Which Australian secondary school students are at risk of illicit drug use?

This is the peer reviewed version of the following article: [Freeman, T., White, V., & Roche, A.M. (2011) Which Australian secondary school students are at risk of illicit drug use? : A nationwide survey. Drug and Alcohol Review, 30, 589-596], which has been published in final form at [DOI: 10.1111/j.1465-3362.2010.00246.x]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Introduction and aims: Over recent years, numerous school-based preventive strategies have been explored as possible options to address illicit drug use by young people. However, there is scope to extend current knowledge of which school students are most at risk of illicit drug-related harm. To investigate potential differential risk, the prevalence and patterns of illicit drug use of Australian secondary school students were examined according to demographic, school, economic, and licit drug use factors. Design and methods: Analyses were conducted on the 2005 Australian Secondary Students’ Alcohol and Drug (ASSAD) survey. A total of 21,805 secondary school students aged 12-17 from 376 schools completed the pencil and paper classroom questionnaire. Results: The greatest risk factors for students using illicit drugs were tobacco and alcohol use. Students with self-rated below average academic achievement, with more than $20 a week of disposable income, and who were Indigenous were more likely to report illicit drug use. Discussion and conclusions: While causal pathways could not be examined in the current data, and these relationships are likely to be complex and multi-directional, the findings indicate potentially at-risk populations who warrant extra support to address illicit drug-related harm

What Factors Need to be Addressed to Support Dental Hygienists to Assist Their Patients to Quit Smoking?

This is a pre-copyedited, author-produced PDF of an article accepted for publication in NICOTINE AND TOBACCO following peer review. The version of record [Freeman, T., Roche, A.M., Williamson, P., & Pidd K (2012). What factors need to be addressed to support dental hygienists to assist their patients to quit smoking? Nicotine & Tobacco Research, 14, 1040-1047.] is available online at: http://ntr.oxfordjournals.org/content/early/2012/02/16/ntr.ntr329Dental hygienists are well placed to assist their patients to quit smoking. Smoking affects oral health and dental treatments, and hygienists report greater time with patients than dentists with more focus on prevention. However, there has been little research into the extent to which hygienists assist patients to quit smoking, and strategies to support them in this role. Methods. A two stage survey of Australian dental hygienists was conducted. The first survey measured potential predictors of asking patients about smoking and assisting patients to quit smoking using the Theory of Planned Behaviour as a framework. The second survey measured these behaviours in the past week. Structural equation modelling was used to examine predictors of the two behaviours. Results. A total of 362 hygienists returned the first questionnaire. Intentions to ask and assist patients were high. The 273 hygienists who returned the second questionnaire assisted an estimated total of 1,394 patients to quit smoking in one week. Predictors within the Theory of Planned Behaviour framework explained significant variance in asking (11%) and assisting (29%) behaviours, with self-efficacy the most critical predictor in both cases (β =.27, .32 respectively). Conclusions. Dental hygienists may be a viable and willing avenue for addressing smoking. Hygienists may be best supported in this role through increasing skills and confidence around asking sensitively about smoking, building rapport, and assisting patients to quit smoking. . Incorporation of smoking status into general history taking and adoption of organisational policies on assisting patients to quit smoking could also be encouraged

Hazardous alcohol use interventions with emergency patients: Self-reported practices of nurses, and predictors of behaviour

This is the peer reviewed version of the following article: [Freeman, T., Roche, A.M., Williamson, P., & Pidd, K. (2011) Hazardous alcohol use interventions with emergency patients: Self-reported practices of nurses, and predictors of behaviour. Emergency Medicine Australasia, 23, 479-489.], which has been published in final form at [DOI:10.1111/j.1742-6723.2011.01416.x]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.Objectives. This study examined Australian Emergency Department (ED) nurses’ practices in asking patients about alcohol and assisting them to manage their alcohol consumption. It also investigated strategies to support ED nurses in these interventions. Methods. A two stage survey was administered to ED nurses. The first questionnaire measured theoretical and organisational predictors of behaviour, and underlying beliefs, and the subsequent questionnaire explored rates of asking and assisting patients. Results. A total of 125 nurses returned the first questionnaire. Participants held generally positive attitudes, perceived norms, feelings of legitimacy, and perceived ability to ask about and intervene for alcohol, but lower role adequacy. The 71 ED nurses who completed the second questionnaire had intervened with almost 500 patients concerning alcohol in the previous week. Participants asked approximately one in four patients about alcohol (median = 26.3% of patients, 1095/4279 total patients asked). The Theory of Planned Behaviour did not predict rates of asking or assisting patients. Several strategies were identified that may increase rates: identify environmental factors that prevent nurses acting on their intentions to ask and intervene, raise confidence and skills, make asking about alcohol part of routine assessment, make supports such as drug and alcohol units or nurses available, and implement organisational policies on alcohol. Conclusions. Nurses appear positively disposed to engage with patients in regard to alcohol. However, greater support is needed to achieve the considerable significant public health benefits from this engagement. The findings point to several practical strategies that could be pursued to provide this support

Practices following the death of a loved one reported by adults from 14 countries or cultural/ethnic group

Aims: The purpose of this study was to examine the reported ritual practices (dealing with the deceased\u27s remains, wake, funeral, burial and celebration) of White non-Hispanic, Black non-Hispanic and Hispanic/Latino adults in their country of origin or ethnic or cultural group in the United States following the death of a loved one. Design: This descriptive study is a secondary analysis from a longitudinal mixed-methods study that examined parents\u27 health and functioning following the death of a child. Methods: Adult parents whose child died in neonatal intensive care units or paediatric intensive care units were recruited from four hospitals and from death records. Data were collected from 61 adult parents at 7 and 13 months postinfant/child death using semi-structured interviews about the child\u27s death. Only those parents who responded to questions about usual death practices in their country of origin or cultural group were included in the data analysis. Results: Thirty-two adults from 14 countries reported practices in their country or cultural group after a loved one\u27s death including keeping the front door closed, walking funeral processions with a band playing, the deceased in a car accompanied by family and friends, fireworks, making home altars for deceased spirits with food and water for adults, toys and candy for children and no TV or radio for sometime. Relevance to clinical practice: For community health nurses, understanding these practices is important in being sensitive and appropriate around the death. Asking the family about specific practices they hope to carry out and noting this in the family\u27s record will help alert providers to the family\u27s wishes at this challenging time

Can the Theory of Planned Behaviour Improve Our Understanding of the Influence of Organisational Factors on Workers' Behaviour?

Copyright 2007 the Australian Psychological Society. Author version reproduced here with permission from the publisher. This is an electronic version of an article published in 'Freeman, T., Roche, A.M., Williamson, P., & Pidd, K. (2007). Can the Theory of Planned Behaviour improve our understanding of the influence of organisational factors on workers’ behaviour? Proceedings of the 7th Industrial & Organisational Psychology Conference, 81-85.'Understanding and changing workers’ behaviour are key goals of Organisational Psychology. The Theory of Planned Behaviour has the potential to make an important contribution to our understanding of how organisational factors influence workers’ behaviour and of ways to achieve behaviour change with workers. According to the Theory of Planned Behaviour, intentions, attitudes, subjective norms, and perceived behavioural control are the most proximal predictors of behaviour. Any distal variables, such as organisational factors, only influence behaviour through the theoretical predictors. Though a substantial body of research has applied the Theory of Planned Behaviour to the organisational setting, no research to-date has examined whether the Theory of Planned Behaviour accounts for the influence of organisational variables on workers’ behaviour. This paper presents the results of a survey of 273 dental hygienists which applied the Theory of Planned Behaviour to the behaviour of assisting their patients to quit smoking. The findings indicated that organisational factors like the presence of a policy and education or training influenced behaviour only through subjective norms and perceived behavioural control. These results inform understanding of the pathways through which organisational factors influence workers’ behaviour. Practical implications of applying the theory to a wide range of work behaviours are highlighted.Melbourn

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Rhinitis associated with asthma is distinct from rhinitis alone: TARIA‐MeDALL hypothesis

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of “one-airway-one-disease,” coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the “Epithelial Barrier Hypothesis.” This review determined that the “one-airway-one-disease” concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme “allergic” (asthma) phenotype combining asthma, rhinitis, and conjunctivitis.info:eu-repo/semantics/publishedVersio

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients