Positive change in intent to practice rurally is strongly associated with nursing and allied health students of metropolitan origin after rural clinical placement.

OBJECTIVE: To: (1) assess whether rural clinical placements influence change in intention to practice rurally for nursing and allied health students, (2) to assess whether residential origin (metropolitan or rural) or university location (metropolitan or non-metropolitan) influence this change, and (3) assess residential origin of health professionals practicing rurally after graduation. DESIGN: Cross-sectional survey (2014-2022) conducted in Northern/Northeastern Victoria and Grampians region by nursing and allied health students completing rural clinical placements. Survey explored student placement satisfaction, intention to practice rurally and demographic information, with a follow-up two years' post-placement. FINDINGS: Experience of a rural placement increased students' intention of practicing rurally. Importantly, 57% of metropolitan origin students studying at metropolitan campuses exhibited positive change. Logistic regression analysis suggested that after controlling for age, gender and satisfaction with placement and supervision, students of metropolitan origin at metropolitan campuses were 6.4 times more likely to report positive change in intent to practice rurally after placement than students of rural origin studying at non-metropolitan campuses.Follow-up data suggested that a substantial proportion of health professionals providing services in rural areas were of metropolitan origin. RESULTS: These findings concur that rural origin and rural training are important predictors of working rurally. Additionally, metropolitan students can change their intention to practice rurally after a rural placement. CONCLUSIONS: This study supports strategies to enhance intention to practice rurally that are not restricted to rural origin students to build rural workforce.

Experiences of Oncofertility Decision-Making and Care in a National Sample of Adolescent and Young Adult Cancer Patients and Parents.

Purpose: Cancer and its treatments are known to compromise fertility in adolescents and young adults (AYAs). The emotional burden of possible infertility is reduced in those who receive supportive oncofertility care. In legal minors, provision of health care must consider the legal context and desire that AYAs have for autonomous decision-making, together with their competence to make health decisions. This has important implications for how oncofertility discussions may, or may not, involve parents. The aim of this study was to explore oncofertility decision-making and care experiences in a national Australian sample of AYA cancer patients and their parents. Methods: AYAs aged 15-25 years and parents were recruited from 17 cancer care sites and CanTeen Australia as part of a national AYA cancer care study. The cross-sectional survey included open-ended questions regarding oncofertility care experiences. We used reflexive thematic analysis to identify themes. Results: Data were available for 99 AYAs and 111 parents. Four themes were identified: emotional care needs; parent-AYA dynamics including AYA autonomy and agency; decision-making considerations including values and practicalities; and reflections on oncofertility care and follow-up. Both AYAs and parents placed importance on AYA autonomy in fertility decision-making, but many AYAs appreciated the role of parents in providing support and guidance throughout the process. Conclusion: Health care professionals are encouraged to autonomously engage AYAs around fertility decision-making, while concurrently offering opportunities that promote parental support. Better psychological support and follow-up oncofertility care are also needed.

Experiences of Family and Partner Support in Fertility Decision-Making Among Adolescents and Young Adults with Cancer: A National Australian Study.

Purpose: To understand how adolescents and young adults (AYAs) with cancer experience family and partner involvement in fertility preservation (FP) decision-making. Methods: As part of a nationally representative Australian cross-sectional study of 15-25-year olds with cancer, 196 participants (mean age 19.9 [standard deviation 3.2] years at diagnosis; 51% male) were surveyed regarding FP decision-making. Results: One hundred sixty-one (83%) participants reported discussion of potential effects of cancer and its treatment on fertility, of whom 57 (35%) did not undertake FP (51% of females; 19% of males). Parental involvement (mothers 62%, fathers 45%) in decision-making was considered helpful, including for 73% of 20-25-year olds with partners. Sisters and brothers were involved less often, yet rated helpful in 48% and 41% of cases, respectively. Older participants were more likely than younger ones to have involved partners (47% vs. 22%, p = 0.001) and less likely to have involved mothers (56% vs. 71%, p = 0.04) or fathers (39% vs. 55%, p = 0.04). Conclusion: This is the first quantitative study to explore family and partner involvement in AYA FP decision-making in both females and males in a nationally representative sample. Parents are important resources who commonly assist AYAs with these complex decisions. Although many AYAs will be the main decision-makers when it comes to FP, particularly as AYAs mature, these data suggest that resources and support should be available for and inclusive of parents, partners, and siblings.

A one-step, tunable method of selective reactive sputter deposition as a wrinkling approach for silver/polydimethylsiloxane for electrically conductive pliable surfaces.

The wrinkle period and morphology of a metal thin film on an elastic substrate is typically controlled by modifying the substrate before carrying out additional metal deposition steps. Herein, we show that a simultaneously selective and reactive sputtering plasma that modifies the surface of a polydimethylsiloxane (PDMS) substrate while not reacting with the metal during the deposition process decreases the wrinkle wavelength and induces additional wrinkling components and features such as ripples or folds. The selective reaction of the nitrogen plasma with PDMS functionalizes the siloxane surface into silicon oxynitride. This hardens the immediate surface of PDMS, with a quadratic increase in the Young's modulus as a function of the sputtering flow ratio. The increase in the critical strain mismatch and the corresponding presence of folds in the nitrogen-modified wrinkled silver film form a suitable plasmonic platform for surface-enhanced Raman spectroscopy (SERS), yielding an enhancement factor of 4.8 × 105 for detecting lipids. This enhancement is linked to the emergence of electromagnetic hotspots from surface plasmon polariton coupling between the folds/wrinkles, which in turn enables the detection of low concentrations of organics using SERS. Furthermore, when strained, the nitrogen-modified wrinkles enhance electrical conductivity by a factor of 12 compared with unmodified films. Finally, the optical properties of the substrate can be tuned by altering the N2 content. The simple addition of nonreactive nitrogen to silver sputtering enables simultaneous PDMS hardening and growth of the silver film and together provide a new avenue for tuning wrinkling parameters and enhancing the electrical conductivity of pliable surfaces.

The changing nature of social support for adolescents and young adults with cancer.

PURPOSE: The aim of this study was to explore adolescent and young adult (AYA) experiences and preferences for social support early within the continuum of cancer treatment. METHODS: AYAs aged 15-25 years old at diagnosis were recruited from 6 clinical services that were purposively selected for providing specialist cancer care to AYAs across 3 Australian states and within paediatric and adult services. In-depth, semi-structured interviews were conducted by telephone 6-24 months from diagnosis. The narrative-based interviews included preferences for psychosocial support. Interviews were transcribed and thematic analysis was undertaken using grounded theory methodology. RESULTS: 60 AYAs were interviewed (mean age 20.52 [SD 2.97] years; 58% male; 72% adult settings). Analysis revealed that parents provided the foundation of emotional, informational and instrumental social support, even for older AYAs and those with partners and children. Informal emotional engagement with cancer peers was strongly appreciated during hospital treatment, while healthy peers provided welcome diversion at this time and during the transition towards their usual life. Nurses and allied health staff provided informational support to hospitalised AYAs and also provided a strong source of emotional support. Formal peer support programs were not endorsed by AYAs early in treatment but appreciated to be of greater interest to some following treatment completion. CONCLUSION: Social support was predominantly provided by family, peers and health professionals. The sources and types of support most welcomed by AYAs varied according to the intensity and phase of cancer treatment and where the young person was in their cancer trajectory.

The age of paediatrics.

The epidemiological transition towards non-communicable diseases is characterised by an upward shift in age of disease burden across the lifecourse. One response, within a suite of wider actions, would be to extend the upper age limit of paediatric practice to embrace adolescent health. We did an online survey to explore the upper age limit of paediatric care, obtaining responses from 1372 paediatricians in 115 countries. Marked variation in the upper age limit was apparent. Among high-income countries, a higher upper age limit was associated with greater disease burden in adolescents relative to young children (<5 years). Although paediatricians reported the mean upper age limit of paediatrics had risen over the past 20 years, the mean preferred age of 18·7 (SD 2·6) years was higher than the mean current age of 17·4 (SD 2·5) years (p<0·0001). Paediatricians reported the main reasons for the rising age over time was their greater awareness of adolescent health and leadership by professional associations. Reports of the quality of adolescent health education within national paediatric training suggest that this education is largely inadequate. A greater focus on adolescent health is required within paediatrics to ensure that the future paediatric workforce is appropriately equipped to respond to the changing disease burden across childhood and adolescence.

Information needs of adolescent and young adult cancer patients and their parent-carers.

PURPOSE: This study aimed to explore health-related information needs of adolescent and young adults (AYAs) and their parent-carers and to examine demographic and clinical variables associated with unmet information needs, including patient activation. METHODS: In a national cross-sectional study, 196 Australian AYAs diagnosed with cancer between 15 and 25 years and within 24 months of diagnosis and 204 parent-carers reported on total and unmet needs for cancer and health-related information. Fifty-one percent of AYAs were male, 81% had completed treatment and 86% were treated in adult hospitals. RESULTS: AYAs and parents reported high levels of total need for information. The mean number of unmet needs was 5.63 and 6.82 for AYAs and parents, respectively. AYAs reported the highest unmet needs in relation to their cancer (e.g. late effects and cancer recurrence, and having children in the future). The highest unmet parent information needs were related to medical information about their child as well as information on financial issues for their children and themselves. Unmet information need was associated with psychological distress (posttraumatic stress symptoms) for AYAs and parents. Patient activation was negatively associated with unmet information needs for AYAs. Demographic and treatment variables were not significantly associated with information needs. CONCLUSION: These findings indicate the importance of information needs for AYAs and their carers. The association between patient activation and information needs suggests that promoting young people's engagement with healthcare is a key opportunity within AYA care. Parent information needs and associated emotional distress additionally highlight the importance of family-centered care.

Early Education and Employment Outcomes After Cancer in Adolescents and Young Adults.

PURPOSE: This study describes the early educational and vocational outcomes of Australian adolescents and young adults (AYAs) after cancer diagnosis and examines factors associated with these outcomes. METHODS: Within this cross-sectional national Australian study, 196 AYAs aged 15-25 years at cancer diagnosis and within 6-24 months of diagnosis were recruited from 18 sites. Participants completed a survey that included questions about school and work outcomes, support received regarding necessary changes to education and vocation, and validated measures of anxiety, depression, and post-traumatic stress. RESULTS: Almost half of the sample (43%) was not fully "back on track" with their previous educational and vocational plans. Post-traumatic stress and emotional symptoms were associated with poorer school/work functioning (ß = -0.95, p = 0.009 and ß = -1.27, p = 0.001, respectively). Higher PedsQL school/work functioning was associated with a slightly greater likelihood of being "back on track" with education and work plans (OR 1.03, p = 0.001). AYAs who felt well supported regarding changes to education and work plans more frequently reported receiving support from formal sources and from more sources than those who felt less supported. Unmet need of accessing an educational or vocational advisor was significantly more frequent in adult than in pediatric settings (42% vs. 17%; p = 0.024). Parents were the most common source of educational or vocational support for AYAs rather than professionals. CONCLUSION: This study highlights the connection between school and work participation and mental health in a national sample of AYAs with cancer. It suggests distinct benefits of educational and vocational support.

Unmet need for healthcare services in adolescents and young adults with cancer and their parent carers.

PURPOSE: Cancer in adolescents in and young adults (AYA) has the potential to disrupt health, well-being and developmental trajectories. This study aimed to describe the healthcare support service needs of AYAs with cancer and parent carers and to explore the association of unmet need and emotional distress. METHODS: As part of a national Australian survey of 15-25 year olds with cancer and a nominated parent carer, 196 AYAs reported total and unmet need for 10 clinical services and 204 parents reported on their child's and their own healthcare service needs. Proportions of total and unmet need for specific clinical services are reported. The association of unmet service needs and distress (measured using the Posttraumatic Stress Disorder Checklist) was also examined. RESULTS: AYAs and parent carers expressed high total need for clinical services during treatment. Leading AYA unmet needs were for an exercise therapist (37%), genetic counsellor (30%), dietitian (26%), peer support group (26%) and educational and vocational advisor (24%). After treatment, AYAs and parents had fewer total needs. However, 60% of AYA and 38% of parents had two or more unmet needs, similar to during treatment. Female gender and receiving treatment in an adult setting were significantly associated with unmet need for clinical services. After treatment, higher distress levels in AYAs and parents were associated with two or more unmet service needs. DISCUSSION: AYAs and parents had high levels of total and unmet service need, which were associated with greater emotional distress. These results highlight opportunities to re-orientate services to better meet AYA and parent needs.

Psychological Distress and Posttraumatic Stress Symptoms in Adolescents and Young Adults with Cancer and Their Parents.

PURPOSE: To investigate the prevalence and predictors of psychological distress in adolescent and young adult (AYA) cancer patients and their parent caregivers. METHODS: In a cross-sectional study design, AYA participants (n = 196) and parent caregivers (n = 204) were recruited from 18 sites across Australia. AYAs were aged 15-25 years at cancer onset and within 6-24 months of diagnosis. AYAs and parents completed a survey that includes validated measures of psychological distress (anxiety, depression, and posttraumatic stress symptoms [PTSS]). Additional measures included validated and study-specific questionnaires related to sociodemographic and medical information, social supports, cancer impacts, and life stressors. RESULTS: Nearly half the sample (48% AYAs and 42% parents) scored above a clinical cutoff score for PTSS, indicating further assessment was warranted. Nearly one third of AYAs and parents (31% AYAs and 28% parents) reported moderate to severely elevated symptoms of anxiety and depression. Factors associated with elevated AYA distress included female gender, less social support, and self-image and identity issues. For parents, living outside the metropolitan area, other life stressors, and impact on plans for the future and broader family were factors associated with increased distress. CONCLUSION: Despite numerous studies of AYA cancer survivors, very few studies have examined the psychosocial and psychological impacts of cancer when onset occurs during adolescence and young adulthood. Almost no studies have examined the impacts on their parent caregivers. The findings of this study support the need for early identification of psychological distress, appropriate developmental perspectives to understand AYA distress, and the need for family-based psychological assessment and interventions.

Fulfilling the Vision of Youth-Friendly Cancer Care: A Study Protocol.

PURPOSE: There is growing evidence about the extent that cancer in adolescents and young adults (AYAs) can interrupt normal developmental trajectories, which places the onus on cancer services to buffer these impacts. This article reports the protocol of a four-stage study that aimed to establish how well Australian cancer treatment services are providing youth-friendly cancer care, that is, quality care that best meets young people's needs. The overall goal of this study is to develop an evidence-informed model of cancer care for this age group. METHODS: Eligible patients were 15-25 years old and 6-24 months from a cancer diagnosis, and a nominated carer. Stage 1 consisted of in-depth, semi-structured interviews. Qualitative analysis identified the major domains affected by cancer. Stage 2 was the development of a survey tool for AYA and parents to measure these domains, compiled from validated instruments of: psychological distress; post-traumatic growth; quality of life; social support; quality of services, information, and needs; physical, psychological, and social needs; self-management; and experience of care, as well as questions covering additional domains (e.g., fertility preservation). Stage 3 was a national survey of AYAs and parents. This information will inform the development of a program model, to be refined by stakeholder consultation in Stage 4. CONCLUSION: Analysis of these data will inform how well cancer services meet the needs of AYAs and their parents around clinical services and psychosocial supports, the physical environment, and information, with the ultimate goal of informing a program model of AYA cancer care.

Identification of four novel COL10A1 missense mutations in schmid metaphyseal chondrodysplasia: further evidence that collagen X NC1 mutations impair trimer assembly.

Schmid metaphyseal chondrodysplasia (SMCD) is an autosomal dominant disorder affecting the growth plate cartilage of long bones caused by heterozygous mutations in the gene for collagen X (COL10A1), a short-chain collagen expressed by hypertrophic chondrocytes of growth plate cartilage. In this paper we analyzed six unrelated patients clinically determined as affected by SMCD, and characterized four missense mutations, c.52G>A (p.G18R), c.1744T>G (p.Y582D), c.1792T>G (p.Y598D) and c.1958A>C (p.Q653P). These mutations were clustered in the two regions of the collagen X protein shown to contain all previous SMCD mutations; the signal sequence cleavage site (p.G18R), or the C-terminal NC1 trimerization domain (p.Y582D, p.Y598D and p.Q653P). To determine the functional effect of the mutations we produced engineered p.Y582D, p.Y598D and p.Q653P cDNA and expressed these in vitro. Our data showed that while the wild-type collagen X assembled in vitro into trimers that were stable to SDS-PAGE analysis, p.Y582D (the most N-terminal of the SMCD NC1 mutations described), p.Q653P, and the previously analyzed p.Y598D impair collagen X trimerization. However, in two patients no mutations were detected despite complete sequence analysis of the COL10A1 coding region, the exon-intron splice consensus sequences and the 500bp gene promoter region. Heterozygosity for known polymorphisms ruled out major COL10A1 gene deletions and Southern analysis excluded major rearrangements. The data suggest that in these two patients, SMCD results from mutations at another gene locus. No mutations were detected in RMRP, the gene for cartilage-hair hypoplasia that has phenotypic overlap with SMCD.

Analysis of the Arg345Trp disease-associated allele of the EFEMP1 gene in individuals with early onset drusen or familial age-related macular degeneration.

BACKGROUND: A single base change within the EFEMP1 gene has been associated with malattia leventinese and Doyne honeycomb retinal dystrophy, two dominantly inherited macular diseases with early onset drusen. The aim of this study was to determine whether the same disease allele was also associated with other forms of early onset drusen or familial cases of age-related macular degeneration. METHODS: Thirteen index cases of early onset drusen together with 15 other family members were examined. In addition, 54 familial cases of age-related macular degeneration were examined. Blood was taken for DNA analysis and screened for the Arg345Trp disease-associated allele of the EFEMP1 gene. Twenty-four cases of malattia leventinese or Doyne honeycomb retinal dystrophy were also screened as positive controls. Another 150 ethnicity- and age-matched individuals acted as controls. RESULTS: The Arg345Trp disease-associated allele in the EFEMP1 gene was confirmed in individuals with malattia leventinese and Doyne honeycomb retinal dystrophy. However, involvement of this allele was not evident in either early onset drusen or familial age-related macular degeneration. CONCLUSIONS: The Arg345Trp disease-associated allele of the EFEMP1 gene does not appear to be associated with cases of early onset drusen that fall outside the diagnosis of malattia leventinese or Doyne honeycomb retinal dystrophy, nor does it appear to play a role in familial age-related macular degeneration. These findings do not exclude the involvement of other alleles of the EFEMP1 gene in either phenotype. The genetic mechanisms involved in the heterogeneous group of early onset drusen remain to be elucidated but should lead to insights into the genetic causes of macular diseases.