Professor David Sibbritt

Biography

Twitter: @davidsibbritt
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Professor David Sibbritt is a professor of epidemiology who focuses on complementary and alternative medicines and, in particular, on how women use them to treat chronic illnesses, and for their general well being. David has also extensively researched primary health care and health services planning. He is Deputy Director of the Australian Research Centre in Complementary and Integrative Medicine (ARCCIM) at UTS, a world-leading critical public health research centre focusing on complementary and integrative health care.

David is an experienced quantitative researcher, with expertise in research methodology. He has produced over 200 peer-reviewed academic publications, with an H-Index of 30, is an associate editor of two international peer-reviewed journals, and is a chief investigator on numerous National Health and Medical Research Council and Australian Research Council-funded projects.

Professional

Deputy Director, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)

Deputy Director, NORPHCAM

Associate Editor, BMC Complementary and Alternative Medicine

Associate Editor, BMC Health Services Research

Editorial Board Member, Complementary Therapies in Medicine

Editorial Board Member, Journal of Integrative Medicine

Professor of Epidemiology, Faculty of Health

Deputy Director, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)

Core Member, CHSP - Health Services and Practice

Bachelor of Mathematics, Master of Medical Statics, Doctor of Philosophy

Email

David.Sibbritt@uts.edu.au

Phone

+61 2 9514 4172

ORCID

0000-0003-3561-9447

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Research
Teaching Areas
Publications
Projects

Research Interests

Research expertise:

Complimentary therapies
Traditional medicines
Primary health care, health services planning
Integrative health care
Epidemiology
Biostatistics

Can supervise: Yes

Areas of research supervision:

Complimentary therapies
Traditional medicines
Primary health care, health services planning
Integrative health care
Women's health
Epidemiology
Biostatistics

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Biostatistics
Epidemiology
Health Research Methods

Chapters

Conferences

Journal articles

Other

Chapters

Adams, J., Sibbritt, D., Broom, A., Kroll, T., Prior, J., Dunston, R., Leung, B., Davidson, P. & Andrews, G. 2017, 'Traditional, complementary and integrative medicine as self-care in chronic illness' in Adams, J. & et al (eds), Public Health and Health Services Research in Traditional, Complementary and Integrative Medicine: International Perspectives, Imperial College Press, London.

Peng, W., Sibbritt, D., Steel, A. & Adams, J. 2017, 'Women's Health and Complementary and Integrative Medicine' in Women's Health and Complementary and Integrative Medicine, Routledge.

Adams, J., Hollenberg, D., Broom, A., Steel, A.E., Sibbritt, D. & Lui, C. 2013, 'Integration in Primary Health Care: A focus upon practice and education and the importance of a critical social science perspective' in Adams, J., Magin, P. & Broom, A. (eds), Primary Health Care and Complementary and Integrative Medicine, Imperial College Press, London, pp. 203-227.
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In this chapter we argue that the mainstream work and commentary around integrative health care and education has often lacked a critical social science perspective

Steel, A.E., Frawley, J.E., Adams, J., Sibbritt, D. & Broom, A. 2013, 'Primary Health Care, Complementary and Alternative Medicine and Women's Health: A Focus Upon Menopause' in Adams, J., Magin, P. & Broom, A. (eds), Primary Health Care and Complementary and Integrative Medicine, Imperial College Press, London, pp. 11-33.
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Australian Women are integrating primary health care and complementary and alternative medicine to alleviate a range of symptoms and conditions. This chapter introduces the use of CAM for women's health in general and more particularly, explores the integration of CAM alongside mainstream primary health care

Wardle, J., Adams, J., Broom, A. & Sibbritt, D. 2013, 'Examining the relationship between complementary and integrative medicine and rural general practice: A focus upon health services research' in Adams, J., Magin, P. & Broom, A. (eds), Primary Health Care and Complementary and Integrative Medicine, Imperial College Press, London, pp. 115-132.
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Recent research has revealled that complementary and integrative medicine (CIM) is particularly popular amongst rural populations, with a growing body of literature supporting this interpretation

Aljadani, H., Patterson, A., Sibbritt, D. & Collins, C. 2013, 'The Association Between Diet Quality and Weight Change in Adults Over Time: A Systematic Review of Prospective Cohort Studies.' in Preedy, V., Hunter, L. & Patel, V. (eds), Diet Quality An Evidence-Based Approach, Springer Science & Business Media, pp. 3-27.
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In this book, Diet Quality: An Evidence-Based Approach, Volume 2 all of the major facets of diet quality in relation to health outcomes are covered.

Adams, J., Lui, C., Sibbritt, D., Broom, A., Wardle, J., Homer, C.S., Steel, A.E. & Beck, S. 2012, 'Women's use of complementary and alternative medicine during pregnancy: A critical review of the literature' in Adams, J., Andrews, G., Barnes, J., Broom, A. & Magin, P. (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, Basingstoke, pp. 35-43.
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The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. Methods: A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Results: Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile," "motivation and condition of use," "perception and self-reported evaluation," and "referral and information sources." Conclusions: This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care.

Adams, J., Sibbritt, D., Broom, A., Wardle, J., Steel, A.E., Murthy, V. & Daley, J. 2012, 'Research capacity building in traditional, complementary and integrative medicine: Grass-roots action towards a broader vision' in Adams, J., Andrews, G., Barnes, J., Broom, A. & Magin, P. (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, London, pp. 275-281.
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Developing capacity to undertake health research effectively is an integral component of national and global health research systems (Lansang and Dennis, 2004) and is essential to producing a sound evidence base for decision making in policy and practice (Cooke, 2005). Moreover, research capacity building (RCB) - nurturing and producing sustainable increased capacity for future research endeavours - is important fOr all health research fields and TCIM is no exception (Andrews, 2006; Adams, 2007). There is currently a great opportunity to embrace RCB in relation to TCIM in order to help develop an evidence base and a stronger and more robust research culture among scholars and practitioners alike.

Sibbritt, D. & Adams, J. 2012, 'Utilising existing data sets to investigate CAM consumption: cohort studies and longitudinal analyses.' in Adams, J., Andrews, G., Barnes, J., Broom, A. & Magin, P. (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, Basingstoke, pp. 26-32.
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Sibbritt, D. 2007, 'Utilising and Analysing Existing Data Sets for CAM Research: A Focus on Cohort Studies' in Jon Adams (ed), Researching Complementary and Alternative Medicine, Routledge, Oxon, pp. 37-54.

Conferences

Lauche, R., Adams, J., Ostermann, T., Fuller, N.R., Sibbritt, D. & Cramer, H. 2016, 'Associations between yoga/meditation, body satisfaction and weight control in Australian mid-aged women', Abstract Book, Public Health Association of Australia 44th Annual and 20th Chronic Diseases Network Conference, Alice Springs, NT, Australia, pp. 37-37.
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Lauche, R., Adams, J., Sibbritt, D. & Cramer, H. 2016, 'The association between yoga/meditation practice and falls among older Australian women', Abstract Book, Public Health Association of Australia 44th Annual and 20th Chronic Diseases Network Conference, Alice Springs, NT, Australia, pp. 36-36.
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Duffield, C.M., Perry, L., Gallagher, R., Sibbritt, D. & Nicholls, R. 2016, 'Fit for the future? The health and health behaviours of the nursing and midwifery workforce.', RCN International nursing research conference, Edinburgh, Scotland..

Rao, A., Sibbritt, D., Phillips, J. & Hickman, L.D. 2016, 'Prayer or spiritual healing for the health and well-being of two generations of women: A nationally representative cross-sectional study.', 21st international Council on Women's Health Issues (ICOWHI) Congress. Scale and Sustainability: Moving Women's Health Issues Forward., Baltimore, Maryland, USA.
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Rao, A., Sibbritt, D., Phillips, J. & Hickman, L. 2016, ''Prayer or spiritual healing as adjuncts to conventional care: A cross sectional analysis of the prevalence and characteristics of use among women.'.
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Peng, W., Sibbritt, D. & Adams, J. 2015, 'The use of complementary and alternative medicine amongst postmenopausal women experiencing vasomotor symptoms', Integrative Medicine Research, 10th International congress on complementary medicine research, Korea, pp. 36-37.
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Peng, W., Sibbritt, D. & Adams, J. 2014, '1. Utilisation of self-prescribed complementary and alternative medicine in current hormone replacement therapy users, 2007-2010;2. Hormone replacement therapy use in menopausal women with palpitations, 2004-2010', 18th Congress of the Australasian Menopause Society.
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Steel, A., Sibbritt, D., Adams, J. & Frawley, J. 2014, 'Steel A, Sibbritt D, Adams J, Frawley J, Broom A, Gallois C. (2014). 'The Association Between Women's Choice of Birth Setting and Their Use of CAM During Labor and Birth.' 2014 International Research Congress on Integrative Medicine and Health, Miami, US.'.
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Steel, A., Adams, J., Broom, A., Sibbritt, D. & Frawley, J. 2014, 'Steel A, Adams J, Broom A, Sibbritt D, Frawley J. (2014). 'Marginalization and Companionable Silence: CAM Practitioners' Perspectives of Their Interprofessional Relationships with Maternity Care Providers.' 2014 International Research Congress on Integrative Medicine and Health, Miami, US.'.

Steel, A., Adams, J., Sibbritt, D., Broom, A. & Frawley, J.E. 2013, 'Steel A, Adams J, Sibbritt D, Broom A, Frawley J. (2013). 'The influence of complementary and alternative medicine use in pregnancy on pain management in labour and birth outcomes' presented at the 2013 International Research Congress on Integrative Medicine and Health, London, UK.'.

Mitchell, G., Girgis, A., Jiwa, M., Sibbritt, D. & Burridge, L. 2012, 'Using General Practitioners to provide systematic care for the primary lay carers of people with advanced cancer: A randomized controlled trial.', Selected Abstracts Research Fora, Workshops and Proffered Papers and Posters Submitted to the 19th International Congress on Palliative Care, 19th International Congress on Palliative Care, Palliative Care MCGill, MCGILL University, Montreal, Canada.

Chiarelli, P. & Sibbritt, D. 2012, 'OSTEOPOROSIS AND URINARY INCONTINENCE IN AUSTRALIAN WOMEN: A LONGITUDINAL ANALYSIS.', NEUROUROLOGY AND URODYNAMICS, pp. 768-769.

Huynh, D., Dibley, M., Sibbritt, D., Tran, H. & Ploeg, H. 2008, 'Multiple factors for development of overweight and obesity in preschool children in urban areas of Ho Chi Minh City, Vietnam', INTERNATIONAL JOURNAL OF OBESITY, pp. S185-S185.

Tang, H.K., Dibley, M.J., Sibbritt, D. & Nguyen, T.H.H.D. 2008, 'TV viewing, physical activity, soft-drink consumption and overweight/obesity of adolescents in Ho Chi Minh City, Vietnam', INTERNATIONAL JOURNAL OF OBESITY, pp. S197-S197.

Hong, T.K., Dibley, M.J., Sibbritt, D. & Trang, N.H.H.D. 2008, 'Dietary behaviors and their relationship with overweight/obesity in adolescents of Ho Chi Minh City, Vietnam', INTERNATIONAL JOURNAL OF OBESITY, pp. S213-S213.

Dibley, M.J., Hong, T.K., Sibbritt, D. & Trang, N.H.H.D. 2008, 'Gender differences in associations between home environment and overweight/obesity among adolescents of Ho Chi Minh City, Vietnam', INTERNATIONAL JOURNAL OF OBESITY, pp. S199-S199.

Journal articles

Frawley, J., Sibbritt, D., Steel, A., Chang, S. & Adams, J. 2017, 'Author Reply.', Urology, vol. 99, pp. 98-99.
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Frawley, J., Hall, H., Adams, J. & Sibbritt, D. 2017, 'Health care utilization of women who experience pregnancy related reflux, nausea and/or vomiting.', The Journal of Maternal-Fetal and Neonatal Medicine, pp. 1-18.
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Nausea, vomiting and reflux are common conditions experienced by women during pregnancy. The objective of this project was to examine women's use of health services for these conditions.The study sample was obtained via the Australian Longitudinal Study on Women's Health. A total of 2,445 women who were pregnant or who had recently given birth in 2009 were invited to complete a sub-survey in 2010 about pregnancy and health service utilization. A response rate of 79.2% was obtained.During their pregnancy, 604 (32.9%) respondents experienced nausea, with 255 (42.2%) of these women seeking help from a health care practitioner. A total of 201 women (11%) reported repeated vomiting, and 637 women (34.7%) reported reflux, of which 78.6% and 59.2% sought help respectively. There were no significant differences in the mental and physical health measures between women with nausea, vomiting and/or reflux who sought help and women who did not. Having private health insurance with obstetric cover was associated with seeking help for reflux; this was the only demographic measure significantly associated with seeking help for any condition.Research is required to understand why many women do not seek professional help for common gastrointestinal conditions during pregnancy.

Frawley, J., Sibbritt, D., Steel, A., Chang, S. & Adams, J. 2017, 'Complementary and Conventional Health-care Utilization Among Young Australian Women With Urinary Incontinence.', Urology, vol. 99, pp. 92-99.
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OBJECTIVE: To examine the relationship between health status and health service utilization (including conventional and complementary and alternative medicine [CAM]) accessed by women experiencing urinary incontinence (UI). Although a high number of younger women report symptoms of UI, such as leaking urine, only a small proportion seek help for these symptoms. MATERIALS AND METHODS: The Australian Longitudinal Study on Women's Health is a large nationally representative study that investigates the health and well-being of women. The 2 most recent surveys (2006 and 2009) of the young cohort (women aged 28-33 and 31-36 respectively) were analyzed. RESULTS: The presence of UI was 8.5% in 2006 (n=859) and 23.3% in 2009 (n=1878), whereas the percentage of women who sought help for their UI was 18.6% (n=160) and 2.2% (n=182) respectively. Women with UI had poorer health compared with women without UI (P<.005), and women who sought help for their symptoms had poorer physical functioning than women who did not (P<.005). Women who sought help were greater users of conventional and CAM health services (P<.005), including a general practitioner, specialist, hospital doctor, physiotherapist, and naturopath. CONCLUSION: UI is relatively common in younger women. However, many do not seek help. Of the women who do seek care, a large number visit CAM professionals as well as conventional medical professionals, despite a lack of research evaluating the efficacy of CAM treatment. Research is needed to explore CAM practitioner approaches to the treatment of UI and to evaluate the efficacy of these treatments.

Steel, A., Adams, J. & Sibbritt, D. 2017, 'The Characteristics of Women Who Use Complementary Medicine While Attempting to Conceive: Results from a Nationally Representative Sample of 13,224 Australian Women.', Womens Health Issues, vol. 27, no. 1, pp. 67-74.
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BACKGROUND: Preconception is acknowledged globally as an important part of ensuring health for the next generation and is underpinned by principles of health promotion and preventive medicine. There is a demand for more holistic, preventive health care within preconception health services. Many women are also using complementary medicine during their reproductive years. MATERIALS AND METHODS: This paper presents a longitudinal analysis of women's consultations with a complementary medicine practitioner while attempting to become pregnant, and the characteristics of women who choose to consult a complementary medicine practitioner during the preconception period. The cross-sectional and longitudinal analyses conducted in this study utilise data from the 1973 through 1978 cohort of the Australian Longitudinal Study on Women's Health (n = 13,224). Multivariate logistic regression models and generalized estimating equation models, with and without time lag, were used. RESULTS: Women who identified as attempting to conceive were more likely to consult with an acupuncturist (adjusted odds ratio, 1.46) or a naturopath/herbalist (adjusted odds ratio, 1.30). Women who consulted with an acupuncturist were likely to be consulting with a specialist doctor (odds ratio, 3.73) and/or have previous fertility issues (odds ratio, 2.30). Women who consulted with a naturopath were more likely to report experiencing premenstrual tension (odds ratio, 2.30) but less likely to have had a previous miscarriage (odds ratio, 0.18). CONCLUSIONS: Policymakers and other health professionals need to be aware that health professionals who are largely unregulated and structurally isolated from conventional health care may be actively contributing to women's reproductive and physical health during the preconception period.

Lamont, S., Brunero, S., Perry, L., Duffield, C., Sibbritt, D., Gallagher, R. & Nicholls, R. 2017, ''Mental health day' sickness absence amongst nurses and midwives: workplace, workforce, psychosocial and health characteristics.', Journal of Advanced Nursing, vol. 73, no. 5, pp. 1172-1181.
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AIM: To examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as 'mental health days'. BACKGROUND: The occupational stress associated with the nursing profession is increasingly recognized and nurse/midwifery absenteeism is a significant global problem. Taking a 'mental health day' as sickness absence is a common phenomenon in Australian health care. No previous studies have empirically explored the characteristics of nurses and midwives using such sickness absence. DESIGN: Online cross-sectional survey. METHODS: Survey comprising validated tools and questions on workplace and health characteristics was distributed to nurses and midwives in New South Wales, Australia, between May 2014 - February 2015. Sample characteristics were reported using descriptive statistics. Factors independently predictive of 'mental health day' reportage were determined using logistic regression. RESULTS: Fifty-four percentage of the n = 5041 nurse and midwife respondents took 'mental health days'. Those affected were significantly more likely to be at younger ages, working shifts with less time sitting at work; to report workplace abuse and plans to leave; having been admitted to hospital in previous 12 months; to be current smokers; to report mental health problems, accomplishing less due to emotional problems and current psychotropic medication use. CONCLUSION: Specific characteristics of nurses and midwives who report taking 'mental health day' sickness absence offer healthcare administrators and managers opportunities for early identification and intervention with workplace measures and support frameworks to promote well-being, health promotion and safety.

Nicholls, R., Perry, L., Gallagher, R., Duffield, C., Sibbritt, D. & Xu, X. 2017, 'The personal cancer screening behaviours of nurses and midwives.', Journal of Advanced Nursing, vol. 73, no. 6, pp. 1403-1420.
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AIM: The aim of this study was to identify the personal cancer screening behaviours of nurses and midwives in New South Wales, Australia, and identify factors predictive of cancer screening uptake. BACKGROUND: The nursing workforce may have a higher risk for some cancers and is ageing. In Australia, more than 40% are over 50 years - an age where cancer incidence rises rapidly, but when screening may reduce cancer mortality. Nurses and midwives are important health role models for the population, but their engagement in cancer screening is unknown. DESIGN: A cross-sectional survey conducted in 2014-2015. METHODS: Data were obtained from the 'Fit for the Future' study on 5041 working nurses and midwives in New South Wales, Australia and analyses were conducted on subsets of age-eligible respondents. Demographic, geographical and occupational data were analysed in relation to population-based screening for breast, cervical and bowel cancers and opportunistic screening for prostate and skin cancer screening participation, in line with Australian recommendations. RESULTS: Nurses' and midwives' recent screening rates were higher than the Australian general population across relevant age groups. Compared with full-time nurses and midwives, part-time/casual/pool workers were significantly more likely to undertake cervical, breast and bowel screening. Compared with those working office hours, shift workers were significantly less likely to undertake breast and bowel screening, but more likely to undertake skin screening. CONCLUSIONS: Disparities in reported screening prevalence and factors predictive of screening uptake indicate opportunities for targeted strategies to inform and/or promote workforce engagement with screening programmes and protect the health of this ageing workforce.

Yang, L., Sibbritt, D. & Adams, J. 2017, 'A critical review of complementary and alternative medicine use among people with arthritis: a focus upon prevalence, cost, user profiles, motivation, decision-making, perceived benefits and communication.', Rheumatol Int, vol. 37, no. 3, pp. 337-351.
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A critical review of complementary and alternative medicine (CAM) use among people with arthritis was conducted focusing upon prevalence and profile of CAM users as well as their motivation, decision-making, perceived benefits and communication with healthcare providers. A comprehensive search of peer-reviewed literature published from 2008 to 2015 was undertaken via CINAHL, Medline and AMED databases. The initial search identified 4331 articles, of which 49 articles met selection criteria. The review shows a high prevalence of CAM use (often multiple types and concurrent to conventional medical care) among those with arthritis which is not restricted to any particular geographic or social-economic status. A large proportion of arthritis sufferers using CAM consider these medicines to be somewhat or very effective but almost half do not inform their healthcare provider about their CAM use. It is suggested that rheumatologists and others providing health care for patients with arthritis should be cognizant of the high prevalence of CAM use and the challenges associated with possible concurrent use of CAM and conventional medicine among their patients.

Adams, J., Lauche, R., Peng, W., Steel, A., Moore, C., Amorin-Woods, L.G. & Sibbritt, D. 2017, 'A workforce survey of Australian chiropractic: the profile and practice features of a nationally representative sample of 2,005 chiropractors.', BMC Complement Altern Med, vol. 17, no. 1, p. 14.
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BACKGROUND: This paper reports the profile of the Australian chiropractic workforce and characteristics of chiropractic care from a large nationally-representative sample of practitioners. METHODS: A 21-item questionnaire examining practitioner, practice and clinical management characteristics was distributed to all registered chiropractors (n=4,684) in Australia in 2015 via both online and hard copy mail out. RESULTS: The survey attracted a response rate of 43% (n=2,005), and the sample is largely representative of the national chiropractic workforce on a number of key indicators. The average age of the chiropractors was 42.1 years, nearly two-thirds are male, and the vast majority hold a bachelor degree or higher qualification. Australian chiropractors are focused upon treating people across a wide age range who mainly present with musculoskeletal conditions. Australian chiropractors have referral relationships with a range of conventional, allied health and complementary medicine (CAM) providers. CONCLUSION: The chiropractic profession represents a substantial component of the contemporary Australian health care system with chiropractors managing an estimated 21.3 million patient visits per year. While the Australian chiropractic workforce is well educated, research engagement and research capacity remains sub-optimal and there is much room for further capacity building to help chiropractic reach full potential as a key integrated profession within an evidence-based health care system. Further rich, in-depth research is warranted to improve our understanding of the role of chiropractic within the Australian health care system.

Steel, A., Sibbritt, D., Schloss, J., Wardle, J., Leach, M., Diezel, H. & Adams, J. 2017, 'An Overview of the Practitioner Research and Collaboration Initiative (PRACI): a practice-based research network for complementary medicine.', BMC Complement Altern Med, vol. 17, no. 1, p. 87.
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BACKGROUND: The Practitioner Research and Collaboration Initiative (PRACI) is an innovative, multi-modality practice-based research network (PBRN) that represents fourteen complementary medicine (CM) professions across Australia. It is the largest known PBRN for complementary healthcare in the world and was launched in 2015. The purpose of this paper is to provide an update on the progress of the PRACI project, including a description of the characteristics of PRACI members in order to facilitate further sub-studies through the PRACI PBRN. METHODS: A CM workforce survey was distributed electronically to CM practitioners across fourteen disciplines, throughout Australia. Practitioners electing to become a member of PRACI were registered on the PBRN database. The database was interrogated and the data analysed to described sociodemographic characteristics, practice characteristics, professional qualification and practice interest of PRACI members. RESULTS: Foundational members of PRACI were found to be predominately female (76.2%) and middle-aged (82.5%). Members were primarily located in urban settings (82.5%) across the Eastern seaboard of Australia (82.5%), with few working remotely. The main modalities represented include massage therapists (58.5%), naturopaths (26.4%) and nutritionists (14.4%). The primary area of clinical interest for PRACI members were general health and well-being (75.4%), musculoskeletal complaints (72%) and pain management (62.6%). CONCLUSIONS: PRACI provides an important infrastructure for complementary healthcare research in Australia and its success relies on CM practitioners being involved in the research being conducted through the PBRN. The aim of this database is to ensure that the research conducted through PRACI is rigorous, robust, clinically relevant and reflects the diversity of clinical practice amongst CM practitioners in Australia.

Cottingham, P., Adams, J., Vempati, R., Dunn, J. & Sibbritt, D. 2017, 'The characteristics, experiences and perceptions of homeopaths in New Zealand: results from a national survey of practitioners.', Homeopathy, vol. 106, no. 1, pp. 11-17.
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BACKGROUND: The popularity of homeopathy is seemingly at odds with the scientific controversy over its effectiveness. Several studies have reported on effectiveness of clinical homeopathy, but few studies have been conducted on practices and perceptions of homeopaths, and none in New Zealand (NZ). To address this gap, this paper reports findings from the first national survey examining the characteristics, perceptions and experiences of NZ-based homeopaths regarding a wide range of issues relating to their role and practice. There were 176 homeopaths in NZ at the time of this survey, who were members of a voluntary register (The New Zealand Council of Homeopaths), homeopaths are not statutorily registered in NZ. METHODS: A 65 question, online survey was sent to homeopathic practitioners via their professional associations. A total of 176 homeopaths were invited to participate. Of these 176, 57 (32%) responded. RESULTS: The majority of homeopaths were female (93%). Twelve percent were under 45 years and 20% over 55 years. Most (85%) had qualification in homeopathy of diploma or certificate level and most (66%) were engaged in part-time practice. Mean year of experience was 12.6 and mean caseload per month was 25. 90% considered research useful to validate practice, while 88% considered that it impacted on practice, although only 48% had skills to interpret research papers. There was an association between skills to interpret research and its impact on practice (p = 0.038). The majority (87%) were in favour of registration, with a statistically significant association between attitudes to registration and age (p = 0.027), the older homeopaths being more in favour. Most (68%) were in favour of integration with conventional practitioners and many referred to conventional practitioners (mean referrals per annum to GPs = 57 and midwives = 30). Homeopaths assessed their contribution to New Zealand Ministry of Health objectives as significant, with 77% perceiving that th...

Meredith, S., Frawley, J., Adams, J. & Sibbritt, D. 2017, 'The utilization of health services and self-care by older women with sleeping problems: Results from a nationally representative sample of 9,110 women', Journal of Aging and Health.
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Yang, L., Adams, J. & Sibbritt, D. 2017, 'Prevalence and factors associated with the use of acupuncture and Chinese medicine: results of a nationally representative survey of 17161 Australian women.', Acupunct Med, vol. 35, no. 3, pp. 189-199.
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BACKGROUND: Traditional Chinese Medicine has considerable public support in Australia and elsewhere around the world; the literature suggests Chinese medicine (CM) and acupuncture are particularly popular. AIM: To examine factors associated with CM/acupuncture use among young/middle-aged Australian women. METHODS: This research formed part of the Australian Longitudinal Study on Women's Health (ALSWH), a population-based cohort study. Data were obtained from the 'young' (34-39years; n=8010) and 'middle-aged' (62-67years; n=9151) ALSWH cohorts, who completed survey 6 (in 2012) and survey 7 (in 2013), respectively. Outcome measures included use of CM and visits to an acupuncturist in the previous 12months. Predictive factors included demographic characteristics, and measures of health status (diagnosed chronic medical conditions) and health service utilisation. Statistical analyses included bivariate (2) tests, two proportions Z-tests and backward stepwise multiple logistic regression modelling. RESULTS: In total, 9.5% and 6.2% of women in the young and middle-aged cohorts, respectively, had consulted an acupuncturist, and 5.7% and 4.0%, respectively, had used CM. Young women with low iron levels and/or endometriosis were more likely to use CM and/or acupuncture. Middle-aged women with low iron levels and/or chronic fatigue syndrome (CFS) were more likely to use CM, while middle-aged women with arthritis and/or CFS were more likely to use acupuncture. CONCLUSIONS: Women with chronic conditions (including arthritis, low iron, CFS and endometriosis) were associated with higher odds of CM/acupuncture use. There is a need for further research to examine the potential benefits of CM/acupuncture for these chronic illnesses.

Duffield, C.M., Perry, L., Xu, X., Gallagher, R., Nicholls, R. & Sibbritt, D. 2017, 'Health, workforce characteristics, quality of life and intentionto leave: The 'Fit for the Future' survey of Australian nursesand midwives', Journal of Advanced Nursing, pp. 1-12.
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Duffield, C.M., Perry, L., Xu, X., Gallagher, R., Sibbritt, D. & Nicholls, R. 2017, 'Do health and workforce characteristics influence nurses' and midwives' quality of life? Does quality of life affect workforce retention?'.

Moore, C.S., Sibbritt, D.W. & Adams, J. 2017, 'A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness.', BMC Neurol, vol. 17, no. 1, p. 61.
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BACKGROUND: Despite the expansion of conventional medical treatments for headache, many sufferers of common recurrent headache disorders seek help outside of medical settings. The aim of this paper is to evaluate research studies on the prevalence of patient use of manual therapies for the treatment of headache and the key factors associated with this patient population. METHODS: This critical review of the peer-reviewed literature identified 35 papers reporting findings from new empirical research regarding the prevalence, profiles, motivations, communication and self-reported effectiveness of manual therapy use amongst those with headache disorders. RESULTS: While available data was limited and studies had considerable methodological limitations, the use of manual therapy appears to be the most common non-medical treatment utilized for the management of common recurrent headaches. The most common reason for choosing this type of treatment was seeking pain relief. While a high percentage of these patients likely continue with concurrent medical care, around half may not be disclosing the use of this treatment to their medical doctor. CONCLUSIONS: There is a need for more rigorous public health and health services research in order to assess the role, safety, utilization and financial costs associated with manual therapy treatment for headache. Primary healthcare providers should be mindful of the use of this highly popular approach to headache management in order to help facilitate safe, effective and coordinated care.

Suswardany, D.L., Sibbritt, D.W., Supardi, S., Pardosi, J.F., Chang, S. & Adams, J. 2017, 'A cross-sectional analysis of traditional medicine use for malaria alongside free antimalarial drugs treatment amongst adults in high-risk malaria endemic provinces of Indonesia.', PLoS One, vol. 12, no. 3, p. e0173522.
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BACKGROUND: The level of traditional medicine use, particularly Jamu use, in Indonesia is substantial. Indonesians do not always seek timely treatment for malaria and may seek self-medication via traditional medicine. This paper reports findings from the first focused analyses of traditional medicine use for malaria in Indonesia and the first such analyses worldwide to draw upon a large sample of respondents across high-risk malaria endemic areas. METHODS: A sub-study of the Indonesia Basic Health Research/Riskesdas Study 2010 focused on 12,226 adults aged 15 years and above residing in high-risk malaria-endemic provinces. Logistic regression was undertaken to determine the significant associations for traditional medicine use for malaria symptoms. FINDINGS: Approximately one in five respondents use traditional medicine for malaria symptoms and the vast majority experiencing multiple episodes of malaria use traditional medicine alongside free antimalarial drug treatments. Respondents consuming traditional medicine for general health/common illness purposes every day (odds ratio: 3.75, 95% Confidence Interval: 2.93 4.79), those without a hospital in local vicinity (odds ratio: 1.31, 95% Confidence Interval: 1.10 1.57), and those living in poorer quality housing, were more likely to use traditional medicine for malaria symptoms. CONCLUSION: A substantial percentage of those with malaria symptoms utilize traditional medicine for treating their malaria symptoms. In order to promote safe and effective malaria treatment, all providing malaria care in Indonesia need to enquire with their patients about possible traditional medicine use.

Adams, J., Steel, A., Frawley, J., Broom, A. & Sibbritt, D. 2017, 'Substantial out-of-pocket expenditure on maternity care practitioner consultations and treatments during pregnancy: estimates from a nationally-representative sample of pregnant women in Australia.', BMC Pregnancy Childbirth, vol. 17, no. 1, p. 114.
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BACKGROUND: A wide range of health care options are utilised by pregnant women in Australia. The out-of-pocket costs of maternity care in Australia vary depending on many factors including model of care utilised, health insurance coverage, and women's decision to access health services outside of conventional maternity care provision. METHODS: Women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) who identified as pregnant or as recently having given birth in 2009 were invited to complete a sub-study questionnaire investigating health service utilisation during their most recent pregnancy. RESULTS: A total of 1,835 women agreed to participate in the sub-study. The majority of women (99.8%) consulted with a conventional health care practitioner during pregnancy, 49.4% consulted with a complementary and alternative medicine practitioner at least once during pregnancy and 89.6% of the women used a complementary and alternative medicine product. Women reported an average of AUD$781.10 in out-of-pocket expenses for consultations with conventional health care practitioners, AUD$185.40 in out-of-pocket expenses for consultations with complementary and alternative medicine practitioners and AUD$179.60 in out-of-pocket expenses for complementary and alternative medicine products. From the study data we estimate Australian pregnant women spend over AUD$337 M on out-of-pocket health services. CONCLUSION: While the majority of pregnant women in Australia may obtain health services via the publically-funded health care system and/or private health insurance coverage, our analysis identifies substantial out-of-pocket expenditure for health care by pregnant women - a trend in public spending for maternity care of importance to policy makers, health administrators, and health professionals.

Adams, J., Peng, W., Cramer, H., Sundberg, T., Moore, C., Amorin-Woods, L., Sibbritt, D., Lauche, R. & Masters of Clinical Trials Research 2017, 'The prevalence, patterns, and predictors of chiropractic use among US adults: Results from the 2012 National Health Interview Survey.', Spine (Phila Pa 1976).
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STUDY DESIGN: Secondary analysis of a national survey. OBJECTIVE: To investigate the prevalence, patterns, and predictors of chiropractic utilization in the US general population. SUMMARY OF BACKGROUND DATA: Chiropractic is one of the largest manual therapy professions in the US and internationally. Very few details have been reported about the use of chiropractic care in the US in recent years. METHODS: Cross-sectional data from the 2012 National Health Interview Survey (n=34,525) were analyzed to examine the lifetime and 12-month prevalence and utilization patterns of chiropractic use, profile of chiropractic users and health-related predictors of chiropractic consultations. RESULTS: Lifetime and 12-month prevalence of chiropractic use were 24.0% and 8.4%, respectively. There is a growing trend of chiropractic use amongst US adults from 2002 to 2012. Back pain (63.0%) and neck pain (30.2%) were the most prevalent health problems for chiropractic consultations and the majority of users reported chiropractic helping a great deal with their health problem and improving overall health or well-being. A substantial number of chiropractic users had received prescription (23.0%) and/or over-the-counter medications (35.0%) for the same health problem for which chiropractic was sought and 63.8% reported chiropractic care combined with medical treatment as helpful. Both adults older than 30 years (compared to younger adults), and those diagnosed with spinal pain (compared to those without spinal pain) were more likely to have consulted a chiropractor in the past 12 months. CONCLUSIONS: A substantial proportion of US adults utilized chiropractic services over the past 12 months and reported associated positive outcomes for overall well-being and/or specific health problems for which concurrent conventional care was common. Studies on the current patient integration of chiropractic and conventional health services are warranted. LEVEL OF EVIDENCE: 3.

Lauche, R., Schumann, D., Sibbritt, D., Adams, J. & Cramer, H. 2017, 'Associations between yoga practice and joint problems: a cross-sectional survey among 9151 Australian women.', Rheumatol Int, vol. 37, no. 7, pp. 1145-1148.
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Yoga exercises have been associated with joint problems recently, indicating that yoga practice might be potentially dangerous for joint health. This study aimed to analyse whether regular yoga practice is associated with the frequency of joint problems in upper middle-aged Australian women. Women aged 62-67 years from the Australian Longitudinal Study on Women's Health (ALSWH) were questioned in 2013 whether they experienced regular joint pain or problems in the past 12 months and whether they regularly practiced yoga. Associations of joint problems with yoga practice were analysed using Chi-squared tests and multiple logistic regression modelling. Of 9151 women, 29.8% reported regular problems with stiff or painful joints, and 15.2, 11.9, 18.1 and 15.9% reported regular problems with shoulders, hips, knees and feet, respectively, in the past 12 months. Yoga was practiced sometimes by 10.1% and often by 8.4% of women. Practicing yoga was not associated with upper or lower limb joint problems. No association between yoga practice and joint problems has been identified. Further studies are warranted for conclusive judgement of benefits and safety of yoga in relation to joint problems.

Akter, T., Dawson, A. & Sibbritt, D. 2017, 'What impact does antenatal and postnatal care have on neonatal deaths in low- and lower-middle-income countries? Evidence from Bangladesh.', Health Care Women Int, pp. 1-13.
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We investigated the contribution of antenatal and postnatal care in reducing the risk of neonatal deaths in Bangladesh. The effects of these services were examined using adjusted Cox regression models and secondary data with 7,314 live-born infants. We observed that neonatal mortality was significantly decreased for newborns whose mothers' attended antenatal care services but postnatal care did not show any effect. Health promotion programs offering antenatal care in Bangladesh and other low- and lower-middle-income countries may build awareness about these practices. Further research is required to examine the reasons for the lack of impact of postnatal care on mortality.

Sibbritt, D., Leach, M., Chang, S., Sundberg, T., Cramer, H., Lauche, R. & Adams, J. 2017, 'Health care utilization among young Australian women with severe tiredness: Results from the Australian Longitudinal Study on Women's Health (ALSWH)', Health Care for Women International.
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In this article we explore the use of health services and self-prescribed treatments amongst 8,088 young Australian women with severe tiredness. Data were obtained from the Australian Longitudinal Study on Women's Health. The prevalence of severe tiredness was 49.2%. The frequency of visits to healthcare practitioners was greater among women who sought help for their severe tiredness, compared with women who did not seek help for their severe tiredness or who did not report severe tiredness. Given the impact of this health problem on Australian women, we call for further research on the optimal treatment for severe tiredness.

Alharbi, M., Gallagher, R., Kirkness, A., Sibbritt, D. & Tofler, G. 2016, 'Long-term outcomes from Healthy Eating and Exercise Lifestyle Program for overweight people with heart disease and diabetes', European Journal of Cardiovascular Nursing, vol. 15, no. 1, pp. 91-99.
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BACKGROUND: The benefits of exercise and weight reduction for overweight or obese people with coronary heart disease and/or diabetes mellitus are well recognised. The Healthy Eating and Exercise Lifestyle Program demonstrated these outcomes at 4 months, but longer-term outcomes are not yet reported. AIM: To determine whether positive weight, body mass index, waist and exercise duration outcomes were sustained in the long term (12 months) and to identify the independent predictors of these outcomes at 4 and 12 months. METHODS: Longitudinal design, combining data of all Healthy Eating and Exercise Lifestyle Program participants (intervention and wait-list control, n = 134). Participants had a body mass index between 27 and 39 kg/m(2) and had completed cardiac rehabilitation and/or diabetes education programmes. Healthy Eating and Exercise Lifestyle Program intervention included an active phase of two 1-hour group-based supervised structured exercise sessions every week for 4 months and four 90-minute group information and support sessions. The maintenance phase included one 90-minute group-based booster information session and three 15-minute goal-focused telephone follow-up calls over 8 months. RESULTS: Participants had statistically significant reductions from baseline in weight, body mass index and waist circumference and improvements in exercise duration and capacity at 4 and 12 months. Time, self-efficacy, depressive symptoms and male gender were independent predictors for body mass index, waist and/or exercise duration (p < 0.05). CONCLUSION: The Healthy Eating and Exercise Lifestyle Program was an effective programme to achieve and sustain weight loss and increase exercise participation over 1 year.

Peng, W., Adams, J., Hickman, L. & Sibbritt, D.W. 2016, 'Longitudinal analysis of associations between women's consultations with complementary and alternative medicine practitioners/use of self-prescribed complementary and alternative medicine and menopause-related symptoms, 2007-2010.', Menopause, vol. 23, no. 1, pp. 74-80.
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This study aims to determine associations between consultations with complementary and alternative medicine (CAM) practitioners/use of self-prescribed CAM and menopause-related symptoms.Data were obtained from the Australian Longitudinal Study on Women's Health. Generalized estimating equations were used to conduct longitudinal data analyses, which were restricted to women born in 1946-1951 who were surveyed in 2007 (survey 5; n=10,638) and 2010 (survey 6; n=10,011).Women with menopause-related symptoms were more likely to use self-prescribed CAM but were not more likely to consult a CAM practitioner. Overall, CAM use was lower among women who had undergone hysterectomy or women who had undergone oophorectomy, compared with naturally postmenopausal women, and decreased with increasing age of postmenopausal women. Weak associations between CAM use and hot flashes were observed. Women experiencing hot flashes were more likely to consult a massage therapist (odds ratio, 1.09; 95% CI, 1.00-1.20) and/or use self-prescribed herbal medicines (odds ratio, 1.13; 95% CI, 1.03-1.23) than women not experiencing hot flashes.Consultations with CAM practitioners and use of self-prescribed CAM among naturally or surgically postmenopausal women are associated with menopause-related symptoms. Our study findings should prompt healthcare providers, in particular family medicine practitioners, to be cognizant of clinical evidence for CAM typically used for the management of common menopause-related symptoms in their aim to provide safe, effective, and coordinated care for women.

Frawley, J., Sundberg, T., Steel, A., Sibbritt, D., Broom, A. & Adams, J. 2016, 'Prevalence and characteristics of women who consult with osteopathic practitioners during pregnancy; a report from the Australian Longitudinal Study on Women's Health (ALSWH).', Journal of Bodywork and Movement Therapies, vol. 20, no. 1, pp. 168-172.
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The use of complementary medicine (CM) is common during pregnancy with visits to osteopathic practitioners growing in recent years. This study was conducted to investigate the prevalence and characteristics of women who consult osteopathic practitioners during pregnancy.The study sample was obtained via the Australian Longitudinal Study on Women's Health (ALSWH). The women answered questions about consultations with osteopathic practitioners, pregnancy-related health concerns and attitudes to CM use.A total response rate of 79.2% (1835) was obtained. Of these, 104 women (6.1%) consulted with an osteopath during pregnancy for a pregnancy-related health condition. Women were more likely to consult an osteopath if they suffered from back pain, sadness, weight management issues, or had a history of retained placenta.Women are visiting osteopaths for help with common pregnancy health complaints, highlighting the need for research to evaluate the safety, clinical and cost effectiveness of osteopathy in pregnancy.

Navin Cristina, T.J., Stewart Williams, J.A., Parkinson, L., Sibbritt, D.W. & Byles, J.E. 2016, 'Identification of diabetes, heart disease, hypertension and stroke in mid- and older-aged women: Comparing self-report and administrative hospital data records', Geriatrics and Gerontology International, vol. 16, no. 1, pp. 95-102.
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© 2016 Japan Geriatrics Society. Aim: To estimate the prevalence of diabetes, heart disease, hypertension and stroke in self-report and hospital data in two cohorts of women; measure sensitivity and agreement between data sources; and compare between cohorts. Methods: Women born between 1946-1951 and 1921-1926 who participated in the Australian Longitudinal Study on Women's Health (ALSWH); were New South Wales residents; and admitted to hospital (2004-2008) were included in the present study. The prevalence of diabetes, heart disease, hypertension and stroke was estimated using self-report (case1 at latest survey, case2 across multiple surveys) and hospital records. Agreement (kappa) and sensitivity (%) were calculated. Logistic regression measured the association between patient characteristics and agreement. Results: Hypertension had the highest prevalence and estimates were higher for older women: 32.5% case1, 45.4% case2, 12.8% in hospital data (1946-1951 cohort); 57.8% case1, 73.2% case2, 38.2% in hospital data (1921-1926 cohort). Agreement was substantial for diabetes: =0.75 case1, =0.70 case2 (1946-1951 cohort); =0.77 case1, =0.80 case2 (1921-1926 cohort), and lower for other conditions. The 1946-1951 cohort had 2.08 times the odds of agreement for hypertension (95% CI 1.56 to 2.78; P<0.0001), and 6.25 times the odds of agreement for heart disease (95% CI 4.35 to 10.0; P<0.0001), compared with the 1921-1926 cohort. Conclusion: Substantial agreement was found for diabetes, indicating accuracy of ascertainment using self-report or hospital data. Self-report data appears to be less accurate for heart disease and stroke. Hypertension was underestimated in hospital data. These findings have implications for epidemiological studies relying on self-report or administrative data.

Hall, H., Lauche, R., Adams, J., Steel, A., Broom, A. & Sibbritt, D. 2016, 'Healthcare utilisation of pregnant women who experience sciatica, leg cramps and/or varicose veins: A cross-sectional survey of 1835 pregnant women', Women and Birth, vol. 29, no. 1, pp. 35-40.
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Lauche, R., Hall, H., Adams, J., Steel, A., Broom, A. & Sibbritt, D. 2016, 'Health-care utilisation amongst pregnant women who experience sleeping problems and/or tiredness or fatigue: secondary analysis of a cross-sectional survey of 1835 pregnant women.', Sleep & breathing = Schlaf & Atmung, vol. 20, no. 1, pp. 355-362.
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Sleeping problems and fatigue in pregnancy are often accepted as a normal part of pregnancy; however, these conditions can be linked to serious consequences for both the mother and child. Despite established links between sleeping disturbance and a wide range of pregnancy complications, little is known about the health-care utilisation of women experiencing sleeping problems and fatigue. This study addresses the existing gap in the literature by examining cross-sectional data to identify health service utilisation patterns of pregnant women experiencing sleeping problems and/or tiredness or fatigue.In 2010, a sub-study of the Australian Longitudinal Study on Women's Health was conducted as a cross-sectional survey of 2445 women who had recently given birth. Associations between reported symptoms of sleeplessness and/or tiredness or fatigue and health service utilisation were determined using logistic regression analysis.During their pregnancy, 15.2 % of women experienced sleeping problems while 35.4 % experienced tiredness or fatigue. Women most commonly consulted with an obstetrician (n=96) or a general practitioner (GP) (n=74) for their tiredness or fatigue rather than a midwife (n=56). A substantial number of women sought help from a complementary and alternative medicine (CAM) practitioner for sleeping problems (33 %) or tiredness/fatigue (28 %).Sleeping problems and/or tiredness or fatigue is reported by a reasonable percentage of pregnant women, and women obtain assistance from conventional and CAM practitioners for their symptoms, but not all seek help. Given the serious implications of untreated sleep- and fatigue-related symptoms for mother and baby, this area of research deserves and requires more attention.

Frawley, J., Sibbritt, D., Broom, A., Gallois, C., Steel, A. & Adams, J. 2016, 'Women's attitudes towards the use of complementary and alternative medicine products during pregnancy.', Journal of Obstetrics and Gynaecology, vol. 36, no. 4, pp. 462-467.
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The aim of this study was to analyse women's attitudes towards the use of complementary and alternative medicine (CAM) products during pregnancy. The study sample was obtained via the Australian Longitudinal Study on Women's Health or ALSWH. A response rate of 79.2% (n = 1,835) was attained. Women who use herbal medicines (34.5%, n = 588) view CAM as a preventative measure, are looking for something holistic and are concerned about evidence of clinical efficacy when considering the use of these products during pregnancy. Women who use aromatherapy (17.4%, n = 319) and homoeopathy (13.3%, n = 244) want more personal control over their body and are concerned more about their own personal experience of the efficacy of CAM than clinical evidence of efficacy. As CAM use in pregnancy appears to be increasingly commonplace, insights into women's attitudes towards CAM are valuable for maternity healthcare providers.

Murthy, V., Adams, J., Broom, A., Kirby, E., Refshauge, K.M. & Sibbritt, D. 2016, 'The influence of communication and information sources upon decision-making around complementary and alternative medicine use for back pain among Australian women aged 60-65 years.', Health & social care in the community.
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This study examined factors influencing decision-making on complementary and alternative medicine (CAM) use for back pain and back pain sufferers' communication about CAM use. A cross-sectional postal survey was conducted in 2011/2012 as a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH). The sample contained 1620 women from the 1945-1951 cohort of the ALSWH, aged 60-65 years who were eligible for the sub-study, as they had experienced back pain during 12 months prior to the survey. Of these, 1310 (80.9%) returned completed questionnaires. A significant proportion of women consulted a CAM practitioner (76%, n = 1001) and/or had self-prescribed CAM treatment (75%, n = 985). Of the women who used CAM for their back pain, 20% consulted their general practitioner (GP) prior to using CAM and 34% always informed their GP following CAM use. Forty-three per cent of the women were influenced by their doctors, 39% by friends/colleagues, 36% by family/relatives, 33% by their partner, 30% by a CAM practitioner, 20% by a pharmacist, 16% by a book/magazine, 11% by mass media, 10% by an allied health worker and 6% by the Internet. Our results show that information sources used by women for their decision-making on CAM use differed according to the symptoms. While non-professional information sources (e.g. family/relatives) positively influenced women in their decision to use CAM for a range of back pain-related symptoms (e.g. headaches/migraines), doctors and allied health workers (e.g. nurses) negatively influenced women in their decision to consult a CAM practitioner for a range of back pain-related symptoms (e.g. headaches/migraines, neck pain). Women seek information from a wide range of professional and non-professional sources with regard to their decision-making around CAM use for back pain. Back pain care providers need to ensure effective communication with their back pain patients regarding safe, effective and co-ordinated back pain care option...

Cramer, H., Sibbritt, D., Adams, J. & Lauche, R. 2016, 'The association between regular yoga and meditation practice and falls and injuries: Results of a national cross-sectional survey among Australian women', Maturitas, vol. 84, pp. 38-41.
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Akter, T., Dawson, A. & Sibbritt, D. 2016, 'What impact do essential newborn care practices have on neonatal mortality in low and lower-middle income countries? Evidence from Bangladesh.', Journal of Perinatology, vol. 36, pp. 225-230.
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To assess the impact of essential newborn care (ENC) practices on the mortality of neonates delivered at home in Bangladesh.This study used cross-sectional data from the 2011 Bangladesh Demographic and Health Survey. Adjusted logistic regression model was used to examine the effect of ENC practices on neonatal mortality based on 3190 live-born infants.Delayed bathing (72h after delivery) significantly contributed to reducing neonatal mortality. A significant but counterintuitive relation was observed between the dry cord care and neonatal deaths.Neonatal mortality may be reduced through emphasizing delayed bathing. Specific guidelines on the cleanliness of the fabric used to dry and wrap newborns, as well as emphasizing the use of clean delivery kits and initiation of immediate and exclusive breastfeeding, may improve neonatal outcomes. Further, the ENC guidelines in Bangladesh should include the application of topical antiseptics to the cord stump.Journal of Perinatology advance online publication, 3 December 2015; doi:10.1038/jp.2015.181.

Aljadani, H.M., Patterson, A.J., Sibbritt, D. & Collins, C.E. 2016, 'Diet quality and six-year risk of overweight and obesity among mid-age Australian women who were initially in the healthy weight range.', Health Promotion Journal of Australia, vol. 27, no. 1, pp. 29-35.
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Issue addressed: The present study investigated the association between diet quality, measured using the Australian Recommended Food Score (ARFS), and 6-year risk of becoming overweight or obese in mid-age women from the Australian Longitudinal Study of Women's Health (ALSWH).Methods: Women (n = 1107) aged 47.6-55.8 years who were a healthy weight (body mass index (BMI) between 18.5 and <25.0 kg m-2) at baseline and who reported valid total energy intakes were included in the study. BMI was calculated from self-reported data in 2001 and 2007. ARFS scores were calculated from data collected using the Dietary Questionnaire for Epidemiological Studies Version 2. Logistic regression was used to examine the relationship between ARFS score as a continuous variable and risk of becoming overweight or obese.Results: The 6-year incidence of overweight and obesity was 18.5% and 1.1%, respectively. The mean (± s.d.) ARFS (maximum possible 74) among those who remained within the healthy weight range and those who became overweight or obese at follow-up was 35.3 ± 8.1 and 34.3 ± 8.8, respectively. There was no relationship between baseline ARFS and risk of becoming overweight or obese over 6 years. Women who were smokers were more likely to become overweight or obese (odds ratio 1.5; 95% confidence interval 1.11-2.09; P = 0.008).Conclusions: Poor diet quality was common among mid-age women of a healthy weight in the ALSWH. Higher diet quality was not associated with the risk of overweight or obesity 6 six years, yet smoking status was.So what?: Better diet quality alone will not achieve maintenance of a healthy weight, but should be encouraged to improve other health outcomes.

Frawley, J., Sibbritt, D., Broom, A., Gallois, C., Steel, A. & Adams, J. 2016, 'Complementary and alternative medicine practitioner use prior to pregnancy predicts use during pregnancy.', Women and Health, vol. 56, no. 8, pp. 926-939.
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The objective of this study was to determine if prior visits to a complementary and alternative medicine (CAM) practitioner were associated with CAM use during pregnancy. The study sample comprised the Australian Longitudinal Study on Women's Health. Women were surveyed prior to pregnancy in 2006, and then again in 2010 if they were pregnant or had recently given birth, and asked a range of questions relating to demographic variables, health status and use of CAM. A multivariable analysis identified significant covariates associated with visits to specific CAM practitioner modalities during pregnancy. Of the 447 women who consulted a CAM practitioner prior to pregnancy, 62.4% (n = 279) continued this use during pregnancy. Prior use of massage therapy, acupuncture, herbalist/naturopath or chiropractor was related to use of the same service during pregnancy. Higher income and working full-time were associated with the continued use of massage, while continued visits to a chiropractor were associated with having depressive symptoms, a urinary tract infection and living in a rural community. Prior use of CAM was highly related to continuing use during pregnancy. Further research is required to elucidate the benefits women attain from a CAM-model of care that they do not get from their conventional maternity care providers alone.

Newton, P.J., Davidson, P.M., Reid, C.M., Krum, H., Hayward, C., Sibbritt, D.W., Banks, E. & MacDonald, P.S. 2016, 'Acute heart failure admissions in New South Wales and the Australian Capital Territory: the NSW HF Snapshot Study.', The Medical journal of Australia, vol. 204, no. 3, pp. 113-113.
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The primary aim of the NSW Heart Failure (HF) Snapshot was to obtain a representative cross-sectional view of patients with acute HF and their management in New South Wales and Australian Capital Territory hospitals.A prospective audit of consecutive patients admitted to 24 participating hospitals in NSW and the ACT with a diagnosis of acute HF was conducted from 8 July 2013 to 8 August 2013.A total of 811 participants were recruited (mean age, 77 ± 13 years; 58% were men; 42% had a left ventricular ejection fraction 50%). The median Charlson Comorbidity Index score was 3, with ischaemic heart disease (56%), renal disease (55%), diabetes (38%) and chronic lung disease (32%) the most frequent comorbidities; 71% of patients were assessed as frail. Intercurrent infection (22%), non-adherence to prescribed medication (5%) or to dietary or fluid restrictions (16%), and atrial fibrillation/flutter (15%) were the most commonly identified precipitants of HF. Initial treatment included intravenous diuretics (81%), oxygen therapy (87%), and bimodal positive airways pressure or continuous positive airways pressure ventilation (17%). During the index admission, 6% of patients died. The median length of stay in hospital was 6 days, but ranged between 3 and 12 days at different hospitals. Just over half the patients (59%) were referred to a multidisciplinary HF service. Discharge medications included angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (59%), -blockers (66%) and loop diuretics (88%).Patients admitted to hospital with acute HF in NSW and the ACT were generally elderly and frail, with multiple comorbidities. Evidence-based therapies were underused, and there was substantial interhospital variation in the length of stay. We anticipate that the results of the HF Snapshot will inform the development of strategies for improving the uptake of evidence-based therapies, and hence outcomes, for HF patients.

Sibbritt, D., Lui, C., Kroll, T. & Adams, J. 2016, 'Prevalence of glucosamine and omega-3 fatty acid use and characteristics of users among mid-age women: analysis of a nationally representative sample of 10,638 women', The Journal of Nutrition Health and Aging, vol. 20, no. 6, pp. 637-644.
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Steel, A., Frawley, J., Sibbritt, D., Broom, A. & Adams, J. 2016, 'The characteristics of women who use hypnotherapy for intrapartum pain management: Preliminary insights from a nationally-representative sample of Australian women', Complementary Therapies in Medicine, vol. 25, pp. 67-70.
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Frawley, J., Peng, W., Sibbritt, D., Ward, L., Lauche, R., Zhang, Y. & Adams, J. 2016, 'Is there an association between women's consultations with a massage therapist and health-related quality of life? Analyses of 1800 women aged 56-61 years.', J Bodyw Mov Ther, vol. 20, no. 4, pp. 734-739.
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BACKGROUND: The use of complementary and alternative medicine (CAM) is commonplace in Australia with massage being a popular CAM modality. METHODS: This is a sub-study from the Australian Longitudinal Study on Women's Health (ALSWH). A total of 2120 mid-age (56-61 year old) women who consulted a CAM practitioner were invited to participate in this study. The Short-Form (SF-36) questionnaire was used to measure women's health-related quality of life. RESULTS: A total of 1800 women returned the questionnaire generating a response rate of 85.0%. Overall, 912 (50.7%) women visited a massage therapist in the previous 12 months. Women with lower quality of life scores in terms of bodily pain (p = 0.012) and/or emotional health (p = 0.029) were more likely to consult a massage therapist than those with higher scores. CONCLUSION: The implications of these associations are important for informing healthcare providers in providing effective and coordinated care for patients with pain and mood symptoms.

Islam, M.R., Attia, J., Ali, L., McEvoy, M., Selim, S., Sibbritt, D., Akhter, A., Akter, S., Peel, R., Faruque, O., Mona, T., Lona, H. & Milton, A.H. 2016, 'Zinc supplementation for improving glucose handling in pre-diabetes: A double blind randomized placebo controlled pilot study', DIABETES RESEARCH AND CLINICAL PRACTICE, vol. 115, pp. 39-46.
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Fisher, C., Adams, J., Hickman, L. & Sibbritt, D. 2016, 'The use of complementary and alternative medicine by 7427 Australian women with cyclic perimenstrual pain and discomfort: a cross-sectional study', BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE, vol. 16.
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Rao, A., Hickman, L.D., Phillips, J.L. & Sibbritt, D. 2016, 'Prevalence and characteristics of Australian women who use prayer or spiritual healing: A nationally representative cross-sectional study', COMPLEMENTARY THERAPIES IN MEDICINE, vol. 27, pp. 35-42.
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Fisher, C., Sibbritt, D., Hickman, L. & Adams, J. 2016, 'A critical review of complementary and alternative medicine use by women with cyclic perimenstrual pain and discomfort: A focus upon prevalence, patterns and applications of use and users' motivations, information seeking and self-perceived efficacy.', Acta obstetricia et gynecologica Scandinavica, vol. 95, no. 8, pp. 861-871.
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Complementary and alternative medicine (CAM) is used for treating cyclic perimenstrual pain and discomfort. This critical review examines women's reported CAM use, its perceived effectiveness and information relating to women's attitudes, behaviours, motivations and patterns of CAM use in its treatment MATERIAL AND METHODS: An extensive search of the main medical databases EBSCO, CINAHL, Medline, AMED and SCOPUS, as well as additional hand searches, was conducted. Papers included were confined to those that had been peer-reviewed, written in English and containing original research into CAM use for cyclic perimenstrual pain and discomfort amongst adult women RESULTS: CAM, particularly herbal medicine, nutritional supplements and massage, is widely used for a range of cyclic perimenstrual pain and discomfort symptoms. A large number of CAM modalities are adopted, often simultaneously and with little professional oversight. Women's assessment of efficacy of different CAM modalities is positive, though the majority of users are self-prescribing apparently without professional guidance. Although the uptake of CAM for cyclic perimenstrual pain and discomfort is wide-spread, little empirical data is available regarding which women are using CAM, their motivations for doing so and importantly the sources via which women receive information about CAM CONCLUSIONS: This review highlights the extensive use of (often self-prescribed) CAM in a number of countries to alleviate the widespread symptoms of cyclic perimenstrual pain and discomfort. An understanding of all health care utilisation by women with perimenstrual pain and discomfort is vital to help ensure safe, effective and coordinated health care that can lead to optimal patient outcomes. This article is protected by copyright. All rights reserved.

Sibbritt, D., Davidson, P., Peng, W.B., Adams, J. & Hickman, L. 2016, 'Hypertension: What are the self-care and health-care-seeking behaviours in women over time?', Journal of human hypertension, vol. 30, pp. 783-787.
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The aim of this study was to estimate the prevalence and incidence of hypertension in women, and describe their self-care and health-seeking behaviours. This research was conducted as part of the Australian Longitudinal Study on Women's Health, a study comprising a nationally representative sample of Australian women in three age groups. The focus of this research is 14099 women born in 1946-1951, who have been surveyed six times (1996-2010). Student t-tests were used to compare women who did or did not have hypertension by their health-care utilization. Longitudinal analyses were conducted using a Poisson generalized estimating equation model. The incidence of hypertension among this cohort during 1996 to 2010 ranged from 400 to 597 participants per survey, resulting in an increase in prevalence of hypertension from 20.9% in 1996 to 41.3% in 2010. For all survey periods, women with hypertension had a significantly higher average number of visits to doctors and allied health practitioners compared with women without hypertension (P<0.005). The use of complementary medicine (practitioners and self-prescribed treatments) by women with hypertension was significantly lower compared to women without hypertension (P<0.005). Over time, conventional health-care utilization was higher for women with hypertension compared with women without hypertension (adjusted RR=1.18; 95% CI: 1.14, 1.22; P<0.0001). Our findings show that women with hypertension are using a range of conventional and complementary and alternative medicine: with hypertensive women using more conventional medicine and less complementary and alternative medicine than non-hypertensive women. As such, health-care providers should communicate with their patients regarding their use of complementary and alternative medicine in their efforts to provide safe, effective and coordinate care.Journal of Human Hypertension advance online publication, 28 April 2016; doi:10.1038/jhh.2016.20.

Thomson Mangnall, L.J., Sibbritt, D.W., Al-Sheyab, N. & Gallagher, R.D. 2016, 'Predictors of warfarin non-adherence in younger adults after valve replacement surgery in the South Pacific.', Heart Asia, vol. 8, no. 2, pp. 18-23.

Globally, mechanical valves are predominant as replacements for adolescents and younger adults with rheumatic heart disease (RHD). Mechanical valve implantation necessitates lifelong antithrombotic management (warfarin) and associated lifestyle modification, with event-free survival largely dependent on international normalised therapeutic ratios (INRs) remaining within the target therapeutic range. There is limited information on factors that may influence warfarin adherence among younger people or those in resource-limited settings. This study sought to identify predictors of warfarin adherence after valve replacement surgery for RHD in Fiji (n=127).A cross-sectional study design was used.The sample had a mean age of 31.23years (SD 13.34) and a mean time-since-surgery of 3.72years (SD 3.95). Just over half were women (n=71, 56%) and almost two-thirds were indigenous (I-taukei, n=78, 61%). Most had an isolated valve procedure (n=94, 74%) and at the time of survey, they were in New York Heart Association Class I (n=97, 76%). A quarter (n=33, 26%) reported poor adherence with anticoagulation therapy and 13.38% (n=17) reported complete warfarin cessation. While younger age was significantly associated with non-adherence to warfarin therapy (p=0.008), the independent predictors of people who discontinue warfarin completely were those not understanding why warfarin was needed (OR=9.97, p=0.006); a history of forgetting to take warfarin (OR=8.64, p=0.0013) and travel time to heart clinic >1hour (OR=5.80, p=0.039).While medication adherence is complex and multifactorial, the consequences of warfarin non-adherence are potentially catastrophic. These results provide an important first step towards the development of country-specific and disease-specific strategies to improve warfarin adherence.

Akter, T., Dawson, A. & Sibbritt, D. 2016, 'Workforce Interventions to Deliver Postnatal Care to Improve Neonatal Outcomes in Low- and Lower-Middle-Income Countries: A Narrative Synthesis', Asia-Pacific Journal of Public Health, vol. 28, no. 8, pp. 659-681.
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Reducing neonatal mortality rates in low- and lower-middle-income countries (LMICs) requires postnatal interventions to be delivered through an appropriately prepared and supported workforce. This review examines health workforce interventions that deliver integrated packages of postnatal care to improve neonatal outcomes in LMICs. We conducted a structured search of peer-reviewed articles published during 2003-2014 that investigated the delivery of postnatal interventions by formal and lay health workers. We selected 13 studies and analyzed them using a narrative synthesis methodology. This review observed a wide divergence among studies regarding the outcomes as well as the approaches and duration of workforce training and staff supervision. Except 4, all studies observed a significant reduction in neonatal mortality. On the other hand, teams of lay health workers appear to be more effective in improving neonatal outcomes. Further improvement in the performance of health care providers may require emphasis on workforce interventions such as competency assessment, the acquisition of appropriate skills, and supervisory guidelines. Nevertheless, the heterogeneity and limited number of studies do not allow us to arrive at definitive conclusions, and we recommend the need for the harmonization of future studies, with uniformity of outcome measures and cost analyses.

