Psychosocial factors, dentist-patient relationships, and oral health-related quality of life: a structural equation modelling.

BACKGROUND: Psychosocial factors and dentist-patient relationships (DPR) have been suggested to be associated with oral health outcomes. This study aimed to test a conceptual model which hypothesised relationships among psychosocial factors, DPR variables, and oral health-related quality of life (OHRQoL) in the 'distal-to-proximal' framework. METHODS: A total of 12,245 adults aged 18 years or over living in South Australia were randomly sampled for the study. Data were collected from self-complete questionnaires in 2015-2016. The outcome variable of Oral Health Impact Profile was used to measure OHRQoL. Psychosocial domain consisted of psychological well-being, social support, and health self-efficacy. DPR domain included trust in dentists, satisfaction with dental care, and dental fear. The hypothesised model was tested using the two-step approach in structural equation modelling. RESULTS: Data were analysed from 3767 respondents after the screening/preparing process (adjusted valid response rate 37.4%). In the first step of the analysis, confirmatory factor analyses produced acceptable measurement models for each of the six latent variables (GFI = 0.95, CFI = 0.98, RMSEA = 0.04). The final structural model indicated that better well-being, higher self-efficacy, and more satisfaction were associated with lower oral health impact (ß = - 0.12, - 0.07, - 0.14, respectively) whereas fear was positively associated (ß = 0.19). Among intermediates, support was positively associated with satisfaction within a small effect size (ß = 0.06) as compared to self-efficacy with trust (ß = 0.22). The invariance of the final model was also confirmed on participants' SES and dental service characteristics except the variable of 'last dental visit'. CONCLUSIONS: Psychosocial factors and DPR variables were associated with oral health impact in both direct and indirect paths. The framework of 'distal-to-proximal' actions is empirically supported from psychosocial factors via DPR variables to OHRQoL.

Sodium-Glucose Cotransporter 2 Inhibitors in South Australia: The Magic Before the Fame.

BACKGROUND: Recent clinical trials have demonstrated that sodium-glucose cotransporter 2 inhibitors (SGLT2i), which were previously only indicated in treatment of type 2 diabetes mellitus (T2DM), can markedly reduce heart failure hospitalisation (HFH), with less striking potential reductions in acute coronary syndromes and cardiac arrhythmias. To evaluate the impact of SGLT2i on cardiovascular outcomes in real-world practice, we performed a retrospective cohort analysis on South Australian (SA) data. METHODS: A total of 842 individuals with T2DM receiving SGLT2i were identified from SA public hospitals between 2011 and 2019. Episodes of care were temporally matched with those of 3,128 individuals with T2DM not receiving SGLT2i (control). Baseline characteristics were adjusted using inverse probability treatment weighting. The incidence of cardiovascular events at 12 and 24 months was evaluated using coded (International Classification of Diseases, Tenth Revision, Australian Modification [ICD-10-AM]) data. RESULTS: The primary outcome of HFH was lower with SGLT2i use at 12 months (adjusted hazard ratio [HRadj] 0.44; 95% confidence interval [CI] 0.29-0.68; p<0.001) and 24 months. There were also lower hospitalisations due to acute myocardial infarction (HRadj 0.42; 95% CI 0.21-0.85; p=0.015) and atrial or ventricular arrhythmias (HRadj 0.29; 95% CI 0.14-0.59; p=0.001), with no difference observed in hospitalisation due to ischaemic cerebrovascular events. There was no difference in all-cause mortality at 12 months but interestingly a higher rate at 24 months (HRadj 2.08; 95% CI 1.59-2.72; p<0.001). Despite this, similar reductions in cardiovascular outcomes were observed at 24 months. CONCLUSION: Use of SGLT2i in patients with T2DM in SA was associated with reductions in cardiovascular events even before their recent Pharmaceutical Benefits Scheme (PBS) listing for heart failure. Furthermore, this analysis supports that SGLT2i play a role not only in HFH reduction but also in reducing coronary and tachyarrhythmic events. This real-world evidence supports the use of SGLT2i as broadly protective cardiovascular drugs.

Factors affecting the isolation and diversity of marine sponge-associated bacteria.

Marine sponges are an ideal source for isolating as yet undiscovered microorganisms with some sponges having about 50% of their biomass composed of microbial symbionts. This study used a variety of approaches to investigate the culturable diversity of the sponge-associated bacterial community from samples collected from the South Australian marine environment. Twelve sponge samples were selected from two sites and their bacterial population cultivated using seven different agar media at two temperatures and three oxygen levels over 3 months. These isolates were identified using microscopic, macroscopic, and 16S rRNA gene analysis. A total of 1234 bacterial colonies were isolated which consisted of four phyla: Actinobacteria, Firmicutes, Proteobacteria, and Bacteroidetes, containing 21 genera. The diversity of the bacterial population was demonstrated to be influenced by the type of isolation medium, length of the incubation period and temperature, sponge type, and oxygen level. The findings of this study showed that marine sponges of South Australia can yield considerable bacterial culturable diversity if a comprehensive isolation strategy is implemented. Two sponges, with the highest and the lowest diversity of culturable isolates, were examined using next-generation sequencing to better profile the bacterial population. A marked difference in terms of phyla and genera was observed using culture-based and culture-independent approaches. This observed variation displays the importance of utilizing both methods to reflect a more complete picture of the microbial population of marine sponges. KEY POINTS: Improved bacterial diversity due to long incubations, 2 temperatures, and 3 oxygen levels. Isolates identified by morphology, restriction digests, and 16S rRNA gene sequencing. At least 70% of culturable genera were not revealed by NGS methods.

Investigating the breast cancer screening-treatment-mortality pathway of women diagnosed with invasive breast cancer: Results from linked health data.

OBJECTIVE: To examine the screening-treatment-mortality pathway among women with invasive breast cancer in 2006-2014 using linked data. METHODS: BreastScreen histories of South Australian women diagnosed with breast cancer (n = 8453) were investigated. Treatments recorded within 12 months from diagnosis were obtained from linked registry and administrative data. Associations of screening history with treatment were investigated using logistic regression and with cancer mortality outcomes using competing risk analyses, adjusting for socio-demographic, cancer and comorbidity characteristics. RESULTS AND CONCLUSION: For screening ages of 50-69 years, 70% had participated in BreastScreen SA ≤ 5 years and 53% ≤ 2 years of diagnosis. Five-year disease-specific survival post-diagnosis was 90%. Compared with those not screened ≤5 years, women screened ≤2 years had higher odds, adjusted for socio-demographic, cancer and comorbidity characteristics, and diagnostic period, of breast-conserving surgery (aOR 2.5, 95% CI 1.9-3.2) and radiotherapy (aOR 1.2, 95% CI 1.1-1.3). These women had a lower unadjusted risk of post-diagnostic cancer mortality (SHR 0.33, 95% CI 0.27-0.41), partly mediated by stage (aSHR 0.65, 95% CI 0.51-0.81), and less breast surgery (aSHR 0.78, 95% CI 0.62-0.99). Screening ≤2 years and conserving surgery appeared to have a greater than additive association with lower post-diagnostic mortality (interaction term SHR 0.42, 95% CI 0.23-0.78). The screening-treatment-mortality pathway was investigated using linked data.

The spatial influences of organic farming and environmental heterogeneity on biodiversity in South Australian landscapes.

The potential link between certified organic farming and biodiversity and conservation remains unexplored in Australia, despite the country having the world's largest amount of certified organic farmland and unprecedented biodiversity loss. This study modelled the spatial effects of organic farming (intensity of local farming systems), environmental heterogeneity, and urbanisation on two widely studied environmental taxa - vascular plant and bird species richness (surrogate measures of biodiversity) - in South Australia, using a unique certified organic farming postcode level dataset from 2001 to 2016 (N = 5440). The spatial Durbin error model results confirmed the positive spatial congruence of organic farming with greater vascular plant species richness, whereas only weak to no significant evidence was found for bird species richness. Landscape features (habitat heterogeneity) and green vegetation (a proxy indicator of resource availability) - rather than organic farming - appeared to be most associated with bird species richness. Both plant and bird species richness were positively associated with habitat heterogeneity (land cover diversity and elevation range), plant productivity and proportion of conservation land and water bodies. Whereas, increased anthropogenic land use for cropping and horticultural farming, soil type diversity and proximity to the coast significantly reduced species richness of both taxa. The results suggest that a multi-scale spatially refined biodiversity conservation strategy, with spatial targeting that promotes low intensive farming systems and increases landscape heterogeneity to provide quality habitat (a whole of landscape approach by incorporating private agricultural landholders), could be beneficial for biodiversity conservation.

