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This study examined the nature and prevalence of bullying/victimization by peers and teachers reported by 1,284 students (mean age = 15.2 years) drawn from a representative sample of 25 South Australian government and private schools. Students completed a self-report survey containing questions relating to teacher and peer-related bullying, measures of psychosocial adjustment, and personality. The results showed that students could be clearly differentiated according to the type of victimization they had experienced. Students reporting peer victimization typically showed high levels of social alienation, poorer psychological functioning, and poorer self-esteem and self-image. By contrast, victims of teacher victimization were more likely to be rated as less able academically, had less intention to complete school and were more likely to be engaged in high-risk behaviours such as gambling, drug use and under-age drinking. Most bullying was found to occur at school rather than outside school and involved verbal aggression rather than physical harm. Boys were significantly more likely to be bullied than girls, with the highest rates being observed amongst boys attending single-sex government schools. Girls were more likely to be subject to bullying if they attended coeducational private schools. The implications of this work for enhancing school-retention rates and addressing psychological distress amongst adolescent students are discussed. [Author abstract]

Background: Obesity and eating disorders are often studied and treated separately. While the increases in obesity prevalence are well known, examination of its co-occurrence with eating disorders, a problem also of public health concern, is important because eating disorder behaviors are known to contribute to obesity onset and maintenance, and vice versa. Methods: Data from large cross-sectional representative statewide community samples of people in the years of 1995 ( n =3001), 2005 ( n =3047) and 2015 ( n =3005) were analyzed. Data were collected using a structured, self-report interview that included demographic, health-related, weight, height and eating disorder behavior questions. Eating behavior questions assessed binge eating, very strict dieting/fasting and purging, and were derived from the Eating Disorder Examination. Logistic regression analyses were conducted comparing prevalence of obesity, eating disorder behaviors and their co-occurrence. Results: The prevalence of obesity or binge eating, or obesity with comorbid binge eating, each increased significantly from 1995 to 2005 ( P <0.001 for each comparison) and continued to increase significantly from 2005 to 2015 ( P <0.001 for each comparison). The highest increases from 1995 to 2015 were in the prevalence of obesity with comorbid binge eating (7.3-fold), or obesity with comorbid very strict dieting/fasting (11.5-fold). The prevalence of very strict dieting/fasting also increased significantly from 1995 to 2015 (3.8-fold). The prevalence of purging, or obesity with comorbid purging, did not change significantly from 1995 to 2015. Conclusion: There were statewide increases during the 20 years from 1995 to 2015 in the independent prevalence of obesity, binge eating and very strict dieting/fasting, and even higher increases in the prevalence of obesity with comorbid binge eating, and obesity with comorbid very strict dieting/fasting. These findings support the need for more integrated approaches to both the prevention and treatment of obesity and eating disorder behaviors, namely binge eating and very strict dieting/fasting.

Background COVID-19 continues to represent the single biggest challenge to contemporary community sport globally. Compliance with social distancing policies, strict return-to-play protocols, and COVID-19 specific training has, perhaps, forever changed the way that children and young people engage in organised sport. Within this context, and while many children and families seek to re-engage with community sport, we (researchers and sport practitioners) have an obligation to ask questions about how the pandemic has impacted youth sport, understand the short- and long-term consequences, and explore what (if any) opportunities can be seized to assist and improve future participation and retention. The aim of this paper was to present an in-depth exploration of the impact of COVID-19 on youth sport in South Australia. Methods Within an interpretive descriptive methodology, this qualitative investigation draws on rich, individual interview and focus group data with 39 youth (ages 15–18), parents, coaches, and sport administrators. A reflexive thematic analysis was undertaken, leading to the development of four substantive themes. Results We conceptualised the ‘4 Rs’ to advance theoretical understandings about the pandemic’s impact on youth sport, including the themes ‘recognising struggle’, ‘reconnection’, ‘re-engaging after restrictions, and ‘reimagining sport’. The themes captured insights about a decline in mental wellbeing and physical activity, an increase in family connectedness, the challenge for sports to attract volunteers and participants back into sport, and the opportunities to reset values and philosophies underpinning the provision of youth sport. Conclusion The findings provide valuable insight into the youth sport setting as a result of the global pandemic and suggest that families, sporting clubs and sporting organisations require additional resources and tools (for example, support for parents to facilitate their children’s training at home during lockdown) to aid recovery efforts and to ensure the survival and prosperity of youth sport into the future.

OBJECTIVE: Gestational diabetes mellitus (GDM) may cause obesity in the offspring. The objective was to assess the effect of treatment for mild GDM on the BMI of 4- to 5-year-old children. RESEARCH DESIGN AND METHODS: Participants were 199 mothers who participated in a randomized controlled trial of the treatment of mild GDM during pregnancy and their children. Trained nurses measured the height and weight of the children at preschool visits in a state-wide surveillance program in the state of South Australia. The main outcome measure was age- and sex-specific BMI Z score based on standards of the International Obesity Task Force. RESULTS: At birth, prevalence of macrosomia (birth weight ≥4,000 g) was 5.3% among the 94 children whose mothers were in the intervention group, and 21.9% among the 105 children in the routine care control group. At 4- to 5-years-old, mean (SD) BMI Z score was 0.49 (1.20) in intervention children and 0.41 (1.40) among controls. The difference between treatment groups was 0.08 (95% CI -0.29 to 0.44), an estimate minimally changed by adjustment for maternal race, parity, age, and socio-economic index (0.08 [-0.29 to 0.45]). Evaluating BMI ≥85th percentile rather than continuous BMI Z score gave similarly null results. CONCLUSIONS: Although treatment of GDM substantially reduced macrosomia at birth, it did not result in a change in BMI at age 4- to 5-years-old.

Recent research has challenged the stereotype that eating disorders are largely limited to young, White, upper-class females. This study investigated the association between indicators of socioeconomic status and eating disorder features. Data were merged from cross-sectional general population surveys of adults in South Australia in 2008 (n = 3034) and 2009 (n = 3007) to give a total sample of 6041 participants. Multivariate logistic regressions were employed to test associations between indicators of socioeconomic status (household income, educational level, employment status, indigenous status and urbanicity) and current eating disorder features (objective binge eating, subjective binge eating, purging, strict dieting and overvaluation of weight/shape). Eating disorder features occurred at similar rates across all levels of income, education, indigenous status, and urbanicity (p > 0.05). However, compared to working full-time, not working due to disability was associated with an increased risk of objective binge eating (odds ratio (OR) = 2.30, p < 0.01) and purging (OR = 4.13, p < 0.05), engagement in home-duties with an increased risk of overvaluation of weight/shape (OR = 1.39, p < 0.05), and unemployment with an increased risk of objective binge eating (OR = 2.02, p < 0.05) and subjective binge eating (OR = 2.80, p < 0.05). Furthermore, participants with a trade or certificate qualification were at a significantly increased risk of reporting strict dieting compared to participants without a tertiary qualification (OR = 1.58, p <0.01). Limitations included the small numbers of indigenous participants (n = 115) and participants who reported purging (n = 54), exclusion of excessive exercise (which is associated with eating disorders, particularly in males), and the conduct of interviews by laypersons. Overall, symptoms of eating disorders are distributed equally across levels of socioeconomic status. This study highlights the need for universal access to specialised services, to train healthcare workers in the detection and diagnosis of eating disorders in diverse subgroups, and to combat barriers to help-seeking experienced by people who do not conform to the demographic stereotype of an eating disorder. The increased prevalence of various eating disorder features in those who are not working could be addressed by providing support to help sufferers join the workforce, or engage in meaningful social or community activities to improve resilience against the development of eating disorders.

•58,637 doses of 4CMenB vaccine were administered to 30,522 students.•193 AEFI including nine serious adverse events in 187 students were reported.•The AEFI reporting rate was low and consistent with other adolescent vaccines. Four-component meningococcal B (4CMenB) vaccine is licensed in many countries but has had limited use in adolescents despite this age group being at increased risk of meningococcal disease. To assess the safety profile of two doses of 4CMenB in adolescents. Cluster randomised controlled trial of senior school students in South Australia (SA) with participating schools randomised to intervention (4CMenB) or control. Vaccine safety was monitored using the South Australian Vaccine Safety Surveillance System (SAVSS), a spontaneous reporting system for adverse events following immunisation (AEFI) with enhanced follow-up of AEFI. 58,637 doses of 4CMenB vaccine were administered to 30,522 students (median age 16 years) during 2017–2018. Of 18,348 and 12,174 students vaccinated in 2017 and 2018, 97.3% and 84.3%, respectively, received both scheduled doses (N = 28,115). 193 AEFI in 187 students were reported with a reporting rate of 0.32% (95%CI: 0.28–0.39%). Seventy individuals sought medical review, including nine serious adverse events. 98% (166/169) of those who were contactable for AEFI follow-up (87.6% 169/193) reported resolution of the event. Most common AEFI were injection site reaction (126/193), headache (99/193) and nausea (61/193). AEFI were more frequently reported in females (aOR = 1.409 (95%CI: 1.002, 1.980)), schools with high level of educational advantage (adjusted Odds Ratio (aOR) = 1.515 (95%CI: 1.005, 2.284)), following first dose (aOR = 1.619 (95%CI: 1.168, 2.244)), and in 2017 (aOR = 1.437 (95%CI: 1.001, 2.064)). Reported AEFI declined with increasing age (aOR = 0.771 (95%CI: 0.673, 0.883)). In this largest post-licensure use of 4CMenB in adolescents, the low AEFI reporting rate provides real-world evidence of 4CMenB safety in this age group. (ClinicalTrials.gov number: NCT03089086).

Background Globally, hepatitis C virus (HCV) elimination is a priority for marginalised communities, including Aboriginal and Torres Strait Islander peoples in Australia. Innovative and equity focused models of care are required to achieve elimination. The aim of this analysis was to evaluate prevalence of, and factors associated with, HCV infection among Aboriginal peoples engaged during implementation of a point-of-care testing and treatment intervention at Aboriginal primary health care services. Methods The SCALE-C prospective cohort study implemented a decentralised, on-site community-based “test and treat” intervention through four regional Aboriginal Community Controlled Health Organisations (primary care services) in New South Wales and South Australia between May 2019 and July 2022. Following a screening questionnaire (history of HCV infection, injecting drug use, incarceration, opioid agonist therapy use), participants underwent fingerstick point-of-care HCV testing (antibody [no risk] and/or RNA [history of HCV, ever at risk]); those at risk or with current HCV infection were also offered point-of-care HIV and HBV testing, education, and longitudinal follow-up. Participants with current HCV infection were offered DAA treatment. The primary endpoint was current HCV infection, with secondary endpoints including DAA uptake and outcome. Factors associated with current HCV infection were assessed using logistic regression analysis. Results Of 536 individuals enrolled (median age 39 years, 49% women, 37% injecting drug use ever, 32% incarceration ever), 79% identified as Aboriginal and/or Torres Strait Islander. The proportion with current HCV infection was 9%, ranging from 0.5% among people reporting no lifetime risk to 20% among those reporting risk within the past 12 months. Current HCV infection was associated with recent injecting drug use (adjusted OR: 10.43; 95% CI: 1.34–81.01). Among participants with HCV infection, 62% (28/45) received DAA treatment (median time from enrolment to treatment initiation, nine days [range 2, 22]) and 57% (16/28) of those treated had confirmed sustained virological response (SVR); SVR was 100% (16/16) among those retained in follow up. Conclusion A community-based decentralised on-site “test and treat” intervention integrated within existing Aboriginal community-controlled health organisations was feasible and effective in HCV case detection. While it holds potential for future elimination efforts, health system enhancement will be required (including dedicated staffing and infrastructure) to support broader implementation and improve linkage to care and treatment. Clinical trial This study was registered with clinicaltrials.gov (NCT03776760) on December 12, 2018.

Objective: The goal of this study was to identify mental, behavioral, and cognitive disorders that may be triggered or exacerbated during heat waves, predisposing individuals to heat-related morbidity and mortality. Design: Using health outcome data from Adelaide, South Australia, for 1993-2006, we estimated the effect of heat waves on hospital admissions and mortalities attributed to mental, behavioral, and cognitive disorders. We analyzed data using Poisson regression accounting for overdispersion and controlling for season and long-term trend, and we performed threshold analysis using hockey stick regression. Results: Above a threshold of 26.7°C, we observed a positive association between ambient temperature and hospital admissions for mental and behavioral disorders. Compared with non-heat-wave periods, hospital admissions increased by 7.3% during heat waves. Specific illnesses for which admissions increased included organic illnesses, including symptomatic mental disorders; dementia; mood (affective) disorders; neurotic, stress related, and somatoform disorders; disorders of psychological development; and senility. Mortalities attributed to mental and behavioral disorders increased during heat waves in the 65- to 74-year age group and in persons with schizophrenia, schizotypal, and delusional disorders. Dementia deaths increased in those up to 65 years of age. Conclusion: Our results suggest that episodes of extreme heat pose a salient risk to the health and well-being of the mentally ill. Relevance to Clinical or Professional Practice: Improvements in the management and care of the mentally ill need to be addressed to avoid an increase in psychiatric morbidity and mortality as heat waves become more frequent.

In multidisciplinary research interpreting interactions between diverse data sources requires a Complexity approach. A Complex Adaptive Systems (CAS) framework allows the relationships of multiple factors to be explored and may provide a more holistic and nuanced understanding. This study is innovative in explaining the potential benefits in a CAS approach to combining bioarchaeological and historical data when examining a rare archaeological skeletal sample of early migrants to South Australia (SA). Macroscopic, radiographic and micro-CT methods were used for the analysis of the skeletal remains of a group of 19 th century migrants buried in an unmarked area of St Mary’s Anglican Church Cemetery. The relevant historical records explored were from British emigrant ships to SA (1836–1885 CE) and the Church burial records (1847–1885 CE). Evidence of poor oral and general health was present in the skeletal material. Dental developmental defects indicated health insults in early life. Pathological manifestations in bone were compatible with joint and infectious diseases, and metabolic deficiencies. Historical documents recorded that the voyages to SA were challenging, with some ships experiencing a high death rate. Diseases, e.g., measles and scarlet fever, and diarrhoea were frequently recorded as causes of death at sea for both non-adults and adults. In the Colony, burial records showed similar causes of death for non-adults, but for adults, accidents and tuberculosis were often reported. The CAS approach provided insights beyond those from analysis of the individual sources. It increased understanding of emergent, non-predicted outcomes that resulted from interactions between multiple factors, the impact of fluctuating economy, political instability and ideological pressures, on the health of migrants. The CAS framework is a valuable methodology for interpreting health patterns and can be further developed including for a range of historical and contemporary health contexts.

Appropriate understanding of health information by patients with cardiovascular disease (CVD) is fundamental for better management of risk factors and improved morbidity, which can also benefit their quality of life. To assess the relationship between health literacy and health-related quality of life (HRQoL) in patients with ischaemic heart disease (IHD), and to investigate the role of sociodemographic and clinical variables as possible confounders. Cross-sectional study of patients with IHD recruited from a stratified sample of general practices in two Australian states (Queensland and South Australia) between 2007 and 2009. Health literacy was measured using a validated questionnaire and classified as inadequate, marginal, or adequate. Physical and mental components of HRQoL were assessed using the Medical Outcomes Study Short Form (SF12) questionnaire. Analyses were adjusted for confounders (sociodemographic variables, clinical history of IHD, number of CVD comorbidities, and CVD risk factors) using multiple linear regression. A total sample of 587 patients with IHD (mean age 72.0±8.4 years) was evaluated: 76.8% males, 84.2% retired or pensioner, and 51.4% with up to secondary educational level. Health literacy showed a mean of 39.6±6.7 points, with 14.3% (95%CI 11.8-17.3) classified as inadequate. Scores of the physical component of HRQoL were 39.6 (95%CI 37.1-42.1), 42.1 (95%CI 40.8-43.3) and 44.8 (95%CI 43.3-46.2) for inadequate, marginal, and adequate health literacy, respectively (p-value for trend = 0.001). This association persisted after adjustment for confounders. Health literacy was not associated with the mental component of HRQoL (p-value = 0.482). Advanced age, lower educational level, disadvantaged socioeconomic position, and a larger number of CVD comorbidities adversely affected both, health literacy and HRQoL. Inadequate health literacy is a contributing factor to poor physical functioning in patients with IHD. Increasing health literacy may improve HRQoL and reduce the impact of IHD among patients with this chronic CVD.