Perry, L., Gallagher, R., Duffield, C.M., Sibbritt, D., Bichel-Findlay, J. & Nicholls, R. 2016, 'Does nurses' health affect their intention to remain in their current position', Journal of Nursing Management, vol. 24, no. 8, pp. 1088-1097.
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Wardle, J.L., Sibbritt, D., Broom, A., Steel, A. & Adams, J. 2016, 'Is Health Practitioner Regulation Keeping Pace with the Changing Practitioner and Health-Care Landscape? An Australian Perspective.', Frontiers in public health, vol. 4, p. 91.
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Health-care delivery is undergoing significant evolution and change. Task substitution has resulted in some practitioner groups expanding their scope of practice by assuming more complex clinical roles, new practitioner groups have emerged, and consumer-driven demand has changed the way the public engage with health practitioners and the way many health-care services are delivered. Using Australia as a case study, this paper explores the issue of the hesitancy to include new professions in health professions regulation schemes. Despite the significant changes in the health-care delivery landscape, policy development in this area has remained relatively static, with active resistance to extending formal registration to new practitioner groups. Ignoring the issue of new practitioner groups in regulatory schemes is unacceptable from a public health perspective and runs against the key public protection objectives of health practitioner regulation. Development of pathways for the entry of new health practitioner groups into regulatory schemes must be developed as a matter of priority.

Peng, W., Liang, H., Sibbritt, D. & Adams, J. 2016, 'Complementary and alternative medicine use for constipation: a critical review focusing upon prevalence, type, cost, and users' profile, perception and motivations', INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, vol. 70, no. 9, pp. 712-722.
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Rao, A., Hickman, L.D., Sibbritt, D., Newton, P.J. & Phillips, J.L. 2016, 'Is energy healing an effective non-pharmacological therapy for improving symptom management of chronic illnesses? A systematic review', Complementary Therapies in Clinical Practice, vol. 25, pp. 26-41.
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Sibbritt, D., Peng, W., Chang, S., Liang, H. & Adams, J. 2016, 'The use of conventional and complementary health services and self-prescribed treatments amongst young women with constipation: A national cohort study.', Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, vol. 48, no. 11, pp. 1308-1313.
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Little research has been conducted regarding the comprehensive health service utilisation in constipation care. This study investigates the comprehensive health service utilisation amongst Australian women with constipation.This study draws upon data from the Australian Longitudinal Study on Women's Health. A total of 8074 young women were asked about their frequency of constipation, measures of quality of life, and use of a range of health services and self-prescribed treatments via two postal surveys conducted in 2006 and 2009, respectively.The prevalence of constipation was 18.5% amongst women in 2009. Constipated women had poorer quality of health than women without constipation. Women who sought help for constipation were more likely to visit multiple groups of conventional and complementary health practitioners compared to women who did not experience constipation (p<0.005). However, women were less likely to visit a specialist for the management of constipation over time (2006 to 2009). There was an increase in the proportion of women with constipation who self-prescribed vitamins/minerals over time (p<0.001).Although only 4.5% of women sought help for their constipation, given the increasing use of multiple health services across time, more studies are required regarding the optimal treatment in constipation care.

Hall, H., Cramer, H., Sundberg, T., Ward, L., Adams, J., Moore, C., Sibbritt, D. & Lauche, R. 2016, 'The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain: A systematic review with meta-analysis', MEDICINE, vol. 95, no. 38.
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Sibbritt, D., Lauche, R., Sundberg, T., Peng, W., Moore, C., Broom, A., Kirby, E. & Adams, J. 2016, 'Severity of back pain may influence choice and order of practitioner consultations across conventional, allied and complementary health care: a cross-sectional study of 1851 mid-age Australian women', BMC Musculoskeletal Disorders, vol. 17, no. 1.
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BACKGROUND: Back pain is a common, disabling and costly disorder for which patients often consult with a wide range of health practitioners. Unfortunately, no research to date has directly examined the association between the severity of back pain and back pain sufferers' choice of whom and in what order to consult different health practitioners. METHODS: This is a sub-study of the large nationally representative Australian Longitudinal Study on Women's Health (ALSWH). The mid-age cohort women (born 1946-51, n=13,715) of the ALSWH were recruited from the Australian national Medicare database in 1996. These women have been surveyed six time, with survey 6 being conducted in 2010 (n=10,011). Mid-age women (n=1851) who in 2010 had sought help from a health care practitioner for their back pain were mailed a self-report questionnaire targeting their previous 12 months of health services utilisation, health status and their levels of back pain intensity. RESULTS: A total of 1620 women were deemed eligible and 1310 (80.9 %) returned completed questionnaires. Mid-age women with back pain visited various conventional, allied health and CAM practitioners for care: 75.6 % consulted a CAM practitioner; 58.4 % consulted a medical doctor; and 54.2 % consulted an allied health practitioner. Women with the most severe back pain sought conventional care from a general practitioner, and those who consulted a general practitioner first had more severe back pain than those who consulted another practitioner first. Following the general practitioner visit, the women with more severe back pain were more likely to be referred to a conventional specialist, and those with less severe back pain were more likely to be referred to a physiotherapist. CONCLUSIONS: Our findings suggest that women with more severe back pain are likely to visit a conventional practitioner first, whereas women with less severe back pain are likely to explore a range of treatment options including CA...

Lauche, R., Sibbritt, D., Ostermann, T., Fuller, N.R., Adams, J. & Cramer, H. 2016, 'Associations between yoga/meditation use, body satisfaction and weight management methods: Results of a national cross-sectional survey of 8009 Australian Women', Nutrition, vol. 34, pp. 58-64.
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Objectives To analyse whether yoga use is associated with body (dis)satisfaction and weight control methods in Australian women. Research Methods & Procedures Women aged 34-39 years from the Australian Longitudinal Study on Women's Health (ALSWH) were surveyed regarding body satisfaction, weight control behaviours, and yoga practice. Associations of body satisfaction and weight control methods with yoga practice were analysed using chi-squared tests and multiple logistic regression modelling. Results Of the 8009 women, 49% were overweight or obese. Sixty-five percent of women with normal BMI and approximately 95% of women with overweight/obesity wanted to lose weight. At least one in four women with normal BMI was dissatisfied with body weight and shape, as were more than two in three women with overweight/obesity. The most common weight control methods included exercising (82.7%), cutting down meal sizes (76.8%), and cutting down sugars or fats (71.9%). Yoga was practiced frequently by 688 (8.6%) and occasionally by 1176 (14.7%) women. Yoga users with normal BMI were less likely dissatisfied with body weight and shape. All yoga users more likely exercised, followed a low glycaemic diet or diet books; and women with obesity occasionally using yoga also more likely used fasting or smoking to lose weight. Conclusion Yoga users with normal BMI appear to be more satisfied with their body weight and shape than non-yoga users. While women with normal BMI or overweight tend to rely on healthy weight control methods, women with obesity occasional using yoga may more likely utilise unhealthy weight control methods.

Adams, J., Steel, A., Moore, C., Amorin-Woods, L. & Sibbritt, D. 2016, 'Establishing the ACORN National Practitioner Database: Strategies to Recruit Practitioners to a National Practice-Based Research Network', JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS, vol. 39, no. 8, pp. 594-602.
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Sibbritt, D., Ladanyi, S. & Adams, J. 2016, 'Healthcare practitioner utilisation for back pain, neck pain and/or pelvic pain during pregnancy: an analysis of 1835 pregnant women in Australia.', International journal of clinical practice, vol. 70, no. 10, pp. 825-831.
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Back, neck and/or pelvic pain are common symptoms experienced by pregnant women. Although pregnant women are known to use complementary and alternative medicine (CAM) frequently, no research to date has provided in-depth examination of healthcare practitioner utilisation of pregnant women who experience back, neck and/or pelvic pain.A sub-study of 1835 pregnant women from the nationally representative Australian Longitudinal Study on Women's Health (ALSWH). Demographics, health status and healthcare utilisation measures were analysed for symptoms of back, neck and/or pelvic pain during pregnancy, using regression models.During their pregnancy, 39.5% women experienced back pain, 12.4% experienced neck pain and 16.3% women experienced pelvic pain. Pregnant women were more likely to consult a massage therapist for their back pain (32.3%) and neck pain (39.9%), and another alternative practitioner (27.3%) or obstetrician (22.1%) for pelvic pain, while some women did not seek treatment (<30%). Women who sought help for each symptom reported significantly worse levels of mental and physical health across most SF-36 domains (P<.05). Women without health insurance, or pregnancy-related healthcare insurance were less likely to seek treatment.Pregnant women experiencing back, neck and/or pelvic pain frequently consult CAM practitioners, particularly if they have healthcare insurance. There is a need for all healthcare practitioners providing maternity care to enquire about possible back, neck and pelvic pain amongst women in their care and be cognisant of possible corresponding CAM use for such symptoms.

Steel, A., Adams, J., Frawley, J., Wardle, J., Broom, A., Sidebotham, M. & Sibbritt, D. 2016, 'Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?', BIRTH-ISSUES IN PERINATAL CARE, vol. 43, no. 4, pp. 273-276.
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Akter, T., Dawson, A. & Sibbritt, D. 2016, 'The determinants of essential newborn care for home births in Bangladesh.', Public Health, vol. 141, pp. 7-16.
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OBJECTIVES: To examine the association of sociodemographic, antenatal and delivery care factors with the essential newborn care (ENC) practices of neonates born at home in Bangladesh. STUDY DESIGN: This study analyzed data of a cross-sectional survey-the Bangladesh Demographic and Health Survey, 2011. METHODS: This analysis considered 3190 most recent live-born infants who were delivered at home within three years of the survey. Logistic regression models were used to identify the factors affecting the implementation of six ENC practices, namely using disinfected instruments to cut the umbilical cord, avoidance of application of any substances to the umbilical cord stump, immediate drying and wrapping of newborns, delayed bathing of newborns, and immediate initiation of breastfeeding. RESULTS: Factors affecting ENC practices in Bangladesh are low parental education, low utilization of antenatal care services, the absence of skilled birth attendants, smaller size at birth, higher birth order and mother's age at birth. Regional factors also seem to considerably affect ENC practices. CONCLUSION: There is ample scope to improve the coverage of ENC practices in Bangladesh. Health promotion programmes that target parents with low education and older mothers may help to build awareness of ENC practices. This investigation provides insight into the key determinants of ENC practices, which require consideration when scaling up ENC practices in low-income and lower middle-income countries.

Broom, A., Wong, W.K.T., Kirby, E., Sibbritt, D., Karikios, D., Harrup, R. & Lwin, Z. 2016, 'A Qualitative Study of Medical Oncologists' Experiences of Their Profession and Workforce Sustainability', PLOS ONE, vol. 11, no. 11.
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Sibbritt, D., Millbank, J., Stuhmcke, A., Kaye, M., Karpin, I. & Wardle, J. 2016, 'The failure of contemporary law and regulation to keep pace with growing complementary medicine (CM) use: The significance of examining 'hidden' gaps in Australia's current regulatory and legislative infrastructure', Advances in Integrative Medicine, vol. 3, no. 2, pp. 43-44.
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Steel, A.E., Adams, J., Sibbritt, D., Broom, A., Gallois, C. & Frawley, J.E. 2015, 'Managing the pain of labour: factors associated with the use of labour pain management for pregnant Australian women.', Health Expectations, vol. 18, no. 5, pp. 1633-1644.
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Despite high rates of women's use of intrapartum pain management techniques, little is known about the factors that influence such use. ... Examine the determinants associated with women's use of labour pain management. ... Cross-sectional survey of a substudy of women from the 'young' cohort of the Australian Longitudinal Study of Women's Health (ALSWH). ... Women aged 3135 years who identified as being pregnant or recently given birth in the 2009 ALSWH survey (n = 2445) were recruited for the substudy. The substudy survey was completed by 1835 women (RR = 79.2%).

Mangnall, L.J.T., Gallagher, R.D., Sibbritt, D.W. & Fry, M.M. 2015, 'Health-related quality of life of patients after mechanical valve replacement surgery: An integrative review', European Journal of Cardiovascular Nursing, vol. 14, no. 1, pp. 16-25.
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Daley, C., Patterson, A., Sibbritt, D. & MacDonald-Wicks, L. 2015, 'Unsaturated fat intakes and mental health outcomes in young women from the Australian Longitudinal Study on Women's Heath.', Public health nutrition, vol. 18, no. 3, pp. 546-553.
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OBJECTIVE: To determine if associations exist between a range of unsaturated fatty acid intakes and mental health outcomes. DESIGN: Cross-sectional data analysis of the Australian Longitudinal Study on Women's Health (ALSWH) Young Cohort Survey 3 that included the validated seventy-four-item Dietary Questionnaire for Epidemiological Studies FFQ, validated mental health scales and self-report questions on depression and anxiety. SETTING: Australia, 2003. SUBJECTS: A nationally representative sample of young Australian women (25-30 years) from ALSWH. The 7635 women with plausible energy intakes (>45 but <200 MJ/d) were included in the analyses. RESULTS: Adjusted logistic regression analyses found statistically significant associations between higher intakes of -linolenic acid and decreased likelihood of depressive symptoms indicated by the ten-item Center for Epidemiological Studies Depression Scale (CESD-10; OR=077; 95% CI 060, 099; P=0040) and the Short Form Health Survey (SF-36) mental health subscale (OR=073 95% CI 056, 096; P=0024). Furthermore, higher intakes of n-6 fatty acids (OR=096, 95% CI 093, 099; P=0019) and linoleic acid (OR=096, 95% CI 093, 099; P=0020) were associated with decreased likelihood of self-reported diagnosed anxiety and higher intakes of n-9 fatty acids (OR=102, 95% CI 100, 104; P=0041) and oleic acid (OR=102, 95% CI 100, 105; P=0046) were associated with increased likelihood of self-reported diagnosed anxiety. CONCLUSIONS: Increased intakes of -linolenic acid were associated with a reduced likelihood of depressive symptoms, increased intakes of n-6 fatty acids and linoleic acid were associated with a reduced likelihood of self-reported anxiety, and increased intakes of n-9 fatty acids and oleic acid were associated with an increased likelihood of anxiety. Additional studies are needed to further elucidate associations between unsaturated fatty acids and depression and anxiety.

Adams, J., Frawley, J., Steel, A., Broom, A. & Sibbritt, D. 2015, 'Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: Examination of a nationally representative sample of 1835 pregnant women', MIDWIFERY, vol. 31, no. 4, pp. 458-463.
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Peng, W., Adams, J., Hickman, L. & Sibbritt, D.W. 2015, 'Association between consultations with complementary/alternative medicine practitioners and menopause-related symptoms: a cross-sectional study', Climacteric, vol. 18, no. 4, pp. 551-558.
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Chang, S., Davidson, P.M., Newton, P.J., Macdonald, P., Carrington, M.J., Marwick, T.H., Horowitz, J.D., Krum, H., Reid, C.M., Chan, Y.K., Scuffham, P.A., Sibbritt, D. & Stewart, S. 2015, 'Composite outcome measures in a pragmatic clinical trial of chronic heart failure management: A comparative assessment', International Journal of Cardiology, vol. 185, pp. 62-68.
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Suswardany, D.L., Sibbritt, D.W., Supardi, S., Chang, S. & Adams, J. 2015, 'A critical review of traditional medicine and traditional healer use for malaria and among people in malaria-endemic areas: contemporary research in low to middle-income Asia-Pacific countries', Malaria Journal, vol. 14, no. 98.
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Adams, J., Steel, A., Chang, S. & Sibbritt, D. 2015, 'Helping address the national research and research capacity needs of Australian chiropractic: introducing the Australian Chiropractic Research Network (ACORN) project.', Chiropractic and Manual Therapies, vol. 23, no. 12.
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Chiropractic is a popular health care choice in Australia and yet major gaps in our empirical understanding of this area of practice remain. Furthermore, while some research excellence exists, a largely uncoordinated approach to research activity and development has in effect led to silos of interest and a lack of strategic 'big-picture' planning essential to producing a sustainable research culture and capacity for the profession. This commentary identifies the significance of a number of key features - including a national, coordinated focus, and a rich engagement with the practitioner and patient base amongst others - arguably important to the future development of research and research capacity within Australian chiropractic. The design features and phases of the Australian Chiropractic Research Network (ACORN) project are also outlined. ACORN is one contemporary initiative specifically developed to address chiropractic's research and research capacity building needs and help grow a broad evidence-base to inform safe, effective patient care.

Harris, M.L., Byles, J.E., Sibbritt, D. & Loxton, D. 2015, '"Just Get on with It": Qualitative Insights of Coming to Terms with a Deteriorating Body for Older Women with Osteoarthritis', PLoS One, vol. 10, no. 3, pp. e0120507-e0120507.
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Zhang, Y., Leach, M.J., Hall, H., Sundberg, T., Ward, L., Sibbritt, D. & Adams, J. 2015, 'Differences between Male and Female Consumers of Complementary and Alternative Medicine in a National US Population: A Secondary Analysis of 2012 NIHS Data', Evidence-Based Complementary and Alternative Medicine.
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Adams, J., Frawley, J., Steel, A., Broom, A. & Sibbritt, D. 2015, 'Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: Examination of a nationally representative sample of 1835 pregnant women', Midwifery, vol. 31, no. 4, pp. 458-463.
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© 2015 Elsevier Ltd. Women use various labour pain management techniques during birth. The objective of this study is to investigate women's use of pharmacological and non-pharmacological labour pain management techniques in relation to birth outcomes. Methods: a sub-survey of a nationally representative sample of pregnant women (. n=1835) from the Australian Longitudinal Study on Women's Health. Results: our analysis identified women's use of water for labour pain management as decreasing the likelihood of their baby being admitted to special care nursery (OR=0.42, p<0.004) whereas the use of epidural increased this likelihood (OR=3.38, p<0.001) as well as for instrumental childbirth (OR=7.27, p<0.001). Epidural and pethidine use decreased women's likelihood of continuing breast-feeding (ORs=0.68 and 0.59, respectively, both p<0.01) whereas the use of breathing techniques and massage for pain control increased the likelihood of women continuing breast-feeding (ORs=1.72 and 1.62, respectively, both p<0.01). Conclusions: our study illustrates associations between the use of both pharmacological and non-pharmacological labour pain management techniques and selected birth outcomes while controlling for confounding variables. There remain significant gaps in the evidence base for the use of non-pharmacological labour pain control methods and our findings provide a platform with which to develop a broad clinical research programme around this topic.

Cottingham, P., Adams, J., Vempati, R., Dunn, J. & Sibbritt, D. 2015, 'The characteristics, experiences and perceptions of naturopathic and herbal medicine practitioners: results from a national survey in New Zealand', BMC Complementary and Alternative Medicine, vol. 15, pp. 114-114.
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Sibbritt, D., Davidson, P., DiGiacomo, M., Newton, P. & Adams, J. 2015, 'Use of Complementary and Alternative Medicine in Women With Heart Disease, Hypertension and Diabetes (from the Australian Longitudinal Study on Women's Health)', AMERICAN JOURNAL OF CARDIOLOGY, vol. 115, no. 12, pp. 1691-1695.
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Murthy, V., Sibbritt, D.W. & Adams, J. 2015, 'An integrative review of complementary and alternative medicine use for back pain: a focus on prevalence, reasons for use, influential factors, self-perceived effectiveness, and communication', The Spine Journal, vol. 15, no. 8, pp. 1870-1883.
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Adams, J., Valery, P.C., Sibbritt, D., Bernardes, C.M., Broom, A. & Garvey, G. 2015, 'Use of Traditional Indigenous Medicine and Complementary Medicine Among Indigenous Cancer Patients in Queensland, Australia', Integrative Cancer Therapies, vol. 14, no. 4, pp. 359-365.
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Frawley, J., Adams, J., Steel, A., Broom, A., Gallois, C. & Sibbritt, D. 2015, 'Women's Use and Self-Prescription of Herbal Medicine during Pregnancy: An Examination of 1,835 Pregnant Women', Women's Health Issues, vol. 25, no. 4, pp. 396-402.
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van der Riet, P., Maguire, J., Dedkhard, S. & Sibbritt, D. 2015, 'Are traditional Thai therapies better than conventional treatment for stroke rehabilitation? A quasi-experimental study', European Journal of Integrative Medicine, vol. 7, no. 1, pp. 16-22.
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Charaf, S., Wardle, J.L., Sibbritt, D.W., Lal, S. & Callaway, L.K. 2015, 'Women's use of herbal and alternative medicines for preconception care.', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 55, no. 3, pp. 222-226.
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Use of complementary and alternative medicine (CAM), particularly herbal and alternative medicine supplements, for preconception care and fertility management is becoming increasingly common.To determine the factors associated with the use of CAMs by women for preconception care.412 women who had visited an antenatal 'first visit' clinic situated at a Brisbane obstetric hospital or had visited a private ultrasound clinic in the same city for the purposes of a routinely indicated ultrasound scan in the first trimester were recruited into the study. Data were collected via a cross-sectional questionnaire.Complementary and alternative medicines (not including multivitamins) were used during preconception by 8.3% of women attending for obstetric care. Approximately half (55.8%) of women taking herbal and alternative medicines ceased these medications on discovery of their pregnancy, though fewer (17.4%) ceased taking multivitamin supplements. Baseline characteristics (age, education and income) are not significantly different between CAM users and those who did not take CAMs preconception. The results of statistical analyses showed that only visiting a practitioner to check for health (OR = 2.00; 95% CI: 1.33, 3.00) and trying to lose weight prior to pregnancy (OR = 1.53; 95% CI: 1.00, 2.36) were the key predictors for women using CAM during preconception.Women do consume CAMs to enhance preconception care to a certain extent, though CAM users remain in the minority. CAM users also tend to cease use once pregnant.