Female breast cancer treatment and survival in South Australia: Results from linked health data.

OBJECTIVE: We investigated treatment and survival by clinical and sociodemographic characteristics for service evaluation using linked data. METHOD: Data on invasive female breast cancers (n = 13,494) from the South Australian Cancer Registry (2000-2014 diagnoses) were linked to hospital inpatient, radiotherapy and universal health insurance data. Treatments ≤12 months from diagnosis and survival were analysed, using adjusted odds ratios (aORs) from logistic regression, and adjusted sub-hazard ratios (aSHRs) from competing risk regression. RESULTS AND CONCLUSION: Five-year disease-specific survival increased to 91% for 2010-2014. Most women had breast surgery (90%), systemic therapy (72%) and radiotherapy (60%). Less treatment applied for ages 80+ vs <50 years (aOR 0.10, 95% CI 0.05-0.20) and TNM stage IV vs stage I (aOR 0.13, 95% CI 0.08-0.22). Surgical treatment increased during the study period and strongly predicted higher survival. Compared with no surgery, aSHRs were 0.31 (95% CI 0.26-0.36) for women having breast-conserving surgery, 0.49 (95% CI 0.41-0.57) for mastectomy and 0.42 (95% CI 0.33-0.52) when both surgery types were received. Patients aged 80+ years had lower survival and less treatment. More trial evidence is needed to optimise trade-offs between benefits and harms in these older women. Survival differences were not found by residential remoteness and were marginal by socioeconomic status.

Exploring the social conditions of physical activity participation amongst rural South Australian women: A qualitative study.

ISSUE ADDRESSED: Australian women are less likely to participate in recommended levels of weekly physical activity compared with men. Physical activity participation rates decrease with geographical remoteness. Research suggests that a lack of social support mechanisms within the home environment may act as a barrier for rural women to engage in physical activity, along with discomfort experienced within exercise environments. The purpose of this study was to explore the social conditions that facilitate or inhibit physical activity participation amongst women from two rural South Australian communities. METHODS: A qualitative descriptive approach underpinned by a phenomenological methodological orientation was applied. Participants were recruited using a purposive sampling strategy before semi-structured interviews (N = 16) were conducted and prepared for thematic analysis. RESULTS: Four inter-related themes were identified: support from others, time, expectations and available opportunities. Further contextual analysis revealed interwoven notions of physical activity spaces, time and social context within the themes. CONCLUSIONS: Multiple types of regulators interact to shape the motivational pattern of an individual. The themes identified align with self-determination, transactional and structuration theory, suggesting a need to consider human behaviour both pragmatically and conceptually. SO WHAT?: Results provide insight into social barriers and facilitators for physical activity participation and concomitantly provide the initial development of a framework for local strategic planning of health-promoting activities, and individual reflection to increase physical activity participation amongst rural women.

Geographical distribution of 3 allied health professions in South Australia: A summary of access and disadvantage.

OBJECTIVE: To describe the distribution of 3 allied health professionals-occupational therapists, physiotherapists and podiatrists-in South Australia stratified by the Modified Monash Model and the Index of Relative Socio-Economic Disadvantage. DESIGN: A descriptive data linkage cross-sectional study. SETTING: The state of South Australia, Australia. PARTICIPANTS AND MAIN OUTCOME MEASURES: Distribution of the 3 registered allied health professional groups stratified by Modified Monash Model and Index of Relative Socio-Economic Disadvantage. RESULTS: The largest proportion of the 3 allied health professional groups (occupational therapists, physiotherapists and podiatrists) were found in areas classified as Modified Monash 1 and Modified Monash 2 (86.5%). The lowest proportion of allied health professionals were found in Modified Monash 7. The largest number of allied health professionals per 10 000 population was found in areas classified as Modified Monash 1 and Modified Monash 2. The lowest number of allied health professionals per 10 000 population was found in Modified Monash 7 areas. The largest number of allied health professionals per 10 000 population was found in areas with Index of Relative Socio-Economic Disadvantage quintile 2, while the lowest number of allied health professionals per 10 000 population was found in areas with Index of Relative Socio-Economic Disadvantage quintile 1. CONCLUSIONS: The distribution of allied health professionals according to geographical remoteness, socio-economic disadvantage and per 10 000 population varies widely in South Australia. The number of allied health professionals per 10 000 population was lowest in rural and remote/very remote areas, explaining the typically poor access to allied health services for communities in these areas. The number of allied health professionals per 10 000 population according to Index of Relative Socio-Economic Disadvantage was variable within the context of both urban and rural areas.

Infection dynamics of Bonamia exitiosa on intertidal Ostrea angasi farms.

Bonamia spp. cause epizootics in oysters worldwide. In southern Australia, Bonamia exitiosa Hine, Cochennac and Berthe, 2001 threatens aquaculture of Ostrea angasi Sowerby, 1871. Bonamia spp. infections can display strong seasonality, but seasonal dynamics of B. exitiosa-O. angasi are unknown. Ostrea angasi naïve to B. exitiosa infection were stocked onto farms in three growing regions, and B. exitiosa was monitored seasonally for one year. Environmental parameters we measured did not correlate with B. exitiosa prevalence or infection intensities. Extreme temperatures suggest O. angasi culture systems need development. Bonamia exitiosa prevalence increased over time. After three months, O. angasi had B. exitiosa prevalence of 0.08-0.4, and after one year, the prevalence was 0.57-0.88. At some sites, O. angasi had >0.5 B. exitiosa prevalence in >6 months, but at other sites, >9 months passed before prevalence was >0.5. Bonamia exitiosa infection intensities were low with no seasonal pattern but were affected by the interaction of site, season and oyster meat:shell ratio. Understanding infection and initiating a breeding programme for resistance would provide benefits for O. angasi industry expansion.

Urban soil health: A city-wide survey of chemical and biological properties of urban agriculture soils.

The integration of urban green spaces into modern city planning is seen as a promising tool to offset the drawbacks of ever-expanding cities. Urban agriculture is a common method to implement such strategies and to increase urban sustainability with a special focus on food security. Due to their location, urban farms are highly influenced by past and present anthropogenic activities which can threaten both soil health and food safety. This study includes 12 urban agriculture sites in the metropolitan area of Adelaide, Australia. It is the first of its kind to focus on soil health in urban agriculture systems with a further emphasis on mycorrhizal fungi. Descriptive information about each site, the biodiversity of the selected plots and soil samples from different depths and locations were collected and analysed for chemical and biological parameters. Seven metals, total and plant-available (Colwell) phosphorus and available nitrogen were measured in soils. A glasshouse bioassay was also conducted to determine the abundance of beneficial arbuscular mycorrhizal fungi in the soils and the change of root colonization after inoculation with the mycorrhizal fungus Rhizophagus irregularis. Results showed a generally high biodiversity of plants that correlated with site activity (commercial or community garden) and which could potentially be used for urban biodiversity conservation. Metal concentrations in soils were below national guidelines levels for all samples, although sites with previous industrial history showed elevated levels when compared to sites without industrial history. The use of raised beds with introduced soils eliminated differences in previous land-use history, thereby providing a good option to support cleaner production. Gardening soils were considered highly fertile, with plant-available (Colwell) P concentrations exceeding recommended levels for most horticultural crops, while soils were adequately supplied with nitrogen. Most plant nutrients were derived from freely available urban waste streams and integrated via composting. Various urban waste streams could be used to counter-act imbalanced soil nutrients. Arbuscular mycorrhizal fungi were present in all sites, indicating that the practiced soil management is sustainable from a microbial perspective. Given their important role in supporting plant nutrition, and potential to reduce the need for external nutrient inputs, they provide an important focal point for achieving clean and sustainable urban food production. The results were incorporated into a framework for the management of urban soil health.

