Longitudinal cohort study describing persistent frequent attenders in Australian primary healthcare

Objectives: To describe patterns of frequent attendance in Australian primary care, and identify the prospective risk factors for persistent frequent attendance. Design, setting and participants: This study draws on data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study of residents from the Canberra region of Australia. Participants were assessed on 3 occasions over 8 years. The survey assessed respondents’ experience of chronic physical conditions, self-reported health, symptoms of common mental disorders, personality, life events, sociodemographic characteristics and self-reported medication use. A balanced sample was used in analysis, comprising 1734 respondents with 3 waves of data. The survey data for each respondent were individually linked to their administrative health service use data which were used to generate an objective measure of general practitioner (GP) consultations in the 12 months surrounding their interview date. Main outcome measures: Respondents in the (approximate) highest decile of attenders on number of GP consultations over a 12-month period at each time point were defined as frequent attenders (FAs). Results: Baseline FAs (8.4%) were responsible for 33.4% of baseline consultations, while persistent FAs (3.6%) for 15.5% of all consultations over the 3 occasions. While there was considerable movement between FA status over time, consistency was greater than expected by chance alone. While there were many factors that differentiated non-FAs from FAs in general, persistent frequent attendance was specifically associated with gender, baseline reports of depression, self-reported physical conditions and disability, and medication use. Conclusions: The degree of persistence in GP consultations was limited. The findings of this study contribute to our understanding of the risk factors that predict subsequent persistent frequent attendance in primary care. However, further detailed investigation of longitudinal patterns of frequent attendance and consideration of time-varying determinants of frequent attendance is required

Out-of-pocket costs, primary care frequent attendance and sample selection : Estimates from a longitudinal cohort design

Acknowledgements: Thank you to the study participants, PATH Interviewers, Karen Maxwell and Trish Jacomb; and to the other PATH Chief Investigators: Kaarin Anstey, Helen Christensen, Anthony Jorm, Bryan Rodgers, Andrew Mackinnon, Simon Easteal and Nicolas Cherbuin. The PATH Through Life Study is funded by National Health and Medical Research Council Grants 973302, 179805 and 418039. Peter Butterworth is funded by ARC Future Fellowship FT13101444.Peer reviewedPostprin

What is mathematics? : an examination of the perceptions of mathematics, mathematical expertise and its relationship to reasoning and language

The nature of mathematical abilities is poorly understood in comparison to most other abilities, such as language and reasoning. Most research on the psychology of mathematics has focused on simple mathematical abilities such as numerical calculation. This thesis contributes to foundations for research examining high level mathematical abilities, particularly expert level abilities. These contributions are twofold. The first contribution is ascertaining how mathematics is defined and perceived by individuals currently working in high-level mathematics. The studies in chapters 3 and 4 examined mathematicians' definitions of mathematics, perceptions of how expertise in mathematics may be defined, the skills important for mathematics, and the barriers to studying mathematics. The results suggest that mathematicians view criteria commonly used in psychological research on expertise as less important than performance-based measures, and differentiate between the skills required by a successful student of mathematics and a mathematical expert. The second contribution concerns the relationships between mathematical abilities and abilities in other appropriate domains. Results reported in chapters 1 and 2 and a review of the relevant literature indicate that the two most relevant domains for such investigations are deductive reasoning and language processing. Chapter 5 examined the relationship between performance on mathematical and deductive reasoning tasks, specifically syllogisms and the Wason Card Task. Performance on neither reasoning task was found to be related to mathematical performance, suggesting that performance on mathematical tasks and simple reasoning may be unrelated. The final three empirical chapters examined the relationship between mathematical and linguistic abilities from three perspectives. Chapter 6 reports a survey of high school teachers' perceptions of the skills required for success in mathematics, English and science. In general the skills perceived to be important for the three subjects differed and, importantly, not just the skills traditionally linked to the different subjects but also general cognitive abilities such as long term memory and creativity. Chapters 7 and 8 examined the link between mathematical processing and linguistic processing abilities which has been proposed by previous research. The study in chapter 7 found that reaction times to mathematical stimuli generally showed the same pattern as the linguistic stimuli they were modelled on. The type of stimulus influenced the way participants interacted with the stimuli so the relationship and the degree of similarity may depend on the area of mathematics, as well as how the stimuli are presented. Chapter 8 continued this examination using eye tracking to more closely examine how stimuli are being parsed. Influences on parsing included expertise and the mathematical stimulus format, (for example numerical as oppose to worded problems). Findings are not consistent with predictions from previous linguistic research, even with linguistic stimuli used in earlier studies, thereby raising new questions regarding the effects of stimulus format and task demands. The thesis concludes with a discussion of methodological issues in experimental studies of mathematical and other cognitive abilities, and research on expertise

Changing circumstances drive changing attendance: A longitudinal cohort study of time varying predictors of frequent attendance in primary health care.

Objective: To investigate risk factors for frequent attendance in primary care over time, contrasting models based on baseline and time-varying characteristics. Methods: Analysis of data from the Personality and Total Health (PATH) Through Life Project: a representative community cohort study from the Canberra region of Australia. A balanced sample of 1734 respondents, initially aged in their early 40s, were assessed on three occasions over 8 years. The survey assessed respondents' experience of chronic physical conditions, self-reported health, depression symptoms, personality, life events, socio-demographic characteristics and self-reported medication use. Survey data were linked to respondent's own administrative health service use data, and used to generate an objective measure of general practitioner (GP) consultations over a 12-month period. For each gender, respondents in the (approximate) highest decile of GP consultations at each time point were defined as frequent attenders (FAs). Results: Analysis showed chronic health conditions, self- reported health, mental health and medication use measured at baseline was associated with FA status, with some gender differences evident. However taking into account of changing circumstances improved the model fit and the prediction over FA status over time. Conclusions: The study showed that there is considerable variability in frequent attender status over the study period. While baseline characteristics can predict current and future frequent attender status, it is clear that frequent attender in primary care does reflect changing circumstances over time

Factors that explain the poorer mental health of caregivers: Results from a community survey of older Australians

Objectives: To contrast the level of anxiety and depression reported by older Australians providing assistance to someone who is ill, disabled or elderly with that of non-caregivers; and to identify secondary stressors and mediating factors which explai

Age of acquisition effects in recognition without identification tasks

The Age of Acquisition (AoA) effect results in early-acquired words being processed more quickly and accurately than later-acquired words. This effect is argued to result from a gradual development of semantic representations and a changing neural network throughout development (Chang et al., 2019). Some forms of the Recognition Without Identification (RWI) effects have been observed at a perceptual level. The present study used the RWI paradigm to examine whether the AoA effect is located at the perceptual loci. A total of 174 participants were presented a list of pictures (Experiment 1) or words (Experiment 2) followed by a list of mixed early- and late-acquired picture or word fragments that participants had to identify; half of which corresponded to studied words and half of which to unstudied words. Irrespective of whether the item was identified, participants then rated the likelihood that the item appeared in the study phase. In both experiments, results showed that studied items were recognised more accurately than unstudied items, even when they could not be identified and late-acquired items were recognised more than early-acquired items, even when they were not identified. Finally, RWI interacted with the AoA effect only in pictorial stimuli, indicating that the RWI and AoA effects are located at the perceptual level