Steel, A., Hemmings, B., Sibbritt, D. & Adams, J. 2015, 'Research challenges for a complementary medicine higher education institution: Results from an organisational climate survey', EUROPEAN JOURNAL OF INTEGRATIVE MEDICINE, vol. 7, no. 5, pp. 442-449.
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Steel, A., Adams, J., Sibbritt, D. & Broom, A. 2015, 'The outcomes of complementary and alternative medicine use among pregnant and birthing women: current trends and future directions.', Women's Health, vol. 11, no. 3, pp. 309-323.
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Complementary and alternative medicine is used by a substantial number of pregnant women and maternity care providers are often faced with the task of ensuring women are using safe and effective treatments while respecting a woman's right to autonomous decision-making. In the era of evidence-based medicine maternity health professionals are expected to draw upon the best available evidence when making clinical decisions and providing health advice. This review will outline the current trends in research evidence associated with the outcomes of complementary and alternative medicine use amongst pregnant and birthing women as well as highlight some potential directions for future development in this important yet largely unknown topic in contemporary maternity care.

Rao, A., Sibbritt, D., Phillips, J.L. & Hickman, L.D. 2015, 'Prayer or spiritual healing as adjuncts to conventional care: a cross sectional analysis of prevalence and characteristics of use among women', BMJ Open, vol. 5, no. 6, pp. e007345-e007345.
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Cramer, H., Frawley, J., Steel, A., Hall, H., Adams, J., Broom, A. & Sibbritt, D. 2015, 'Characteristics of women who practice yoga in different locations during pregnancy', BMJ Open, vol. 5, no. 8, pp. e008641-e008641.
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Kirby, E., Broom, A., Sibbritt, D., Refshauge, K. & Adams, J. 2015, 'Suffering, recognition and reframing: Healthcare choices and plural care pathways for women with chronic back pain', Current Sociology, vol. 63, no. 5, pp. 652-668.
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Steel, A., Adams, J., Frawley, J., Broom, A. & Sibbritt, D. 2015, 'The characteristics of women who birth at home, in a birth centre or in a hospital labour ward: A study of a nationally-representative sample of 1835 pregnant women', Sexual & Reproductive Healthcare, vol. 6, no. 3, pp. 132-137.
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Mitchell, G., Girgis, A., Jiwa, M., Sibbritt, D., Burridge, L. & Senior, H. 2015, 'Using a self completed checklist to assess and manage the needs of the carers of people with advanced cancer in general practice: a randomised controlled trial', EUROPEAN JOURNAL OF CANCER CARE, vol. 24, no. S2, pp. 10-10.

Background: Carers of patients with advanced cancer havespecic health and psychosocial needs, often not addressed.GPs may be able to meet these needs.Research question: Can GPs consultations guided by a self-completed checklist reduce the number and intensity ofunmet carer needs.Methods: Prospective randomised controlled trial. Interven-tion was a self-reported checklist completed by the carer fol-lowed by a carer-GP consultation, at baseline and at 3 monthsand a GP-Toolkit to assist GPs to provide relevant interven-tions to address carer-identied needs. We also identied howneeds change over time in all carers, and what needs wereexpressed over time in intervention carers

Fletcher, S., Sibbritt, D., Stark, D., Harkness, J., Rawlinson, W., Andresen, D., van Hal, S., Merif, J. & Ellis, J.T. 2015, 'Descriptive epidemiology of infectious gastrointestinal illnesses in Sydney,Australia, 2007–2010', Western Pacific Surveillance and Response Journal, vol. 6, no. 4, pp. 7-16.
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Bowe, S., Adams, J., Lui, C.-.W. & Sibbritt, D. 2015, 'A longitudinal analysis of self-prescribed complementary and alternative medicine use by a nationally representative sample of 19,783 Australian women, 2006-2010', Complementary Therapies in Medicine, vol. 23, no. 5, pp. 699-704.
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Elliott, D., Elliott, R., Burrell, A., Harrigan, P., Murgo, M., Rolls, K. & Sibbritt, D. 2015, 'Incidence of ventilator associated pneumonia in Australian intensive care units: Use of a consensus-developed clinical surveillance checklist in a multi-site prospective audit', BMJ Open, vol. 5, no. 10, pp. e008924-e008924.
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Objectives: With disagreements on diagnostic criteria for ventilator-associated pneumonia (VAP) hampering efforts to monitor incidence and implement preventative strategies, the study objectives were to develop a checklist for clinical surveillance of VAP, and conduct an audit in Australian/New Zealand intensive care units (ICUs) using the checklist. Setting: Online survey software was used for checklist development. The prospective audit using the checklist was conducted in 10 ICUs in Australia and New Zealand. Participants: Checklist development was conducted with members of a bi-national professional society for critical care physicians using a modified Delphi technique and survey. A 30-day audit of adult patients mechanically ventilated for >72 h. Primary and secondary outcome measures: Presence of items on the screening checklist; physician diagnosis of VAP, clinical characteristics, investigations, treatments and patient outcome. Results: AVAP checklist was developed with five items: decreasing gas exchange, sputum changes, chest X-ray infiltrates, inflammatory response, microbial growth. Of the 169 participants, 17% (n=29) demonstrated characteristics of VAP using the checklist. A similar proportion had an independent physician diagnosis (n=30), but in a different patient subset (only 17% of cases were identified by both methods). The VAP rate per 1000 mechanical ventilator days for the checklist and clinician diagnosis was 25.9 and 26.7, respectively. The item 'inflammatory response' was most associated with the first episode of physician-diagnosed VAP. Conclusions: VAP rates using the checklist and physician diagnosis were similar to ranges reported internationally and in Australia. Of note, different patients were identified with VAP by the checklist and physicians. While the checklist items may assist in identifying patients at risk of developing VAP, and demonstrates synergy with the recently developed Centers for Disease Control (CDC) guidelines, dec...

Peng, W., Sibbritt, D.W., Hickman, L. & Adams, J. 2015, 'Association between use of self-prescribed complementary and alternative medicine and menopause-related symptoms: a cross-sectional study.', Complementary Therapies in Medicine, vol. 23, no. 5, pp. 666-673.
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To examine the association between self-prescribed complementary and alternative medicine use and menopause-related symptoms, stratified by menopausal status.Data were obtained from a cross-sectional survey of a nationally representative sample of 10,011 menopausal women from the Australian Longitudinal Study on Women's Health, conducted in 2010. Multivariable logistic regression models were applied to identify if the use of selected self-prescribed complementary and alternative medicine was significantly associated with a range of menopause-related symptoms.Vitamins/minerals were more likely to be used by natural menopausal women experiencing anxiety (adjusted OR=1.20) and/or stiff/painful joints (adjusted OR=1.16). Yoga/meditation was more likely to be used by women with hysterectomy (adjusted OR=1.76) or natural menopausal women (adjusted OR=1.38) experiencing anxiety. Herbal medicines were more likely to be used by natural menopausal women experiencing anxiety (adjusted OR=1.22), tiredness (adjusted OR=1.20), and/or stiff/painful joints (adjusted OR=1.17), and by women with oophorectomy experiencing tiredness (adjusted OR=1.45). Aromatherapy oils were more likely to be used by natural menopausal women experiencing night sweats (adjusted OR=1.25) and by women with hysterectomy experiencing anxiety (adjusted OR=2.02). Chinese medicines were more likely to be used by women with oophorectomy experiencing stiff/painful joints (adjusted OR=4.06) and/or palpitations (adjusted OR=3.06).Our study will help improve the patient-provider communication regarding complementary and alternative medicine use for menopause, and we conclude that menopausal status should be taken into account by providers for menopause care. The women's experience and motivations of such use warrant further research.

Murthy, V., Sibbritt, D., Broom, A., Kirby, E., Frawley, J., Refshauge, K.M. & Adams, J. 2015, 'Back pain sufferers' attitudes toward consultations with CAM practitioners and self- prescribed CAM products: A study of a nationally representative sample of 1310 Australian women aged 60-65 years', Complementary Therapies in Medicine, vol. 23, no. 6, pp. 782-788.
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Vinaya, T.M., Aravind, B.S., Sibbritt, D., Tapasbrata, T. & Shivakumar, S. 2015, 'The use of Benincasa hispida for the treatment of uninvestigated dyspepsia: Preliminary results of a non-randomised open label pilot clinical trial', Advances in Integrative Medicine, vol. 2, no. 3, pp. 130-134.
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© 2015 Elsevier Ltd. Background: Dyspepsia is becoming a common health problem for which an individual seeks medical help. The approach to the management of dyspepsia is complex with high treatment costs and possible adverse effects. Methods: A prospective pilot study was designed to assess the effectiveness of the fruit juice of Ash Gourd (Benincasa hispida) on twenty dyspeptic subjects, who were followed up for 45 days. Measures of retrosternal pain, post-prandial fullness, bloating, sour belching, nausea, vomiting and changes in bowel habits were taken at three times periods (baseline, 30 days and 45 days). Results: Statistically significant improvements were seen in several parameters, including pain (p <. 0.001), retrosternal burning (p <. 0.001), nausea (p <. 0.001), belching (p <. 0.001) and bowel habits (p <. 0.05), which are considered as the classical symptoms of dyspepsia. Bloating, though not a common symptom also improved (p <. 0.001) over time. Conclusion: The trial drug is an effective remedy for uninvestigated dyspepsia. Randomised controlled trials are further needed to confirm the pharmaco-dynamics of the trial drug for anti-ulcer, acid suppression, H2 receptor antagonistic, anti-cholinergic properties.

Murthy, V., Sibbritt, D., Adams, J., Broom, A., Kirby, E. & Refshauge, K.M. 2014, 'Consultations with complementary and alternative medicine practitioners amongst wider care options for back pain: a study of a nationally representative sample of 1,310 Australian women aged 60-65 years', Clinical Rheumatology, vol. 33, no. 2, pp. 253-262.
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Back pain is a significant health service issue in Australia and internationally. Back pain sufferers can draw upon a range of health care providers including complementary and alternative medicine (CAM) practitioners. Women are higher users of health services than men and tend to use CAM frequently for musculoskeletal conditions. However, there remain important gaps in our understanding of womens consultation patterns with CAM practitioners for back pain. The objective of this study is to examine the prevalence of use and characteristics of women who use CAM practitioners for back pain. The method used was a survey of a nationally representative sample of women aged 6065 years from the Australian Longitudinal Study on Womens Health. Women consulted a massage therapist (44.1 %, n?=?578) and a chiropractor (37.3 %, n?=?488) more than other CAM practitioners for their back pain. Consultations with a chiropractor for back pain were lower for women who consulted a General Practitioner (GP) (OR, 0.56; 95 % CI 0.41, 0.76) or a physiotherapist (OR, 0.53; 95 % CI 0.39, 0.72) than for those who did not consult a GP or a physiotherapist. CAM practitioner consultations for back pain were greater for women who visited a pharmacist (OR, 1.99; 95 % CI 1.23, 3.32) than for women who did not visit a pharmacist. There is substantial use of CAM practitioners alongside conventional practitioners amongst women for back pain, and there is a need to provide detailed examination of the communication between patients and their providers as well as across the diverse range of health professionals involved in back pain care.

Peng, W., Sibbritt, D., Hickman, L., Kong, X., Yang, L. & Adams, J. 2014, 'A critical review of traditional Chinese medicine use amongst women with menopausal symptoms', Climacteric, vol. 17, no. 6, pp. 635-644.
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Objectives To provide the first critical review of traditional Chinese medicine (TCM) use amongst symptomatic menopausal women, drawing upon work examining the perspectives of both TCM users and TCM practitioners. Methods A search was conducted in three English-language databases (MEDLINE, CINAHL and AMED) and three Chinese-language databases (CNKI, VIP and CBM Disc) for 2002-2013 international peer-reviewed articles reporting empirical findings of TCM use in menopause. Results A total of 25 journal articles reporting 22 studies were identified as meeting the review inclusion criteria. Chinese herbal medicine appears to be the most common therapy amongst symptomatic menopausal women, and vasomotor symptoms and emotional changes are the most frequent symptoms for which TCM is sought. However, evidence regarding the prevalence of TCM use and users' profile in menopause is limited. Existing studies are of varied methodological quality, often reporting low response rate, extensive recall bias and a lack of syndrome differentiation. Conclusions This review provides insights for practitioners and health policy-makers regarding TCM care to symptomatic menopausal women. More nationally representative studies are required to rigorously examine TCM use for the management of menopausal symptoms. Syndrome differentiation of menopausal women is an area which also warrants further attention.

Broom, A., Meurk, C., Adams, J. & Sibbritt, D. 2014, 'My health, my responsibility? Complementary medicine and self (health) care', Journal of Sociology, vol. 50, no. 4, pp. 515-530.
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People are increasingly compelled to take responsibility for their health and illness trajectories. The existing literature on what may be termed self-care points to the ways that public health initiatives have instigated the transfer of governance onto the individual through campaigns promoting physical activity and diet among other things.

Steel, A.E., Adams, J., Sibbritt, D., Broom, A., Frawley, J.E. & Gallois, C. 2014, 'The Infuence of Complementary and Alternative Medicine Use in Pregnancy on Labor Pain Management Choices: Results from a Nationally Representative Sample of 1,835 Women', Journal of Alternative and Complementary Medicine, vol. 20, no. 2, pp. 87-97.
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Objectives: This study examines involvement with a range of complementary and alternative medicine (CAM) during pregnancy on the use of pharmacologic (PPMT) and nonpharmacologic (NPMT) pain management techniques for labor and birth. Design: Longitudinal analysis of survey data. Participants: A substudy (n=2445) of the ``young cohort of the nationally representative Australian Longitudinal Study on Womens Health was conducted. Outcome measures: Use of PPMT and NPMT during labor and birth. Results: The survey was completed by 1835 women (response rate, 79.2%). Most respondents used either intrapartum PPMT (81.9%) or NPMT (74.4%). Many (60.7%) used some form of CAM during pregnancy and also used PPMT during birth. More than two thirds of women (66.7%) who used NPMT used CAM during pregnancy. There was a general trend of increased likelihood of NPMT use by women who applied CAM during pregnancy. There was an inverse effect on use of epidural analgesia for women who consumed herbal teas during pregnancy (odds ratio, 0.60).

Broom, A., Meurk, C., Adams, J. & Sibbritt, D. 2014, 'Networks of knowledge or just old wives' tales?: A diarybased analysis of women's selfcare practices and everyday lay expertise', Health, vol. 18, no. 4, pp. 335-351.
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Complementary and alternative medicine is increasingly popular in Australia and particularly among women. While existing research provides some understanding of women's engagement with complementary and alternative medicine and biomedicine, there has been comparatively little examination of the day-to-day character of their experiences. In this study, we utilise solicited diaries with women aged 60 -65 years drawn from the 1946-1951 cohort of the Australian Longitudinal Study on Women's Health to capture the temporal dimension of their therapeutic engagement. Focusing on 30 active complementary and alternative medicine users, we explore womens experiences of managing their health, illness and well-being over a 1-month period.

Peng, W., Adams, J., Sibbritt, D.W. & Frawley, J.E. 2014, 'Critical review of complementary and alternative medicine use in menopause: focus on prevalence, motivation, decision-making, and communication', Menopause, vol. 21, no. 5, pp. 536-548.
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This article presents the first critical review of complementary and alternative medicine (CAM) use among menopausal women (a term here used to include premenopausal, perimenopausal and postmenopausal women) by focusing on the prevalence of CAM use and CAM users' characteristics, motivation, decision-making, and communication with healthcare providers.

Homer, C.S., Thornton, T., Scarf, V.L., Ellwood, D., Oats, J., Foureur, M., Sibbritt, D., McLachlan, H.L., Forster, D. & Dahlen, H. 2014, 'Birthplace in New South Wales, Australia: an analysis of perinatal outcomes using routinely collected data', BMC Pregnancy and Childbirth, vol. 14, pp. 206-206.
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Background: The outcomes for women who give birth in hospital compared with at home are the subject of ongoing debate. We aimed to determine whether a retrospective linked data study using routinely collected data was a viable means to compare perinatal and maternal outcomes and interventions in labour by planned place of birth at the onset of labour in one Australian state. Methods: A population-based cohort study was undertaken using routinely collected linked data from the New South Wales Perinatal Data Collection, Admitted Patient Data Collection, Register of Congenital Conditions, Registry of Birth Deaths and Marriages and the Australian Bureau of Statistics. Eight years of data provided a sample size of 258,161 full-term women and their infants. The primary outcome was a composite outcome of neonatal mortality and morbidity as used in the Birthplace in England study. Results: Women who planned to give birth in a birth centre or at home were significantly more likely to have a normal labour and birth compared with women in the labour ward group. There were no statistically significant differences in stillbirth and early neonatal deaths between the three groups, although we had insufficient statistical power to test reliably for these differences. Conclusion: This study provides information to assist the development and evaluation of different places of birth across Australia. It is feasible to examine perinatal and maternal outcomes by planned place of birth using routinely collected linked data, although very large data sets will be required to measure rare outcomes associated with place of birth in a low risk population, especially in countries like Australia where homebirth rates are low.

Sheerin, N.J., Newton, P.J., MacDonald, P.S., Leung, D., Sibbritt, D., Spicer, T., Johnson, K., Krum, H. & Davidson, P.M. 2014, 'Worsening renal function in heart failure: The need for a consensus definition', International Journal of Cardiology, vol. 174, no. 3, pp. 484-491.
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Acute decompensated heart failure is a common cause of hospitalisation. This is a period of vulnerability both in altered pathophysiology and also the potential for iatrogenesis due to therapeutic interventions. Renal dysfunction is often associatedwith heart failure and portends adverse outcomes. Identifying heart failure patients at risk of renal dysfunction is important in preventing progression to chronic kidney disease or worsening renal function, informing adjustment to medication management and potentially preventing adverse events. However, there is no working or consensus definition in international heart failure management guidelines for worsening renal function. In addition, there appears to be no concordance or adaptation of chronic kidney disease guidelines by heart failure guideline development groups for the monitoring of chronic kidney disease in heart failure. Our aim is to encourage the debate for an agreed definition given the prognostic impact of worsening renal function in heart failure. Wepresent the case for the uptake of the Acute Kidney Injury Network criteria for acute kidney injurywith some minor alterations. This has the potential to inform study design and meta-analysis thereby building the knowledgebase for guideline development. Definition consensus supports data element, clinical registry and electronic algorithm innovation as instruments for quality improvement and clinical research for better patient outcomes. In addition, we recommend all community managed heart failure patients have their baseline renal function classified and routinely monitored in accordance with established renal guidelines to help identify those at increased risk for worsening renal function or progression to chronic kidney disease.

Sibbritt, D., Catling, C., Adams, J., Shaw, A. & Homer, C.S. 2014, 'The self-prescibed use of aromatherapy oils by pregnant women', Women and Birth, vol. 27, no. 1, pp. 41-45.
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Peng, W., Adams, J., Hickman, L. & Sibbritt, D.W. 2014, 'Complementary/alternative and conventional medicine use amongst menopausal women: Results from the Australian Longitudinal Study on Women's Health', Maturitas, vol. 79, no. 3, pp. 340-342.
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Wardle, J., Adams, J. & Sibbritt, D. 2014, 'Referral to yoga therapists in rural primary health care: A survey of general practitioners in rural and regional New South Wales, Australia.', International Journal of Yoga, vol. 7, no. 1, pp. 9-16.
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Yoga is an increasingly accepted complementary treatment modality for referral in Australian general practice, yet this practitioner group has largely escaped research attention in Australia. Complementary medicine use is highest in rural and regional areas, where a number of primary health care challenges are also more pronounced. Despite the significant role of complementary therapists in rural and regional Australia, and the increasing acceptance of yoga therapy in general practice, there has been little exploration of the interface between yoga therapists and conventional primary health care practitioners in this area. A 27-item questionnaire was sent to all 1486 general practitioners (GPs) currently practising in rural and regional Divisions of General Practice in New South Wales, Australia. Completed questionnaires were returned by 585 GPs, with 49 returned as 'no longer at this address' (response rate 40.7%). One-in-eight GPs (12.1%) advised their patients of specific yoga therapies and protocols, and 7.2% advised specific meditation techniques. Three-quarters of GPs (76.6%) referred to a yoga therapist at least a few times per year, with 12.5% of GPs referring at least once per week. GPs being in a remote location (OR = 10.95; CI: 1.55, 77.31), being female (OR = 1.85; 95% CI: 1.16, 2.94), GPs graduating from an Australian medical school (OR = 4.52; 95% CI: 2.61, 7.80), perceiving lack of other treatment options (OR = 3.29; 95% CI: 1.61, 6.74), GPs reporting good or very good knowledge of yoga therapies (OR = 18.2; 95% CI: 9.19, 36.19), and GPs using CAM for their own personal health (OR = 4.53; 95% CI: 2.60, 7.87) were all independently predictive of increased referral to yoga therapists amongst the rural GPs in this study. There is a significant interface between yoga therapists in Australian rural and regional general practice. There is generally high support for yoga therapies among Australian GPs, with low levels of opposition to the incorporation of...

