ORCID Profile
0000-0002-6043-6071
Current Organisations
University of New South Wales
,
University of Sydney
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: The Sax Institute
Date: 2020
Publisher: JMIR Publications Inc.
Date: 30-03-2021
DOI: 10.2196/25610
Abstract: It is unclear how people with hypertension are responding to the COVID-19 pandemic given their increased risk, and whether targeted public health strategies are needed. This retrospective case-control study compared people with hypertension to matched healthy controls during the COVID-19 lockdown to determine whether they have higher risk perceptions, anxiety, and vaccination intentions. Baseline data from a national survey were collected in April 2020 during the COVID-19 lockdown in Australia. People who reported hypertension with no other chronic conditions were randomly matched to healthy controls of similar age, gender, education, and health literacy level. A subset including participants with hypertension was followed up at 2 months after restrictions were eased. Risk perceptions, anxiety, and vaccination intentions were measured in April and June. Of the 4362 baseline participants, 466 (10.7%) reported hypertension with no other chronic conditions. A subset of 1369 people were followed up at 2 months, which included 147 (10.7%) participants with hypertension. At baseline, perceived seriousness was high for both hypertension and control groups. The hypertension group reported greater anxiety compared to the controls and were more willing to vaccinate against influenza, but COVID-19 vaccination intentions were similar. At follow-up, these differences were no longer present in the longitudinal subs le. Perceived seriousness and anxiety had decreased, but vaccination intentions for both influenza and COVID-19 remained high across groups ( %). Anxiety was above normal levels during the COVID-19 lockdown. It was higher in the hypertension group, which also had higher vaccination intentions. Groups that are more vulnerable to COVID-19 may require targeted mental health screening during periods of greater risk. Despite a decrease in perceived risk and anxiety after 2 months of lockdown restrictions, vaccination intentions remained high, which is encouraging for the future prevention of COVID-19.
Publisher: Elsevier BV
Date: 07-2013
Publisher: Cold Spring Harbor Laboratory
Date: 20-10-2021
DOI: 10.1101/2021.10.19.21265230
Abstract: Objective: This study aimed to explore the psychological, social, and financial impacts of COVID-19 on culturally and linguistically erse communities in Australia. Design: Cross-sectional survey informed by the Framework for Culturally Competent Health Research conducted between March and July, 2021. Setting: Participants were recruited from Greater Western Sydney, New South Wales, Australia. Participants: 708 community members who speak a language other than English at home participated (mean age: 45.4years [range 18 to 91] 88% [n=622] born outside of Australia). Outcome measures: Fifteen items regarding impacts of COVID-19, adapted from validated scales, previous surveys or co-designed in partnership with Multicultural Health and interpreter service staff. Logistic regression models (using post-stratification weighted frequencies) identified factors associated with psychological, social, and financial impacts. Surveys were available in English or translated (11 languages). Results: Even prior to the COVID-19 outbreak in Sydney, 25% of the s le reported feeling nervous or stressed most/all of the time and 22% felt lonely or alone most/all of the time. One quarter of participants reported negative impacts on their spousal relationships as a result of COVID-19 and most parents reported that their children were less active (64%), had more screen time (63%), and were finding school harder (45%). Mean financial burden was 2.9/5 (95%CI=2.8 to 2.9). Regression analyses consistently showed distinct impact patterns for different language groups and more negative outcomes for those with comorbidities. Conclusion: Culturally and linguistically erse communities experience significant psychological, social and financial impacts of COVID-19, with distinct impact patterns across language groups. A whole-of-government approach with policy and sustainable infrastructure is needed to co-design innovative, tailored and culturally-safe COVID-19 support packages.
Publisher: SAGE Publications
Date: 20-04-2023
DOI: 10.1177/1742271X231164591
Abstract: Adenomyosis is histologically defined by the presence of endometrial glands and stroma in the myometrium. Ultrasound findings of adenomyosis are being redefined to better diagnose adenomyosis pre-operatively. A single-centre retrospective study was performed at a regional hospital. The myometrial–cervical ratio was calculated on pre-operative ultrasounds, and histopathology reviewed for each case. Logistic regression was used to estimate the association between the myometrial–cervical ratio and adenomyosis confirmed on histopathology, and the area under the receiver operating characteristic curve was calculated. Comparisons were performed based on the presence of fibroids on ultrasound. Complete data were available for 136 benign hysterectomies between 1 January 2015 and 31 December 2020. When the myometrial–cervical ratio was treated as a continuous variable in a logistic regression of adenomyosis on histopathology, there was no statistical evidence (χ 2 (1) 0.01, p = 0.98) of an association. When cases including fibroids in the myometrial–cervical ratio were excluded, there was a non-significant association between myometrial–cervical ratio and adenomyosis on histopathology (odds ratio = 3.435, 95% confidence interval = 0.964, 12.235 χ 2 (1) = 3.62, p = 0.057) area under the receiver operating characteristic = 0.637 (95% confidence interval = 0.504, 0.770). The optimal myometrial–cervical ratio cutpoint was 1.875 (95% confidence interval = 1.698, 2.051), which achieved 71.43% sensitivity and 60.00% specificity. There was strong statistical evidence (χ 2 (1) = 9.02, p = 0.003) that the myometrial–cervical ratio outperformed standard pre-operative ultrasound identification of adenomyosis. While accuracy remains suboptimal, the myometrial–cervical ratio outperformed standard ultrasound diagnostic features of adenomyosis in a regional setting. The myometrial–cervical ratio may offer a simple imaging measurement for adenomyosis in inexperienced hands when fibroids are absent.
Publisher: Oxford University Press (OUP)
Date: 05-11-2022
Abstract: Older adults should be supported to make informed decisions about cancer screening. However, it is unknown how general practitioners (GPs) in Australia communicate about cancer screening with older people. To investigate GPs’ views and experiences of communicating about cancer screening (breast, cervical, prostate, and bowel) with older people (≥70 years). Qualitative, semi-structured interviews, Australia. Interviews were conducted with GPs practising in Australia (n = 28), recruited through practice-based research networks, primary health networks, social media, and email invitation. Interviews were audio-recorded and analysed thematically using Framework Analysis. Findings across GPs were organized into 3 themes: (i) varied motivation to initiate cancer screening discussions some GPs reported that they only initiated screening within recommended ages (& years), others described initiating discussions beyond recommended ages, and some experienced older patient-initiated discussions (ii) GPs described the role they played in providing screening information, whereby detailed discussions about the benefits/risks of prostate screening were more likely than other nationally funded screening types (breast, cervical, and bowel) however, some GPs had limited knowledge of recommendations and found it challenging to explain why screening recommendations have upper ages (iii) GPs reported providing tailored advice and discussion based on personal patient preferences, overall health/function, risk of cancer, and previous screening. Strategies to support conversations between GPs and older people about the potential benefits and harms of screening in older age and rationale for upper age limits to screening programmes may be helpful. Further research in this area is needed.
Publisher: American Medical Association (AMA)
Date: 09-2019
Publisher: Springer Science and Business Media LLC
Date: 31-03-2016
DOI: 10.1007/S11926-016-0577-9
Abstract: Cognitive difficulties represent a common and debilitating feature of the enigmatic chronic fatigue syndrome (CFS). These difficulties manifest as self-reported problems with attention, memory, and concentration and present objectively as slowed information processing speed particularly on complex tasks requiring sustained attention. The mechanisms underlying cognitive dysfunction remain to be established however, alterations in autonomic nervous system activity and cerebral blood flow have been proposed as possibilities. Heterogeneity in the experience of cognitive impairment, as well as differences in the methods utilised to quantify dysfunction, may contribute to the difficulties in establishing plausible biological underpinnings. The development of a brief neurocognitive battery specifically tailored to CFS and adoption by the international research community would be beneficial in establishing a profile of cognitive dysfunction. This could also provide better insights into the underlying biological mechanisms of cognitive dysfunction in CFS and enhance the development of targeted treatments.
Publisher: Elsevier BV
Date: 03-2021
Publisher: BMJ
Date: 19-11-2019
DOI: 10.1136/BMJQS-2018-008659
Abstract: ‘Nudges’ are subtle cognitive cues thought to influence behaviour. We investigated whether embedding nudges in a general practitioner (GP) clinical decision support display can reduce low-value management decisions . Australian GPs completed four clinical vignettes of patients with low back pain. Participants chose from three guideline-concordant and three guideline-discordant (low-value) management options for each vignette, on a computer screen. A 2×2 factorial design randomised participants to two possible nudge interventions: ‘partition display’ nudge (low-value options presented horizontally, high-value options listed vertically) or ‘default option’ nudge (high-value options presented as the default, low-value options presented only after clicking for more). The primary outcome was the proportion of scenarios where practitioners chose at least one of the low-value care options. 120 GPs (72% male, 28% female) completed the trial (n=480 vignettes). Participants using a conventional menu display without nudges chose at least one low-value care option in 42% of scenarios. Participants exposed to the default option nudge were 44% less likely to choose at least one low-value care option (OR 0.56, 95%CI 0.37 to 0.85 p=0.006) compared with those not exposed. The partition display nudge had no effect on choice of low-value care (OR 1.08, 95%CI 0.72 to 1.64 p=0.7). There was no interaction between the nudges (OR 0.94, 95% CI 0.41 to 2.15 p=0.89). A default option nudge reduced the odds of choosing low-value options for low back pain in clinical vignettes. Embedding high value options as defaults in clinical decision support tools could improve quality of care. More research is needed into how nudges impact clinical decision-making in different contexts.
Publisher: Elsevier BV
Date: 02-2019
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.IJPSYCHO.2017.07.012
Abstract: Music-listening can be a powerful therapeutic tool for mood rehabilitation, yet quality evidence for its validity as a singular treatment is scarce. Specifically, the relationship between music-induced mood improvement and meaningful physiological change, as well as the influence of music- and person-related covariates on these outcomes are yet to be comprehensively explored. Ninety-four healthy participants completed questionnaires probing demographics, personal information, and musical background. Participants listened to two prescribed musical pieces (one classical, one jazz), an "uplifting" piece of their own choice, and an acoustic control stimulus (white noise) in randomised order. Physiological responses (heart rate, respiration, galvanic skin response) were recorded throughout. After each piece, participants rated their subjective responses on a series of Likert scales. Subjectively, the self-selected pieces induced the most joy, and the classical piece was perceived as most relaxing, consistent with the arousal ratings proposed by a music selection panel. These two stimuli led to the greatest overall improvement in composite emotional state from baseline. Psycho-physiologically, self-selected pieces often elicited a "eustress" response ("positive arousal"), whereas classical music was associated with the highest heart rate variability. Very few person-related covariates appeared to affect responses, and music-related covariates (besides self-selection) appeared arbitrary. These data provide strong evidence that optimal music for therapy varies between in iduals. Our findings additionally suggest that the self-selected music was most effective for inducing a joyous state while low arousal classical music was most likely to shift the participant into a state of relaxation. Therapy should attempt to find the most effective and "heartfelt" music for each listener, according to therapeutic goals.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 06-2010
Publisher: Elsevier BV
Date: 11-2016
Publisher: BMJ
Date: 30-01-2020
DOI: 10.1136/SEXTRANS-2019-054290
Abstract: From December 2017, the Australian National Cervical Screening Program commenced 5 yearly primary human papillomavirus (HPV) screening one of the first high-income countries to implement primary HPV screening. This study aimed to examine the psychosocial impact of self-reporting testing HPV positive in a s le of women screened since the renewal of the programme. Women in Australia aged 25–74 years who reported participating in cervical screening since December 2017 were recruited through an online market research company to complete a cross-sectional survey. The primary outcomes were anxiety and general distress. 1004 women completed the online survey 80.9% reported testing HPV negative (HPV−), 6.5% reported testing HPV positive (HPV+) and 12.9% did not know/remember their test result. Women who reported testing HPV+ had significantly poorer psychological outcomes on a range of measures. Those who reported testing HPV+ had higher anxiety scores (53.03 vs 43.58 out of 80, p .001), showed more general distress (3.94 vs 2.52 out of 12, p=0.004), concern about their test result (5.02 vs 2.37, p .001), expressed greater distress about their test result (7.06 vs 4.74, p .001) and cancer worry (quite or very worried 35.4% vs 11.6%, p .001) than women who reported testing HPV−. Concern regarding test results was also significantly higher in women who did not know/remember their test result (3.20 vs 2.37, p .001) compared with women who reported testing HPV−. Women who reported testing HPV+ had greater knowledge of HPV (9.25 vs 6.62, p .001) and HPV testing (2.44 vs 1.30, p .001) than women who reported testing HPV−. Receipt of an HPV+ test result was associated with high levels of anxiety and distress, which reached clinical significance. Further work is needed to understand whether distress and concern could be reduced by ensuring all women receive high-quality standardised information with their results or by other interventions.
Publisher: Elsevier BV
Date: 06-2022
Publisher: Cold Spring Harbor Laboratory
Date: 25-09-2020
DOI: 10.1101/2020.09.24.20201236
Abstract: The current suppression strategy for COVID-19 in Australia is dependent on people getting tested and self-isolating while they have COVID-19 symptoms. However, there is very little research on the behaviours and behavioural barriers involved in getting tested, both in Australia and worldwide, despite there being some evidence that these barriers do exist. The Sydney Health Literacy Lab (SHeLL) has been conducting a national longitudinal survey in Australia since April 2020. A list of testing barriers was included in Wave 3 in June 2020 (n=1369), along with intentions to test and self-isolate if symptomatic. Open responses were also collected. The test barriers identified were categorised using the COM-B framework. Only 49% of people strongly agreed they would get tested if they had COVID-19 symptoms, but most people agreed to some extent that they would get tested (96%). The most common barriers selected from the list provided were that testing is painful (11%), not knowing how to get tested (7%), and worry about getting infected at the testing centre (5%). Many participants (10%) indicated other reasons, and open responses included many additional barriers to testing than those provided in the initial list. These covered all components of the COM-B model. We identified a wide range of barriers using both quantitative and qualitative methods, which need to be addressed in order to increase COVID-19 testing behaviour.
Publisher: Cold Spring Harbor Laboratory
Date: 23-10-2021
DOI: 10.1101/2021.10.20.21265299
Abstract: To investigate whether culturally and linguistically erse communities in Western Sydney have experienced any positive effects during the COVID-19 pandemic, and if so, what these were. A cross–sectional survey with ten language groups was conducted from 21 st March to 9 th July 2021 in Sydney, Australia. Participants were recruited through bilingual multicultural health staff and health care interpreter service staff and answered a question, ‘In your life, have you experienced any positive effects from the COVID-19 pandemic?’ Differences were explored by demographic variables. Free–text responses were thematically coded using the Content Analysis method. 707 people completed the survey, aged 18 to , 49% males and 51% females. Only 161 (23%) of those surveyed reported any positive impacts. There were significant differences in the proportion of those who reported positives based on age (p=0.004), gender (p=0.013), language (p=0.003), health literacy (p=0.014), English language proficiency (p=0.003), education (p= .001) and whether participants had children less than 18 years at home (p=0.001). Reporting of positive impacts ranged from 12% for people aged seventy years or older to 30% for the 30–49-year age group. Reporting of positive impacts for different language groups ranged from 9% to 42%. 18% of men reported positive impacts compared to 27% of women, and 18% of people with inadequate health literacy reported positive impacts compared to 26% with adequate health literacy. Content Analysis of open-ended responses showed that, of those that did report positives, the top themes were ‘Family time’ (44%), ‘Improved self-care’ (31%) and, ‘Greater connection with others’ (17%). From 21st March to July 9th, 2021, few surveyed participants reported finding any positives because of the COVID–19 pandemic. This finding is in stark contrast to related research in Australia in a population dominated by adults with English as their first language, carried out in June 2020, in which many more people experienced positives. The needs of people from culturally and linguistically erse backgrounds must inform future responses to community crises to facilitate an equitable effect of any collateral positives that may arise.
Publisher: MDPI AG
Date: 30-05-2023
Abstract: This paper aims to delineate the cognitive, emotional, and behavioural responses of women with polycystic ovary syndrome (PCOS) to their illness by applying the Common-Sense Model of Self-Regulation (CSM) to their health behaviour. An online cross-sectional design was used to examine the relationship between participants’ illness perceptions (illness identity, consequence, timeline, control, and cause) and emotional representations of their PCOS, and their health behaviours (diet, physical activity, and risky contraceptive behaviour). The participants were 252 women between the ages of 18 and 45 years, living in Australia, and self-reporting a diagnosis of PCOS, recruited through social media. Participants completed an online questionnaire regarding illness perceptions as well as their diet, physical activity, and risky contraceptive behaviour. Illness identity was positively associated with the number of maladaptive dietary practices (B = 0.71, 95% CI: 0.003, 0.138 p = 0.04), and perception of longer illness duration was associated with reduced physical activity (OR = 0.898, 95% CI: 0.807, 0.999 p = 0.49) and risky contraceptive behaviour (OR = 0.856, 95% CI: 0.736, 0.997 p = 0.045). The limitations of the study include all data being self-reported (including PCOS diagnosis), and the potential for analyses of physical activity and risky contraceptive use being underpowered due to reduced s le sizes. The s le was also highly educated and restricted to those who use social media. These findings suggest that illness perceptions may play a role in influencing health behaviour in women with PCOS. A better understanding of the illness perceptions of women with PCOS is needed to increase health-promoting behaviour and improve health outcomes for women with PCOS.
Publisher: American Medical Association (AMA)
Date: 03-2019
Publisher: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-028544
Abstract: Health literacy describes the cognitive and social skills that in iduals use to access, understand and act on health information. Health literacy interventions typically take the ‘universal precautions approach’ where all consumers are presented with simplified materials. Although this approach can improve knowledge and comprehension, its impact on complex behaviours is less clear. Systematic reviews also suggest that health literacy interventions underuse volitional strategies (such as planning) that play an important role in behaviour change. A recent study found volitional strategies may need to be tailored to the participant’s health literacy. The current study aims to replicate these findings in a s le of people who have diabetes and/or are overweight or obese as measured by body mass index, and to investigate the most effective method of allocating an action plan to a participant to reduce unhealthy snacking. We plan to recruit approximately 2400 participants at baseline. Participants will receive one of two alternative online action plans intended to reduce unhealthy snacking (‘standard’ action plan or ‘literacy-sensitive’ action plan). Participants will be randomised to a method of allocation to an action plan: (1) random allocation (2) allocation by health literacy screening tool or (3) allocation by participant selection. Primary outcome is self-reported serves of unhealthy snacks during the previous month. Multiple linear regression will evaluate the impact of health literacy on intervention effectiveness. The analysis will also identify independent contributions of each action plan, method of allocation, health literacy and participant selections on unhealthy snacking at 4-week follow-up. This study was approved by the University of Sydney Human Research Ethics Committee (2017/793). Findings will be disseminated through peer-reviewed international journals, conferences and updates with collaborating public health bodies (Diabetes New South Wales (NSW) & Australian Capital Territory (ACT), and Western Sydney Local Health District). ACTRN12618001409268 Pre-results.
Publisher: JMIR Publications Inc.
Date: 07-10-2021
Abstract: hared decision-making is an essential principle for the prevention of cardiovascular disease (CVD), where asymptomatic people consider lifelong medication and lifestyle changes. his study aims to develop and evaluate the first literacy-sensitive CVD prevention decision aid (DA) developed for people with low health literacy, and investigate the impact of literacy-sensitive design and heart age. e developed a standard DA based on international standards. The standard DA was based on our existing general practitioner DA. The literacy-sensitive DA included simple language, supporting images, white space, and a lifestyle action plan. The control DA used Heart Foundation materials. A randomized trial included 859 people aged 45-74 years using a 3 (DA: standard, literacy-sensitive, control) ×2 (heart age: heart age + percentage risk, percentage risk only) factorial design, with outcomes including prevention intentions and behaviors, gist and verbatim knowledge of risk, credibility, emotional response, and decisional conflict. We iteratively improved the literacy-sensitive version based on end-user testing interviews with 20 people with varying health literacy levels. mmediately after the intervention (n=859), there were no differences in any outcome among the DA groups. The heart age group was less likely to have a positive emotional response, perceived the message as less credible, and had higher gist and verbatim knowledge of heart age risk but not percentage risk. After 4 weeks (n=596), the DA group had better gist knowledge of percentage risk than the control group. The literacy-sensitive DA group had higher fruit consumption, and the standard DA group had better verbatim knowledge of percentage risk. Verbatim knowledge was higher for heart age than for percentage risk among those who received both. he literacy-sensitive DA resulted in increased knowledge of CVD risk and increased fruit consumption in participants with varying health literacy levels and CVD risk results. Adding heart age did not increase lifestyle change intentions or behavior but did affect psychological outcomes, consistent with previous findings. This tool will be integrated with additional resources to improve other lifestyle outcomes. ustralian New Zealand Clinical Trials Registry ACTRN12620000806965 26yhk8a
Publisher: Public Library of Science (PLoS)
Date: 17-01-2019
Publisher: Wiley
Date: 12-05-2021
DOI: 10.1002/HPJA.494
Abstract: To investigate whether Australians have experienced any positive effects during the COVID‐19 pandemic. National online longitudinal survey. As part of a June 2020 survey, participants (n = 1370) were asked ‘In your life, have you experienced any positive effects from the COVID‐19 pandemic’ (yes/no) and also completed the World Health Organisation‐Five well‐being index. Differences were explored by demographic variables. Free‐text responses were thematically coded. Nine hundred sixty participants (70%) reported experiencing at least one positive effect during the COVID‐19 pandemic. Living with others ( P = .045) and employment situation ( P .001) at baseline (April) were associated with experiencing positive effects. In iduals working for pay from home were more likely to experience positive effects compared to those who were not working for pay (aOR = 0.45, 95% CI: 0.32, 0.63, P .001) or who were working for pay outside the home (aOR = 0.40, 95% CI: 0.28, 0.58, P .001). 54.2% of participants reported a sufficient level of well‐being, 23.2% low well‐being and a further 22.6% very low well‐being. Of those experiencing positive effects, 945/960 (98%) provided an explanation. The three most common themes were ‘Family time’ (33%), ‘Work flexibility’ (29%) and ‘Calmer life’ (19%). A large proportion of participants reported positive effects resulting from changes to daily life due to the COVID‐19 pandemic in Australia. The needs of people living alone, and of those having to work outside the home or who are unemployed, should be considered by health policymakers and employers in future pandemic preparedness efforts.
Publisher: BMJ
Date: 09-2017
DOI: 10.1136/BMJOPEN-2017-016837
Abstract: Clinical training in the undergraduate medical course places multiple stressors on trainees, which have been held to lead to heightened distress, depression, suicide, substance misuse/abuse and poor mental health outcomes. To date, evidence for morbidity in trainees is largely derived from cross-sectional survey-based research. This limits the accuracy of estimates and the extent to which predispositional vulnerabilities (biological and/or psychological), contextual triggers and longer-term consequences can be validly identified. Longitudinal clinical assessments embedded within a biopsychosocial framework are needed before effective preventative and treatment strategies can be put in place. This study is an observational longitudinal cohort study of 330 students enrolled in the undergraduate medicine course at the University of New South Wales (UNSW) Sydney, Australia. Students will be recruited in their fourth year of study and undergo annual assessments for 4 consecutive years as they progress through increasingly demanding clinical training, including internship. Assessments will include clinical interviews for psychiatric morbidity, and self-report questionnaires to obtain health, psychosocial, performance and functioning information. Objective measures of cognitive performance, sleep/activity patterns as well as autonomic and immune function (via peripheral blood s les) will be obtained. These data will be used to determine the prevalence, incidence and severity of mental disorder, elucidate contextual and biological triggers and mechanisms underpinning psychopathology and examine the impact of psychopathology on performance and professional functioning. Ethics approval has been granted by the UNSW human research ethics committee (reference HC16340). The findings will be disseminated through peer-reviewed publications and conference presentations, and distributed to key stakeholders within the medical education sector. The outcomes will also inform targeted preventative and treatment strategies to enhance stress resilience in trainee doctors.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.BBI.2015.03.001
Abstract: Depression in the context of acute coronary syndrome (ACS) is understood to confer increased morbidity and mortality risk. The pathophysiological mechanisms underlying this association remain poorly understood, although several candidates including inflammation, cardiac autonomic dysregulation, and behavioural factors are viewed as of key importance. No single bio-behavioural explanatory model of ACS-associated depression has emerged, likely due the substantial heterogeneity across both conditions. We studied 344 patients with ACS 45 fulfilled diagnostic (DSM-IV) criteria for a major depressive episode occurring within 1-month of ACS, and 13 had ongoing major depression that pre-dated ACS and continued through to 1 month post-ACS. We employed two statistical methods (multinomial logistic regression and latent class analysis) and a range of immunological, autonomic and nutritional markers in an attempt to characterise a biological basis for ACS-associated depression. Regression modelling failed to accurately predict categorical group membership of ACS-associated depression. An alternative data-driven approach produced a three-class solution, with the derived classes differing on measure of C-reactive protein, vitamin D, omega-6:omega-3 ratio, heart rate variability, and age (all p⩽0.004). The majority of participants with ACS-associated and ongoing depression were members of the class characterised by the greatest biological disturbance. Patients with depression differed from those without depression on a range of psychological trait and state variables additionally reporting poorer sleep quality, higher levels of social isolation, and functional impairment, but had similar biological profiles. Patients with ongoing depression generally had higher scores on these psychological/behavioural measures. Our novel analytic approach identified a combination of biomarkers suggestive of a role for immune, autonomic, and nutritional pathways in the manifestation of depression during ACS, in the context of additional psychosocial and behavioural vulnerabilities. Further studies are required to confirm the causal role of these factors in perpetuating depression and increasing risk of poor-health outcomes.
Publisher: Springer Science and Business Media LLC
Date: 12-03-2021
DOI: 10.1038/S41430-021-00893-7
Abstract: To compare the Australian Dietary Guideline Index (DGI-2013) and the Pyramid-based Mediterranean Diet Score (pyrMDS) as measures of diet quality in an ethnically erse group of older men. Seven hundred and ninety-four older men aged ≥75 participated in wave 3 (2012-2013) of the Concord Health and Ageing in Men Project. Dietary intake was assessed using a validated diet history questionnaire. Ethnicity was based on self-reported country of birth and categorised as Australian-born (418 men), Italian or Greek migrants (188), and other migrants (188). Incident cardiovascular outcomes until March 2018 were measured using the composite of major adverse cardiovascular events (MACE), which comprises all-cause mortality, acute myocardial infarction, congestive cardiac failure, coronary revascularisation and/or ischaemic stroke. Ability to predict incident cardiovascular outcomes and all-cause mortality were compared between standardised DGI-2013 pyrMDS scores by comparison of hazard ratios, discrimination (Harrell's C-statistic) and calibration (calibration plots). Italian and Greek migrant men had significantly lower DGI-2013 scores (91.7 vs. 93.9 p = 0.01) but significantly higher pyrMDS scores (8.8 vs. 8.2 p < 0.0001) than Australian-born men. In the whole s le (794 men), the pyrMDS was a better predictor of both MACE (age-adjusted HR = 0.84 95% CI = 0.75-0.94 vs. HR = 0.92 95% CI = 0.82-1.03 for DGI-2013) and all-cause mortality (age-adjusted HR = 0.69 95% CI = 0.60-0.80 vs. HR = 0.86 95% CI = 0.74-0.99). The pyrMDS also demonstrated superior discrimination for predicting all-cause mortality and superior calibration for MACE and all-cause mortality. The DGI-2013 appears to underestimate diet quality in older Italian and Greek migrant men. The pyrMDS appears superior to the DGI-2013 for prediction of incident cardiovascular disease and mortality regardless of ethnic background.
Publisher: Elsevier BV
Date: 04-2021
Publisher: JMIR Publications Inc.
Date: 30-03-2021
DOI: 10.2196/28718
Publisher: SLACK, Inc.
Date: 07-2019
DOI: 10.3928/24748307-20190402-01
Abstract: Adult education targeting health literacy (HL) may bring added value in the form of improved health. This study evaluated the effects of a HL program as part of an adult education curriculum for adults with low literacy and numeracy. This was a partial-cluster randomized controlled trial among 308 adults enrolled in basic education programs in Australia. Of the 308 participants, 141 (46%) were randomized to either the standard program (language, literacy, and numeracy [LLN]), or the HL intervention (LLN with embedded health content) the remainder ( n = 167) were allocated to standard intervention programs by the education provider at the class level. The main outcomes were functional HL, self-reported confidence, patient activation, generic HL (ie, HLQ, health knowledge, and self-reported health behavior). Data were collected at baseline, immediately after, and at 6 months post-intervention. Of the 308 participants, 71% had limited literacy and 60% spoke a language other than English at home. Both interventions benefited participants, with improvements from baseline to immediate follow up on in idual-level functional HL (e.g., reading a thermometer HL group 18.4% vs. standard group 7.2% p = .001), confidence (HL group 0.34 vs. standard group 0.06 p = .014) and health literacy questionnaire (HLQ) subscales. At 6 months, improvements in confidence ( p .001) and some HLQ measures were retained. A consistent pattern of increased improvement in the HL program was observed compared to the standard program, although only some measures reached statistical significance: reading a food label (HL group 6.03/10 correct vs. standard group 5.49/10 correct p = .022) confidence ( p = .008) ability to actively manage health (HLQ) ( p = .017), and health knowledge at 6 months (HL group 68% vs. standard group 60% correct, p = .052). HL participants reported being more likely to share course information and rated the program more useful to understand their health. Improving language, literacy, and numeracy generally has potential public health benefits that are retained at 6 months. Integrating health content adds further value to adult basic learning, is feasible, and potentially scalable. [ HLRP: Health Literacy Research and Practice . 2019 (Suppl.):S42–S57.] We compared the effect of an adult education-based health literacy (HL) program versus a standard language, literacy, and numeracy program on students' HL skills and psychosocial outcomes. Although students in both trial arms improved their skills, students in the HL program had better outcomes with higher HL, greater confidence, and higher health knowledge scores at 6 months.
Publisher: Acoustical Society of America (ASA)
Date: 02-2012
DOI: 10.1121/1.3676605
Abstract: This study investigated whether the production of prosodic focus and phrasing contrasts was modified when interlocutors could only hear each other [auditory only (AO)], compared to when they could hear and see each other [face to face (FTF)]. The prosodic characteristics of utterances produced by six talkers were examined using both acoustic and perceptual measures (ratings of the degree of focus or clarity of the statement-question contrast). The acoustic measures showed a range of differences between narrow focus and between phrasing contrasts and some of these differences were greater in the AO setting than the FTF one. The listener’s ratings of focus and phrasing showed a clear difference between the AO and FTF conditions, with perceptual attributes of both narrow focus and echoic question phrasing being rated as clearer in the AO condition. To explain these results it is proposed that talkers compensate for the lack of visual prosodic cues in the AO condition by taking extra care (relative to FTF conditions) to ensure the effective transmission of prosodic cues.
Publisher: Frontiers Media SA
Date: 25-07-2022
DOI: 10.3389/FNEUR.2022.935442
Abstract: Prospective cohort studies following in iduals from acute infections have documented a prevalent post-infective fatigue state meeting diagnostic criteria for chronic fatigue syndrome (CFS) – that is, a post-infective fatigue syndrome (PIFS). The Dubbo Infection Outcomes Study (DIOS) was a prospective cohort following in iduals from acute infection with Epstein-Barr virus (EBV), Ross River virus (RRV), or Q fever through to assessment of caseness for CFS designated by physician and psychiatrist assessments at 6 months. Previous studies in DIOS have revealed that functional genetic polymorphisms in both immunological (pro- and anti-inflammatory cytokines) and neurological (the purinergic receptor, P2X7) genes are associated with both the severity of the acute infection and subsequent prolonged illness. Principal components analysis was applied to self-report data from DIOS to describe the severity and course of both the overall illness and concurrent mood disturbance. Associations between demographics and acute infection characteristics, with prolonged illness course as well as the PIFS outcome were examined using multivariable statistics. Genetic haplotype-driven functional variations in the neuropeptide Y (NPY) gene previously shown to be associated with brain responses to stress, and to trait anxiety were also examined as predictors. The s le included 484 subjects (51% female, median age 32, IQR 19–44), of whom 90 (19%) met diagnostic criteria for CFS at 6 months. Participants with greater overall illness severity and concurrent mood disturbance in the acute illness had a more prolonged illness severity (HR = 0.39, 95% CI: 0.34–0.46, p & 0.001) and mood disturbance (HR = 0.36, 95% CI: 0.30–0.42, p & 0.001), respectively. Baseline illness severity and RRV infection were associated with delayed recovery. Female gender and mood disturbance in the acute illness were associated with prolonged mood disturbance. Logistic regression showed that the odds of an in idual being diagnosed with PIFS increased with greater baseline illness severity (OR = 2.24, 95% CI: 1.71–2.94, p & 0.001). There was no association between the NPY haplotypes with overall illness severity or mood disturbance either during the acute illness phase or with prolonged illness ( p & 0.05). Severe acute infective illnesses predicted prolonged illness, prolonged mood disturbance and PIFS. These factors may facilitate early intervention to manage both PIFS and mood disturbances.
Publisher: SAGE Publications
Date: 28-07-2015
Abstract: To examine the evidence for shared pathophysiological pathways in acute coronary syndrome and major depression and to conceptualise the dynamic interplay of biological systems and signalling pathways that link acute coronary syndrome and depression within a framework of neuro-visceral integration. Relevant articles were sourced via a search of published literature from MEDLINE, EMBASE and PubMed using a variety of search terms relating to biological connections between acute coronary syndrome and depression. Additional articles from bibliographies of retrieved papers were assessed and included where relevant. Despite considerable research efforts, a clear understanding of the biological processes connecting acute coronary syndrome and depression has not been achieved. Shared abnormalities are evident across the immune, platelet/endothelial and autonomic/stress-response systems. From the available evidence, it seems unlikely that a single explanatory model could account for the complex interactions of biological pathways driving the pathophysiology of these disorders and their comorbidity. A broader conceptual framework of mind–body or neuro-visceral integration that can incorporate the existence of several causative scenarios may be more useful in directing future research and treatment approaches for acute coronary syndrome–associated depression.
Publisher: Cold Spring Harbor Laboratory
Date: 22-09-2021
DOI: 10.1101/2021.09.20.21263868
Abstract: Shared decision making is as an essential principle for cardiovascular disease (CVD) prevention, where asymptomatic people are considering lifelong medication and lifestyle changes. This project aimed to develop and evaluate the first literacy-sensitive CVD prevention decision aid (DA) developed for people with low health literacy, and investigate the impact of literacy-sensitive design and heart age. We developed the standard DA based on international standards. The literacy-sensitive version included simple language, supporting images, white space and a lifestyle action plan. A randomised trial included 859 people aged 45-74 using a 3 (DA: standard, literacy-sensitive, control) x 2 (heart age: heart age + percentage risk, percentage risk only) factorial design, with outcomes including prevention intentions/behaviours, gist/verbatim knowledge of risk, credibility, emotional response and decisional conflict. We iteratively improved the literacy-sensitive version based on end user testing interviews with 20 people with varying health literacy levels. Immediately post-intervention (n=859), there were no differences between the DA groups on any outcome. The heart age group was less likely to have a positive emotional response, perceived the message as less credible, and had higher gist/verbatim knowledge of heart age risk but not percentage risk. After 4 weeks (n=596), the DA groups had better gist knowledge of percentage risk than control. The literacy-sensitive decision aid group had higher fruit consumption, and the standard decision aid group had better verbatim knowledge of percentage risk. Verbatim knowledge was higher for heart age than percentage risk amongst those who received both. The literacy-sensitive DA resulted in increased knowledge and lifestyle change for participants with varying health literacy levels and CVD risk results. Adding heart age did not increase lifestyle change intentions or behaviour but did affect psychological outcomes, consistent with previous findings. Health Literacy, Cardiovascular Diseases, Decision Making (Shared), Life Style, Decision Support Techniques
Publisher: SAGE Publications
Date: 26-06-2018
Abstract: Medical training brings with it multiple stressors, including demanding workloads in highly competitive environments, with well-documented impact on psychiatric morbidity. This study evaluated the impact of sleep-related factors on psychological wellbeing, cognitive task performance and academic standing in medical students. A total of 59 undergraduate medical students took part in this cross-sectional study over two consecutive days. Participants responded to questionnaires about their physical and psychological health, sleep, functioning and academic performance at the initial visit. Participants then wore an ambulatory bioharness overnight (to derive heart rate variability measures), before returning to complete a computerised battery of cognitive tasks. A sleep diary was completed for the next 7 days. Poor sleep quality in the month preceding assessment correlated with psychological distress ( p < 0.001) and reduced nocturnal heart rate variability ( p = 0.007). Psychological distress also correlated with reduced nocturnal heart rate variability ( p = 0.031) and less refreshing sleep during the monitoring week ( p < 0.001), but not with sleep timing parameters. A greater increase in heart rate variability during the transition from awake to sleep significantly predicted better spontaneous cognitive performance ( p = 0.021). Better academic standing was predicted by consistently short, less refreshing sleep (all p < 0.001), along with earlier bedtimes ( p = 0.004) and greater psychological wellbeing ( p = 0.009). Unrefreshing, short-duration sleep and psychological distress are prevalent in medical students during university training and were associated with reduced nocturnal parasympathetic autonomic activity. Achieving higher academic grades was associated with high psychological wellbeing despite consistently short, unrefreshing sleep. The long-term repercussions of such sleep behaviours on later professional functioning remain unclear, warranting further research.
Publisher: Cold Spring Harbor Laboratory
Date: 05-06-2020
DOI: 10.1101/2020.06.03.20121814
Abstract: To explore the variation in understanding, attitudes and uptake of COVID-19 health advice during the 2020 pandemic lockdown by health literacy. National cross sectional community survey. Australian general public. Adults aged over 18 years (n = 4362). Knowledge, attitudes and behaviours related to COVID-19 health literacy and socio-demographic factors. People with inadequate health literacy had poorer understanding of COVID-19 symptoms (49% vs 68% p .001), were less able to identify behaviours to prevent infection (59% vs 72% p .001), and experienced more difficulty finding information and understanding government messaging about COVID-19 than people with adequate health literacy. They were less likely to rate social distancing as important (6.1 vs 6.5, p .001) and reported more difficulty remembering/accessing medication since lockdown (3.6 vs 2.7, p .001). Importantly there was higher endorsement of misinformation beliefs related to COVID-19 and vaccination in people with lower health literacy. Similar results were observed among people who primarily speak a language other than English at home. Our findings show important disparities by health literacy and language in COVID-19 related knowledge, attitudes and behaviours that have the potential to undermine efforts to reduce viral transmission and may lead to social inequalities in health outcomes in Australia. Those with the greatest burden of chronic disease are most disadvantaged, and most likely to experience severe disease and die from COVID-19. Addressing the health literacy needs of the community in public health messaging about COVID-19 must now be a priority in Australia.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Springer Science and Business Media LLC
Date: 06-04-2019
Publisher: Springer Science and Business Media LLC
Date: 04-05-2023
DOI: 10.1007/S11606-023-08213-4
Abstract: Primary care practitioners (PCPs) play a key role in cancer screening decisions for older adults (≥ 65 years), but recommendations vary by cancer type and jurisdiction. To examine the factors influencing PCPs’ recommendations for breast, cervical, prostate, and colorectal cancer screening for older adults. MEDLINE, Pre-Medline, EMBASE, PsycINFO, and CINAHL, searched from 1 January 2000 to July 2021, and citation searching in July 2022. Assessed factors influencing PCPs’ breast, prostate, colorectal, or cervical cancer screening decisions for older adults’ (defined either as ≥ 65 years or 10-year life expectancy). Two authors independently conducted data extraction and quality appraisal. Decisions were crosschecked and discussed where necessary. From 1926 records, 30 studies met inclusion criteria. Twenty were quantitative, nine were qualitative, and one used a mixed method design. Twenty-nine were conducted in the USA, and one in the UK. Factors were synthesized into six categories: patient demographic characteristics, patient health characteristics, patient and clinician psycho-social factors, clinician characteristics, and health system factors. Patient preference was most reported as influential across both quantitative and qualitative studies. Age, health status, and life expectancy were also commonly influential, but PCPs held nuanced views about life expectancy. Weighing benefits/harms was also commonly reported with variation across cancer screening types. Other factors included patient screening history, clinician attitudes ersonal experiences, patient rovider relationship, guidelines, reminders, and time. We could not conduct a meta-analysis due to variability in study designs and measurement. The vast majority of included studies were conducted in the USA. Although PCPs play a role in in idualizing cancer screening for older adults, multi-level interventions are needed to improve these decisions. Decision support should continue to be developed and implemented to support informed choice for older adults and assist PCPs to consistently provide evidence-based recommendations. PROSPERO CRD42021268219. NHMRC APP1113532.
Publisher: ISCA
Date: 26-09-2010
Publisher: JMIR Publications Inc.
Date: 10-12-2020
DOI: 10.2196/24531
Abstract: In response to the COVID-19 pandemic, telehealth has rapidly been adopted to deliver health care services around the world. To date, studies have not compared people’s experiences with telehealth services during the pandemic in Australia to their experiences with traditional in-person visits. This study aimed to compare participants’ perceptions of telehealth consults to their perceptions of traditional in-person visits and investigate whether people believe that telehealth services would be useful after the pandemic. A national, cross-sectional, community survey was conducted between June 5 and June 12, 2020 in Australia. In total, 1369 participants who were aged ≥18 years and lived in Australia were recruited via targeted advertisements on social media (ie, Facebook and Instagram). Participants responded to survey questions about their telehealth experience, which included a free-text response option. A generalized linear model was used to estimate the adjusted relative risks of having a poorer telehealth experience than a traditional in-person visit experience. Content analysis was performed to determine the reasons why telehealth experiences were worse than traditional in-person visit experiences. Of the 596 telehealth users, the majority of respondents (n=369, 61.9%) stated that their telehealth experience was “just as good as” or “better than” their traditional in-person medical appointment experience. On average, respondents perceived that telehealth would be moderately useful to very useful for medical appointments after the COVID-19 pandemic ends (mean 3.67, SD 1.1). Being male (P=.007), having a history of both depression and anxiety (P=.016), and lower patient activation scores (ie, in iduals’ willingness to take on the role of managing their health/health care) (P=.036) were significantly associated with a poor telehealth experience. In total, 6 overarching themes were identified from free-text responses for why participants’ telehealth experiences were poorer than their traditional in-person medical appointment experiences, as follows: communication is not as effective, limitations with technology, issues with obtaining prescriptions and pathology results, reduced confidence in their doctor, additional burden for complex care, and inability to be physically examined. Based on our s le’s responses, telehealth appointment experiences were comparable to traditional in-person medical appointment experiences. Telehealth may be worthwhile as a mode of health care delivery while the pandemic continues, and it may continue to be worthwhile after the pandemic.
Publisher: Elsevier BV
Date: 03-2021
Publisher: JMIR Publications Inc.
Date: 24-08-2220
Abstract: isinformation about COVID-19 is common and has been spreading rapidly across the globe through social media platforms and other information systems. Understanding what the public knows about COVID-19 and identifying beliefs based on misinformation can help shape effective public health communications to ensure efforts to reduce viral transmission are not undermined. his study aimed to investigate the prevalence and factors associated with COVID-19 misinformation in Australia and their changes over time. his prospective, longitudinal national survey was completed by adults (18 years and above) across April (n=4362), May (n=1882), and June (n=1369) 2020. tronger agreement with misinformation was associated with younger age, male gender, lower education level, and language other than English spoken at home ( i P /i & .01 for all). After controlling for these variables, misinformation beliefs were significantly associated ( i P /i & .001) with lower levels of digital health literacy, perceived threat of COVID-19, confidence in government, and trust in scientific institutions. Analyses of specific government-identified misinformation revealed 3 clusters: prevention (associated with male gender and younger age), causation (associated with lower education level and greater social disadvantage), and cure (associated with younger age). Lower institutional trust and greater rejection of official government accounts were associated with stronger agreement with COVID-19 misinformation. he findings of this study highlight important gaps in communication effectiveness, which must be addressed to ensure effective COVID-19 prevention.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.PEC.2019.03.022
Abstract: Limited ex les exist globally of coordinated, organisation-wide health literacy approaches to systematically improve the understandability and actionability of patient health information. Even fewer have been formally evaluated. The aim of this study was to use the Patient Education Materials Assessment Tool (PEMAT) to evaluate the effectiveness of an organisation-wide, evidence-based approach to improve the understandability and actionability of patient information materials in regional health service in New South Wales, Australia. Two independent raters (blinded to the document version) evaluated pre- and post-implementation versions of 50 randomly-selected patient information materials using the PEMAT, with differences in understandability and actionability analysed using paired s les tests. Mean (±SD) overall scores for understandability increased significantly by 5% (95% CI 2-8 p = 0.002) up to 77%±10%, and mean actionability (±SD) increased significantly by 4% (95% CI 0-8 p = 0.046) up to 56%±22%. These results demonstrate that organisation-wide approaches with standardised processes for staff to prepare, review and store written patient information and education materials can be successfully implemented to address the impacts and risks of low health literacy. The success of this approach provides a framework for other health organisations to work in partnership with patients to make health information more understandable and actionable.
Publisher: Cold Spring Harbor Laboratory
Date: 06-08-2020
DOI: 10.1101/2020.08.04.20168583
Abstract: To investigate prevalence of beliefs in COVID-19 misinformation and examine whether demographic, psychosocial and cognitive factors are associated with these beliefs, and how they change over time. Prospective national longitudinal community online survey. Australian general public. Adults aged over 18 years (n=4362 baseline/Wave 1 n=1882 Wave 2 n=1369 Wave 3). COVID-19 misinformation beliefs. Stronger agreement with misinformation beliefs was significantly associated with younger age, male gender, lower education, and primarily speaking a language other than English at home (all p .01). After controlling for these variables, misinformation beliefs were significantly associated (p .001) with lower digital health literacy, lower perceived threat of COVID-19, lower confidence in government, and lower trust in scientific institutions. The belief that the threat of COVID-19 is “greatly exaggerated” increased between Wave 1-2 (p=0.002), while belief that herd immunity benefits were being covered up decreased (p .001). Greatest support from a list of Australian Government identified myths was for those regarding ‘hot temperatures killing the virus’ (22%) and ‘Ibuprofen exacerbates COVID-19’ (13%). Lower institutional trust and greater rejection of official government accounts were associated with greater support for COVID-19 myths after controlling for sociodemographic variables. These findings highlight important gaps in communication effectiveness. Stronger endorsement of misinformation was associated with male gender, younger age, lower education and language other than English spoken at home. Misinformation can undermine public health efforts. Public health authorities must urgently target groups identified in this study when countering misinformation and seek ways to enhance public trust of experts, governments, and institutions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2017
Publisher: SAGE Publications
Date: 23-05-2020
Abstract: Mental health problems among medical students have been widely reported, but the predisposing and perpetuating factors and biological concomitants are poorly understood. Adopting a biopsychosocial approach, we studied well-being in a group of Australian medical students, focusing on sleep, autonomic and immune mechanisms, as well as mental, social and physical well-being, health-related behaviours, and daily functioning. Fourth-year medical students ( N = 151) completed comprehensive assessments, including laboratory-based and nocturnal autonomic monitoring via ambulatory bioharness, a psychiatric diagnostic interview, and questionnaires assessing sleep quality and psychosocial and physical well-being. A blood s le was taken to quantify the inflammatory marker C-reactive protein. Sleep, mood and activity was additionally monitored daily for 7 days. A sizable minority of students reported diminished physical, mental and psychosocial well-being. We also found concerning levels of sleep disturbance and social and occupational impairment in a subset of students. The strong co-occurrence of problems across symptom domains supported a biopsychosocial interdependence of health and well-being states. Maladaptive coping behaviours were apparent, notably hazardous alcohol consumption, which was associated with a clinically significant elevation in C-reactive protein levels ( 3 mg/L). We documented, for the first time, significantly diminished nocturnal heart rate variability in medical students with a mental health diagnosis. Nocturnal heart rate variability was strongly associated with sleep quality, daytime autonomic stress reactivity, as well as occupational and social functioning. Well-being is a multifaceted phenomenon firmly interlinked with sleep, autonomic and immune function, health behaviours and functional outcomes. Our novel findings supported a key role for nocturnal autonomic function in promoting sleep quality and mental well-being. Interventions could focus on sleep hygiene and health behaviours as a buffer for well-being and teach more adaptive strategies for coping with the stresses of medical training.
Publisher: Cold Spring Harbor Laboratory
Date: 26-10-2021
DOI: 10.1101/2021.10.25.21265503
Abstract: The current study examined patterns in COVID-19 testing and vaccination intentions across multiple language groups in Greater Western Sydney, Australia. Participants completed a cross-sectional survey available from March 21 to July 9, 2021 in Sydney, Australia. Surveys were available in English or translated (11 languages). Participants could complete surveys independently or with support from bilingual staff. Logistic regression models using post-stratification weighted frequencies identified factors associated with testing and vaccination intentions. Most of the 708 participants (88%, n=622) were not born in Australia 31% reported that they did not speak English well or at all (n=220) 70% had no tertiary qualifications (n=497) and 41% had inadequate health literacy (n=290). Most participants reported high testing intention (77.2%, n=546), with differences observed across language groups (p .001). The most frequently reported barrier to testing was concerns about infection at the clinic (26.1%). Half (53.0%) reported willingness to get a COVID-19 vaccine if recommended to them (n=375) 18% were unwilling (n=127), and the remainder unsure (29%, n=205). These proportions varied significantly by language group (p .001). Participants were more likely to be unwilling/hesitant if they were female (p=0.02) or did not use Australian commercial information sources (p=0.01). Concerns about side effects (30.4%, n=102) and safety (23.9%, n=80), were key reported barriers to vaccination. Different language groups have unique and specific needs to support uptake of COVID-19 testing and vaccination. Health services must work collaboratively with culturally and linguistically erse communities to provide tailored support to encourage COVID-19 testing and vaccination. 708 adults living in Sydney, Australia, who did not speak English as their main language at home took part in a survey about COVID-19 vaccination and testing. Participants could complete the survey online (English/translated) or with support from bilingual staff. The survey was available in 11 languages. Three quarters of participants (77%) reported they would get tested for COVID-19 if they had symptoms ‘no matter what.’ The most common barrier was concern about getting infected at the testing clinic. 53% of participants reported that they would get a COVID-19 vaccine if it was recommended to them. 18% reported that they wouldn’t get the vaccine, and 29% were unsure. The main barriers were concerns about vaccine side effects and safety. Intentions to get tested for COVID-19 or to get vaccinated varied significantly across language groups. Participants who were female, or who did not use Australian commercial information sources were more likely to be unwilling or unsure about getting a COVID-19 vaccine. Different language groups have unique and specific needs to support uptake of COVID-19 testing and vaccination. Health services must work collaboratively with culturally and linguistically erse communities to provide tailored support to encourage COVID-19 testing and vaccination.
Publisher: JMIR Publications Inc.
Date: 29-06-2023
DOI: 10.2196/40441
Abstract: Polymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia’s prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respiratory symptoms, and little was known about the drivers of and barriers to COVID-19 PCR testing as a novel behavior at that time. We aimed to identify and address COVID-19 testing barriers, and test the effectiveness of multiple eHealth interventions on knowledge for people with varying health literacy levels. The intervention was developed in 4 phases. Phase 1 was a national survey conducted in June 2020 (n=1369), in which testing barriers were coded using the capability-opportunity-motivation-behavior framework. Phase 2 was a national survey conducted in November 2020 (n=2034) to estimate the prevalence of testing barriers and health literacy disparities. Phase 3 was a randomized experiment testing health literacy–sensitive written information for a wide range of barriers between February and March 2021 (n=1314), in which participants chose their top 3 barriers to testing to view a tailored intervention. Phase 4 was a randomized experiment testing 2 audio-visual interventions addressing common testing barriers for people with lower health literacy in November 2021, targeting young adults as a key group endorsing misinformation (n=1527). In phase 1, barriers were identified in all 3 categories: capability (eg, understanding which symptoms to test for), opportunity (eg, not being able to access a PCR test), and motivation (eg, not believing the symptoms are those of COVID-19). Phase 2 identified knowledge gaps for people with lower versus higher health literacy. Phase 3 found no differences between the intervention (health literacy–sensitive text for top 3 barriers) and control groups. Phase 4 showed that a fact-based animation or a TikTok-style video presenting the same facts in a humorous style increased knowledge about COVID-19 testing compared with government information. However, no differences were found for COVID-19 testing intentions. This study identified a wide range of barriers to a novel testing behavior, PCR testing for COVID-19. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available. We showed that key capability barriers, such as knowledge gaps, can be improved with simple videos targeting people with lower health literacy. Additional behavior change strategies are required to address motivational issues to support testing uptake. Future research will explore health literacy strategies in the current context of self-administered rapid antigen tests. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviors are required. Australian New Zealand Clinical Trials Registry ACTRN12621000876897, www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318 Australian New Zealand Clinical Trials Registry ACTRN12620001355965, www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380916& isReview=true
Publisher: SAGE Publications
Date: 07-09-2001
DOI: 10.1177/09691413221125320
Abstract: Controversy surrounding recommendations for supplemental screening (ultrasound and magnetic resonance screening) in women with dense breasts exists, as the long-term benefits from these additional modalities may not outweigh the harms. This study aimed to examine factors associated with supplemental screening intentions following a hypothetical breast density notification in a population of women who have not been routinely notified. Australian women of breast screening age participated in an online randomised experimental study where they were presented with one of two breast density notifications (with or without health literacy-sensitive information) and asked their screening intentions. After adjusting for covariates in multivariable analyses, women in both groups (n = 940) who indicated higher levels of breast cancer worry, had private health insurance, had a family history of breast cancer, and had a greater number of times previously attending mammography screening had higher intentions for supplemental screening. Understanding women's supplemental screening intentions following notification of dense breasts has important implications for health systems with breast screening considering the impacts of widespread notification. Personal, clinical and psychological factors should be considered when discussing both the benefits and harms of supplemental screening with women with dense breasts.
Publisher: Wiley
Date: 08-07-2023
DOI: 10.1002/JCLP.23410
Abstract: People with depression experience barriers to seeking professional help. Different diagnostic terminology can influence people's treatment/management preferences. The aim of this study was to investigate how alternative depression diagnostic labels and recommendations impact help‐seeking intentions and psychosocial outcomes. Participants (18–70 years) were recruited using an online panel (Australia) to complete a randomized controlled trial. They read a hypothetical scenario where they discussed experiencing depressive symptoms with their GP and were randomized to receive one of four diagnoses (“depression,” “burnout,” “functional impairment syndrome” [fictitious label], no label [control]), and one of two follow‐up recommendations (“clinical psychologist,” “mind coach”). Primary outcome: help‐seeking intention (5‐point scale, higher = greater intention) secondary outcomes: intention to speak to boss, self‐stigma, worry, perceived severity, illness perceptions, and personal stigma. A total of 676 participants completed the survey. There was no main effect of diagnostic label on help‐seeking intention or stigma outcomes. Intention to speak to a boss was higher with the depression compared to burnout label (MD = 0.40, 95% CI: 0.14–0.66) and perceived severity was higher with the depression label compared to control (MD = 0.48, 95% CI: 0.22–0.74) and all other labels. Those who received the “clinical psychologist” recommendation reported higher help‐seeking intention (MD = 0.43, 95% CI: 0.25–0.60) and treatment control (MD = 0.69, 95% CI: 0.29–1.10) compared to the “mind coach” recommendation. Findings highlight the success of efforts to promote help‐seeking from clinical psychologists for depression. If burnout is considered a separate diagnostic entity to depression, greater awareness around what such a diagnosis means may be needed. Future research should examine how different terminologies surrounding other mental health conditions impact help‐seeking and stigma.
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.COGNITION.2011.11.013
Abstract: Prosody can be expressed not only by modification to the timing, stress and intonation of auditory speech but also by modifying visual speech. Studies have shown that the production of visual cues to prosody is highly variable (both within and across speakers), however behavioural studies have shown that perceivers can effectively use such visual cues. The latter result suggests that people are sensitive to the type of prosody expressed despite cue variability. The current study investigated the extent to which perceivers can match visual cues to prosody from different speakers and from different face regions. Participants were presented two pairs of sentences (consisting of the same segmental content) and were required to decide which pair had the same prosody. Experiment 1 tested visual and auditory cues from the same speaker and Experiment 2 from different speakers. Experiment 3 used visual cues from the upper and the lower face of the same talker and Experiment 4 from different speakers. The results showed that perceivers could accurately match prosody even when signals were produced by different speakers. Furthermore, perceivers were able to match the prosodic cues both within and across modalities regardless of the face area presented. This ability to match prosody from very different visual cues suggests that perceivers cope with variation in the production of visual prosody by flexibly mapping specific tokens to abstract prosodic types.
Publisher: Elsevier BV
Date: 08-2022
Publisher: American Medical Association (AMA)
Date: 08-11-2021
Publisher: MDPI AG
Date: 25-07-2022
Abstract: Background: There is a lack of evidence around Australian general practitioners’ (GPs) views of issues surrounding breast density. The current study aimed to quantitatively assess GPs’ current knowledge, understanding, and feelings around breast density information and notification. Methods: This study involved a cross-sectional survey using an online platform to collect quantitative data from Australian GPs. Survey data were analysed with descriptive statistics. Results: A total 60 responses from GPs were analysed. Most (n = 58 97%) had heard or read about breast density and nearly 90% (n = 52 87%) have had discussions about breast density with patients. Three-quarters (n = 45 75%) were supportive of making breast density notification mandatory for patients with dense tissue and a similar proportion (n = 45/58 78%) felt they need or want more education on breast density. Conclusions: There is strong support for notifying patients of breast density, and interest in further education and training among the surveyed GPs. As GPs play a central role in cancer prevention and control, their involvement in discussions related to breast density notification, evaluation and appraisal of evidence, development of communication strategies, and participation in ongoing research on the topic will be indispensable.
Publisher: Public Library of Science (PLoS)
Date: 03-11-2020
Publisher: BMJ
Date: 05-2022
DOI: 10.1136/BMJOPEN-2021-058323
Abstract: To explore the psychological, social and financial outcomes of COVID-19—and the sociodemographic predictors of those outcomes—among culturally and linguistically erse communities in Sydney, Australia. Cross-sectional survey informed by the Framework for Culturally Competent Health Research conducted between March and July 2021. Participants who primarily speak a language other than English at home were recruited from Greater Western Sydney, New South Wales. 708 community members (mean age: 45.4 years (range 18–91)). 88% (n=622) were born outside of Australia, 31% (n=220) did not speak English well or at all, and 41% (n=290) had inadequate health literacy. Thirteen items regarding COVID-19-related psychological, social and financial outcomes were adapted from validated scales, previous surveys or co-designed in partnership with Multicultural Health and interpreter service staff. Logistic regression models (using poststratification weighted frequencies) were used to identify sociodemographic predictors of outcomes. Surveys were available in English or translated (11 languages). In this analysis, conducted prior to the 2021 COVID-19 outbreak in Sydney, 25% of the s le reported feeling nervous or stressed most/all of the time and 22% felt lonely or alone most/all of the time. A quarter of participants reported negative impacts on their spousal relationships as a result of COVID-19 and most parents reported that their children were less active (64%), had more screen time (63%) and were finding school harder (45%). Mean financial burden was 2.9/5 (95% CI 2.8 to 2.9). Regression analyses consistently showed more negative outcomes for those with comorbidities and differences across language groups. Culturally and linguistically erse communities experience significant psychological, social and financial impacts of COVID-19. A whole-of-government approach is needed to support rapid co-design of culturally safe support packages in response to COVID-19 and other national health emergencies, tailored appropriately to specific language groups and accounting for pre-existing health disparities.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2021
DOI: 10.1161/CIRCOUTCOMES.120.007160
Abstract: Recent US guidelines lowered the threshold for diagnosing hypertension while other international guidelines use alternative/no labels for the same group (blood pressure [BP], /90 mm Hg). We investigated potential benefits and harms of hypertension and high-normal BP labels, compared with control, among people at lower risk of cardiovascular disease. We conducted a randomized experiment using a national s le of Australians (n=1318) 40 to 50 years of age recruited from an online panel. Participants were randomized to 1 of 3 hypothetical scenarios where a general practitioner told them they had a BP reading of 135/85 mm Hg, using either hypertension/high-normal BP/control (general BP description) labels. Participants were then randomized to receive an additional absolute risk description or nothing. Primary outcomes were willingness to change diet and worry. Secondary outcomes included exercise/medication intentions, risk perceptions, and other psychosocial outcomes. There was no difference in willingness to change diet across label groups ( P =0.22). The hypertension label (mean difference [MD], 0.74 [95% CI, 0.41–1.06] P .001) and high-normal BP label (MD, 0.45 [95% CI, 0.12–0.78] P =0.008) had increased worry about cardiovascular disease risk compared with control. There was no evidence that either label increased willingness to exercise ( P =0.80). However, the hypertension (MD, 0.20 [95% CI, 0.04–0.36] P =0.014), but not high-normal label (MD, 0.06 [95% CI, −0.10 to 0.21] P =0.49), increased willingness to accept BP-lowering medication compared with control. Psychosocial differences including lower control, higher risk perceptions, and more negative affect were found for the hypertension and high-normal labels compared with control. Providing absolute risk information decreased willingness to change diet (MD, 0.25 [95% CI, 0.10–0.41] P =0.001) and increase exercise (MD, 0.28 [95% CI, 0.11–0.45] P =0.001) in the hypertension group. Neither hypertension nor high-normal labels motivated participants to change their diet or exercise more than control, but both labels had adverse psychosocial outcomes. Labeling people with systolic BP of 130 to 140 mm Hg, who are otherwise at low risk of cardiovascular disease, may cause harms that outweigh benefit. URL: www.anzctr.org.au/ Unique identifier: ACTRN12618001700224.
Publisher: Cold Spring Harbor Laboratory
Date: 14-10-2020
DOI: 10.1101/2020.10.12.20211722
Abstract: It is unclear how people with hypertension are responding to the COVID-19 pandemic given their increased risk, and whether targeted public health strategies are needed. This retrospective case-control study compared people with hypertension to matched healthy controls during COVID-19 lockdown, to determine whether they have higher risk perceptions, anxiety and prevention intentions. Baseline data from a national survey were collected in April 2020 during COVID-19 lockdown. Of 4362 baseline participants, 466 people reported hypertension with no other chronic conditions, and were randomly matched to healthy controls with similar age, gender, education and health literacy. A subset (n=1369) was followed-up at 2 months after restrictions eased, including 147 participants with hypertension only. Risk perceptions, prevention intentions and anxiety were measured. At baseline, perceived seriousness was high for both hypertension and control groups. The hypertension group had higher anxiety than controls and were more willing to have the influenza vaccine. At follow-up, these differences were no longer present in the longitudinal sub-s le. Perceived seriousness and anxiety had decreased, but vaccine intentions for both influenza and COVID-19 remained high ( %). Anxiety was above normal levels during the COVID-19 lockdown. This was higher in the hypertension group, who also had higher vaccination intentions. Locations with prolonged restrictions may require targeted mental health screening for vulnerable groups. Despite a decrease in perceived risk and anxiety after 2 months of lockdown restrictions, vaccination intentions for both influenza and COVID-19 remained high, which is encouraging for future prevention of COVID-19.
Publisher: Springer Science and Business Media LLC
Date: 03-10-2023
Publisher: Cold Spring Harbor Laboratory
Date: 21-01-2022
DOI: 10.1101/2022.01.17.22269450
Abstract: Recent observational studies have suggested that vaccines for the omicron variant of SARS-Cov2 may have little or no effect in preventing infection. However, the observed effects may be confounded by patient factors and preventive behaviours or vaccine-related differences in testing behaviour. To assess the potential degree of confounding, we aimed to estimate differences in testing behaviour between unvaccinated and vaccinated populations. We recruited 1,526 Australian adults for an online randomised study about COVID testing between October and November 2021, and collected self-reported vaccination status and three measures of COVID-19 testing behaviour. We examined the association between testing intentions and vaccination status in the cross-sectional baseline data of this trial. Of the 1,526 participants (mean age 31 years): 22% had a COVID-19 test in the past month and 61% ever 17% were unvaccinated, 11% were partially vaccinated (1 dose), 71% were fully vaccinated (2+ doses). Fully vaccinated participants were twice as likely (RR 2.2 95% CI 1.8 to 2.8) to report positive COVID testing intentions than those who were unvaccinated (p .001). Partially vaccinated participants had less positive intentions than those fully vaccinated (p .001) but higher intentions than those who were unvaccinated (p=.002). For all three measures vaccination predicted greater COVID testing intentions. If the unvaccinated tested at half the rate of the vaccinated, a true vaccine effectiveness of 30% could appear to be a “negative” observed vaccine effectiveness of -40%. Assessing vaccine effectiveness should use methods to account for differential testing behaviours. Test negative designs are currently the preferred option, but its assumptions should be more thoroughly examined.
Publisher: MDPI AG
Date: 06-08-2019
DOI: 10.3390/NU11081810
Abstract: Introduction: Hepatic encephalopathy (HE) is common in patients with cirrhosis and is characterised by reduced hepatic ammonia clearance. This is accompanied by alterations in gut bacteria that may be ameliorated with synbiotics (pro- and prebiotics). Branched chain amino acids (BCAAs) are thought to have a role in the detoxification of ammonia. We investigated the effects of the administration of synbiotics and/or BCAAs in treating HE. Methods: Participants with overt HE were randomised in a blinded placebo-controlled study to receive synbiotics, BCAAs, or a combination of BCAAs and Synbiotics. Relevant biochemical and nutritional data and depression and anxiety scores (DASS-21) were collected at entry, 4 weeks, and on completion, at 8 weeks. The Trail Making Test (TMT) and Inhibitory Control Test (ICT) were used to assess cognitive function in patients withHE. Results were analysed using linear mixed effects regression analyses. Results: Sixty-one participants were enrolled and 49 who returned for at least 1 follow-up review were included in the intention to treat analysis. The mean age was 55.8 ± 6.1 years and 86% were males. Despite evidence of a placebo effect, there was significant improvement in TMT B and ICT weighted lures in participants who received combined synbiotics/BCAAs treatment compared to placebo at study completion (p ≤ 0.05). Cognitive improvement occurred without a significant change in ammonia levels. Conclusion: To our knowledge, this is the first study reporting that combined synbiotics and BCAAs improve HE, and that may be beneficial in the management of HE. A larger study is needed to confirm these results.
Publisher: BMJ
Date: 08-2020
DOI: 10.1136/SEXTRANS-2019-054098
Abstract: Gay, bisexual and other men who have sex with men (GBMSM), particularly HIV-positive GBMSM, are at increased anal cancer risk compared with the general population. This study examined the psychological and quality of life (QoL) impact of receiving abnormal anal cancer screening results during the baseline visit of the Study of the Prevention of Anal Cancer (SPANC). SPANC was a prospective cohort study of the natural history of anal human papillomavirus (HPV) and associated abnormalities in GBM aged 35 years and over. Participants completed questionnaires including aspects of health-related QoL (HR-QoL) and psychosocial functioning at baseline. Participants underwent procedures including an anal swab for cytology, and high-resolution anoscopy with biopsy of any possibly HPV-related abnormality. Questionnaires were readministered 2 weeks and 3 months after participants were given cytology and histology results. Perceived test result served as the study factor. Participants with perceived abnormal results (n=232) reported poorer HR-QoL (mean difference=1.8 p=0.004) and lower utility-based QoL (mean difference=0.02 p=0.018) 2 weeks after screening than in iduals with perceived normal results (n=268). These differences did not persist at 3-month follow-up. A greater proportion of participants who perceived their results as abnormal reported feeling worse than usual about their anal health and anal cancer fear (p’s .001), experienced more intrusive thoughts about their results (p’s≤0.006) and felt more likely to develop cancer than other gay men their age (p’s≤0.025) at both time points than those with perceived normal results. Providing abnormal results may cause psychological distress and impact HR-QoL, with sustained intrusive thoughts, increased cancer worry and perceived cancer risk. The potential for psychological harm needs to be considered when implementing anal cancer screening programmes.
Publisher: BMJ
Date: 11-2019
DOI: 10.1136/BMJOPEN-2019-033126
Abstract: Choosing Wisely, an international effort to reduce low value care worldwide, considers communication between clinicians and patients during routine clinical encounters a key mechanism for change. In Australia, Choosing Wisely has developed a 5 Questions resource to facilitate better conversations. The primary aim of this study is to evaluate the impact of the Choosing Wisely Australia 5 Questions resource and a video designed to prepare patients for question-asking and participation in shared decision-making on (a) self-efficacy to ask questions and participate in shared decision-making, (b) intention to participate in shared decision-making and (c) a range of secondary outcomes. The secondary aim of this study is to determine whether participants’ health literacy modifies the effects of the interventions. We will use 2×2×2 between-subjects factorial design (preparation video: yes, no × Choosing Wisely 5 Questions resource: yes, no × health literacy: adequate, inadequate). Participants will be recruited by an online market research company, presented with a hypothetical non-specific low back pain scenario, and randomised to study groups stratified by health literacy. Quantitative primary and secondary outcome data will be analysed as intention-to-treat using appropriate regression models (ie, linear regression for continuous outcomes, logistic regression for dichotomous categorical outcomes). Ethical approval for this study was obtained from the University of Sydney Human Research Ethics Committee (protocol number: 2018/965). The results from this work will be disseminated through peer-reviewed international journals, conferences and updates with collaborating public health bodies. Resources developed for this study will be made available to patients and clinicians following trial completion. This trial has been registered with the Australia New Zealand Clinical Trials Registry (trial number: 376477) and the stage is Pre-results.
Publisher: JMIR Publications Inc.
Date: 14-12-2020
Abstract: t is unclear how people with hypertension are responding to the COVID-19 pandemic given their increased risk, and whether targeted public health strategies are needed. his retrospective case-control study compared people with hypertension to matched healthy controls during the COVID-19 lockdown to determine whether they have higher risk perceptions, anxiety, and vaccination intentions. aseline data from a national survey were collected in April 2020 during the COVID-19 lockdown in Australia. People who reported hypertension with no other chronic conditions were randomly matched to healthy controls of similar age, gender, education, and health literacy level. A subset including participants with hypertension was followed up at 2 months after restrictions were eased. Risk perceptions, anxiety, and vaccination intentions were measured in April and June. f the 4362 baseline participants, 466 (10.7%) reported hypertension with no other chronic conditions. A subset of 1369 people were followed up at 2 months, which included 147 (10.7%) participants with hypertension. At baseline, perceived seriousness was high for both hypertension and control groups. The hypertension group reported greater anxiety compared to the controls and were more willing to vaccinate against influenza, but COVID-19 vaccination intentions were similar. At follow-up, these differences were no longer present in the longitudinal subs le. Perceived seriousness and anxiety had decreased, but vaccination intentions for both influenza and COVID-19 remained high across groups (& %). nxiety was above normal levels during the COVID-19 lockdown. It was higher in the hypertension group, which also had higher vaccination intentions. Groups that are more vulnerable to COVID-19 may require targeted mental health screening during periods of greater risk. Despite a decrease in perceived risk and anxiety after 2 months of lockdown restrictions, vaccination intentions remained high, which is encouraging for the future prevention of COVID-19. >
Publisher: Oxford University Press (OUP)
Date: 20-01-2021
Abstract: The acute sickness response to infection is a stereotyped set of illness manifestations initiated by proinflammatory signals in the periphery but mediated centrally. P2RX7 is a highly polymorphic gene encoding an ATP-gated cationic pore, widely expressed on immune cells and the brain, and regulating the NLRP3 inflammasome, as well as erse neural functions. Associations between P2RX7 genotype, pore activity, and illness manifestations were examined in a cohort with acute viral and bacterial infections (n = 484). Genotyping of 12 P2RX7 function-modifying single-nucleotide polymorphisms (SNPs) was used to identify haplotypes and diplotypes. Leucocyte pore activity was measured by uptake of the fluorescent dye, YO-PRO-1, and by ATP-induced interleukin-1β (IL-1β) release. Associations were sought with scores describing the symptom domains, or endophenotypes, derived from principal components analysis. Among the 12 SNPs, a 4-SNP haplotype block with 5 variants was found in 99.5% of the subjects. These haplotypes and diplotypes were closely associated with variations in pore activity and IL-1β production. Homozygous diplotypes were associated with overall illness severity as well as fatigue, pain, and mood disturbances. P2RX7 signaling plays a significant role in the acute sickness response to infection, likely acting in both the immune system and the brain.
Publisher: SAGE Publications
Date: 21-10-2019
Abstract: Given the fundamental emotional, social and physical development that occurs during the early years of life, childhood experiences are formative in shaping a person’s life trajectory. Childhood trauma is a prevalent, multifaceted issue with well-documented long-term adverse health effects in clinical populations however the impact of childhood trauma in the community is less clear. To address this, this study investigated how childhood trauma may impact physical and psychological health, sleep quality and autonomic function in a non-clinical community s le of adults. Participants completed questionnaires, an in-laboratory autonomic assessment (including stress reactivity to mental and physical stressors) and overnight autonomic and sleep monitoring. Overall childhood trauma and its subtypes (e.g. physical abuse, emotional neglect) were defined using the Childhood Trauma Questionnaire. We identified 22 childhood trauma cases (total score 36) and, of the 89 non-childhood trauma cases, some in iduals also experienced significant levels of trauma in one or more of the childhood trauma subtypes. Childhood trauma and some trauma subtypes were significantly correlated with a myriad of negative physiological and physical health outcomes including elevated psychological distress, increased sleep disturbances, reduced emotional wellbeing and lower perceived social support. Autonomic dysregulation was found in those with high levels of childhood trauma, which was reflected in an increased stress response to laboratory tasks. Notably, the experience of physical abuse in childhood was significantly associated with alterations in nocturnal heart rate and heart rate variability. Together, these results highlight that childhood trauma can have lasting detrimental consequences on an in idual’s emotional and physical health, sleep quality and stress reactivity.
Publisher: Cold Spring Harbor Laboratory
Date: 25-10-2021
DOI: 10.1101/2021.10.24.21265451
Abstract: Little is known about COVID-19 information-seeking experiences for culturally and linguistically erse groups in Australia. Participants were recruited using a cross-sectional survey from March 21 to July 9, 2021, translated into 11 languages, and with supporting bilingual staff. Linear regression models identified factors associated with difficulty finding easy-to-understand COVID-19 information. Across 708 participants (88% born overseas, 31% poor English proficiency), difficulty finding easy-to-understand COVID-19 information was rated 4.13 for English materials (95%CI: 3.85 to 4.41) and 4.36 for translated materials (95%CI: 4.07 to 4.66) (1 easy to 10 hard). Participants who were older (p .001), had inadequate health literacy (Mean Difference (MD)=-1.43, 95%CI -2.03 to - 0.82, p .001), or poor English proficiency (MD=-1.9, 95%CI-2.51 to -1.29, p .001) found it harder to find easy-to-understand English-language COVID-19 information. Those who had greater difficulty finding easy-to-understand translated COVID-19 information were younger (p=0.004), had poor English proficiency (MD=-1.61, 95%CI -2.29 to -0.9, p .001), university education (MD=0.77, 95%CI 0.00 to 1.53, p=0.05), and had spent longer living in Australia (p=0.001). They were more likely to rely on friends and family for COVID-19 information (p=0.02). There was significant variation in information-seeking experiences across language groups (p’s .001). Easy-to-understand and accessible COVID-19 information is needed to meet the needs of people in culturally and linguistically erse communities. This approach should involve working alongside these communities to tailor messages and leverage existing communication channels.
Publisher: Public Library of Science (PLoS)
Date: 29-06-2021
DOI: 10.1371/JOURNAL.PONE.0253930
Abstract: In Australia in March 2020 a national public health directive required that non-essential workers stay at home, except for essential activities. These restrictions began easing in May 2020 as community transmission slowed. This study investigated changes in COVID prevention behaviours from April-July 2020, and psychosocial predictors of these behaviours. An Australia-wide (national) survey was conducted in April, with monthly follow-up over four months. Participants who were adults (18+ years), currently residing in Australia and who could read and understand English were eligible. Recruitment was via online social media. Analysis s le included those who provided responses to the baseline survey (April) and at least one subsequent follow-up survey (N = 1834 out of a possible 3216 who completed the April survey). 71.7% of the s le was female (n = 1,322). Principal components analysis (PCA) combined self-reported adherence across seven prevention behaviours. PCA identified two behaviour types: ‘distancing’ (e.g. staying 1.5m away) and ‘hygiene’ (e.g. washing hands), explaining 28.3% and 24.2% of variance, respectively. Distancing and hygiene behaviours were analysed in idually using multivariable regression models. On average, participants agreed with statements of adherence for all behaviours (means all above 4 out of 7). Distancing behaviours declined each month (p’s .001), whereas hygiene behaviours remained relatively stable. For distancing, stronger perceptions of societal risk, self-efficacy to maintain distancing, and greater perceived social obligation at baseline were associated with adherence in June and July (p’s .05). For hygiene, the only significant correlate of adherence in June and July was belief that one’s actions could prevent infection of family members (p .001). High adherence to COVID prevention behaviours were reported in this social media s le however, distancing behaviours tended to decrease over time. Belief in social responsibility may be an important aspect to consider in encouraging distancing behaviours. These findings have implications for managing a shift from government-imposed restrictions to in idual responsibility.
Publisher: MDPI AG
Date: 19-12-2019
Abstract: This study assessed the impact of the Chronic Disease Self-Management Program (CDSMP) on different domains of health literacy using a pre-post study design. Participants aged over 16 years and with one or more self-reported chronic diseases were recruited for the CDSMP in western Sydney (a highly erse area of New South Wales, Australia) between October 2014 and September 2018. Health literacy was assessed pre- and immediately post-intervention using the Health Literacy Questionnaire (HLQ), with differences in mean scores for each HLQ domain analysed using paired s le t-tests. A total of 486 participants were recruited into the CDSMP. Of those, 316 (65.0%) completed both pre- and post-intervention surveys and were included in the analysis. The median age of the participants was 68 years, the majority were female (62.5%), and most were born in a country other than Australia (80.6%). There were statistically significant (P 0.001) improvements across all nine domains of the HLQ. This is the first study evaluating the potential impact of the CDSMP on improving different domains of health literacy amongst a erse s le of participants with chronic diseases using a multi-dimensional instrument. The absence of a control population in this study warrants caution when interpreting the results.
Publisher: Cold Spring Harbor Laboratory
Date: 07-02-2022
DOI: 10.1101/2022.02.05.22270416
Abstract: To provide an overview of Australian residential aged care facilities’ (RACFs’) COVID-19 outbreak preparedness and responses, 12 months after the pandemic began in early 2020. A cross-sectional survey of RACF managers was conducted as part of an overview of COVID-19 experience during 2020. Survey questions were based on findings of previous outbreak reviews. Comparison with available data from the Australian Institute for Health and Welfare suggested that survey respondents (n=331) were a representative s le. Almost all RACFs had outbreak management plans, including provision for a surge workforce. However, anticipated staff replacements fell short of those often required during outbreaks. Staff of most (83%) RACFs had completed online infection control training, and a smaller proportion (73%) face-to-face training, by the time of the survey. Exploratory analyses to identify RACF characteristics associated with increased outbreak risk found a strong association with location in Victoria (adjusted risk ratio [aRR] 12.8) where most community transmission occurred during 2020. The only other association was an increased risk in facilities where all staff had not completed face-to-face infection control training (aRR 2.1). Respondents ranked leadership and management planning and preparation and infection control as the top three of seven critical lines of defence against COVID-19. Survey results suggest that, in early 2021, most Australian RACFs were better prepared for the ongoing risk of COVID-19 than in 2020. Continued implementation of the Aged Care Royal Commission’s recommendations is needed to ensure the aged care sector is prepared for future infectious disease emergencies.
Publisher: Wiley
Date: 23-08-2018
DOI: 10.1111/APT.14950
Abstract: Painful muscle cr s occur in the majority of patients with cirrhosis impacting significantly on quality of life and sleep patterns. They are frequently unrecognised or overlooked. Current management is based on anecdotal evidence or case study reports. To investigate the effect of oral taurine supplementation on frequency, duration, and intensity of muscle cr s in patients with chronic liver disease. Patients with chronic liver disease who experienced three or more muscle cr s/week were enrolled in a double-blinded, randomised control, crossover, taurine dose-variable study. Each participant received either taurine supplementation or placebo for 4 weeks then crossed to the alternative arm. Primary outcome data for frequency, duration, and intensity of muscle cr s was recorded by participants. Participants recorded frequency, duration, and location of muscle cr s. Biochemical parameters, including serum taurine and methionine levels, were measured at each time point. Linear mixed models were used to analyse outcomes. Forty-nine patients were enrolled in the study and 30 patients completed the protocol. Participants who were unable to complete the protocol were not included in the final analysis due to the absence of outcome data. The mean age of participants was 54.7 years and 70% were males. Oral taurine supplementation increased serum taurine levels (P < 0.001). There were no adverse side effects associated with taurine supplementation. Participants receiving 2 g taurine/d experienced a reduction in cr frequency (seven cr s fewer/fortnight, P = 0.03), duration (89 minutes less/fortnight P = 0.03), and severity (1.4 units less on a Likert scale P < 0.004) compared to placebo. Oral supplementation with 2 g taurine/d results in a clinically significant reduction in the frequency, duration, and intensity of muscle cr s in patients with chronic liver disease. Taurine should be considered as a safe and effective intervention in the management of muscle cr s in in iduals with chronic liver disease. This study was registered with the Australian New Zealand Clinical Trials Register: ACTRN12612000289819.
Publisher: Mary Ann Liebert Inc
Date: 12-2022
Publisher: Cold Spring Harbor Laboratory
Date: 28-08-2021
DOI: 10.1101/2021.08.26.21262649
Abstract: COVID-19 testing and contact tracing has been crucial in Australia’s prevention strategy. However, testing for COVID-19 is far from optimal, and behavioural barriers are unknown. Study 1 aimed to identify the range of barriers to testing. Study 2 aimed to estimate prevalence in a nationally relevant s le to target interventions. Study 1: National longitudinal COVID-19 survey from April-November 2020. Testing barriers were included in the June survey (n=1369). Open responses were coded using the COM-B framework (capability-opportunity-motivation). Study 2: Barriers from Study 1 were presented to a new nationally representative s le in November to estimate prevalence (n=2869). Barrier prevalence was analysed by health literacy level using Chi square tests. Study 1: 49% strongly agreed to get tested for symptoms, and 69% would self-isolate. Concern about pain was the top barrier from a provided list (11%), but 32 additional barriers were identified from open responses and coded to the COM-B framework. Study 2: The most prevalent barriers were motivation issues (e.g. don’t believe symptoms are COVID-19: 28%, few local cases: 18%). Capability issues were also common (e.g. not sure symptoms are bad enough: 19%, not sure whether symptoms need testing: 15%). Many barriers were more prevalent amongst people with low compared to high health literacy, including motivation (preference to self isolate: 21% vs 12%, pain: 15% vs 9%) and capability (not sure symptom needs testing: 12% vs 8%, not sure how to test:11% vs 4%). Even in a health system with free and widespread access to COVID-19 testing, motivation and capability barriers were prevalent issues, particularly for people with lower health literacy. This study highlights the important of diagnosing behaviour barriers to target public health interventions for COVID-19 and future pandemics.
Publisher: CSIRO Publishing
Date: 30-09-2021
DOI: 10.1071/PY21165
Abstract: Limited studies at the beginning of the COVID-19 pandemic found GPs have been negatively affected by increased workload, reduced income and major concerns about staff and patient safety. This study aimed to investigate the challenges of COVID-19 in general practice 1 year since it was declared a pandemic. A national cross-sectional online survey was conducted in March 2021 of a convenience s le of 295 Australian GPs attending an online educational webcast. Twenty-five multipart and free-text questions collected information regarding GPs’ main COVID-19-related issues and concerns, including COVID-19 vaccines, useful sources of information, information needs and their perceived role as GPs in COVID-19 management. Descriptive statistics were calculated for all quantitative variables. Content analysis was used to analyse text data from open-ended questions. Of the 596 eligible attendees of the online educational webcast, 295 completed the survey (49.5% response rate). One year since COVID-19 was declared a pandemic, GPs still have concerns regarding patients ignoring prescreening and presenting with flu-like symptoms, the safety of their colleagues and family and catching COVID-19 themselves, as well as concerns about the effect of the pandemic on their patients and patients delaying essential care for non-COVID-19 conditions. More education and resources about vaccines was identified as the top information need, which will assist with what GPs’ perceived to be their key roles in managing the COVID-19 pandemic, namely educating the public, correcting misunderstandings and providing the COVID-19 vaccine. These findings highlight gaps in communication and information, particularly regarding COVID-19 vaccines. GPs need high-quality information and resources to support them in undertaking complex risk communication with their patients.
Publisher: Informa UK Limited
Date: 22-03-2016
DOI: 10.3109/09273948.2016.1139734
Abstract: To assess the vision-related (VR) and health-related (HR) quality-of-life (QoL) of patients with uveitis. In total, 60 patients with uveitis, 81 patients with diabetic retinopathy (DR), and 70 healthy subjects completed the National Eye Institute Visual Functioning Questionnaire and the Medical Outcome Study 36-Item Short Form. Patients with uveitis reported lower HR- and VR-QoL than healthy subjects (p<0.05) and lower VR-QoL (p<0.001) than patients with DR. For patients with uveitis, multiple linear regression analyses indicated that lower HR-QoL scores were predicted by younger age (p<0.01), while lower VR-QoL scores were predicted by poorer visual acuity (p<0.001), ocular comorbidities (p<0.05), and female sex (p<0.05). Patients with uveitis have significantly poorer VR- and HR-QoL than healthy control subjects. Uveitis has a more debilitating impact on VR-QoL than DR.
Publisher: Springer Science and Business Media LLC
Date: 02-2019
DOI: 10.1007/S11926-019-0804-2
Abstract: Unexplained fatigue is commonly reported in the general population, with varying severity. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) sits at the extreme of the fatigue continuum, yet more in iduals experience unexplained prolonged fatigue (1-6-month duration) or chronic fatigue (> 6 months) that, although debilitating, does not fulfil ME/CFS criteria. This review examines the empirical literature comparing symptoms for those with prolonged fatigue, chronic fatigue and ME/CFS. Substantial overlap of self-reported psychological, physical and functional impairments exists between chronic fatigue and ME/CFS. The conversion rate from prolonged or chronic fatigue to ME/CFS is not understood. Current research has failed to uncover factors accounting for differences in fatigue trajectories, nor incorporate comprehensive, longitudinal assessments extending beyond self-reported symptoms. Distinguishing factors between prolonged fatigue, chronic fatigue and ME/CFS remain poorly understood, highlighting a need for longitudinal studies integrating biopsychosocial approaches to inform early management and targeted rehabilitation strategies.
Publisher: Springer Science and Business Media LLC
Date: 29-07-2020
DOI: 10.1186/S12877-020-01648-Y
Abstract: Conflicting evidence exists regarding the association of socioeconomic status (SES) with mortality among older people and little is known about the mechanisms underlying this association. We investigated the association of SES with mortality among older Australian men. We also investigated potential mediating effects of health-related behaviours in SES-mortality associations. We used data from a prospective population-based cohort (the Concord Health and Aging in Men Project), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score were assessed at baseline. Longitudinally assessed alcohol consumption, smoking, physical activity, and body mass index were investigated as potential mediators. Associations were quantified using Cox regression. We evaluated 1527 men (mean age: 77.4 ± 5.5 years). During a mean follow-up time of 9.0 years, 783 deaths occurred. For deaths from all causes, the adjusted hazard ratio (HR) for the lowest tertile of cumulative SES score versus the highest tertile was 1.44 (95% CI 1.21 to 1.70) the corresponding sub-HRs were 1.35 (0.96 to 1.89) for cardiovascular disease (CVD) mortality 1.58 (1.15 to 2.18) for cancer mortality, and 1.86 (1.36 to 2.56) for non-CVD, non-cancer mortality. SES-mortality associations were attenuated by 11–25% after adjustment for mediating health-related behaviours. Low SES is associated with increased mortality in older Australian men and health-related behaviours accounted for less than one-fourth of these associations. Further research is needed to fully understand the mechanisms underlying SES inequalities in mortality among older people.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.YPMED.2022.106980
Abstract: This study aimed to explore the impact of health literacy on psychosocial and behavioural outcomes for people who were not at high risk of cardiovascular disease receiving a hypothetical blood pressure reading of 135/85 mmHg. We performed a secondary analysis of data from a national s le of Australians aged 40 to 50 years (n = 1318) recruited online. Health literacy was measured using the validated Newest Vital Sign (inadequate: 0-3 adequate: 4-6). Analysed outcomes included: willingness to increase exercise and accept medication perceived severity positive and negative affect illness perceptions and impacts on life and motivation. Participants with inadequate levels of health literacy perceived a blood pressure reading of 135/85 mmHg to be less serious compared to in iduals with adequate health literacy (Mean Difference [MD]:0.21 95%CI 0.03-0.39 p = .024 d = 0.13), and reported less motivation to eat well (MD:0.44 95%CI 0.31-0.58 p < .001 d = 0.38) and exercise (MD:0.43 95%CI 0.31-0.58 p < .001 d = 0.36). However, they were more willing to accept medication (MD:0.20 95%CI 0.07-0.34 p = .004 d = 0.17). Participants with inadequate health literacy also perceived the condition to have fewer negative impacts on aspects of life and work than in iduals with adequate health literacy, but reported greater negative emotion and more negative illness perceptions (all p < .001). Tailored communication and behaviour change support may be needed when communicating blood pressure information to people with lower health literacy and not at high risk of cardiovascular disease given the differential impacts on medication (increased willingness) and healthy exercise and diet behaviours (decreased willingness) observed in this study.
Publisher: Cold Spring Harbor Laboratory
Date: 11-12-2020
DOI: 10.1101/2020.12.10.20247346
Abstract: To investigate whether Australians have experienced any positive effects during the COVID-19 pandemic, despite the disruption to society and daily life. National online longitudinal survey. As part of a June 2020 survey, participants (n=1370) were asked ‘In your life, have you experienced any positive effects from the COVID-19 pandemic’ (yes/no), with a free-text explanation if yes, and also completed the WHO-Five well-being index. Differences were explored by demographic variables. Free-text responses were thematically coded. 960 participants (70%) reported experiencing at least one positive effect during the COVID-19 pandemic. Living with others (p=.045) and employment situation (p .001) at baseline (April), were associated with experiencing positive effects. In iduals working for pay from home were more likely to experience positive effects compared to those who were not working for pay (aOR=0.45, 95%CI: 0.32, 0.63, p .001), or who were working for pay outside the home (aOR=0.40, 95%CI: 0.28, 0.58, p .001). Age and education were not associated with positive effects when controlling for employment and household numbers. There was an overall effect of gender (p=.001), where those identifying as female were more likely than males (aOR=1.62, 95%CI: 1.25, 2.09) to report experiencing a positive effect. 54.2% of participants reported a sufficient level of wellbeing, 23.2% low wellbeing and a further 22.6% very low wellbeing. Of those experiencing positives, 945/960 (98%) provided an explanation. The three most common themes were ‘Family time’ (33%), ‘Work flexibility’ (29%), and ‘Calmer life’ (19%). A large proportion of surveyed Australians reported positive effects resulting from changes to daily life due to the COVID-19 pandemic in Australia. Enhancing these aspects may build community resilience to cope with future pandemic responses. The needs of people living alone, and of those having to work outside the home or who are unemployed, should be considered by health policy makers and employers in future pandemic preparedness efforts, as these groups were least likely to report positive experiences and may be more vulnerable.
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.COMPPSYCH.2016.02.002
Abstract: Neurocognitive difficulties are commonly reported by patients suffering from chronic fatigue syndrome (CFS). Moderate improvements from 'best practice' therapy are promising, but to date reported efficacy is based entirely on subjective measures. This is problematic, given the well-documented ergence between subjective perceptions and actual neurocognitive performance, including in this patient group. Subjective and objective measures of neurocognitive performance were obtained from 25 patients with well-characterized CFS before and after the completion of a 12-week graded-activity program incorporating a cognitive training component. Additionally, self-reported symptoms, cardiac autonomic activity (a relevant biomarker of stress responsivity), and their relation to neurocognitive improvements were examined. Substantive post-intervention improvements in subjective (p=0.006) and objective (including faster responses speeds and greater accuracy, p's<0.001) neurocognitive performance were documented. Participants also demonstrated reduced autonomic reactivity to the cognitive challenge at follow-up (p's≤0.01). These improvements were accompanied by improvements in symptom ratings (p's≤0.01). However, subjective ratings of neurocognitive difficulties, and CFS-related symptoms were not linked to objective performance improvements. These initial data provide the first evidence of objective neurocognitive performance improvements accompanied by a significant reduction in responsiveness in stress-related neural pathways consequent to cognitive-behavioral/graded exercise therapy programs. These findings provide support for the effectiveness of such programs in remediating clinical status. These promising findings warrant further investigation, including replication in a larger s le utilizing more controlled study designs.
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.PEC.2021.04.027
Abstract: Many older adults (aged 75+) continue cancer screening despite guidelines suggesting they should not. Using mixed-methods, we examined psychosocial and clinical factors associated with continued breast rostate screening. We conducted an online, scenario-based, randomized study in Australia with participants aged 65+ years. The primary outcome was screening intention (10-point scale, dichotomized: low (1-5) and high (6-10)). We also measured demographic, psychosocial, and age-related clinical variables. Participants provided reason/s for their screening intentions in free-text. 271 eligible participants completed the survey (aged 65-90 years, 71% adequate health literacy). Those who reported higher cancer anxiety, were men, screened more recently, had family history of breast rostate cancer and were independent in activities of daily living, were more likely to intend to continue screening. Commonly reported reasons for intending to continue screening were grouped into six themes: routine adherence, the value of knowing, positive screening attitudes, perceived susceptibility, benefits focus, and needing reassurance. Psychosocial factors may drive continued cancer screening in older adults and undermine efforts to promote informed decision-making. When communicating benefits and harms of cancer screening to older adults, both clinical and psychosocial factors should be discussed to support informed decision-making.
Publisher: JMIR Publications Inc.
Date: 11-03-2021
Abstract: his is author responses.
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.JPSYCHORES.2015.08.008
Abstract: To design and validate an instrument to capture the characteristic post-exertional exacerbation of fatigue in patients with chronic fatigue syndrome (CFS). Firstly, patients with CFS (N=19) participated in five focus group discussions to jointly explore the nature of fatigue and dynamic changes after activity, and inform development of a self-report instrument - the Fatigue and Energy Scale (FES). The psychometric properties of the FES were then examined in two case-control challenge studies: a physically-demanding challenge (moderate-intensity aerobic exercise N=10 patients), and a cognitively-demanding challenge (simulated driving N=11 patients). Finally, ecological validity was evaluated by recording in association with tasks of daily living (N=9). Common descriptors for fatigue included 'exhaustion', 'tiredness', 'drained of energy', 'heaviness in the limbs', and 'foggy in the head'. Based on the qualitative data, fatigue was conceptualised as consisting of 'physical' and 'cognitive' dimensions. Analysis of the psychometric properties of the FES showed good sensitivity to the changing symptoms during a post-exertional exacerbation of fatigue following both physical exercise and driving simulation challenges, as well as tasks of daily living. The 'fatigue' experienced by patients with CFS covers both physical and cognitive components. The FES captured the phenomenon of a post-exertional exacerbation of fatigue commonly reported by patients with CFS. The characteristics of the symptom response to physical and cognitive challenges were similar. Both the FES and the challenge paradigms offer key tools to reliably investigate biological correlates of the dynamic changes in fatigue.
Publisher: Wiley
Date: 14-06-2022
DOI: 10.1111/AJO.13552
Abstract: Secondary postpartum haemorrhage (PPH) complicates ~1% of pregnancies and can cause serious maternal morbidity. However, evidence guiding optimal management is scarce and often based on case series and expert opinion. To measure the success of primary medical therapy in managing secondary PPH and to identify factors associated with need for surgical management. Postpartum patients presenting to a tertiary women's hospital emergency department between July 2020 and October 2021 with secondary PPH were recruited. Data from the acute presentation were prospectively collected. Antenatal and intrapartum data were collected from medical record review. The primary outcome was the success of medical management for secondary PPH, defined by the implementation of medical or expectant measures without subsequent need for surgical intervention. One‐hundred and twenty patients underwent primary medical management for secondary PPH. Ninety‐eight (82%) were managed successfully with medical management and 22 (18%) required surgery. Medical management involved misoprostol ( n = 33 27.5%), antibiotics ( n = 108 90%), and less commonly other uterotonics ( n = 6 5%). Factors associated with lower rates of successful medical management included: antecedent manual removal of placenta (MROP) (odds ratio (OR) 0.2, P = 0.047), primary PPH ≥500 mL (OR 0.39, P = 0.048) or ≥1 L (OR 0.24, P = 0.009), mL blood loss at presentation (OR 0.17, P = 0.015), increasing time post‐delivery (OR 0.84, P = 0.044), retained products of conception (RPOC) on ultrasound (OR 0.024, P = 0.001) and vaginal birth (OR 0.27, P = 0.027). Medical management was highly successful. Vaginal birth, MROP, primary PPH, RPOC on ultrasound and increasing time post‐delivery were associated with increased need for surgical management.
Publisher: Wiley
Date: 09-08-2021
DOI: 10.1111/ANS.17128
Publisher: Elsevier BV
Date: 03-2170
DOI: 10.1016/J.JPSYCHORES.2017.10.010
Abstract: To explore changes in autonomic functioning, sleep, and physical activity during a post-exertional symptom exacerbation induced by physical or cognitive challenge in participants with chronic fatigue syndrome (CFS). Thirty-five participants with CFS reported fatigue levels 24-h before, immediately before, immediately after, and 24-h after the completion of previously characterised physical (stationary cycling) or cognitive (simulated driving) challenges. Participants also provided ratings of their sleep quality and sleep duration for the night before, and after, the challenge. Continuous ambulatory electrocardiography (ECG) and physical activity was recorded from 24-h prior, until 24-h after, the challenge. Heart rate (HR) and HR variability (HRV, as high frequency power in normalized units) was derived from the ECG trace for periods of wake and sleep. Both physical and cognitive challenges induced an immediate exacerbation of the fatigue state (p<0.001), which remained elevated 24-h post-challenge. After completing the challenges, participants spent a greater proportion of wakeful hours lying down (p=0.024), but did not experience significant changes in sleep quality or sleep duration. Although the normal changes in HR and HRV during the transition from wakefulness to sleep were evident, the magnitude of the increase in HRV was significantly lower after completing the challenge (p=0.016). Preliminary evidence of reduced nocturnal parasympathetic activity, and increased periods of inactivity, were found during post-exertional fatigue in a well-defined group of participants with CFS. Larger studies employing challenge paradigms are warranted to further explore the underlying pathophysiological mechanisms of post-exertional fatigue in CFS.
Publisher: Cold Spring Harbor Laboratory
Date: 08-2021
DOI: 10.1101/2021.07.29.21261321
Abstract: To manage the COVID-19 pandemic effectively, governments need clear and effective communication. This is a challenge for culturally erse communities as groups may have different informational needs and information-seeking behaviours. In this paper we present the frequency of information sources for COVID-19 in a culturally erse area of Sydney, Australia. This study reports findings from two surveys. The first recruited participants across 10 languages between March 21 and July 9, 2021. The second provides a point of reference, and was an Australian, nationally-representative s le of English-speaking participants between November 4 – 18, 2020. For the survey in culturally and linguistically erse communities, of 708 participants, mean age was 45.4 years (SE 0.78), and 51% of respondents were female. Across all language groups, 54.7% of participants used Australian official or public broadcasters to find out about COVID-19 (n=421). Australian commercial information sources (54.1%, n=417), social media (51.6%, n=397), and family and friends in Australia (32.7%, n=252) were common sources. Patterns varied substantially across language groups. In the nationally representative survey (n=2313), 67% of participants (n=1540) used Australian official or public broadcasters, with lower proportions for social media (31.9%, n=738) and friends, family or other personal sources (23.1% n=533). Almost 50% of participants from culturally and linguistically erse communities did not report using Australian official or public broadcaster as main sources of information. Instead Australian commercial information sources, friends and family, overseas sources and social media were common. Though a crude comparison of the two datasets, this data can guide policy decisions for communication to different community groups. Further analysis is needed to interpret this data. Better understanding of how erse communities seek and receive COVID-19 health information is imperative as we manage the current COVID-19 outbreak in the Sydney region.
Publisher: Springer Science and Business Media LLC
Date: 18-04-2023
DOI: 10.1038/S41366-023-01305-5
Abstract: The Paediatric Quality of life Inventory (PedsQL TM ) Generic Core Scales and the Child Health Utilities 9 Dimensions (CHU9D) are two paediatric health-related quality of life (HRQoL) measures commonly used in overweight and obesity research. However, no studies have comprehensively established the psychometric properties of these instruments in the context of paediatric overweight and obesity. The aim of this study was to assess the reliability, acceptability, validity and responsiveness of the PedsQL and the CHU9D in the measurement of HRQoL among children and adolescents living with overweight and obesity. Subjects were 6544 child participants of the Longitudinal Study of Australian Children, with up to 3 repeated measures of PedsQL and CHU9D and aged between 10 and 17 years. Weight and height were measured objectively by trained operators, and weight status determined using World Health Organisation growth standards. We examined reliability, acceptability, known group and convergent validity and responsiveness, using recognised methods. Both PedsQL and CHU9D demonstrated good internal consistency reliability, and high acceptability. Neither instrument showed strong convergent validity, but PedsQL appears to be superior to the CHU9D in known groups validity and responsiveness. Compared with healthy weight, mean (95%CI) differences in PedsQL scores for children with obesity were: boys −5.6 (−6.2, −4.4) girls −6.7 (−8.1, −5.4) and differences in CHU9D utility were: boys −0.02 (−0.034, −0.006) girls −0.035 (−0.054, −0.015). Differences in scores for overweight compared with healthy weight were: PedsQL boys −2.2 (−3.0, −1.4) and girls −1.3 (−2.0, −0.6) and CHU9D boys: no significant difference girls −0.014 (−0.026, −0.003). PedsQL and CHU9D overall demonstrated good psychometric properties, supporting their use in measuring HRQoL in paediatric overweight and obesity. CHU9D had poorer responsiveness and did not discriminate between overweight and healthy weight in boys, which may limit its use in economic evaluation.
Publisher: Elsevier BV
Date: 2007
DOI: 10.1016/J.PSYCHRES.2017.08.035
Abstract: Neurocognitive disturbance with subjectively-impaired concentration and memory is a common, disabling symptom reported by patients with chronic fatigue syndrome (CFS). We recently reported preliminary evidence for benefits of cognitive remediation as part of an integrated cognitive-behavioral therapy (CBT)/ graded exercise therapy (GET) program. Here, we describe a contemporaneous, case-control trial evaluating the effectiveness of an online cognitive remediation training program (cognitive exercise therapy CET) in addition to CBT/GET (n=36), compared to CBT/GET alone (n=36). The study was conducted in an academic, tertiary referral outpatient setting over 12 weeks (11 visits) with structured, home-based activities between visits. Participants self-reported standardized measures of symptom severity and functional status before and after the intervention. Those in the CET arm also completed standardized neurocognitive assessment before, and following, treatment. The addition of formal CET led to significantly greater improvements in self-reported neurocognitive symptoms compared to CBT/GET alone. Subjective improvement was predicted by CET group and lower baseline mood disturbance. In the CET group, significant improvements in objectively-measured executive function, processing speed, and working memory were observed. These subjective and objective performance improvements suggest that a computerized, home-based cognitive training program may be an effective intervention for patients with CFS, warranting randomized controlled trials.
Publisher: JMIR Publications Inc.
Date: 15-04-2022
DOI: 10.2196/34142
Abstract: Shared decision-making is an essential principle for the prevention of cardiovascular disease (CVD), where asymptomatic people consider lifelong medication and lifestyle changes. This study aims to develop and evaluate the first literacy-sensitive CVD prevention decision aid (DA) developed for people with low health literacy, and investigate the impact of literacy-sensitive design and heart age. We developed a standard DA based on international standards. The standard DA was based on our existing general practitioner DA. The literacy-sensitive DA included simple language, supporting images, white space, and a lifestyle action plan. The control DA used Heart Foundation materials. A randomized trial included 859 people aged 45-74 years using a 3 (DA: standard, literacy-sensitive, control) ×2 (heart age: heart age + percentage risk, percentage risk only) factorial design, with outcomes including prevention intentions and behaviors, gist and verbatim knowledge of risk, credibility, emotional response, and decisional conflict. We iteratively improved the literacy-sensitive version based on end-user testing interviews with 20 people with varying health literacy levels. Immediately after the intervention (n=859), there were no differences in any outcome among the DA groups. The heart age group was less likely to have a positive emotional response, perceived the message as less credible, and had higher gist and verbatim knowledge of heart age risk but not percentage risk. After 4 weeks (n=596), the DA group had better gist knowledge of percentage risk than the control group. The literacy-sensitive DA group had higher fruit consumption, and the standard DA group had better verbatim knowledge of percentage risk. Verbatim knowledge was higher for heart age than for percentage risk among those who received both. The literacy-sensitive DA resulted in increased knowledge of CVD risk and increased fruit consumption in participants with varying health literacy levels and CVD risk results. Adding heart age did not increase lifestyle change intentions or behavior but did affect psychological outcomes, consistent with previous findings. This tool will be integrated with additional resources to improve other lifestyle outcomes. Australian New Zealand Clinical Trials Registry ACTRN12620000806965 26yhk8a
Publisher: ISCA
Date: 27-08-2011
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.BBI.2019.07.034
Abstract: Substantial heterogeneity exists in both the severity of symptoms experienced as part of the sickness response to naturally-occurring infections, and the time taken for in iduals to recover from these symptoms. Although contributing immunological and genetic factors have been previously been explored, less is known about the role of in idual psychological and psychosocial factors, which may modulate the host immune response, or contribute independently, to symptom severity and duration. Longitudinally-collected data from 484 Caucasian participants (mean age: 33.5 years 51% women) experiencing a naturally-occurring acute infective illness enrolled in the prospective Dubbo Infection Outcome Study (DIOS) were analysed. At intake and subsequent follow-up assessments, self-report questionnaires were used to ascertain in idual psychological and psychosocial characteristics and symptom information. Principal component analysis was applied to symptom data to derive endophenotype severity scores representing discrete symptom domains (fatigue, mood, pain, neurocognitive difficulties) and an overall index of severity. The contribution of in idual psychological (trait neuroticism, locus of control, and illness behaviours) and psychosocial factors (relative socioeconomic advantage) to endophenotype severity at baseline were examined using multivariable linear regression models interval-censored flexible parametric proportional hazards survival models were used to explore time to recovery (defined using within-s le negative threshold values). After controlling for time since symptom onset, greater levels of trait neuroticism consistently predicted greater symptom severity across all symptom domains (all p's < 0.015). Similarly, greater relative socioeconomic disadvantage was significantly associated with greater severity across all endophenotypes (p's < 0.025) except neurocognitive disturbance. Locus of control and illness behaviours contributed differentially across endophenotypes. Reduced likelihood of recovery was significantly predicted by greater initial symptom severity for all endophenotypes (all p's < 0.001), as well as higher levels of trait neuroticism. In idual psychological and psychosocial factors contribute to the initial severity and to the prolonged course of symptoms after naturally-occurring infective illnesses. These factors may play an independent role, represent a bias in symptom reporting, or reflect increased stress responsivity and a heightened inflammatory response. Objective metrics for severity and recovery are required to further elucidate their roles.
Publisher: SAGE Publications
Date: 22-03-2019
Abstract: Lifetime depression and depression around the time of an acute coronary syndrome event have been associated with poor cardiac outcomes. Our study sought to examine the persistence of this association, especially given modern cardiac medicine’s successes. For 332 patients admitted for an acute coronary syndrome, a baseline interview assessed major depression status, and psychological measures were administered. At 1 and 12 months post–acute coronary syndrome event, telephone interviews collected rates of hospital readmission and/or death and major depression status, while biomarker information was examined using medical records. The 12-month mortality rate was 2.3% and cardiac readmission rate 21.0%. Depression subsequent to an acute coronary syndrome event resulted in a threefold and 2.5-fold increase in 1-month and 12-month odds of cardiac readmission or death, respectively. No relationship with past depressive episodes was found. Poor sleep was associated with higher trait anxiety and neuroticism scores and with more severe depression. Lifetime depression may increase the risk of depression around the time of an acute coronary syndrome but not influence cardiac outcomes. We suggest that poor sleep quality may be causal or indicate high anxiety/neuroticism, which increases risk to depression and contributes to poor cardiac outcomes rather than depression being the primary causal factor.
Publisher: Elsevier BV
Date: 12-2021
Publisher: American Medical Association (AMA)
Date: 16-06-2022
Publisher: Elsevier BV
Date: 02-2014
Publisher: MDPI AG
Date: 04-06-2022
Abstract: Central to a successful population vaccination program is high uptake of vaccines. However, COVID-19 vaccine uptake may be impeded by beliefs based on misinformation. We sought to understand the prevalence and nature of misbeliefs about COVID-19 vaccines, and identify associated factors, shortly after commencement of Australia’s national vaccine rollout. A cross-sectional survey was administered to unvaccinated young adults (n = 2050) in Australia aged 18–49 years (mean age 33 years), 13 July–21 August 2021. This s le was previously under-represented in COVID-19 research but shown to have less willingness to vaccinate. Two thirds of participants agreed with at least one misbelief item. Misperceptions about COVID-19 vaccines were found to be significantly associated with lower health literacy, less knowledge about vaccines, lower perceived personal risk of COVID-19, greater endorsement of conspiracy beliefs, and lower confidence and trust in government and scientific institutions. Misbeliefs were more common in participants with less educational attainment, in younger age groups, and in males, as per previous research. Understanding determinants and barriers to vaccination uptake, such as knowledge and beliefs based on misinformation, can help to shape effective public health communication and inform debunking efforts at this critical time and in the future.
Publisher: Cold Spring Harbor Laboratory
Date: 11-09-2020
DOI: 10.1101/2020.09.10.20192336
Abstract: To determine how participants perceived telehealth consults in comparison to traditional in-person visits, and to investigate whether people believe that telehealth services would be useful beyond the pandemic. A national cross-sectional community survey. Australian adults aged 18 years and over (n=1369). Telehealth experiences. Of the 596 telehealth users, the majority of respondents (62%) rated their telehealth experience as “just as good” or “better” than a traditional in-person medical appointment. On average, respondents perceived that telehealth would be moderately to very useful for medical appointments after the COVID-19 pandemic is over (M=3.67 out of 5, SD=1.1). Being male (p=0.007), having a history of both depression and anxiety (p=0.037), or lower patient activation (in iduals’ willingness to take on the role of managing their health/healthcare) (p=0.037) were associated with a poorer telehealth experience. Six overarching themes were identified from free-text responses of why telehealth experience was poorer than a traditional in-person medical appointment: communication is not as effective limitations with technology issues with obtaining prescriptions and pathology reduced confidence in doctor additional burden for complex care and inability to be physically examined. Telehealth appointments were reported to be comparable to traditional in-person medical appointments by most of our s le. Telehealth should continue to be offered as a mode of healthcare delivery while the pandemic continues and may be worthwhile beyond the pandemic. The COVID-19 pandemic has resulted in an increase in telehealth services. The majority of telehealth users (62%) perceived their experience to be just as good or better than traditional in-person medical care and that telehealth would be at least somewhat useful beyond the pandemic. Having a history of both depression and anxiety was associated with a poorer telehealth experience and in-person visits were frequently preferred over telehealth visits for mental health appointments. Telehealth should continue to be offered while the COVID-19 pandemic continues and may be worthwhile beyond the pandemic, however, telehealth may be less effective for mental health services.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.BBI.2013.11.002
Abstract: Disturbances in neurocognitive performance are a core feature of the acute sickness response to infection however the underlying mechanisms remain unclear. The current study used a computerised battery to assess neurocognitive functioning in subjects enrolled in the Dubbo Infection Outcomes Study (n=107) - a prospective cohort of subjects followed from documented acute infection with Epstein Barr virus, Ross River virus, or Coxiella burnetii until recovery. Subjects were assessed when ill, and a subset again after complete recovery. Associations between sickness-related cognitive disturbances and single nucleotide polymorphisms (SNPs) in cytokine (interleukin [IL]-6, IL-10, tumor necrosis factor-α and interferon-γ) and neurobehavioral genes (serotonin transporter and catechol-O-methyltransferase) were explored. During acute infection, subjects exhibited slower matching-to-s le responses (p=0.03), poorer working memory capacity (p=0.014), mental planning (p=0.045), and dual attention task performance (p=0.02), and required longer to complete discordant Stroop trials (p=0.01) compared to recovery. Objective impairments correlated significantly with self-reported symptoms (p<0.05) as well as levels of the inflammation marker, C-reactive protein (p=0.001). Linear regression analysis identified an association between neurocognitive disturbance during acute illness and functional polymorphisms in inflammatory cytokine genes. Specifically, the high cytokine producing G allele of the IL-6-174G/C SNP was associated with poorer neurocognitive performance when subjects were ill (p=0.027). These findings confirm that acute infection impacts on neurocognitive performance, manifesting as slowed responses and impaired performance on complex tasks requiring higher-order functioning which has important real-world implications. The data provide the first preliminary evidence for a role of a genetic predisposition to more intense inflammatory responses in objective neurocognitive disturbances during acute infections. These associations require replication in a larger s le size.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.BBI.2015.02.025
Abstract: Depression emerging in conjunction with acute coronary syndrome (ACS) is thought to constitute a distinct high-risk phenotype with inflammatory determinants. This review critically examines the notion put forward in the literature that ACS-associated depression constitutes a meaningful subtype that is qualitatively different from depressive syndromes observed in psychiatric patients and evaluates the salience of an analogy to the acute sickness response to infection or injury as an explanatory model. Specific features differentiating ACS-associated depression from other phenotypes are discussed, including differences in depression symptom profiles, timing of the depressive episode in relation to ACS, severity of the cardiac event, and associated immune activation. While an acute sickness response analogy offers a plausible conceptual framework, concrete evidence is lacking for inflammatory activity as the triggering mechanism. It is likely that ACS-associated depression encompasses several causative scenarios.
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.IJCARD.2018.08.005
Abstract: With population ageing a significant concern, modifiable factors contributing to healthy ageing must be identified. Autonomic responding reflected by heart rate variability (HRV) has well-established links to general health and wellbeing in younger populations but has yet to be explored in older in iduals. Forty-five healthy participants (49-82 years old) completed questionnaires about sleep and physical and psychological health. Autonomic activity was measured during rest and whilst completing a computerised battery of cognitive tasks. Participants then wore an ambulatory heart rate monitor overnight, and recorded their sleep and physical activity for one week. HRV parameters reflecting cardiac vagal tone were derived from electrocardiograph recordings. Age and resting HRV were not related however a positive association was identified between higher HRV in the 2 h prior to sleep and older age. Higher resting HRV, older age, and better sleep quality significantly predicted psychological wellbeing and fewer somatic and physical health symptoms and older age predicted better average sleep quality ratings. Older age and poorer general health were significant predictors of cognitive performance deficits. These findings suggest that an age-related decline in HRV is not inevitable. Longitudinal designs exploring within-in idual changes in cardiac vagal tone are required to better understand the factors contributing to healthy ageing.
Publisher: Oxford University Press (OUP)
Date: 13-06-2023
Abstract: What is the anti-Mullerian hormone (AMH) test usage, awareness, and perceived reasons for testing in a representative community s le of women in Australia? : Among women aged 18–55 years, 13% had heard about AMH testing and 7% had had an AMH test, with the top three reasons for testing including due to infertility investigations (51%), considering pregnancy and wanting to understand their chances (19%) or to find out if a medical condition had affected fertility (11%). The growing availability of direct-to-consumer AMH testing has raised concerns about overuse, however as most AMH tests are paid for privately by consumers, data on test usage is not publicly available. National cross-sectional survey of 1773 women, conducted in January 2022. Females aged 18–55 years were recruited from the representative ‘Life in Australia’ probability-based population panel and completed the survey online or by telephone. Main outcome measures included if and how participants had heard about AMH testing, whether they had ever had an AMH test, main reason for testing and test access. Of the 2423 women who were invited 1773 responded (73% response rate). Of these, 229 (13%) had heard about AMH testing and 124 (7%) had had an AMH test. Testing rates were highest among those currently aged 35–39 years (14%) and associated with educational attainment. Almost all accessed the test through their general practitioner or fertility specialist. Reasons for testing were: part of an infertility investigation (51%), considering pregnancy and wanting to understand chances of conceiving (19%), finding out if a medical condition had affected fertility (11%), curiosity (9%), considering egg freezing (5%), and considering delaying pregnancy (2%). Although the s le was large and mostly representative, it was over-represented by people holding a university degree and under-represented by people aged 18–24, however, we used weighted data where possible to account for this. All data were self-reported so there is a risk of recall bias. The number of survey items was also restricted, so the type of counselling women received prior to testing, reasons for declining an AMH test or test timing were not measured. Whilst most women reported having an AMH test for appropriate reasons, about one third had it for reasons not supported by evidence. Public and clinician education about the lack of utility of AMH testing for women not undergoing infertility treatment is needed. This project was supported by a National Health and Medical Research Council (NHMRC) Centre for Research Excellence grant (1104136) and Program grant (1113532). T.C. is supported by an NHMRC Emerging Leader Research Fellowship (2009419). B.W.M. reports research funding, consultancy and travel support from Merck. D.L. is the Medical Director of City Fertility NSW and reports consultancy for Organon, Ferring, Besins and Merck. The authors have no other competing interests. N/A.
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-01-2020
DOI: 10.5664/JCSM.8114
Publisher: JMIR Publications Inc.
Date: 23-09-2020
Abstract: n response to the COVID-19 pandemic, telehealth has rapidly been adopted to deliver health care services around the world. To date, studies have not compared people’s experiences with telehealth services during the pandemic in Australia to their experiences with traditional in-person visits. his study aimed to compare participants’ perceptions of telehealth consults to their perceptions of traditional in-person visits and investigate whether people believe that telehealth services would be useful after the pandemic. national, cross-sectional, community survey was conducted between June 5 and June 12, 2020 in Australia. In total, 1369 participants who were aged ≥18 years and lived in Australia were recruited via targeted advertisements on social media (ie, Facebook and Instagram). Participants responded to survey questions about their telehealth experience, which included a free-text response option. A generalized linear model was used to estimate the adjusted relative risks of having a poorer telehealth experience than a traditional in-person visit experience. Content analysis was performed to determine the reasons why telehealth experiences were worse than traditional in-person visit experiences. f the 596 telehealth users, the majority of respondents (n=369, 61.9%) stated that their telehealth experience was “just as good as” or “better than” their traditional in-person medical appointment experience. On average, respondents perceived that telehealth would be moderately useful to very useful for medical appointments after the COVID-19 pandemic ends (mean 3.67, SD 1.1). Being male ( i P /i =.007), having a history of both depression and anxiety ( i P /i =.016), and lower patient activation scores (ie, in iduals’ willingness to take on the role of managing their health/health care) ( i P /i =.036) were significantly associated with a poor telehealth experience. In total, 6 overarching themes were identified from free-text responses for why participants’ telehealth experiences were poorer than their traditional in-person medical appointment experiences, as follows: communication is not as effective, limitations with technology, issues with obtaining prescriptions and pathology results, reduced confidence in their doctor, additional burden for complex care, and inability to be physically examined. ased on our s le’s responses, telehealth appointment experiences were comparable to traditional in-person medical appointment experiences. Telehealth may be worthwhile as a mode of health care delivery while the pandemic continues, and it may continue to be worthwhile after the pandemic.
Publisher: Cold Spring Harbor Laboratory
Date: 08-02-2021
DOI: 10.1101/2021.02.04.21251165
Abstract: In Australia in March 2020 a national public health directive required that non-essential workers stay at home, except for essential activities. These restrictions began easing in May 2020 as community transmission slowed. This study investigated changes in COVID-19 prevention behaviours from April-July 2020, and psychosocial predictors of these behaviours. 1,843 participants in Australia completed a national COVID-19 survey in April, with monthly follow-up over four months. Principal components analysis (PCA) combined self-reported adherence across seven prevention behaviours. Multivariable regression models explored baseline (April) correlates of behaviour in June (a period of low community transmission) and July (a period of increasing community transmission). On average, participants agreed with statements of adherence for all behaviours (means all above 4 out of 7). PCA identified two behaviour types: ‘distancing’ (e.g. staying 1.5m away) and ‘hygiene’ (e.g. washing hands), explaining 28.3% and 24.2% of variance, respectively. Distancing declined each month (p’s .001), whereas hygiene remained relatively stable. For distancing, stronger perceptions of societal risk, self-efficacy to maintain distancing, and greater perceived social obligation at baseline were associated with adherence in June and July (p’s .05). For hygiene, the only significant correlate of adherence in June and July was belief that one’s actions could prevent infection of family members (p .001). High adherence to COVID-19 prevention behaviours were reported however, distancing behaviours tended to decrease over time. Belief in social responsibility may be an important aspect to consider in encouraging distancing behaviours. Different policy approaches may be needed for different behavioural categories.
Publisher: JMIR Publications Inc.
Date: 07-01-2021
DOI: 10.2196/23805
Abstract: Misinformation about COVID-19 is common and has been spreading rapidly across the globe through social media platforms and other information systems. Understanding what the public knows about COVID-19 and identifying beliefs based on misinformation can help shape effective public health communications to ensure efforts to reduce viral transmission are not undermined. This study aimed to investigate the prevalence and factors associated with COVID-19 misinformation in Australia and their changes over time. This prospective, longitudinal national survey was completed by adults (18 years and above) across April (n=4362), May (n=1882), and June (n=1369) 2020. Stronger agreement with misinformation was associated with younger age, male gender, lower education level, and language other than English spoken at home (P .01 for all). After controlling for these variables, misinformation beliefs were significantly associated (P .001) with lower levels of digital health literacy, perceived threat of COVID-19, confidence in government, and trust in scientific institutions. Analyses of specific government-identified misinformation revealed 3 clusters: prevention (associated with male gender and younger age), causation (associated with lower education level and greater social disadvantage), and cure (associated with younger age). Lower institutional trust and greater rejection of official government accounts were associated with stronger agreement with COVID-19 misinformation. The findings of this study highlight important gaps in communication effectiveness, which must be addressed to ensure effective COVID-19 prevention.
Publisher: Springer Science and Business Media LLC
Date: 11-07-2018
Publisher: JMIR Publications Inc.
Date: 21-06-2022
Abstract: olymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia’s prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respiratory symptoms, and little was known about the drivers of and barriers to COVID-19 PCR testing as a novel behavior at that time. e aimed to identify and address COVID-19 testing barriers, and test the effectiveness of multiple eHealth interventions on knowledge for people with varying health literacy levels. he intervention was developed in 4 phases. Phase 1 was a national survey conducted in June 2020 (n=1369), in which testing barriers were coded using the capability-opportunity-motivation-behavior framework. Phase 2 was a national survey conducted in November 2020 (n=2034) to estimate the prevalence of testing barriers and health literacy disparities. Phase 3 was a randomized experiment testing health literacy–sensitive written information for a wide range of barriers between February and March 2021 (n=1314), in which participants chose their top 3 barriers to testing to view a tailored intervention. Phase 4 was a randomized experiment testing 2 audio-visual interventions addressing common testing barriers for people with lower health literacy in November 2021, targeting young adults as a key group endorsing misinformation (n=1527). n phase 1, barriers were identified in all 3 categories: capability (eg, understanding which symptoms to test for), opportunity (eg, not being able to access a PCR test), and motivation (eg, not believing the symptoms are those of COVID-19). Phase 2 identified knowledge gaps for people with lower versus higher health literacy. Phase 3 found no differences between the intervention (health literacy–sensitive text for top 3 barriers) and control groups. Phase 4 showed that a fact-based animation or a TikTok-style video presenting the same facts in a humorous style increased knowledge about COVID-19 testing compared with government information. However, no differences were found for COVID-19 testing intentions. his study identified a wide range of barriers to a novel testing behavior, PCR testing for COVID-19. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available. We showed that key capability barriers, such as knowledge gaps, can be improved with simple videos targeting people with lower health literacy. Additional behavior change strategies are required to address motivational issues to support testing uptake. Future research will explore health literacy strategies in the current context of self-administered rapid antigen tests. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviors are required. ustralian New Zealand Clinical Trials Registry ACTRN12621000876897, www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318 Australian New Zealand Clinical Trials Registry ACTRN12620001355965, www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380916& isReview=true
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/BMJOPEN-2019-034061
Abstract: To assess different strategies for communicating to older adults about stopping cancer screening. 4 (recommendation statement about stopping screening)×(2 time) online survey-based randomised controlled trial. Australia. 271 English-speaking participants, aged 65–90, screened for breast rostate cancer at least once in past decade. Time 1: participants read a scenario in which their general practitioner (GP) informed them about the potential benefits and harms of cancer screening, followed by double-blinded randomisation to one of four recommendation statements to stop screening: control (‘this screening test would harm you more than benefit you’), health status (‘your other health issues should take priority’), life expectancy framed positively (‘this test would not help you live longer’) and negatively (‘you may not live long enough to benefit’). Time 2: in a follow-up scenario, the GP explained why guidelines changed over time (anchoring bias intervention). Primary outcomes: screening intention and cancer anxiety (10-point scale, higher=greater intention/anxiety), measured at both time points. Secondary outcomes: trust (in their GP, the information provided, the Australian healthcare system), decisional conflict and knowledge of the information presented. 271 participants’ responses analysed. No main effects were found. However, screening intention was lower for the negatively framed life expectancy versus health status statement (6.0 vs 7.1, mean difference (MD)=1.1, p=0.049, 95% CI 0.0 to 2.2) in post hoc analyses. Cancer anxiety was lower for the negatively versus positively framed life expectancy statement (4.8 vs 5.8, MD=1.0, p=0.025, 95% CI 0.1 to 1.9). The anchoring bias intervention reduced screening intention (MD=0.8, p=0.044, 95% CI 0.6 to 1.0) and cancer anxiety (MD=0.3, p=0.002, 95% CI 0.1 to 0.4) across all conditions. Older adults may reduce their screening intention without reporting increased cancer anxiety when clinicians use a more confronting strategy communicating they may not live long enough to benefit and add an explicit explanation why the recommendation has changed. Australian New Zealand Clinical Trials Registry (ACTRN12618001306202 Results).
Publisher: Cold Spring Harbor Laboratory
Date: 27-04-2021
DOI: 10.1101/2021.04.19.21255709
Abstract: Vaccination rollout against COVID-19 has begun across multiple countries worldwide. Although the vaccine is free, rollout might still be compromised by hesitancy or concerns about COVID-19 vaccines. We conducted two online surveys of Australian adults in April (during national lockdown convenience cross-sectional s le) and November (virtually no cases of COVID-19 nationally representative s le) 2020, prior to vaccine rollout. We asked about intentions to have a potential COVID-19 vaccine (If a COVID-19 vaccine becomes available, I will get it) and free-text responses (November only). After adjustment for differences in s le demographics, the estimated proportion agreeing to a COVID-19 vaccine if it became available in April (n=1146) was 76.2%. In November (n=2034) this was estimated at 71.4% of the s le additional analyses identified that the variation was driven by differences in perceived public health threat between April and November. Across both surveys, female gender, being younger, having inadequate health literacy and lower education were associated with reluctance to be vaccinated against COVID-19. Lower perceived susceptibility to COVID-19, belief that data on the efficacy of vaccines is ‘largely made up’, having lower confidence in government, and lower perception of COVID-19 as a public health threat, were also associated with reluctance to be vaccinated against COVID-19. The top three reasons for agreeing to vaccinate (November only) were to protect myself and others, moral responsibility, and having no reason not to get it. For those who were indifferent or disagreeing to vaccinate, safety concerns were the top reason, followed by indecision and lack of trust in the vaccine respectively. These findings highlight some factors related to willingness to accept a COVID-19 vaccine prior to one being available in Australia. Now that the vaccine is being offered, this study identifies key issues that can inform public health messaging to address vaccine hesitancy. Perceived public health threat is associated with intentions to vaccinate Those believing the efficacy of vaccines is made up were less willing to get vaccinated To protect myself and others was the top reason for getting the vaccine Safety concerns was the top reason against getting the vaccine
Publisher: Springer Science and Business Media LLC
Date: 07-10-2020
DOI: 10.1186/S12939-020-01277-2
Abstract: Among older people, the extent to which psychosocial factors explain socioeconomic inequalities in mortality is debated. We aimed to investigate the potential mediating effect of psychosocial factors on socioeconomic inequalities in mortality. We used data from a prospective population-based cohort (the Concord Health and Ageing in Men Project baseline recruitment in 2005–2007), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Socioeconomic status (SES educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score) was assessed at baseline. Measures of structural and functional social support, as well as depressive and anxiety symptoms were assessed three times during follow-ups. Associations were quantified using Cox regression. Mediation was calculated using “change-in-estimate method”. 1522 men (mean age at baseline: 77·4 ± 5·5 years) were included in the analyses with a mean (SD) follow-up time of 9·0 (3·6) years for all-cause and 8·0 (2·8) years for cause-specific mortality. At baseline, psychosocial measures displayed marked social patterning. Being unmarried, living alone, low social interactions, and elevated depressive symptoms were associated with higher risk of all-cause and cardiovascular disease (CVD) mortality. Psychosocial factors explained 35% of SES inequalities in all-cause mortality, 29% in CVD mortality, 12% in cancer mortality, and 39% in non-CVD, non-cancer mortality. Psychosocial factors may account for up to one-third of SES inequalities in deaths from all and specific causes (except cancer mortality). Our findings suggest that interventional studies targeting social relationships and/or psychological distress in older men aiming to reduce socioeconomic inequalities in mortality are warranted.
Publisher: American Medical Association (AMA)
Date: 12-10-0021
Publisher: Public Library of Science (PLoS)
Date: 09-12-2022
DOI: 10.1371/JOURNAL.PONE.0278923
Abstract: To investigate whether culturally and linguistically erse (CALD) communities in Western Sydney have experienced any positive effects during the COVID-19 pandemic, and if so, what these were. A cross–sectional survey with ten language groups was conducted from 21 st March to 9 th July 2021 in Sydney, Australia. Participants were recruited through bilingual multicultural health staff and health care interpreter service staff and answered a question, ‘In your life, have you experienced any positive effects from the COVID-19 pandemic?’ Differences were explored by demographic variables. Free–text responses were thematically coded using the Content Analysis method. 707 people completed the survey, aged 18 to , 49% males and 51% females. Only 161 (23%) of those surveyed reported any positive impacts. There were significant differences in the proportion of those who reported positives based on age (p = 0.004), gender (p = 0.013), language (p = 0.003), health literacy (p = 0.014), English language proficiency (p = 0.003), education (p = .001) and whether participants had children less than 18 years at home (p = 0.001). Content Analysis of open-ended responses showed that, of those that did report positives, the top themes were ‘Family time’ (44%), ‘Improved self-care’ (31%) and, ‘Greater connection with others’ (17%). Few surveyed participants reported finding any positives stemming from the COVID–19 pandemic. This finding is in stark contrast to related research in Australia with participants whose native language is English in which many more people experienced positives. The needs of people from CALD backgrounds must inform future responses to community crises to facilitate an equitable effect of any collateral positives that may arise.
No related grants have been discovered for Erin Cvejic.