STI and HIV testing: examining factors that influence uptake among domestic Australian-born, domestic overseas-born and international tertiary students studying in Australia.

OBJECTIVES: Sexual health knowledge among international students in Australia is lower than domestic students, however, little is known about what factors affect the uptake of STI testing, nor if there are differences for overseas-born domestic students. METHODS: We included sexually active respondents from a survey of university students in Australia (N = 3,075). Multivariate regression and mediation analyses investigated associations of STI and HIV testing with STI and HIV knowledge respectively, sexual risk behaviour and demographics, including comparisons among: domestic Australian-born, domestic overseas-born, and international students. RESULTS: STI and HIV knowledge was positively associated with STI and HIV testing respectively (STI OR = 1.13, 95% CI: 1.09, 1.16; HIV OR = 1.37, 95% CI: 1.27, 1.48). STI knowledge was significantly lower for international than domestic Australian-born students (10.8 vs. 12.2 out of 16), as was STI testing (32% vs. 38%); the difference in knowledge accounted for half the difference in STI testing rates between these two groups. International students from Southern Asia, and Eastern Asia reported the lowest STI testing rates. HIV testing was highest amongst international students from Africa and North America. Higher sexual risk behaviour, younger age, and identifying as gay or bisexual were positively associated with higher STI and HIV testing rates. CONCLUSIONS: Our study supports greater investment and commitment by universities for the provision of sexual health education that can promote access to testing to improve the health of their students.

Exploring the gap between refugee-background communities' needs and existing community-based physical activity programs in Australia.

Physical activity programs run by local government, public health and not-for-profit sectors are a key public health strategy for improving rates of physical activity within local communities. However, these programs are underutilized. This is especially the case among members of refugee-background communities whose participation could have far-ranging and multilevel benefits. To explore how greater engagement among refugee-background communities with these programs could be fostered in Brisbane, Queensland, Australia, a qualitative study was undertaken from the perspectives of both community-based physical activity program providers and agencies involved in delivering services to refugee-background communities. This study involved a series of semi-structured interviews with a purposive sample of personnel from agencies that work with individuals and families from refugee-background communities and organizations that provide low-cost or no-cost physical activity programs and initiatives. Reflexive thematic analysis was used to interpret meaning from these data. Three themes relating to how participation in community-based physical activity programs could be improved among refugee-background communities were identified: improving cultural safety through intersectoral collaboration; confronting constraints imposed by the broader public health policy environment; and building capacity and empowering the community to diversify the sector. The findings highlight the importance of localized, deep-level intersectoral collaborations in bridging the gap between the health and social care needs of refugee-background communities and existing physical activity programs. However, a range of systems-produced barriers to the creation of such collaborations must be addressed to enable local actors to help mitigate and address the systemic exclusion of marginalized populations from participation in broader society.

This qualitative study explored how participation in community-based physical activity programs could be improved among refugee-background communities. To do this, community-based physical activity program providers and agencies involved in delivering services to refugee-background communities in Brisbane, Queensland, Australia, were invited to participate in a semi-structured interview. Reflexive thematic analysis was then used to identify patterns and themes within the interview data. This analysis found that the cultural safety of community-based physical activity programs needs to be improved. From participants' perspectives, a good way to do this is through genuine collaboration between services providing community-based physical activity programs and those working directly with refugee-background communities. Relatedly, however, participants experienced the broader public health policy environment as increasingly bureaucratic and market orientated, where top-down models are adopted and funding is ad hoc and insecure. This environment was identified as constraining the ability of service providers and agencies to collaborate on the level required to improve cultural safety for members of refugee-background communities. Relatedly, the analysis also identified the importance of building the capacity and empowering members of refugee-background communities for diversifying the sector and increasing the participation rates of refugee-background communities in community-based physical activity programs.

Long term impact of the WHI studies on information-seeking and decision-making in menopause symptoms management: a longitudinal analysis of questions to a medicines call centre.

BACKGROUND: While women are taking a greater role in decisions about menopause symptom management, the legacy of the Women's Health Initiative (WHI) studies persist. Despite hormone therapy (HT) being effective in reducing all-cause mortality, many women seeking relief of menopausal symptoms exaggerate HT harms and overstate the perceived benefits or ignore the risks of alternative therapies. We aimed to explore the longitudinal impact of the widely-publicised WHI 2002 study on women's information-seeking and describe determinants of decision-making about managing menopausal symptoms. METHODS: In a longitudinal analysis of both quantitative and qualitative data, we explored consumer questions about menopause-related medicines received by two Australian medicines call centres (1996-2010) before, during, and after WHI 2002. We analysed calls by age and gender of caller and patient, their relationship, postcode, enquiry type, and motivation to help-seek. We compared calls regarding HT and herbal medicines (HM) with the rest of calls, and thematically analysed question narratives across the three time-periods. RESULTS: There were 1,829 menopause-related calls received of over this time-period, with a call surge, primarily from women in their mid-fifties, in the two months after the WHI 2002 publication. Two in three calls were motivated by negative media reports as women sought support for decision-making, primarily reassurance to cease HT. While HT safety concerns persisted for eight years post-publication, the nature of information-seeking changed over time. Callers subsequently sought reassurance to use menopause treatments together with their other medicines; and pursued HT substitutes, including HM, in response to HT product discontinuation. CONCLUSIONS: Women sought information or reassurance to support a decision, based on dynamic changes in internal (symptom or risk intolerance, attitude towards menopause and treatment preferences) and external factors (perceived source trust and changes in treatment availability). In assessing HT benefit versus risk, women tend to overestimate risk with HT safety concerns persisting over time. Decision-making in managing menopause symptoms is complex and dynamic. Reassurance to reach or justify decisions from a perceived trusted source can support informed decision-making.

STI and HIV knowledge and testing: a comparison of domestic Australian-born, domestic overseas-born and international university students in Australia.

University students usually consist of young people from culturally and linguistically diverse backgrounds, and a group recognised as being at increased risk of STI. This study found lower levels of STI knowledge and STI testing among international students and to a lesser extent, domestic overseas-born students, compared with domestic Australian-born students. International students exhibited lower risk sexual behaviour but were more likely to have had a HIV test than domestic students. This diversity in sexual health knowledge, sexual health services utilisation and sexual experience indicates the need for a variety of public health approaches to improve sexual health.

Psychometric Properties of the Vietnamese Catquest-9 Short Form Questionnaire.

SIGNIFICANCE: The Catquest-9 Short Form (SF) has good psychometric properties but was not available in Vietnamese. This study provides the Vietnamese Catquest-9SF and evidence supporting for its use in hospital settings along with clinical assessment to evaluate visual function. PURPOSE: The purpose of this study was to evaluate the psychometric properties of the Vietnamese Catquest-9SF. METHODS: Literate patients with unilateral/bilateral cataract, without severe systemic and ocular comorbidities, aged 50+ years, and scheduled for first-eye surgery were screened and recruited at the University of Medicine and Pharmacy at Ho Chi Minh City and Trung Vuong Hospital. Age, sex, and education were self-reported. The Catquest-9SF and the 25-item National Eye Institute Visual Function Questionnaire were used to assess vision-related quality of life (VRQOL). Best-corrected unilateral and bilateral log of the minimum angle of resolution (logMAR) visual acuity was measured, as was best-corrected Pelli-Robson contrast sensitivity. Rasch analysis was performed on the Vietnamese version of the Catquest-9SF. Criterion validity and convergent validity were also evaluated. RESULTS: Andrich thresholds and response categories on each Catquest-9SF item were ordered, indicating that patients were able to discriminate VRQOL levels. Person separation index and reliability were 2.51 and 0.86, respectively, indicating that the Catquest-9SF was able to distinguish between patients with low- and high-vision difficulties. The tool was unidimensional, with all items fitting well within the construct. There was no evidence of differential item functioning by sex, age group, or cataract status. The tool also showed criterion validity, correlating significantly with visual acuity in the better eye (r = -0.46), the worse eye (r = -0.39), and both eyes (r = -0.44), and with contrast sensitivity for the better eye (r = 0.41), the worse eye (r = 0.32), and both eyes (r = 0.39). A strong correlation between the Catquest-9SF and the 25-item National Eye Institute Visual Function Questionnaire (r = 0.87) indicated convergent validity. CONCLUSIONS: The Vietnamese Catquest-9SF is valid and psychometrically robust for assessing VRQOL among cataract patients.

Establishing and implementing a health promoting school in rural Cambodia.

Few studies have used a whole-of-school approach in implementing a health promoting schools (HPS) framework. Descriptions of how HPS is being implemented, particularly in low-resourced, developing countries, are limited. This study used an exploratory case study design to examine the planning and implementation of a HPS in a rural Cambodian village. Data were collected via observations of the school, school documentation, and interviews with stakeholders (n = 9). The data were analysed inductively as an iterative process, from initial coding, through to categorizing, leading to concept mapping and then identifying the emergent themes within the stages of school development and implementation of educational and health programming. The case study demonstrated how all six components of the HPS framework can be used to plan and implement a school in a rural village in a developing country. The key elements of implementation were building local and international partnerships, local leadership, and a culture of change and participation. These elements were used to establish a non-profit school that aimed to address the stated health and educational needs of local villagers. This case study adds to the limited evidence on the HPS components and implementation methods that are being applied in low-resourced, developing countries.

Identifying the factors influencing Saudi Arabian nurses' turnover.

AIMS: This study identifies and analyses the risk factors contributing to nursing turnover in Saudi Arabia and identifies practical solutions to decrease turnover and encourage nurses to stay in their jobs. BACKGROUND: Saudi Arabia has a unique nursing profile, as the majority of the nursing workforce are expatriates. The Saudi health care system relies on contracted expatriate nurses to provide most of the direct patient health care. For nurses from other countries, Saudi Arabia can be a challenging place to work due to a range of factors including personal, policy and organisational variables. There is a high turnover of expatriate nurses, and this has been long-standing problem for the Saudi Arabian health care system. METHOD: A cross-sectional survey design among nurses in Saudi Arabia including 502 nurses, of whom 83.7% are female. Structural equation modelling is used to examine the relationships between the study variables. Confirmatory factor analysis is used to create and validate the measurement models for variables. RESULTS: The analysis of the survey data identifies that Filipino nurses are more likely to intend to leave their current position than other expatriates, including Malaysian, Pakistani, Indian or local Saudi nurses. Many expatriates identify discrimination as an important contributing factor for their intention to leave, citing that the national salary remuneration for nurses should be based on competency and delivery of care. Furthermore, several independent variables are found to be significant predictors of anticipated turnover, including discrimination; social support from immediate supervisor; organisational commitment; and autonomy. CONCLUSIONS: This study provides the most comprehensive information available to date about the factors that influence nurses' desire to leave their current job and provides evidence for better health workforce planning in Saudi Arabia. This study strongly indicates that the main factor related to turnover is the unfair and unequal salaries paid to nurses of different nationalities in Saudi Arabia. IMPLICATIONS FOR NURSING MANAGEMENT: The findings relating to both Saudi and foreign nurse employment could be helpful to policymakers and the Ministry of Health in Saudi Arabia.

Developing a conceptual framework for patient safety culture in emergency department: A review of the literature.

Patient safety culture is a critical component of modern health care. However, the high-paced, unpredictable nature of the emergency department (ED) environment may impact adversely on it. The aim of this paper is to explore the concept of patient safety culture as it may apply to emergency health care, and to propose a conceptual framework that could form the basis for interventions designed to improve it. This is a systematic review of the literature. A search was undertaken of common electronic bibliographic databases using key words such as safety culture, safety climate, and Emergency Department. Articles were analysed for consistent themes with the aim to construct a conceptual framework. Ten articles met the inclusion criteria that specifically examined safety culture in the ED. Synthesis of the literature resulted in the emergence of three overarching themes of ED practice found to impact on safety culture in the ED. These were the dimensions of patient safety culture, the factors influencing it, and the interventions for improving it. A conceptual framework was constructed that identifies elements that significantly impact the patient safety culture in the ED. This framework may assist managers and researchers to take a comprehensive approach to build an effective safety culture in ED setting.

Condition-specific associations of symptoms of depression and anxiety in adolescents and young adults with asthma and food allergy.

OBJECTIVE: This study examined associations of asthma and food allergy with symptoms of depression and anxiety at 14 and 21 years of age to determine whether condition-specific associations exist. METHODS: Data come from 4972 adolescents in the Mater University Study of Pregnancy. Symptoms of depression and anxiety were assessed using the Youth Self-Report and Young Adult Self-Report. RESULTS: Condition-specific associations between asthma and depression, OR = 1.37 [1.12, 1.67] and between food allergy and anxiety, OR = 1.26 [1.04, 1.76] were found during adolescence, but not in young adulthood. Whereas asthma was associated with resolved depression, OR = 1.70 [1.13, 2.55], food allergy was associated with persistent anxiety, OR = 1.26 [1.01, 1.59]. CONCLUSIONS: In adolescents, asthma is associated with an increased risk of clinically relevant symptoms of depression and food allergy with an increased risk of clinically relevant symptoms of anxiety. Future research is needed to clarify directionality and mechanisms explaining these relationships. Health professionals should be aware of the increased risk of mental health problems in adolescents with asthma or food allergy.

Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: a quasi-experimental study.

BACKGROUND: There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs). METHODS: A quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis. RESULTS: Significant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67-0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50-0.76); p < 0.0001), and number of hospital admissions per 100 ED presentations (0.61 (0.43-0.85); p = 0.004) were noticed in the experimental hospital after the intervention; while there were no significant differences between intervention and control hospitals before the intervention. Pre-test and post-test comparison in the intervention hospital also presented significant decreases in ED presentation rate (0.75 (0.65-0.86); p < 0.0001) and hospital admission rate per RACF bed (0.66 (0.54-0.79); p < 0.0001), and a non-significant reduction in hospital admission rate per ED presentation (0.82 (0.61-1.11); p = 0.196). CONCLUSIONS: Hospital in the Nursing Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.

Maternal psychological distress mediates the relationship between asthma and physician visits in a population-based sample of adolescents.

OBJECTIVE: This study examined whether maternal psychological distress mediates the relationship between presence of adolescent asthma and number of physician visits and whether the association between maternal psychological distress and physician visits is moderated by adolescent general health. METHODS: Data were obtained from the Mater University Study of Pregnancy and included 4025 adolescents. Path analysis was used to examine mediating and moderating effects. RESULTS: Maternal psychological distress was found to partially mediate the relationship between adolescent asthma and number of physician visits, accounting for 25% of the effect of adolescent asthma on physician visits (p = 0.046). There was no evidence to suggest that adolescent general health moderated the association between maternal psychological distress and physician visits (p = 0.093). CONCLUSIONS: These findings suggest that maternal psychological distress is associated with increased physician visits, regardless of adolescents' general health. Lowering maternal psychological distress may serve to reduce health care utilization and costs among adolescents with asthma.

The child behavior checklist and youth self-report in adolescents with epilepsy: testing measurement invariance of the attention and thought problems subscales.

The objective of this study was to test for the measurement invariance of the Attention and Thought Problems subscales of the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) in a population-based sample of adolescents with and without epilepsy. Data were obtained from the 14-year follow-up of the Mater University Study of Pregnancy in which 33 adolescents with epilepsy and 1068 healthy controls were included for analysis. Confirmatory factor analysis was used to test for measurement invariance between adolescents with and without epilepsy. Structural equation modeling was used to test for group differences in attention and thought problems as measured with the CBCL and YSR. Measurement invariance was demonstrated for the original CBCL Attention Problems and YSR Thought Problems. After the removal of ambiguous items ("confused" and "daydreams"), measurement invariance was established for the YSR Attention Problems. The original and reduced CBCL Thought Problems were noninvariant. Adolescents with epilepsy had significantly more symptoms of behavioral problems on the CBCL Attention Problems, ß=0.51, p=0.002, compared with healthy controls. In contrast, no significant differences were found for the YSR Attention and Thought Problems, ß=-0.11, p=0.417 and ß=-0.20, p=0.116, respectively. In this population-based sample of adolescents with epilepsy, the CBCL Attention Problems and YSR Thought Problems appear to be valid measures of behavioral problems, whereas the YSR Attention Problems was valid only after the removal of ambiguous items. Replication of these findings in clinical samples of adolescents with epilepsy that overcome the limitations of the current study is warranted.

Sleepless nights: the effect of socioeconomic status, physical activity, and lifestyle factors on sleep quality in a large cohort of Australian women.

The aims of this study were to examine: (1) the association between sociodemographic and lifestyle factors and sleep quality in a population-based cohort of Australian women and (2) possible influence of reproductive status and mental and physical health factors on these associations. Data on 3,655 women (mean age = 46.6 years, range 34.3-67.4) were obtained from the Mater Hospital University of Queensland Study of Pregnancy for this cross-sectional study. Self-rated sleep quality was assessed using the Pittsburgh Sleep Quality Index. For the purpose of this study, two cutoff points (scores 5 and 10) were used to divide women into three categories: normal (65.2%), moderately poor (26.4%), and very poor sleep quality (8.5%). Other covariates were measured at 21-year follow-up as well. After adjusting for reproductive status, mental and physical health, there were significant associations between moderately poor sleep quality and education and between very poor sleep quality and unemployment, both measures of socioeconomic status. In addition, work-related exertion was associated with increased rates of moderately poor sleep quality, whereas those women undertaking moderate exercise were less likely to experience very poor sleep quality. Independent associations between sociodemographic factors and exercise with moderately poor and very poor sleep quality were identified. These findings demonstrate the dynamic nature of the association between exercise/exertion, socioeconomic status, and sleep quality and highlight the importance of taking these into consideration when dealing with issues of poor sleep quality in women.

Impact of vision disorders and vision impairment on motor vehicle crash risk and on-road driving performance: A systematic review.

Vision is important for safe driving, but there is limited understanding regarding the impact of vision disorders on driving ability and safety. This systematic review evaluated and summarized evidence on the impact of vision disorders and impairment on motor vehicle crash (MVC) risk and on-road driving performance across seven databases, was prospectively registered with PROSPERO (CRD42020180135), and study quality rated using a standard tool. Forty-eight studies met the inclusion criteria for MVC risk (N = 36), on-road performance (N = 9), and both MVC risk and on-road performance (N = 3). Of these studies, less than half were rated as 'good' quality. Due to the small number of studies and often conflicting findings, it was not possible to draw firm conclusions for most vision disorders. However, evidence from several 'good' and 'fair' quality studies suggested increased MVC risk with binocular visual field impairment. There was mixed evidence regarding the impact of cataract, glaucoma, age-related macular degeneration and homonymous field loss on MVC risk and no evidence of increased MVC risk with mild VA impairment. This review highlights the need for well-designed future studies to further explore the impact of vision disorders and impairment on driving outcomes to inform evidence-based policy and fitness to drive guidelines.

Predicting depressive and anxiety disorders with the YASR internalising scales (empirical and DSM-oriented).

BACKGROUND: The Achenbach problem behaviour scales (CBCL/YSR) are widely used. The DSM-oriented anxiety and depression scales have been created to improve concordance between Achenbach's internalising scales and DSM-IV depression and anxiety. To date no study has examined the concurrent utility of the young adult (YASR) internalising scales, either the empirical or newly developed DSM-oriented depressive or anxiety scales. METHODS: A sample of 2,551 young adults, aged 18-23 years, from an Australian cohort study. The association between the empirical and DSM-oriented anxiety and depression scales were individually assessed against DSM-IV depression and anxiety diagnoses derived from structured interview. Odds ratios, ROC analyses and diagnostic efficiency tests (sensitivity, specificity, positive and negative predictive values) were used to report findings. RESULTS: YASR empirical internalising scale predicted DSM-IV mood disorders (depression OR = 6.9, 95% CI 5.0-9.5; anxiety OR = 5.1, 95% CI 3.8-6.7) in the previous 12 months. DSM-oriented depressive or anxiety scales did not appear to improve the concordance with DSM-IV diagnosed depression or anxiety. The internalising scales were much more effective at identifying those with comorbid depression and anxiety, with ORs between 10.1 and 21.7 depending on the internalising scale used. CONCLUSION: DSM-oriented scales perform no better than the standard internalising in identifying young adults with DSM-IV mood or anxiety disorder.

A scoping review of evidence comparing models of maternity care in Australia.

OBJECTIVES: To synthesize available evidence comparing outcomes and experiences of care received in different maternity models in Australia and identify the information gaps hindering women's decisions between alternative models. DESIGN: A literature search was conducted to identify published research over the last twenty years that directly compared clinical and/or experiential outcomes of women in different maternity models of care in Australia. Outcome measures of included articles were identified and assessed to evaluate current comparative information available to women and health professionals. The quality of included studies was assessed using Joanna Briggs Institute (JBI) critical appraisal tools for randomised controlled studies (RCTs) and cohort studies. Quantitative data were extracted and synthesised for further analysis. SETTING/PARTICIPANTS: Published studies comparing at least two maternity care models providing antenatal, intrapartum and postpartum care in Australia. RESULTS: Eight studies (five RCTs and three observational studies) met inclusion criteria. Seven studies compared the outcomes of public midwifery continuity care and standard public care and one compared the outcomes of public midwifery continuity care, standard care and private obstetric care. There was no evidence directly comparing all broadly categorised available models in Australia. Data for clinical outcomes were collected from hospital records and experiential data were self-reported. Seven out of eight studies used data collected from single public hospital settings and one study included data from two tertiary hospitals. Women in public midwifery continuity models were more likely to have unassisted vaginal births, continuity of care and satisfaction and lower use of interventions (i.e., episiotomy, induction of labour, use of analgesia) and neonatal admission in intensive care units (ICU), compared with those in standard public models (and private obstetric care in one study). CONCLUSION: This scoping review reveals lack of reliable direct comparison of clinical and experiential outcomes across the multiple available public and private maternity models of care in Australia. Quality alignment between women's needs and their maternity model of care can prevent under or over specialised care and avoidable health system costs. Comprehensive information comparing all available maternity care models can guide gatekeeper health professionals and women to choose the best model according to women's needs and preferences. There is a need for research providing more comprehensive and ecological comparisons between available models of maternity care to inform such decision making support. Moreover, women's experiential data across maternity model of care comparisons could be used more consistently to better represent the relative outcomes of alternative models from a consumer-centred perspective.

Pregnancy loss and psychiatric disorders in young women: an Australian birth cohort study.

BACKGROUND: Recent evidence has linked induced abortion with later adverse psychiatric outcomes in young women. AIMS: To examine whether abortion or miscarriage are associated with subsequent psychiatric and substance use disorders. METHOD: A sample (n=1223) of women from a cohort born between 1981 and 1984 in Australia were assessed at 21 years for psychiatric and substance use disorders and lifetime pregnancy histories. RESULTS: Young women reporting a pregnancy loss had nearly three times the odds of experiencing a lifetime illicit drug disorder (excluding cannabis): abortion odds ratio (OR)=3.6 (95% CI 2.0-6.7) and miscarriage OR=2.6 (95% CI 1.2-5.4). Abortion was associated with alcohol use disorder (OR=2.1, 95% CI 1.3-3.5) and 12-month depression (OR=1.9, 95% CI 1.1-3.1). CONCLUSIONS: These findings add to the growing body of evidence suggesting that pregnancy loss per se, whether abortion or miscarriage, increases the risk of a range of substance use disorders and affective disorders in young women.

Screening in early childhood for risk of later mental health problems: a longitudinal study.

Depression in childhood or adolescence is associated with increased rates of depression in adulthood. Does this justify efforts to detect (and treat) those with symptoms of depression in early childhood or adolescence? The aim of this study was to determine how well symptoms of anxiety/depression (A-D) in early childhood and adolescence predict adult mental health. The study sample is taken from a population-based prospective birth cohort study. Of the 8556 mothers initially approached to participate 8458 agreed, of whom 7223 mothers gave birth to a live singleton baby. Children were screened using modified Child Behaviour Checklist (CBCL) scales for internalizing and total problems (T-P) at age 5 and the CBCL and Youth Self Report (YSR) A-D subscale and T-P scale at age 14. At age 21, a sub-sample of 2563 young adults in this cohort were administered the CIDI-Auto. Results indicated that screening at age 5 would detect few later cases of significant mental ill-health. Using a cut-point of 20% for internalizing at child age 5 years the CBCL had sensitivities of only 25% and 18% for major depression and anxiety disorders at 21 years, respectively. At age 14, the YSR generally performed a little better than the CBCL as a screening instrument, but neither performed at a satisfactory level. Of the children who were categorised as having YSR A-D at 14 years 30% and 37% met DSM-IV criteria for major depression and anxiety disorders, respectively, at age 21. Our findings challenge an existing movement encouraging the detection and treatment of those with symptoms of mental illness in early childhood.

Future of Public Health Training: What Are the Challenges? What Might the Solutions Look Like?

The Asia-Pacific region has rapidly changing health needs. This reshaping of health priorities is directly affecting current and future public health education. This brief review focuses on foundational public health skills including epidemiology, biostatistics, and health informatics. Epidemiological skills, in particular, are essential for policymakers and practitioners to identify the emergence of problems and to inform priority setting of public health efforts. Training needs to move beyond didactic, passive learning methods in class settings to approaches that engage and challenge students and academics in active, flexible learning and realistic problem-solving. We provide an overview of future trends in public health training in the Asia-Pacific region and illustrate the diversity of online training resources globally that can enrich staff and student skills and complement our active, class-based teaching.

Cost analysis of improving emergency care for aged care residents under a Hospital in the Nursing Home program in Australia.

BACKGROUND: This study aims to examine the costs associated with a Hospital in the Nursing Home (HiNH) program in Queensland Australia directed at patients from residential aged care facilities (RACFs) with emergency care needs. METHODS: A cost analysis was undertaken comparing the costs under the HiNH program and the current practice, in parallel with a pre-post controlled study design. The study was conducted in two Queensland public hospitals: the Royal Brisbane and Women's Hospital (intervention hospital) and the Logan Hospital (control hospital). Main outcome measures were the associated incremental costs or savings concerning the HiNH program provision and the acute hospital care utilisation over one year after intervention. RESULTS: The initial deterministic analysis calculated the total induced mean costs associated with providing the HiNH program over one year as AU$488,116, and the total induced savings relating to acute hospital care service utilisation of AU$8,659,788. The total net costs to the health service providers were thus calculated at -AU$8,171,671 per annum. Results from the probabilistic sensitivity analysis (based on 10,000 simulations) showed the mean and median annual net costs associated with the HiNH program implementation were -AU$8,444,512 and-AU$8,202,676, and a standard deviation of 2,955,346. There was 95% certainty that the values of net costs would fall within the range from -AU$15,018,055 to -AU$3,358,820. CONCLUSIONS: The costs relating to implementing the HiNH program appear to be much less than the savings in terms of associated decreases in acute hospital service utilisation. The HiNH service model is likely to have the cost-saving potential while improving the emergency care provision for RACF residents.