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1.  The Impact of Personal Background and School Contextual Factors on Academic Competence and Mental Health Functioning across the Primary-Secondary School Transition 
PLoS ONE  2014;9(3):e89874.
Students negotiate the transition to secondary school in different ways. While some thrive on the opportunity, others are challenged. A prospective longitudinal design was used to determine the contribution of personal background and school contextual factors on academic competence (AC) and mental health functioning (MHF) of 266 students, 6-months before and after the transition to secondary school. Data from 197 typically developing students and 69 students with a disability were analysed using hierarchical linear regression modelling. Both in primary and secondary school, students with a disability and from socially disadvantaged backgrounds gained poorer scores for AC and MHF than their typically developing and more affluent counterparts. Students who attended independent and mid-range sized primary schools had the highest concurrent AC. Those from independent primary schools had the lowest MHF. The primary school organisational model significantly influenced post-transition AC scores; with students from Kindergarten - Year 7 schools reporting the lowest scores, while those from the Kindergarten - Year 12 structure without middle school having the highest scores. Attending a school which used the Kindergarten - Year 12 with middle school structure was associated with a reduction in AC scores across the transition. Personal background factors accounted for the majority of the variability in post-transition AC and MHF. The contribution of school contextual factors was relatively minor. There is a potential opportunity for schools to provide support to disadvantaged students before the transition to secondary school, as they continue to be at a disadvantage after the transition.
doi:10.1371/journal.pone.0089874
PMCID: PMC3946588  PMID: 24608366
2.  The use of herbal medicines during breastfeeding: a population-based survey in Western Australia 
Background
Main concerns for lactating women about medications include the safety of their breastfed infants and the potential effects of medication on quantity and quality of breast milk. While medicine treatments include conventional and complementary medicines, most studies to date have focused on evaluating the safety aspect of conventional medicines. Despite increasing popularity of herbal medicines, there are currently limited data available on the pattern of use and safety of these medicines during breastfeeding. This study aimed to identify the pattern of use of herbal medicines during breastfeeding in Perth, Western Australia, and to identify aspects which require further clinical research.
Methods
This study was conducted using a self-administered questionnaire validated through two pilot studies. Participants were 18 years or older, breastfeeding or had breastfed in the past 12 months. Participants were recruited from various community and health centres, and through advertising in newspapers. Simple descriptive statistics were used to summarise the demographic profile and attitudes of respondents, using the SPSS statistical software.
Results
A total of 304 questionnaires from eligible participants were returned (27.2% response rate) and analysed. Amongst the respondents, 59.9% took at least one herb for medicinal purposes during breastfeeding, whilst 24.3% reported the use of at least one herb to increase breast milk supply. Most commonly used herbs were fenugreek (18.4%), ginger (11.8%), dong quai (7.9%), chamomile (7.2%), garlic (6.6%) and blessed thistle (5.9%). The majority of participants (70.1%) believed that there was a lack of information resources, whilst 43.4% perceived herbal medicines to be safer than conventional medicines. Only 28.6% of users notified their doctor of their decision to use herbal medicine(s) during breastfeeding; 71.6% had previously refused or avoided conventional medicine treatments due to concerns regarding safety of their breastfed infants.
Conclusions
The use of herbal medicines is common amongst breastfeeding women, while information supporting their safety and efficacy is lacking. This study has demonstrated the need for further research into commonly used herbal medicines. Evidence-based information should be available to breastfeeding women who wish to consider use of all medicines, including complementary medicines, to avoid unnecessary cessation of breastfeeding or compromising of pharmacotherapy.
doi:10.1186/1472-6882-13-317
PMCID: PMC3835544  PMID: 24219150
Herbal medicines; Breastfeeding; Lactation; Breastfeeding women; Survey; Prevalence
3.  The Case for Using the Repeatability Coefficient When Calculating Test–Retest Reliability 
PLoS ONE  2013;8(9):e73990.
The use of standardised tools is an essential component of evidence-based practice. Reliance on standardised tools places demands on clinicians to understand their properties, strengths, and weaknesses, in order to interpret results and make clinical decisions. This paper makes a case for clinicians to consider measurement error (ME) indices Coefficient of Repeatability (CR) or the Smallest Real Difference (SRD) over relative reliability coefficients like the Pearson’s (r) and the Intraclass Correlation Coefficient (ICC), while selecting tools to measure change and inferring change as true. The authors present statistical methods that are part of the current approach to evaluate test–retest reliability of assessment tools and outcome measurements. Selected examples from a previous test–retest study are used to elucidate the added advantages of knowledge of the ME of an assessment tool in clinical decision making. The CR is computed in the same units as the assessment tool and sets the boundary of the minimal detectable true change that can be measured by the tool.
doi:10.1371/journal.pone.0073990
PMCID: PMC3767825  PMID: 24040139
4.  Internal Consistency, Test–Retest Reliability and Measurement Error of the Self-Report Version of the Social Skills Rating System in a Sample of Australian Adolescents 
PLoS ONE  2013;8(9):e73924.
The social skills rating system (SSRS) is used to assess social skills and competence in children and adolescents. While its characteristics based on United States samples (US) are published, corresponding Australian figures are unavailable. Using a 4-week retest design, we examined the internal consistency, retest reliability and measurement error (ME) of the SSRS secondary student form (SSF) in a sample of Year 7 students (N = 187), from five randomly selected public schools in Perth, western Australia. Internal consistency (IC) of the total scale and most subscale scores (except empathy) on the frequency rating scale was adequate to permit independent use. On the importance rating scale, most IC estimates for girls fell below the benchmark. Test–retest estimates of the total scale and subscales were insufficient to permit reliable use. ME of the total scale score (frequency rating) for boys was equivalent to the US estimate, while that for girls was lower than the US error. ME of the total scale score (importance rating) was larger than the error using the frequency rating scale. The study finding supports the idea of using multiple informants (e.g. teacher and parent reports), not just student as recommended in the manual. Future research needs to substantiate the clinical meaningfulness of the MEs calculated in this study by corroborating them against the respective Minimum Clinically Important Difference (MCID).
doi:10.1371/journal.pone.0073924
PMCID: PMC3767833  PMID: 24040116
5.  A Policy-into-Practice Intervention to Increase the Uptake of Evidence-Based Management of Low Back Pain in Primary Care: A Prospective Cohort Study 
PLoS ONE  2012;7(5):e38037.
Background
Persistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policy-into-practice intervention developed for primary care physicians (PCPs).
Methods
To encourage PCPs to adopt practical evidence-based approaches and facilitate time-efficient, integrated management of patients with nsLBP, we developed an interdisciplinary evidence-based, practical pain education program (gPEP) based on a contemporary biopsychosocial framework. One hundred and twenty six PCPs from primary care settings in Western Australia were recruited. PCPs participated in a 6.5-hour gPEP. Self-report measures recorded at baseline and at 2 months post-intervention included PCPs' attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS), evidence-based clinical practices (knowledge and skills regarding nsLBP management: 5-point Likert scale with 1 =  nil and 5 =  excellent) and practice behaviours (recommendations based on a patient vignette; 5-point Likert scale).
Results
Ninety one PCPs participated (attendance rate of 72%; post-intervention response rate 88%). PCP-responders adopted more positive, guideline-consistent beliefs, evidenced by clinically significant HC-PAIRS score differences (mean change  = −5.6±8.2, p<0.0001; 95% confidence interval: −7.6 to −3.6) and significant positive shifts on all measures of clinical knowledge and skills (p<0.0001 for all questions). Self management strategies were recommended more frequently post-intervention. The majority of responders who were guideline-inconsistent for work and bed rest recommendations (82% and 62% respectively) at pre-intervention, gave guideline-consistent responses at post-intervention.
Conclusion
An interprofessional pain education program set within a framework that aligns health policy and practice, encourages PCPs to adopt more self-reported evidence-based attitudes, beliefs and clinical behaviours in their management of patients with nsLBP. However, further research is required to determine cost effectiveness of this approach when compared with other modes of educational delivery and to examine PCP behaviours in actual clinical practice.
doi:10.1371/journal.pone.0038037
PMCID: PMC3360643  PMID: 22662264
6.  Looking through the Same Eyes? Do Teachers' Participation Ratings Match with Ratings of Students with Autism Spectrum Conditions in Mainstream Schools? 
Autism Research and Treatment  2012;2012:656981.
To create an inclusive classroom and act accordingly, teachers' understanding of the experiences of participation of students with autism spectrum conditions (ASCs) is crucial. This understanding may depend on the teachers' professional experiences, support and personal interests. The aim of the present questionnaire study was to investigate how well the teachers' ratings of their students with ASCs' perception of participation matched with the students' own ratings. Furthermore, possible correlations between the accuracy of teachers' ratings and the teachers' self-reported professional experience, support (including support-staff), and personal interest were investigated. Teachers' ratings were also used to examine how their understandings correlated with classroom actions. The agreements between teachers' and students' ratings were moderate to high, and the ability to attune to the students' perception of participation was not affected by the presence of a support-staff. The teachers' personal interest in teaching students with ASC correlated with their accuracy, suggesting that this is a factor to consider when planning for successful placements in mainstream schools. Teachers' understandings of the students with ASCs' perception of being bullied or unpopular correlated with implementation of activities to improve the attitudes of classmates, but not with actions to enhance social relations for the students with ASC.
doi:10.1155/2012/656981
PMCID: PMC3420386  PMID: 22934176
7.  Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm 
BMJ : British Medical Journal  2004;329(7477):1259.
Objective To assess whether screening for abdominal aortic aneurysms in men reduces mortality.
Design Population based randomised controlled trial of ultrasound screening, with intention to treat analysis of age standardised mortality.
Setting Community based screening programme in Western Australia.
Participants 41 000 men aged 65-83 years randomised to intervention and control groups.
Intervention Invitation to ultrasound screening.
Main outcome measure Deaths from abdominal aortic aneurysm in the five years after the start of screening.
Results The corrected response to invitation to screening was 70%. The crude prevalence was 7.2% for aortic diameter ≥ 30 mm and 0.5% for diameter ≥ 55 mm. Twice as many men in the intervention group than in the control group underwent elective surgery for abdominal aortic aneurysm (107 v 54, P = 0.002, χ2 test). Between scheduled screening and the end of follow up 18 men in the intervention group and 25 in the control group died from abdominal aortic aneurysm, yielding a mortality ratio of 0.61 (95% confidence interval 0.33 to 1.11). Any benefit was almost entirely in men aged between 65 and 75 years, where the ratio was reduced to 0.19 (0.04 to 0.89).
Conclusions At a whole population level screening for abdominal aortic aneurysms was not effective in men aged 65-83 years and did not reduce overall death rates. The success of screening depends on choice of target age group and the exclusion of ineligible men. It is also important to assess the current rate of elective surgery for abdominal aortic aneurysm as in some communities this may already approach a level that reduces the potential benefit of population based screening.
doi:10.1136/bmj.38272.478438.55
PMCID: PMC534438  PMID: 15545293

Results 1-7 (7)