Pre-diagnostic colonoscopies reduce cancer mortality - results from linked population-based data in South Australia.

BACKGROUND: To investigate the association between pre-diagnostic colonoscopy and colorectal cancer mortality in South Australia. METHODS: Colonoscopy histories were obtained for colorectal cancer patients diagnosed in 2003-2013 using linked Medical Benefits Schedule (MBS) claims, hospital-inpatient and cancer-registry data. Colonoscopy histories included the year of colonoscopy, numbers of examinations, and the time from first colonoscopy to diagnosis. Histories of multiple exposures to colonoscopies, and exposures of greater than a year from initial colonoscopy to diagnosis, were regarded as indicators of screening or surveillance activity. Colonoscopies occurring within one year of diagnosis were regarded as more likely to be a response to cancer symptoms than those occurring > 1 year before diagnosis. Associations between colonoscopy history and post-diagnostic survival were analysed using sub-hazard ratios (SHRs) from competing risk regression adjusted for socio-demographic and cancer characteristics. RESULTS: Having pre-diagnostic colonoscopy was associated with an unadjusted reduction in risk of colorectal cancer death of 17% (SHR: 0.83, 95% CI 0.78-0.89). After adjusting for time period and sociodemographic characteristics, the risk of colorectal cancer death reduced by 17% for one pre-diagnostic colonoscopy examination; 27% for two pre-diagnostic colonoscopy examinations; and 45% for three or more pre-diagnostic colonoscopy examinations. Those with a time of over one year from first colonoscopy in the study window to diagnosis, when compared with less than one year, had a 17% lower risk of colorectal cancer death in this adjusted analysis. These reductions were substantially reduced or eliminated when also adjusting for less advanced stage. CONCLUSIONS: Pre-diagnostic colonoscopy, and more so, multiple colonoscopies and first colonoscopy occurring over one year from initial colonoscopy to diagnosis, were associated with longer survival post diagnosis. This was largely explained by less advanced cancer stage at the time of diagnosis.

The advent of animals: The view from the Ediacaran.

Patterns of origination and evolution of early complex life on this planet are largely interpreted from the fossils of the Precambrian soft-bodied Ediacara Biota. These fossils occur globally and represent a diverse suite of organisms living in marine environments. Although these exceptionally preserved fossil assemblages are typically difficult to reconcile with modern phyla, examination of the morphology, ecology, and taphonomy of these taxa provides keys to their relationships with modern taxa. Within the more than 30 million y range of the Ediacara Biota, fossils of these multicellular organisms demonstrate the advent of mobility, heterotrophy by multicellular animals, skeletonization, sexual reproduction, and the assembly of complex ecosystems, all of which are attributes of modern animals. This approach to these fossils, without the constraint of attempting phylogenetic reconstructions, provides a mechanism for comparing these taxa with both living and extinct animals.

How can we value an environmental asset that very few have visited or heard of? Lessons learned from applying contingent and inferred valuation in an Australian wetlands case study.

To date, the majority of environmental assets studied in the economic valuation literature clearly have high amenity and recreational use values. However there are many cases where small, but nevertheless unique and important, ecosystems survive as islands amongst large areas of modified, productive, or urban, landscapes. Development encroaches on the landscape and as urban landscapes become more concentrated these types of conservation islands will become increasingly more important. Previous experience with economic valuation suggests that lower total values for smaller contributions to conservation are more liable to be swamped by survey and hypothetical bias measures. Hence there needs to be more understanding of approaches to economic valuation for small and isolated environmental assets, in particular regarding controlling stated preference biases. This study applied the recently developed method of Inferred Valuation (IV) to a small private wetland in South-East Australia, and compared willingness to pay values with estimates from a standard Contingent Valuation (CV) approach. We found that hypothetical bias did seem to be slightly lower with the IV method. However, other methods such as the use of log-normal transformations and median measures, significantly mitigate apparent hypothetical biases and are easier to apply and allow use of the well-tested CV method.

Day Traders in South Australia: Similarities and Differences with Traditional Gamblers.

The present study investigated the relationship between engaging in day trading and engaging in traditional forms of gambling in South Australia. Consistent with a previous study on this issue, it would appear that most individuals who engage in day trading are heavily involved traditional gamblers who include day trading in their repertoire of activities. They differ somewhat from most gamblers in their strong preference for skill-based types of gambling, their higher overall involvement in gambling, and their higher rates of problem gambling. They also have some demographic differences, in particular, being older and having higher incomes. The present findings provide further evidence that not only do certain types of financial speculation bear some conceptual similarity to gambling, they also appear to be empirically related.

Prevalence and associations of gout and hyperuricaemia: results from an Australian population-based study.

BACKGROUND: Despite gout and hyperuricaemia being major comorbid health issues worldwide, there is a knowledge gap regarding their impact in the Australian community. AIMS: To determine the prevalence and associations of self-reported medically diagnosed gout and hyperuricaemia in an Australian population-based cohort. METHODS: The North West Adelaide Health Study is a longitudinal cohort study consisting of three stages of data collection. Each stage comprised a self-complete questionnaire, clinic assessment and computer-assisted telephone interview. In Stage 3 (2008-2010), participants were asked if a doctor had ever diagnosed them with gout. Additional data included demographics, comorbidities, laboratory data and Short Form 36 (SF-36). Participants were defined as having gout if they had self-reported medically diagnosed gout or were taking any gout-specific medication (allopurinol, colchicine, probenecid). Hyperuricaemia was defined as a serum uric acid (SUA) level >0.42 mmol/L in men and >0.34 mmol/L in women. RESULTS: The overall prevalence of gout was 5.2%. Males were significantly more likely to have gout than females (8.5 vs 2.1%, P < 0.001). The overall prevalence of hyperuricaemia was 16.6%, with being male again identified as a significant risk factor (17.8 vs 15.4%, P < 0.01). Both gout and hyperuricaemia were associated with male sex, body mass index and renal disease after multivariable adjustment. There was no significant difference reported in quality of life (mean SF-36) scores in participants with gout compared to unaffected individuals. CONCLUSION: The prevalence of gout and hyperuricaemia is high in the South Australian population. This study emphasises the need for optimal diagnosis and management of gout in Australia.

Rising incidence of hepatitis B-related hepatocellular carcinoma in South Australia: 1996-2010.

BACKGROUND: Chronic hepatitis B virus (HBV) infection is likely to be an important driver of increasing hepatocellular carcinoma (HCC) incidence in Australia. However, there is paucity of Australian data on HBV-related HCC incidence or outcomes. AIMS: To determine the incidence rates and survival trends of HBV-related HCC in South Australia (SA) over 15 years. METHODS: A population-based cohort study was performed in HBV patients notified to the SA Communicable Disease Control Branch between 1996 and 2010. The dataset was probabilistically linked with the SA Cancer Registry and death registry. Incidence rate trends and survival were determined for three 5-year time periods (1996-2000, 2001-2006 and 2006-2010). RESULTS: Forty-seven of 3881 notifications with HBV were linked to a HCC record (median (interquartile range) age at diagnosis: 58.9 (13.4) years, 83% males, 8.5% born in Australia, 62% diagnosed between 51-69 years). The overall crude HCC incidence was 111.3/100 000 person-years with an age-standardised HCC incidence of 189.1/100 000 person-years, the rate for men was higher than for women: 241.7 versus 88.6/100 000 person-years. The age-standardised HCC incidence increased over time with an annual percentage increase of 20.8% (95% CI: 10.06-32.54, P = 0.001). Median survival following HCC diagnosis was 12.5 months (95% CI: 3.6-21.4), with a trend towards longer survival during the 2006-2010 time period (21.8 months) compared to the previous two time periods (9.2 and 10.2 months, P = 0.056). CONCLUSION: Both crude and age-standardised incidences of HBV-related HCC increased between 1996 and 2010 in SA. There was a trend to longer survival in the latter time-period.

Applying Health in All Policies to obesity in South Australia.

Public policy strategies impact on population health by acting on the effectiveness, availability and distribution of the social determinants of health. Reducing obesity and promoting healthy weight is a key focus of governments, health promoters and researchers, and can benefit from a systems approach with 'upstream' policy action beyond the health sector. Although the literature identifies many areas for hypothetical non-health policy action, and in particular relating to food and activity environments, few have identified practical, politically viable and relatively cost-free processes by which non-health sectors would want to commit to such action. This article details how the Government of South Australia used the Health in All Policies (HiAP) approach in the SA HiAP Healthy Weight Project. It mapped the core business and policy directions of 44 state departments against research on 'what works' to address obesity. Negotiations then developed high-level policy commitments to address factors promoting healthy weight which predominantly changed ways of working rather than requiring new expenditure and also assisted departments in meeting their own goals; departmental chief executives endorsed the commitments. By starting from departmental documents, and not restricting the project to departments with more 'obvious' obesity prevention potential, we gained commitment to a broader range of policy actions than identified elsewhere; for example, for prisons, environment and botanic gardens, housing and vocational education. The SA HiAP Healthy Weight Project provides one example of a workable, evidence-based systems approach to increase commitment to practical and politically viable opportunities across government to address the non-health environments supporting healthy weight.

The Lived Experience of Caring for an Australian Military Veteran With Posttraumatic Stress Disorder.

There is limited literature on the experience of caring for an intimate partner with a mental health condition. Posttraumatic stress disorder (PTSD) is a common mental health condition for military veterans; yet, little is known about how partners experience and cope with these caring relationships. Using an interpretive phenomenological approach, we collected data through individual interviews with 20 female partners of male veterans diagnosed with PTSD living in South Australia. We found the emotional features of caring to be directly derived from the strength of commitment these carers had to their relationships. We show that lack of understanding of carers' lives, particularly by health providers and government, has resulted in a sense of social disconnect and invisibility that has contributed to stress and is a barrier to coping. Of vital importance to these carers was that partners of younger veterans should not have to suffer the same experiences.

Reflections on Aboriginal perinatal mental health, mothers, babies, families and community: A South Australian trainee's experience.

OBJECTIVE: This paper explores novel training opportunities that the Expanded Setting Training Program (ESTP) provides for advanced psychiatry trainees. It is a reflection of a trainee's learning experiences during a year-long posting in Aboriginal Perinatal Mental Health, working alongside the Aboriginal Family Birthing Program, coupled with reflection and supervision. CONCLUSIONS: ESTP provided a fertile area to hone an advanced trainee's skills in the niche areas of Aboriginal mental health, perinatal mental health, culture and psychiatry. In addition, it provided skills in the area of leadership, health advocacy and the establishment and maintenance of successful programs in disadvantaged, culturally and linguistically diverse communities. The ESTP Aboriginal Mental Health rotation provides a unique experience for training, and the learning opportunities are limited only by the creativity of the trainee and supervisor.

Who provides care for people dying of cancer? A comparison of a rural and metropolitan cohort in a South Australian bereaved population study.

OBJECTIVE: To examine and compare urban and rural palliative care service availability and patterns of care from randomised, population-based surveys of caregivers of people at the end of life. DESIGN, SETTING & PARTICIPANTS: Survey responses on the death of 'someone close' from 23,588 interviews of South Australians conducted between 2001 and 2007 are analysed. INTERVENTIONS: A randomised population survey. MAIN OUTCOME MEASURES: Explored palliative care service availability, caregiving provided, and characteristics of the deceased and their caregivers. RESULTS: There was no difference in reported rates of accessing specialist palliative care services between rural and urban respondents (in unadjusted and adjusted analyses) nor did the proportion of people for whom cancer was their life-limiting illness. There was greater reliance on friends than first degree relatives in hands-on care provided at the end of life in rural settings. The rates of reported need for more support did not differ between urban and rural respondents for caregivers of people at the end of life. CONCLUSION: Use of palliative care services was similar for rural and urban caregivers for someone close at the end of life with similar levels of met and unmet needs.