Wardle, J.L., Sibbritt, D.W. & Adams, J. 2014, 'The interface with naturopathy in rural primary health care: a survey of referral practices of general practitioners in rural and regional New South Wales, Australia.', BMC Complementary and Alternative Medicine, vol. 14, pp. 238-238.
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BACKGROUND: Naturopathy forms an increasingly significant part of the Australian healthcare setting, with high utilisation of naturopaths by the Australian public and a large therapeutic footprint in rural and regional Australia. However, despite these circumstances, there has been little exploration of the interface between naturopathy providers and conventional primary health care practitioners in rural and regional Australia. The study reported here examined the referral practices and factors that underlie referral to naturopaths amongst a sample of rural and regional Australian general practitioners (GPs). METHODS: A 27-item questionnaire was sent to all 1,486 GPs currently practising in rural and regional Divisions of General Practice in New South Wales, Australia. RESULTS: A total of 585 GPs responded to the questionnaire, with 49 questionnaires returned as "no longer at this address" (response rate: 40.7%). One-quarter of GPs (25.8%) referred to a naturopath at least a few times per year while nearly half (48.8%) stated that they would not refer to a naturopath under any circumstances. GPs were more likely to refer to a naturopath if the GP: was not initially from a rural area (OR=1.78; 95% CI: 0.95, 3.33); believes in the efficacy of naturopathy (OR=5.62; 95% CI: 2.42, 11.36); has seen positive results from naturopathy previously (OR=2.61; 95% CI: 1.35, 5.05); perceives a lack of other treatment options for their patient (OR=5.25; 95% CI: 2.42; 11.36); uses peer-reviewed literature as their major source of CAM information (OR=3.03; 95% CI: 1.65, 5.55); uses CAM practitioners as a major source of CAM information (OR=6.09; 95% CI: 2.91, 12.72); and does not have an existing relationship with any CAM provider (OR=3.03; 95% CI: 1.53, 6.25). CONCLUSIONS: There is little interaction (both via referrals as well as the development of professional relationships) between the naturopathic and GP communities in rural and regional Australia, with significant levels of...

Frawley, J., Adams, J., Broom, A., Steel, A., Gallois, C. & Sibbritt, D. 2014, 'Majority of Women Are Influenced by Nonprofessional Information Sources When Deciding to Consult a Complementary and Alternative Medicine Practitioner During Pregnancy', Journal of Alternative and Complementary Medicine, vol. 20, no. 7, pp. 571-577.
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Kirby, E.R., Broom, A.F., Adams, J., Sibbritt, D.W. & Refshauge, K.M. 2014, 'A qualitative study of influences on older women's practitioner choices for back pain care.', BMC Health Services Research, vol. 14, pp. 131-131.
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BACKGROUND: Back pain is an increasingly prevalent health concern amongst Australian women for which a wide range of treatment options are available, offered by biomedical, allied health and complementary and alternative medicine (CAM) providers. Although there is an emerging literature on patterns of provider utilisation, less is known about the reasons why women with back pain select their chosen practitioner. In this paper we explore the influences on back pain sufferers' decision-making about treatment seeking with practitioners for their most recent episode of back pain. METHODS: Drawing on 50 semi-structured interviews with women aged 60-65 years from the Australian Longitudinal Study on Women's Health (ALSWH) who have chronic back pain, we focus on the factors which influence their choice of practitioner. Analysis followed a framework approach to qualitative content analysis, augmented by NVivo 9 qualitative data analysis software. Key themes were identified and tested for rigour through inter-rater reliability and constant comparison. RESULTS: The women identified four predominant influences on their choice of practitioner for back pain: familiarity with treatment or experiences with individual practitioners; recommendations from social networks; geographical proximity of practitioners; and, qualifications and credentials of practitioners. The therapeutic approach or evidence-base of the practices being utilised was not reported by the women as central to their back pain treatment decision making. CONCLUSIONS: Choice of practitioner appears to be unrelated to the therapeutic approaches, treatment practices or the scientific basis of therapeutic practices. Moreover, anecdotal lay reports of effectiveness and the 'treatment experience' may be more influential than formal qualifications in guiding women's choice of practitioner for their back pain. Further work is needed on the interpersonal, collective and subjective underpinnings of practitioner choice, pa...

Steel, A., Adams, J., Sibbritt, D., Broom, A., Gallois, C. & Frawley, J. 2014, 'Determinants of Women Consulting with a Complementary and Alternative Medicine Practitioner for Pregnancy-Related Health Conditions', Women and Health, vol. 54, no. 2, pp. 127-144.
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Steel, A., Adams, J., Sibbritt, D., Broom, A., Frawley, J. & Gallois, C. 2014, 'The Influence of Complementary and Alternative Medicine Use in Pregnancy on Labor Pain Management Choices: Results from a Nationally Representative Sample of 1,835 Women', JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, vol. 20, no. 2, pp. 87-97.
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Murthy, V., Sibbritt, D., Adams, J., Broom, A., Kirby, E. & Refshauge, K.M. 2014, 'Self-prescribed complementary and alternative medicine use for back pain amongst a range of care options: Results from a nationally representative sample of 1310 women aged 60-65 years', Complementary Therapies in Medicine, vol. 22, no. 1, pp. 133-140.
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Duffy, L., Adams, J., Sibbritt, D. & Loxton, D. 2014, 'Complementary and Alternative Medicine for Victims of Intimate Partner Abuse: A Systematic Review of Use and Efficacy', Evidence-Based Complementary and Alternative Medicine.
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Zheng, S., Lal, S., Meier, P., Sibbritt, D. & Zaslawski, C. 2014, 'Protocol: the effect of 12 weeks of Tai Chi practice on anxiety in healthy but stressed people compared to exercise and wait-list comparison groups: a randomized controlled trial.', Journal of Acupuncture and Meridian Studies, vol. 7, no. 3, pp. 159-165.
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Stress is a major problem in today's fast-paced society and can lead to serious psychosomatic complications. The ancient Chinese mind-body exercise of Tai Chi may provide an alternative and self-sustaining option to pharmaceutical medication for stressed individuals to improve their coping mechanisms. The protocol of this study is designed to evaluate whether Tai Chi practice is equivalent to standard exercise and whether the Tai Chi group is superior to a wait-list control group in improving stress coping levels. This study is a 6-week, three-arm, parallel, randomized, clinical trial designed to evaluate Tai Chi practice against standard exercise and a Tai Chi group against a nonactive control group over a period of 6 weeks with a 6-week follow-up. A total of 72 healthy adult participants (aged 18-60 years) who are either Tai Chi nave or have not practiced Tai Chi in the past 12 months will be randomized into a Tai Chi group (n = 24), an exercise group (n = 24) or a wait-list group (n = 24). The primary outcome measure will be the State Trait Anxiety Inventory with secondary outcome measures being the Perceived Stress Scale 14, heart rate variability, blood pressure, Short Form 36 and a visual analog scale. The protocol is reported using the appropriate Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) items.

Saravanakumar, P., Higgins, I.J., van der Riet, P.J., Marquez, J. & Sibbritt, D. 2014, 'The influence of tai chi and yoga on balance and falls in a residential care setting: A randomised controlled trial', Contemporary Nurse, vol. 48, no. 1, pp. 76-87.

Saravanakumar, P., Higgins, I.J., Van Der Riet, P.J., Marquez, J. & Sibbritt, D. 2014, 'The influence of tai chi and yoga on balance and falls in a residential care setting: a randomised controlled trial.', Contemporary nurse, pp. 5231-5255.

Abstract Falls amongst older people is a global public health concern. Whilst falling is not a typical feature of ageing, older people are more likely to fall. Fall injuries amongst older people are a leading cause of death and disability. Many older people do not do regular exercise so that they lose muscle tone, strength, and flexibility which affect balance and predispose them to falls. The management of falls in residential care settings is a major concern with strategies for prevention and monitoring a focus in this setting. Yoga and tai chi have shown potential to improve balance and prevent falls in older adults. They also have potential to improve pain and quality of life. The aim of this study was to determine the feasibility of conducting a 3-arm RCT with frail older people in a residential care setting to test the hypothesis that a 14 week modified tai chi or yoga program is more effective than usual care activity in improving balance function, quality of life, pain experience and in reducing number of falls. There were no statistically significant differences between the three groups in the occurrence of falls. Yoga demonstrated a slight decrease in fall incidence; quality of life improved for the tai chi group. Only the yoga group experienced a reduction in average pain scores though not statistically significant. The findings of the study suggest it is possible to safely implement modified yoga and tai chi in a residential care setting and evaluate this using RCT design. They show positive changes to balance, pain and quality of life and a high level of interest through attendance amongst the older participants. The results support offering tai chi and yoga to older people who are frail and dependent with physical and cognitive limitations.

Steel, A., Adams, J., Sibbritt, D., Broom, A., Frawley, J. & Gallois, C. 2014, 'Relationship between complementary and alternative medicine use and incidence of adverse birth outcomes: An examination of a nationally representative sample of 1835 Australian women', Midwifery, vol. 30, no. 12, pp. 1157-1165.
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Objective: there is evidence of high use of complementary and alternative medicine (CAM) by pregnant women. Despite debate and controversy regarding CAM use in pregnancy there has been little research focus upon the impacts of CAM use on birth outcomes. This paper reports findings outlining the incidence of adverse birth outcomes among women accessing CAM during pregnancy. Design: a survey based cohort sub study from the nationally representative Australian Longitudinal Study on Women's Health (ALSWH) was undertaken in 2010. Participants.: women (aged 31-36 years) who identified in 2009 as pregnant or recently given birth (n=2445) from the younger cohort (n=8012) of ALSWH were recruited for the study. Measurements and findings: participants' responses were analysed to examine the relationship between use of CAM and adverse birth outcomes from their most recent pregnancy. Of the respondents (n=1835; 79.2%), there were variations in birth outcomes for the women who used different CAM. Notably, the outcome which was most commonly associated with CAM use was emotional distress. This was found to occur more commonly in women who practised meditation/yoga at home, used flower essences, or consulted with a chiropractor. In contrast, women who consulted with a chiropractor or consumed herbal teas were less likely to report a premature birth, whilst participation in yoga classes was associated with an increased incidence of post parturn/intrapartum haemorrhage. Key conclusions: the results emphasise the necessity for further research evaluating the safety and effectiveness of CAM for pregnant women, with a particular focus on birth outcomes. Implications for practice: health professionals providing care need to be aware of the potential birth outcomes associated with CAM use during pregnancy to enable the provision of accurate information to women in their care, and to assist in safely supporting women accessing CAM to assist with pregnancy, labour and birth.

Mangnall, L.T., Sibbritt, D., Fry, M. & Gallagher, R. 2014, 'Short- and long-term outcomes after valve replacement surgery for rheumatic heart disease in the South Pacific, conducted by a fly-in/fly-out humanitarian surgical team: A 20-year retrospective study for the years 1991 to 2011', Journal of Thoracic and Cardiovascular Surgery, vol. 148, no. 5, pp. 1996-2003.
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Bowman, D., Steel, A., Adams, J., Sibbritt, D. & Broom, A. 2014, 'The characteristics of women using different forms of botanical medicines to manage pregnancy-related health conditions: A preliminary cross-sectional analysis', Advances in Integrative Medicine, vol. 1, no. 3, pp. 138-143.
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Objective: To ascertain the attitudes, perceptions and characteristics of women who used varying forms of botanical medicine (herbal extracts and tinctures, herbal teas, aromatherapy oils) during pregnancy, birth and lactation. Methods: Longitudinal data from a sub-study of women (n = 2445) from the Australian Longitudinal Study of Women's Health (ALSWH) was analysed for the characteristics of women who used only one form of botanical medicine (herbal extracts and tinctures, herbal teas or aromatherapy oils), Fisher's exact tests were used to compare categorical variables due to the small cell numbers of the individual categories. A modified Bonferroni correction was used to compensate for multiple testing. All analyses were performed using Stata 11.1 and statistical significance was set at p = 0.05. Results: Women who held private health insurance were more likely to consult with an acupuncturist or naturopath for pregnancy-related health conditions and use herbal extracts and tinctures rather than herbal teas or aromatherapy oils. Women who used herbal extracts and tinctures also reported higher rates of epidural use and were more likely to initiate breastfeeding than those using aromatherapy oils. Women who used herbal teas were more likely to discuss their expectations of their birth with a general practitioner than a midwife and use birthing pools, baths or showers as intrapartum pain management. Women who used herbal teas were also more likely to initiate breastfeeding than those choosing aromatherapy, and moreover, continue breastfeeding for more than 6 months. Women who showed a preference for breathing techniques as intrapartum pain management were more likely to use aromatherapy rather than herbal extracts, tinctures or teas during pregnancy. Conclusions: Our analysis is a preliminary insight into an as yet unassessed aspect of maternity care. More in-depth investigation of the characteristics of women who choose to use herbal medicines, teas and aromat...

Steel, A., Adams, J. & Sibbritt, D. 2014, 'Developing a multi-modality complementary medicine practice-based research network: The PRACI project', Advances in Integrative Medicine, vol. 1, no. 3, pp. 113-118.
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© 2014 Elsevier LtdObjectives Outline the protocol to be used in the establishment of the Practitioner and Researcher Collaboration Initiative (PRACI) – an innovative national practice-based research network (PBRN) for complementary medicine (CM) professions in Australia. Design and methods A multiphase research design will be employed. Phase 1 will involve geographical mapping of CM practitioner workforce population and location across Australia. Phase 2 involves initial practitioner member recruitment encompassing a preliminary workforce survey to allow population of key information for the PRACI database. Phase 3 will employ a comprehensive practitioner member survey which examines the nature and characteristics of contemporary CM practice. Results PRACI will be a multi-modality PBRN which encompasses 14 CM professions: acupuncturists, aromatherapists, Ayurveda practitioners, Bowen therapists, Chinese herbalists, homoeopaths, kinesiologists, massage therapists, musculoskeletal therapists, myotherapists, naturopaths, nutritionists (non-dietetic), reflexologists, Western herbalists, and yoga teachers. Once established, researchers will be able to utilise the PRACI network and infrastructure to undertake CM research which is embedded in, responsive to, and informed by clinical practice. An Expression of Interest (EOI) process by which potential new research through PRACI is vetted based upon feedback by researchers, community representatives and practitioner members. The PRACI network will enable a broad range of research designs including experimental, observational and qualitative research. As such, research conducted through PRACI will be able to examine important research questions and advance new knowledge about contemporary CM practice. Conclusions PRACI is a practice-based research network which has the potential to offer the CM professions a legacy of clinically relevant research which is embedded in the realities of practice and which can provide a platf...

Frawley, J.E., Steel, A., Adams, J., sibbritt, D., Broom, A. & Gallois, C. 2014, 'The Association between women's choice of birth setting and their use of CAM during labor and birth.', Journal of Alternative and Complementary Medicine, vol. 20, no. 5.
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Sibbritt, D. 2014, 'The decline of herbal medicine/naturopathy consultations: How research can help further the profession', Australian Journal of Herbal Medicine, vol. 26, no. 1, pp. 8-9.

Thomson Mangnall, L.J., Sibbritt, D.W., Fry, M., Windus, M. & Gallagher, R.D. 2014, 'Health-related quality of life of patients after mechanical valve replacement surgery for rheumatic heart disease in a developing country', Heart Asia, vol. 6, no. 1, pp. 172-178.
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Siobhan, C., Broom, A., Adams, J. & Sibbritt, D. 2013, 'Bodies of knowledge: Nature, holism and women's plural health practices', Health: an interdisciplinary journal for the social study of health, illness and medicine, vol. 17, no. 3, pp. 300-318.
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The proliferation of complementary and alternative medicine (CAM), and women's high level of engagement with these practices, has presented sociology with a range of questions regarding gender, embodiment and identity work in the context of contemporary medical pluralism. The current study, drawing on 60 qualitative interviews with women from the Australian Longitudinal Study on Women's Health (ALSWH), examines how a group of Australian women negotiate CAM and biomedicine in a range of health and illness contexts. Selected from the mid-aged cohort of this national study, here we explore their accounts of engagement with CAM and biomedicine, unpacking their logics underpinning, and rhetorical practices surrounding, their therapeutic engagement. The results provide significant insight into: the importa nce of ideas about nature, holism and strengthening; perceptions of the harshness and softness of medicines for women's bodies; and, the relative importance of scientific proof vis-a-vis individual subjectivities. Ultimately, their accounts illustrate gendered and embodied strategies of strategic integration, and importantly, border crossing. We conclude that while women's engagement with CAM and biomedicine may be indeed be gendered in character, we suggest a rethinking of gender-based resistance (to biomedicine) or gender-alignment (to CAM) arguments; the notion of women as designers would more adequately capture the landscapes of contemporary medical pluralism.

Meurk, C., Broom, A., Adams, J. & Sibbritt, D. 2013, 'Rurality, mobility, identity: Women's use of complementary and alternative medicine in rural Australia', Health and Place, vol. 20, pp. 75-80.
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This article explores why women in rural and remote areas of Australia use complementary and alternative medicine (CAM) at higher rates than their counterparts in urban areas. Drawing on qualitative interviews with 60 women 60-65 years of age, currently living in rural Australia, we explore the possibility that CAM use in rural areas may be embedded in processes of spatialised identity-building and the health-creating practices of mobile, ex-urban, individuals who drive this process. We problematise previous explanations which suggest CAM use in rural areas is principally derived from a lack of biomedical service provision and enhanced community ties showing instead how and why identity and mobility are useful additional variables for understanding CAM use in rural areas.

Poulsen, E., Sibbritt, D., McLaughlin, D., Adams, J. & Pachana, N.A. 2013, 'Predictors of Complementary and Alternative Medicine (CAM) use in two cohorts of Australian women', International Psychogeriatrics, vol. 25, no. 1, pp. 168-170.
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Complementary and Alternative Medicine (CAM) use has been researched widely; however, studies with older adults and Australian populations are limited. The profile of Australian women CAM users has been mapped using the 1996 data from the ALSWH (Adams et al., 2003).

Harris, M.L., Loxton, D., Sibbritt, D. & Byles, J. 2013, 'The influence of perceived stress on the onset of arthritis in women: Findings from the australian longitudinal study on women's health', Annals of Behavioral Medicine, vol. 46, no. 1, pp. 9-18.
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Background: Psychosocial factors are considered as risk factors for some chronic diseases. A paucity of research exists surrounding the role of perceived stress in arthritis onset. Purpose: Perceived stress as a risk factor for arthritis development was

Frawley, J.E., Adams, J., Sibbritt, D., Steel, A.E., Broom, A. & Gallois, C. 2013, 'Prevalence and determinants of complementary and alternative medicine use during pregnancy: Results from a nationally representative sample of Australian pregnant women', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 53, no. 4, pp. 347-352.
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Background: Pregnant women have been identi?ed as high users of complementary and alternative medicine (CAM). However, no research to date has provided a detailed analysis of the prevalence and determinants of CAM consumption amongst pregnant women. Aim: To examine the prevalence and determinants of CAM use by pregnant women, utilising a national representative sample. Methods: The study sample was obtained via the Australian Longitudinal Study on Womens Health. This paper is based on a sub-study of 1,835 pregnant women, administered in 2010. The women answered questions about CAM use, demographics, pregnancy-related health concerns and health service utilisation. Results: Complementary and alternative medicine use was found to be high with 48.1% (n = 623) of pregnant women consulting a CAM practitioner and 52.0% (n = 842) of women using CAM products (excluding vitamins and minerals) during pregnancy. CAM practitioner visits were more likely for selected pregnancy-related health concerns, namely back pain or back ache, neck pain and labour preparation. Women were less likely to consult a CAM practitioner if they suffered with headaches/migraines. Employment was also found to be predictive of pregnant womens visits to a CAM practitioner. Signi?cant health history and demographic predictors of CAM product use were tiredness and fatigue, embarking on preparation for labour and having a university education. Conclusion: Most pregnant women are utilising CAM products and/or services as part of their maternity care and obstetricians, general practitioners and midwives need to enquire with women in their care about possible CAM use to help promote safe, effective coordinated maternity care.

Steel, A.E., Diezel, H.M., Johnstone, K., Sibbritt, D., Adams, J. & Adair, R. 2013, 'The Value of Care Provided by Student Doulas: An Examination of the Perceptions of Women in Their Care', Journal of Perinatal Education, vol. 22, no. 1, pp. 39-48.
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This study provides an examination of women's perceptions of care provided by student doulas undertaking a formal qualification in doula support services. Feedback forms completed by women attended by student doulas undertaking a formal qualification in doula support services were analyzed. The women (N = 160) consistently rated the student doulas' contribution to their experience of birth favorably. Qualitative analysis revealed that women value the presence of their student doulas highly with reference to the student doulas' demeanor, support provided to family, interface with other health professionals, and learned skills. Within the Australian context, this study suggests that the support provided by student doulas that have completed a formal training course is held in positive regard by the women receiving their care.

Wardle, J., Sibbritt, D. & Adams, J. 2013, 'Referrals to chiropractors and osteopaths: a survey of general practitioners in rural and regional New South Wales, Australia', Chiropractic and Manual Therapies, vol. 21, pp. 5-5.
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Chiropractic and osteopathy form a significant part of the healthcare setting in rural and regional Australia, with national registration of practitioners, public subsidies for services and high utilisation by the Australian public. However, despite their significant role in rural and regional Australia, there has been little exploration of the interface between chiropractic and osteopathy and conventional primary health care practitioners in this area. The study aim was to examine the referral practices and factors that underlie referral to chiropractors and osteopaths by rural and regional Australian general practitioners (GPs), by drawing on a sample of GPs in rural and regional New South Wales.

Adams, J., Sibbritt, D., Broom, A., Loxton, D., Wardle, J., Pirotta, M. & Lui, C. 2013, 'Complementary And Alternative Medicine Consultations In Urban And Nonurban Areas: A National Survey Of 1427 Australian Women', Journal Of Manipulative And Physiological Therapeutics, vol. 36, no. 1, pp. 12-19.
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Objectives: The purpose of this study was to evaluate survey data from a national cross-sectional sample of 1427 urban and nonurban Australian women focusing on the relationship between the use of specific complementary and alternative medicine (CAM) pra

Kirby, E., Broom, A., Sibbritt, D., Adams, J. & Refshauge, K. 2013, 'A National Cross-sectional Survey Of Back Pain Care Amongst Australian Women Aged 60-65', European Journal of Integrative Medicine, vol. 5, no. 1, pp. 36-43.
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Aim of the study To analyse the use of complementary and alternative medicine (CAM), allied health and biomedicine for back pain amongst Australian women aged 6065. Methodology Self-completion postal survey in 2011/2012 of 1310 women who reported seeking help for back pain from the mid-age cohort of the Australian Longitudinal Study on Women's Health (ALSWH). Questions asked about their use of, and attitudes towards, CAM, allied health and biomedicine for the treatment of back pain. Results Intensity of back pain was greater for those who consulted biomedical and allied health practitioners. Women reported seeking help from biomedical and allied health practitioners more quickly after onset of pain than CAM practitioners but the longer their pain persisted the more likely they were to consult CAM practitioners. Use of CAM reflected less perceived benefit of biomedicine and allied health. The perceived differences in approach of CAM practitioners (e.g. more time in consultation, more equal relationship, more holistic approach) may be influential in their use and perceived benefit. Ease of access/availability may also influence use of CAM in particular. Some communication limitations were reported regarding discussing the use of other practitioner groups with biomedical and CAM practitioners.

Sibbritt, D., Adams, J. & Murthy, V. 2013, 'The Prevalence And Determinants Of Chinese Medicine Use By Australian Women: Analysis Of A Cohort Of 10,287 Women Aged 56-61 Years', The American Journal Of Chinese Medicine, vol. 41, no. 2, pp. 281-291.
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This study aimed to examine the factors associated with Chinese medicine use amongst a sample of 10,287 Australian women aged 5661 years. Data was obtained from a cross-sectional postal questionnaire conducted in 2007, this being the fifth survey of the Australian Longitudinal Study on Women's Health. This representative sample of 10,287 women was randomly selected from the Health Insurance Commission (Medicare) database. The outcome measure was the use of Chinese medicine in the previous 12 months. The predictive factors included demographics, health status measures and health service utilization measures. Statistical analyses included univariate chi-square and ANOVA tests and backward stepwise multiple logistic regression modelling. The use of Chinese medicine amongst women aged 5661 years appears to be strongly influenced by their country of birth, consultation with a range of CAM practitioners, and the use of some self-prescribed CAM. Interestingly, severe tiredness was the only symptom or diagnosis that predicted Chinese medicine use. Given the substantial prevalence of Chinese medicine use and the finding that the use of Chinese medicine is heavily integrated alongside the use of many other CAM and conventional treatments, it is imperative for the safety of patients that health professionals (across complementary and conventional healthcare) fully recognise the possible Chinese medicine use amongst their practice populations. In order to help inform relevant practice and policy development it is also important that future research further examining women's decision-making, motivations and evaluations regarding Chinese medicine use considers such issues within the context of broader CAM and conventional health care utilization.

Parkinson, L., Sibbritt, D., Bolton, P., Van Rotterdam, J. & Villadsen, I. 2013, 'Well-being Outcomes Of Chiropractic Intervention For Lower Back Pain: A Systematic Review', Clinical Rheumatology, vol. 32, no. 2, pp. 167-180.
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The usefulness of chiropractic for treatment of low back pain is a contentious issue. Chiropractors advocate holism and general well-being as a key principle on which they base their clinical practice, yet the quality of life, lifestyle, health and economic impacts of chiropractic intervention for back pain in adults have rarely been investigated. This article provides an overview of chiropractic principles and practices, together with the results of a systematic review of peer-reviewed publications between 2000 and 2010 retrieved from MEDLINE, CINAHL, EMBASE, AMED and Cochrane Database of Systematic Reviews. This review sought to determine the benefits of chiropractic treatment and care to well-being, and to what extent chiropractic treatment and care improve quality of life. Of 1,165 articles, 12 articles were retained, representing six studies (four randomised controlled trial, two observational) of varying quality. There was a high degree of inconsistency and lack of standardisation in measurement instruments and outcome measures. Three studies reported reduced use of other/extra treatments as a positive outcome; two studies reported a positive effect of chiropractic intervention on pain, and two studies reported a positive effect on disability. The six studies reviewed concentrated on the impact of chiropractic care on physical health and disability, rather than the wider holistic view which was the focus of this study. It is difficult, therefore, to defend any conclusion about the impact of chiropractic intervention on the quality of life, lifestyle, health and economic impact on chiropractic patients presenting with back pain.

Wardle, J., Adams, J. & Sibbritt, D. 2013, 'Homeopathy in rural Australian primary health care: a survey of general practitioner referral and practice in rural and regional New South Wales, Australia', Homeopathy, vol. 102, no. 3, pp. 199-206.
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Introduction: Homeopathy has attracted considerable recent attention from the Australian conventional medical community. However, despite such increased attention there has been little exploration of the interface between homeopathy and Australian conventional medical practice. This article addresses this research gap by exploring homeopathic practice and referral by rural and regional Australian general practitioners (GPs).

Aljadani, H.M., Sibbritt, D., Patterson, A. & Collins, C. 2013, 'The Australian Recommended Food Score did not predict weight gain in middle-aged Australian women during six years of follow-up', Australian and New Zealand Journal of Public Health, vol. 37, no. 4, pp. 322-328.
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Objective: To evaluate the relationship between diet quality score, as measured by the Australian Recommended Food Score (ARFS) and six-year weight gain in middle-aged Australian women.

Hart, M., Wilcken, B., Williams, L., Sibbritt, D. & Nunn, K.P. 2013, 'Tyrosine supplementation as an adjunct treatment in anorexia nervosa - a noradrenergic repletion hypothesis', Advances in Eating Disorders: Theory, Research and Practice, vol. 1, no. 2, pp. 161-168.
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Anorexia nervosa (AN) is accompanied by an increased frequency of pre-morbid anxiety. Anxiety disorders are associated with increased brain activity of catecholamines, especially noradrenaline. It has been hypothesized that noradrenergic dysregulation may be a major factor in the causation of AN.

Steel, A.E., Frawley, J.E., Sibbritt, D. & Adams, J. 2013, 'A preliminary profile of Australian women accessing doula care: Findings from the Australian Longitudinal Study on Women's Health', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 6, pp. 589-592.
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Despite growing interest and controversy regarding the value of doulas in contemporary maternity care, little is known about the profile of women who choose to involve a doula in their care team. This preliminary analysis indicates that women's attitudes towards maternity care may influence their use of a doula more so than demographic factors. Further research examining these

Sibbritt, D., Catling, C., Scarf, V.L. & Homer, C.S. 2013, 'The profile of women who consult midwives in Australia', Women and Birth, vol. 26, no. 4, pp. 240-245.
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Background: There is no Australian data on the characteristics of women who consult with midwives. Aim: To determine the profile of women who consult midwives in Australia. Methods: This cross-sectional research was conducted as part of the Australian Longitudinal Study on Womens Health (ALSWH). Participants were the younger (3136 years) cohort of the ALSWH who completed a survey in 2009, and indicated that they were currently pregnant (n = 801). The main outcome measure was consultation with a midwife.

Wardle, J., Sibbritt, D. & Adams, J. 2013, 'Acupuncture referrals in rural primary healthcare: a survey of general practitioners in rural and regional New South Wales, Australia', Acupuncture in medicine, vol. 31, no. 4, pp. 375-382.
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Background Acupuncture services form a significant part of the Australian healthcare setting, with national registration of acupuncture practitioners, public subsidies for acupuncture services and high use of acupuncture by the Australian public. Despite

Wardle, J., Sibbritt, D. & Adams, J. 2013, 'Referral To Massage Therapy In Primary Health Care: A Survey Of Medical General Practitioners In Rural And Regional New South Wales, Australia', Journal of Manipulative and Physiological Therapeutics, vol. 36, no. 9, pp. 595-603.
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Objectives: Massage therapists are an important part of the health care setting in rural and regional Australia and are the largest complementary and alternative medicine (CAM) profession based on both practitioner numbers and use. The purpose of this st

Wardle, J., Adams, J. & Sibbritt, D. 2013, 'Acupuncture in Australian general practice: trends in reimbursed acupuncture services from 1995 to 2011', Acupuncture in Medicine, vol. 31, no. 1, pp. 45-50.
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Objectives: To ascertain the extent of and trends in the use of acupuncture in Australian general practice and the characteristics of patients receiving publicly subsidised acupuncture services from general practitioners (GPs). Design: Secondary analysis of national patient Medicare data for claims by all non-specialist medical practitioners for Medicare Benefits Schedule items for an attendance where acupuncture was performed by a medical practitioner from 1995 to 2011. Main outcome measures: Use of acupuncture by GPs, patients sex and age and the socioeconomic disadvantage index of GPs practice. Results: There has been a 47.7% decline in the number of acupuncture claims by GPs per 100 000 population in the period from 1995 to 2011. Acupuncture claims were made by 3.4% of GPs in 2011. Women were almost twice as likely to receive acupuncture from a GP as men, and patients in urban areas were more than twice as likely to receive acupuncture from a GP as patients in rural areas. Acupuncture claims were highest in areas that were socioeconomically advantaged. Conclusions: Claims for reimbursement for acupuncture by GPs have declined significantly in Australian general practice even though the use of acupuncture by the Australian public has increased. This may be due to increased use of referrals or use of non-medical practitioners, barriers to acupuncture practice in general practice or non-specificf actors affecting reimbursement for non-vocationally registered GPs.

Wardle, J., Sibbritt, D. & Adams, J. 2013, 'Referral to Chinese medicine practitioners in Australian primary care: a survey of New South Wales rural and regional general practitioners', Chinese Medicine, vol. 8, pp. 8-8.
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Background: Chinese medicine practitioners (CMPs) play an important part in rural and regional Australian healthcare. A survey was conducted to investigate referral practices between Chinese medicine (CM) and conventional primary health care practitioners in this region. Methods: A 27-item questionnaire was sent to all 1486 general practitioners (GPs) currently practising in rural and regional Divisions of General Practice in New South Wales, Australia. This survey explored GP opinions, perceptions and practices in relation to complementary and alternative medicine or Chinese medicine specifically. Results: A total of 585 GPs completed the questionnaire. Forty-nine were returned as 'no longer at this address', resulting in an adjusted response rate of 40.7%. One in ten GPs (9.9%) had referred their patients to CMPs at least a few times over the past 12 months, one in five GPs (17.4%) could not locate a CMP to refer to in their local area, and over one-third of GPs (37.7%) stated they would not refer to a CMP under any circumstances. GPs that had graduated from an Australian medical college (OR = 3.71; CI: 1.22, 11.23), GPs observing positive responses previously in patients using CM (OR = 2.53; 95% CI: 1.12, 8.58), GPs perceiving a lack of other options for patients (OR = 3.10; 95% CI: 1.12, 8.58), GPs reporting satisfactory or higher levels of CM knowledge (OR = 15.62; 95% CI: 5.47, 44.56), and GPs interested in increasing their complementary and alternative medicine knowledge (OR = 3.28; 95% CI: 1.17, 9.21) referred to CMPs more frequently than did other groups of GPs amongst the rural GPs included in this study. Conclusion: There has been little interaction between CMPs and Australian rural and regional GPs.

Liddle, J., Parkinson, L. & Sibbritt, D. 2013, 'Purpose and pleasure in late life: Conceptualising older women's participation in art and craft activities', Journal of Aging Studies, vol. 27, no. 4, pp. 330-338.
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The fourth age, as the last stage of life, represents a final challenge to find personal meaning in the face of changing capacities, illness and disability. Participation in valued activities is important for sustaining interest in life and has been associated with enhanced health and well-being. Art and craft activities are a popular form of participation amongst women in late life with growing international interest in the potential for these types of activities to maintain health and well-being and address problems of social isolation. Drawing on open text comments from 114 women enrolled in the Australian Longitudinal Study on Women's Health and in-depth interviews with 23 women all aged in their eighties, this paper explores the nature of older women's participation in art and craft activities and conceptualises links between participation in these activities and health and well-being in late life. Participation in art and craft activities is complex and dynamic, comprising cognitive and physical processes infused with emotion and occurs in the context of social relationships, physical spaces, physical ailments and beliefs about the value of the activities. By participating in art and craft activities, older women find purpose in their lives, contributing to their subjective well-being whilst helping and being appreciated by others. They develop a self view as enabled and as such take on new art and craft challenges, continue to learn and develop as art and craft makers and remain open to new possibilities.

Aljadani, H.M., Patterson, A., Sibbritt, D., Hutchesson, M.J., Jensen, M.E. & Collins, C. 2013, 'Diet quality, measured by fruit and vegetable intake, predicts weight change in young women', Journal of Obesity, vol. 2013.
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This study investigates the relationship between diet quality and weight gain in young women. Young women (.. = 4, 287, with 1,356 women identified as plausible subsample aged 27.6 } 1.5 years at baseline) sampled from the Australian Longitudinal Study on Womenfs Health study completed food frequency questionnaires in 2003, which were used to evaluate diet quality using three indices: Australian Recommended Food Score (ARFS), Australian Diet Quality Index (Aus-DQI), and Fruit and Vegetable Index (FAVI). Weight was self-reported in 2003 and 2009. Multivariate linear regression was used to examine the association between tertiles of each diet quality index and weight change from 2003 to 2009.The ARFS and FAVI were significant predictors of 6-year weight change in this group of young women, while Aus-DQI did not predict weight change (.. > 0.05). In the fully adjustedmodel, those who were in the top tertile of the ARFS significantly gained lower weight gain compared with the lower tertile for the plausible TEI sub-sample (.. = .1.6kg (95% CI: .2.67 to .0.56), .. = 0.003). In the fully adjustment model, young women were classified in the highest FAVI tertile and gained significantly less weight than those in the lowest tertile for the plausible TEI (.. = .1.6kg (95% CI: .2.4 to .0.3) .. = 0.01). In conclusion, overall diet quality measured by the ARFS and the frequency and variety of fruit and vegetable consumption may predict long-term weight gain in young women.Therefore, health promotion programs encouraging frequent consumption of a wide variety of fruits and vegetables are warranted.

Vashum, K.P., Mcevoy, M., Shi, Z., Milton, A.H., Islam, M.R., Sibbritt, D., Patterson, A., Byles, J., Loxton, D.J. & Attia, J. 2013, 'Is dietary zinc protective for type 2 diabetes? Results from the Australian longitudinal study on women's health', BMC Endocrine Disorders, vol. 13, pp. 40-40.
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Animal studies have shown that zinc intake has protective effects against type 2 diabetes, but few studies have been conducted to examine this relationship in humans. The aim of this study is to investigate if dietary zinc is associated with risk of type 2 diabetes in a longitudinal study of mid-age Australian women.

Kirby, E.R., Broom, A.F., Sibbritt, D.W., Refshauge, K.M. & Adams, J. 2013, 'Health care utilisation and out-of-pocket expenditure associated with back pain: a nationally representative survey of Australian women.', PloS one, vol. 8, no. 12, pp. e83559-e83559.
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BACKGROUND: Back pain impacts on a significant proportion of the Australian population over the life course and has high prevalence rates among women, particularly in older age. Back pain care is characterised by multiple practitioner and self-prescribed treatment options, and the out-of-pocket costs associated with consultations and self-prescribed treatments have not been examined to date. OBJECTIVE: To analyse the extent of health care practitioner consultations and self-prescribed treatment for back pain care among Australian women, and to assess the self-reported costs associated with such usage. METHODS: Survey of 1,310 women (response rate 80.9%) who reported seeking help for back pain from the '1946-51 cohort' of the Australian Longitudinal Study on Women's Health. Women were asked about their use of health care practitioners and self-prescribed treatments for back pain and the costs associated with such usage. RESULTS: In the past year 76.4% consulted a complementary and alternative practitioner, 56% an allied health practitioner and 59.2% a GP/medical specialist. Overall, women consulted with, on average, 3.0 (SD=2.0) different health care practitioners, and had, on average, 12.2 (SD=9.7) discrete health care practitioner consultations for back pain. Average self-reported out-of-pocket expenditure on practitioners and self-prescribed treatments for back pain care per annum was AU$873.10. CONCLUSIONS: Multiple provider usage for various but distinct purposes (i.e. pain/mobility versus anxiety/stress) points to the need for further research into patient motivations and experiences of back pain care in order to improve and enhance access to and continuity of care. Our results suggest that the cost of back pain care represents a significant burden, and may ultimately limit women's access to multiple providers. We extrapolate that for Australian working-age women, total out-of-pocket expenditure on back pain care per annum is in excess of AU$1.4 billion,...

Adams, J., Sibbritt, D., Lui, C.-.W., Broom, A. & Wardle, J. 2013, 'Omega-3 fatty acid supplement use in the 45 and Up Study Cohort', BMJ Open, vol. 3, no. 4, pp. e002292-e002292.
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Adams, J., Garvey, G., Sibbritt, D., Bernardes, C., Broom, A. & Valery, P. 2013, 'TRADITIONAL INDIGENOUS MEDICINE AND COMPLEMENTARY MEDICINE USE AMONGST INDIGENOUS CANCER PATIENTS IN QUEENSLAND, AUSTRALIA', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 9, pp. 106-106.

Mitchell, G.K., Girgis, A., Jiwa, M., Sibbritt, D., Burridge, L.H. & Senior, H.E. 2013, 'Providing general practice needs-based care for carers of people with advanced cancer: a randomised controlled trial', British Journal of General Practice, vol. 63, no. 615, pp. E683-E690.
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Liddle, J., Parkinson, L. & Sibbritt, D. 2013, 'Health-related factors associated with participation in creative hobbies by Australian women aged in their eighties', Arts & Health, vol. 6, no. 2, pp. 132-142.
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Sibbritt, D. & Adams, J. 2013, 'The importance of research capacity building for massage therapy: developing partnerships between practitioners and researchers/methodologists', Massage Therapists, vol. 11, no. 4, pp. 14-15.

Harris, M.L., Loxton, D.J., Sibbritt, D. & Byles, J.E. 2012, 'The relative importance of psychosocial factors in arthritis: Findings from 10,509 Australian women', Journal of Psychosomatic Research, vol. 73, no. 4, pp. 251-256.
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Objective: To determine the relative importance of psychosocial factors in arthritis diagnosis in an ageing cohort of Australian women. Methods: This study focused on 10,509 women from the 1946â1951 cohort who responded to questions on arthritis in the fifth mailed population-based survey of the Australian Longitudinal Study on Women's Health conducted in 2007.

Beatty, L., Adams, J., Sibbritt, D. & Wade, T.D. 2012, 'Evaluating the impact of cancer on complementary and alternative medicine use, distress and health related QoL among Australian women: A prospective longitudinal investigation', Complementary Therapies in Medicine, vol. 20, no. 1-2, pp. 61-69.
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Objectives: While several cross-sectional studies have examined psychological correlates of complementary and alternative medicine (CAM) use and cancer, few prospective longitudinal investigations have been reported. This study examined whether CAM use moderated distress and quality of life (HRQoL) from pre- to post-cancer.

Broom, A., Sibbritt, D., Nilan, P., Nayar, K. & Doron, A. 2012, 'Men's Experiences of Family, Domestic and Honour-Related Violence in Gujarat and Uttar Pradesh, India', Asian Social Science, vol. 8, no. 6, pp. 3-10.
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Background: Violence is a major problem in India with family, domestic and honour-related violence having significant impacts on the wellbeing of Indian families and communities. There has been little attention paid to men's experiences, particularly in the Indian State's of Gujarat and Uttar Pradesh. The objective of this study was to provide baseline data on Indian men's experiences of violence and the key predictors such as age, income, education and religion. A cross-sectional survey of men from Uttar Pradesh and Gujarat. Data were obtained from a non-probability purposive sample of 1000 adult men over a two-month period in late 2009. The respondents were selected from public spaces in 10 cities or towns within these two provinces.

Broom, A., Kirby, E., Sibbritt, D., Adams, J. & Refshauge, K. 2012, 'Back pain amongst mid-age Australian women: A longitudinal analysis of provider use and self-prescription treatments.', Complementary Therapies in Medicine, vol. 20, no. 5, pp. 275-282.
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To analyse use of conventional and complementary and alternative (CAM) practitioners and self-prescribed CAM amongst mid-age Australian women with back pain.

Sibbritt, D., Van Der Riet, P., Dedkhard, S. & Shrithong, K. 2012, 'Rehabilitation of stroke patients using traditional Thai massage, herbal treatments and physical therapies.', Journal of Chinese Integrative Medicine, vol. 10, no. 7, pp. 743-750.
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Objective: To determine quantitatively if a unique rehabilitation program using traditional Thai massage, herbal treatments and physical therapies could improve activities of daily living, mood and sleep patterns, and pain intensity of stroke patients over time.

Sibbritt, D., Adams, J., Lui, C., Broom, A. & Wardle, J. 2012, 'Who uses glucosamine and why? A study of 266,848 Australians aged 45 years and older', PLoS One, vol. 7, no. 7, pp. e41540-e41540.
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Objectives: There has been a dramatic increase in the use of complementary medicines over recent decades. Glucosamine is one of the most commonly used complementary medicines in Western societies. An understanding of glucosamine consumption is of significance for public health and future health promotion. This paper, drawing upon the largest dataset to date with regards to glucosamine use (n = 266,844), examines the use and users of glucosamine amongst a sample of older Australians.

Broom, A., Kirby, E., Sibbritt, D., Adams, J. & Refshauge, K. 2012, 'Use of complementary and alternative medicine by mid-age women with back pain: A national cross-sectional survey', BMC Complementary and Alternative Medicine, vol. 12, pp. 98-98.
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The use of complementary and alternative medicine (CAM) has increased significantly in Australia over the past decade. Back pain represents a common context for CAM use, with increasing utilisation of a wide range of therapies provided within and outside conventional medical facilities. We examine the relationship between back pain and use of CAM and conventional medicine in a national cohort of mid-aged Australian women.

Liddle, J., Parkinson, L. & Sibbritt, D. 2012, 'Painting pictures and playing musical instruments: Change in participation and relationship to health in older women', Australian Journal of Ageing, vol. 31, no. 4, pp. 218-221.
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Aim: To explore how changed participation in painting pictures or playing a musical instrument is related to change in physical and mental health in older women.

Sibbritt, D., Adams, J., Lui, C. & Broom, A. 2012, 'Health services use among young Australian women with allergies, hayfever and sinusitis: A longitudinal analysis', Complementary Therapies in Medicine, vol. 20, no. 3, pp. 135-142.
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The existing knowledge base on the use of complementary and alternative medicine among patients with allergies is built upon findings of cross-sectional surveys and there is a lack of longitudinal data. There is also a lack of studies that examine both the use of conventional medicine and complementary and alternative medicine among allergy patients. This paper reports the findings of the first ever longitudinal study of the use of conventional providers, practitioners of complementary and alternative medicine, and self-prescribed modalities amongst women with allergies, hayfever and sinusitis from a large nationally representative sample. Analysis focused upon data from 7538 women from the younger cohort of the Australian Longitudinal Study on Women's Health collected between 1996 and 2006. Chi-square tests were employed to compare the groups across consultations and self-prescribed treatments and one-way analysis of variance was used to compare the groups across health status. A modified Bonferroni test was used to correct for multiple comparisons. The study identified that women who sought help for their allergic disorder were more likely to consult a range of practitioners and self-prescribed complementary and alternative medicine than women who either did not seek help or did not have allergic disorders. The analysis shows that many women with allergic disorders use complementary and alternative medicine alongside or as a complement to conventional healthcare services. The frequent use of a range of conventional providers and practitioner-based and self-prescribed complementary and alternative medicine amongst women with allergic disorders warrants further investigation.

Adams, J., Sibbritt, D. & Lui, C. 2012, 'Health Service Use Among Persons With Self-Reported Depression: A Longitudinal Analysis Of 7,164 Women', Archives of Psychiatric Nursing, vol. 26, no. 3, pp. 181-191.
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Depression is a common mental disorder and a leading contributor to the global burden of disease. In Australia, depression is reportedly the leading cause of morbidity for young women. In addition to conventional treatments, there is also some evidence that there is common use of complementary and alternative medicine (CAM) among people with depressive symptoms. However, there has been little research focus upon broad health care and practitioner use (including consumption of both conventional and CAM practitioners as well as self-prescribed care) among young adults with depression. This article aims specifically to address this knowledge gap by providing the first longitudinal analysis of the use of health service among women with self-reported depression. Methods: Data from a longitudinal cohort study (Australian Longitudinal Study on Women's Health) conducted over a 3-year period on 7,164 young Australian women were analyzed. Information on health status, health service use, and self-prescribed treatments was obtained from two questionnaires mailed to study participants in 2003 and 2006.

Waller, A., Girgis, A., Johnson, C., Lecathelinais, C., Sibbritt, D., Seldon, N., Bonaventura, A. & Currow, D. 2012, 'Implications of a needs assessment intervention for people with progressive cancer: Impact on clinical assessment, response and service utlisation.', Psycho-oncology, vol. 21, no. 5, pp. 550-557.
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To assess the impact of the systematic use of the Palliative Care Needs Assessment Guidelines and Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C) on clinical assessment, response and service utilisation.

Hong, T.K., Dibley, M.J. & Sibbritt, D. 2012, 'Validity and reliability of an FFQ for use with adolescents in Ho Chi Minh City, Vietnam', Public Health Nutrition, vol. 13, no. 3, pp. 368-375.
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Objective: The present study evaluates the reliability and validity of an FFQ designed for use with adolescents in urban Vietnam.

Steel, A.E., Adams, J., Sibbritt, D., Broom, A., Gallois, C. & Frawley, J.E. 2012, 'Utilisation of complementary and alternative medicine (CAM) practitioners within maternitycare provision: results from a nationally representative cohort study of 1,835 pregnant women', BMC Pregnancy and Childbirth, vol. 12, pp. 146-146.
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Background: There is little known about women's concurrent use of conventional and complementary health care during pregnancy, particularly consultation patterns with complementary and alternative medicine (CAM). This study examines health service utilisation among pregnant women including consultations with obstetricians, midwives, general practitioners (GPs) and CAM practitioners.

Mitchell, G., Girgis, A., Jiwa, M., Sibbritt, D. & Burridge, L. 2012, 'A GP Caregiver Needs Toolkit versus usual care in the management of the needs of caregivers of patients with advanced cancer: a randomizedcontrolled trial', Trials, vol. 11, no. 115, pp. 1-7.
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Background: Caring for a person with progressive cancer creates challenges for caregivers. However the needs of caregivers are often not assessed or recognised by health care providers. Research is also lacking in this area, with little knowledge relating to effective strategies to address the specific needs of caregivers. This paper outlines a study protocol aimed at developing and evaluating the effectiveness of a general practice-based intervention to better meet the needs of caregivers of patients with advanced cancer.

Jenkins, L., Mcevoy, M., Patterson, A. & Sibbritt, D. 2012, 'Higher unprocessed red meat, chicken and fish intake is associated with a higher vegetable intakein mid-age non-vegetarian women', Nutrition and Dietetics, vol. 69, no. 4, pp. 293-299.
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Aim: To investigate whether higher intakes of unprocessed red meat, chicken and fish are associated with higher intakes of vegetables in middle-aged, non-vegetarian Australian women.

Broom, A., Sibbritt, D., Nayar, K.R., Nilan, P. & Kirby, E. 2012, 'What Factors Predict Exposure to Caste, Political and Religious Violence in India? A Cross - Sectional Survey of 1000 Indian Men', Asian Social Science, vol. 9, no. 1, pp. 1-8.
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Background: Caste, political and religious violence impact considerably on the wellbeing of communities and individuals in India, where violence represents a significant problem. Given the lack of existing work on the experiences of Indian men, particularly those in Gujarat and Uttar Pradesh, this study aimed to provide baseline data on the Indian men's experiences of caste, political and religious violence in order to identify and examine the predictors of this violence.

Waller, A., Girgis, A., Johnson, C., Lecathelinais, C., Sibbritt, D., Forstner, D., Liauw, W. & Currow, D.C. 2012, 'Improving Outcomes for People With Progressive Cancer: Interrupted Time Series Trial of a Needs Assessment Intervention', Journal of Pain and Symptom Management, vol. 43, no. 3, pp. 569-581.
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Saravanakumar, P., Higgins, I., Sibbritt, D., Van der Riet, P. & Marquez, J. 2012, 'YOGA AND TAI CHI FOR FALL PREVENTION IN RESIDENTIAL CARE: A FEASIBILITY STUDY', JOURNAL OF AGING AND PHYSICAL ACTIVITY, vol. 20, pp. S172-S172.

Chiarelli, P. & Sibbritt, D. 2012, 'OSTEOPOROSIS AND PELVIC ORGAN PROLAPSE IN AUSTRALIAN WOMEN: A LONGITUDINAL ANALYSIS.', INTERNATIONAL UROGYNECOLOGY JOURNAL, vol. 23, pp. S151-S152.

McLaughlin, D., Adams, J., Sibbritt, D. & Lui, C. 2011, 'Sex differences in the use of complementary and alternative medicine in older men and women', Australasian Journal on Ageing, vol. 31, no. 2, pp. 78-82.
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Aim: The aim of this study was to examine sex differences in complementary and alternative medicine (CAM) use among older adults. Methods: Cross-sectional analysis of data from two cohort studies of community-dwelling women (n=5399) and men (n=3188) aged 82-87 and 77-91 years, respectively. The main outcome measure was self-report of consultations with an alternative health practitioner.

Sibbritt, D., Adams, J. & Van Der Riet, P. 2011, 'The Prevalence And Characteristics Of Young And Mid-Age Women Who Use Yoga And Meditation: Results Of A Nationally Representative Survey Of 19,209 Australian Women', Complementary Therapies In Medicine, vol. 19, no. 2, pp. 71-77.
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Objective: To determine the characteristics of yoga and meditation users and non-users amongst young and mid-aged Australian women. Design and setting: The research was conducted as part of the Australian Longitudinal Study on Womens Health (ALSWH) which

Sibbritt, D., Adams, J. & Lui, C. 2011, 'A Longitudinal Analysis Of Complementary And Alternative Medicine Use By A Representative Cohort Of Young Australian Women With Asthma, 1996-2006', Journal Of Asthma, vol. 48, no. 4, pp. 380-386.
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Background. There is evidence of asthma patients using complementary and alternative medicine (CAM). This article reports the findings of the first ever longitudinal study of CAM use among women with asthma from a large nationally representative sample.

Adams, J., Lui, C., Sibbritt, D., Broom, A., Wardle, J. & Homer, C.S. 2011, 'Attitudes And Referral Practices Of Maternity Care Professionals With Regard To Complementary And Alternative Medicine: An Integrative Review', Journal of Advanced Nursing, vol. 67, no. 3, pp. 472-483.
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Aim. This paper presents an integrative literature review examining the attitudes and referral practices of midwives and other maternity care professionals with regard to complementary and alternative treatment and its use by pregnant women. Background.

Adams, J., Sibbritt, D. & Lui, C. 2011, 'The Urban-Rural Divide In Complementary And Alternative Medicine Use: A Longitudinal Study Of 10,638 Women', BMC Complementary And Alternative Medicine, vol. 11, no. 2, pp. 1-7.
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Background: Research has identified women in rural and remote areas as higher users of complementary and alternative medicine (CAM) practitioners than their urban counterparts. However, we currently know little about what influences womens CAM consumptio

Wardle, J., Adams, J., MagalhÃ£es, R.J. & Sibbritt, D. 2011, 'Distribution of complementary and alternative medicine (CAM) providers in rural New South Wales, Australia: A step towards explaining high CAM use in rural health?', Australian Journal of Rural Health, vol. 19, pp. 197-204.
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Objective: Complementary and alternative medicine (CAM) use is high in rural health and an agenda for research in the geography of CAM has been outlined. Unfortunately, no studies to date have mapped the geographic distribution of CAM practitioners in rural areas. For the first time we investigate CAM practitioner distributions across a large district/region in rural Australia.

Adams, J., Sibbritt, D. & Lui, C. 2011, 'The use of complementary and alternative medicine during pregnancy: A longitudinal study of Australian women', Birth: issues in perinatal care, vol. 38, no. 3, pp. 200-206.
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Background: The use of complementary and alternative medicine is increasingly prevalent in contemporary Western societies. The objective of this study was to explore trends and patterns in complementary and alternative medicine practitioner consultations and the use of complementary and alternative medicine consumption before, during, and after pregnancy and between pregnancies. Methods: Analysis focused on data from 13,961 women from the younger cohort of the Australian Longitudinal Study on Womenâs Health collected between 1996 and 2006. Chi-square tests were employed for the cross-sectional analysis of categorical variables and t tests for continuous variables. Generalized estimating equations were used to conduct multivariate longitudinal analysis.

Sibbritt, D., Adams, J. & Moxey, A. 2011, 'Mid-Age Women's Consultations with Acupuncturists: A Longitudinal Analysis of 11,200 Women, 2001-2007', Journal of Alternative and Complementary Medicine, vol. 17, no. 8, pp. 735-740.
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Objectives: The objectives of this study were to chart the patterns and determine the factors associated with acupuncture consultations among a large cohort of mid-aged women in Australia over a 6-year period. Design: A longitudinal analysis of questionnaires completed in 2001, 2004, and 2007 as part of the Australian Longitudinal Study on Women's Health. Statistical analyses included Generalized Estimating Equations. Subjects: Mid-aged women (n = 11,200) were randomly selected from the Australian Medicare database, with oversampling of women from rural and remote areas. Outcome measure: The outcome measure was consultation with an acupuncturist in the 12 months prior to each survey.

Sibbritt, D. & Adams, J. 2011, 'Developing and promoting public health methods for integrative medicine: examples from the field in Australia', Journal of Chinese Integrative Medicine, vol. 9, no. 3, pp. 233-236.
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Integrative medicine (IM) research in China has largely focused on clinical and experimental research , which is critical to determining the efficacy of treatments and enhancing the standing of IM. Nevertheless, there is also a need to extend research activities to include methods and research perspectives from public health , which will provide a greater understanding of clinical practice and assist government and professional organizations to shape policies and directives in IM. In this article we outline the public health research methods we have used in relation to our program of research on complementary and alternative medicine use and area of residence geography, to highlight the usefulness of these methods in IM.

Sibbritt, D., Adams, J. & Lui, C. 2011, 'Health service utilisation by pregnant women over a 7 year period', Midwifery, vol. 27, pp. 474-476.
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To examine the use of complementary and alternative medicine during pregnancy using data from a longitudinal cohort study. The research was conducted as part of the Australian Longitudinal Study on Women's Health which was designed to investigate multiple factors affecting the health and well-being of women over a 20-year period. The younger cohort of the Australian Longitudinal Study on Women's Health who had completed four surveys in 1996, 2000, 2003 and 2006.

Steel, A.E., Adams, J. & Sibbritt, D. 2011, 'Complementary and Alternative Medicine in Pregnancy: a Systematic Review', Journal of the Australian Traditional-Medicine Society, vol. 17, no. 4, pp. 205-209.
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A systematic review of recent peer-reviewed literature exploring womenâs use of complementary and alternative medicine (CAM) in pregnancy, birth and postnatal care.

Adams, J., Sibbritt, D., Broom, A., Loxton, D., Pirotta, M., Humphreys, J. & Lui, C. 2011, 'A comparison of complementary and alternative medicine users and use across geographical areas: A national survey of 1,427 women', BMC Complementary and Alternative Medicine, vol. 11, no. 85, pp. 1-8.
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Background: Evidence indicates that people who reside in non-urban areas have a higher use of complementary and alternative medicine (CAM) than people who reside in urban areas. However, there is sparse research on the reasons for such differences. This paper investigates the reasons for geographical differences in CAM use by comparing CAM users from four geographical areas (major cities, inner regional, outer region, rural/remote) across a range of health status, healthcare satisfaction, neighbourhood and community factors. A cross-sectional survey of 1,427 participants from the Australian Longitudinal Study on Women's Health (ALSWH) conducted in 2009.

Huynh, D.T., Dibley, M.J., Sibbritt, D. & Tran, H.T. 2011, 'Influence of contextual and individual level risk factors on adiposity in a preschool child cohort in Ho Chi Minh City, Vietnam', International Journal of Pediatric Obesity, vol. 6, no. 2, pp. 487-500.
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To identify risk factors associated with changes in BMI and sum of skinfold thickness (SSF) in a cohort of preschool children in Ho Chi Minh City (HCMC), Vietnam. This one year follow-up study, using multi-stage cluster sampling, was conducted from 2005 - 2006 with 526 children aged 4 - 5 years in preschools in urban HCMC. Information on neighborhood, preschool and home environments, socio-economic status, the child and parental characteristics were collected using interview-administered questionnaires. Dietary intake and physical activity were measured using modified, validated questionnaires. Weight, height, and triceps, subscapular and suprailiac skinfold thickness were measured.

Adams, J., Sibbritt, D., Broom, A., Loxton, D., Pirotta, M., Humphreys, J. & Lui, C.-.W. 2011, 'A comparison of complementary and alternative medicine users and use across geographical areas: a national survey of 1,427 women.', BMC complementary and alternative medicine, vol. 11, p. 85.
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BACKGROUND: Evidence indicates that people who reside in non-urban areas have a higher use of complementary and alternative medicine (CAM) than people who reside in urban areas. However, there is sparse research on the reasons for such differences. This paper investigates the reasons for geographical differences in CAM use by comparing CAM users from four geographical areas (major cities, inner regional, outer region, rural/remote) across a range of health status, healthcare satisfaction, neighbourhood and community factors. METHODS: A cross-sectional survey of 1,427 participants from the Australian Longitudinal Study on Women's Health (ALSWH) conducted in 2009. RESULTS: The average total cost of consultations with CAM practitioners was $416 per annum and was highest for women in the major cities, declining with increasing distance from capital cities/remoteness (p < 0.001). The average total cost of self-prescribed CAM was $349 per annum, but this did not significantly differ across geographical areas. The increased use of CAM in rural and remote areas appears to be influenced by poorer access to conventional medical care (p < 0.05) and a greater sense of community (p < 0.05) amongst these rural and remote residents. In contrast to the findings of previous research this study found that health status was not associated with the differences in CAM use between urban and non-urban areas. CONCLUSION: It appears that a number of factors influence the different levels of CAM use across the urban/non-urban divide. Further research is needed to help tease out and understand these factors. Such research will help support health care policy and practice with regards to this topic.

Sibbritt, D., Homer, C.S.E. & Adams, J. 2011, 'The self-prescribed use of aromatherapy oils by pregnant women: Cause for concern?', WOMEN AND BIRTH, vol. 24, pp. S24-S24.
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Azevedo, M.R., Horta, B.L., Gigante, D.P. & Sibbritt, D. 2011, 'Continuidade da atividade física na Coorte de Nascimentos de 1982 de Pelotas', Brazilian Journal of Physical Activity and Health, vol. 16, no. 2, pp. 156-161.
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Collins, C., Sibbritt, D., Patterson, A. & Aljadani, H. 2011, 'The association between diet quality and weight change in adults over time: A systematic review of studies with follow up.', JBI Libr Syst Rev, vol. 9, no. 16 Suppl, pp. 1-9.

Parkinson, L., Warburton, J., Sibbritt, D. & Byles, J.E. 2010, 'Volunteering and older women: Psychosocial and health predictors of participation', Aging & Mental Health, vol. 14, no. 8, pp. 917-927.
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Objectives: As populations age, there will be a need for more volunteers in social welfare, and consequently a need to better understand potential effects of volunteering for older people. Whilst there is a body of international literature exploring health benefits of volunteering in later life, there are currently no longitudinal studies of Australian populations. Internationally, there is a lack of studies focusing on older women, who comprise the majority of the ageing population. The aim of this article was to explore the relationship between volunteering and psychosocial and health factors for a cohort of older Australian women over time.

Li, M., Dibley, M.J., Sibbritt, D. & Yan, H. 2010, 'Dietary habits and overweight/obesity in adolescents in Xi'an City, China', Asia Pacific Journal Of Clinical Nutrition, vol. 19, no. 1, pp. 76-82.
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This study explored the association between dietary habits and overweight and obesity in adolescents from Xiâan City, China. A cross-sectional sample of 1804 adolescents was recruited in 2004 from 30 junior high schools in six districts of Xiâan City, northwest China.

Broom, A., Wijewardena, K., Sibbritt, D., Adams, J. & Nayar, K. 2010, 'The Use Of Traditional, Complementary And Alternative Medicine In Sri Lankan Cancer Care: Results From A Survey Of 500 Cancer Patients', Public Health, vol. 124, no. 4, pp. 232-237.
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Objectives: While the introduction of biomedicine within the Sri Lankan healthcare system has resulted in reduced reliance on traditional, complementary and alternative medicine (TCAM) over the last century in Sri Lanka, treatment modalities such as Ayur

Steinsbekk, A., Adams, J., Sibbritt, D. & Johnsen, R. 2010, 'Complementary And Alternative Medicine Practitioner Consultations Among Those Who Have Or Have Had Cancer In A Norwegian Total Population (Nord-Tr Circle Divide Ndelag Health Study): Prevalence, Socio-Demographics And Health Perceptions', European Journal of Cancer Care, vol. 19, no. 3, pp. 346-351.
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The aim of the study was to identify the use of complementary and alternative medicine (CAM) practitioners among current and previous cancer patients in a total population. A secondary analysis of data from the Nord-Tr circle divide ndelag Health Study (

Pirotta, M., Kotsirilos, V., Brown, J., Adams, J., Morgan, T. & Williamson, M. 2010, 'Complementary Medicine In General Practice A National Survey Of Gp Attitudes And Knowledge', Australian Family Physician, vol. 39, no. 12, pp. 946-950.
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Background Integrative medicine is a holistic approach to patient care that utilises both conventional and complementary therapy. This article compares the demographics of Australian general practitioners who do, and those who do not, practise integrativ

Waller, A., Girgis, A., Lecathelinais, C., Scott, W., Foot, L., Sibbritt, D. & Currow, D. 2010, 'