of Australian farmers: a longitudinal cohort study.

BACKGROUND: Isolation, long work days, climate change and globalization are just some of the many pressures that make farming a vulnerable occupation for incurring mental health issues. The objective of this study was to determine whether farming in Australia is associated with poorer wellbeing, physical and mental health, and less health service use. METHODS: The Australian Rural Mental Health Study, a longitudinal cohort study was analysed over four time points comparing farmers with non-farming workers (n = 1184 at baseline). Participants were recruited from rural NSW, Australia. A number of physical, mental health, wellbeing, service use outcomes were assessed using generalised estimating equations including all waves in each model. Barriers to seeking help were also assessed. RESULTS: Farmers who lived remotely reported worse mental health (ß -0.33, 95 % CI -0.53, -0.13) and wellbeing (ß -0.21(95 % CI -0.35, -0.06) than remote non-farm workers regardless of financial hardship, rural specific factors eg drought worry, or recent adverse events. All farmers were no different to non-farming workers on physical health aspects except for chronic illnesses, where they reported fewer illnesses (OR 0.66, 95 % CI 0.44, 0.98). All farmers were half as likely to visit a general practitioner (GP) or a mental health professional in the last 12 months as compared to non-farm workers regardless of location (OR 0.59, 95 % CI 0.35, 0.97). Rural workers felt that they preferred to manage themselves rather than access help for physical health needs (50 %) or mental health needs (75 %) and there was little difference between farmers and non-farm workers in reasons for not seeking help. CONCLUSIONS: Remoteness is a significant factor in the mental health and wellbeing of farmers, more so than financial stress, rural factors and recent adverse events. Creative programs and policies that improve access for farmers to GPs and mental health professionals should be supported.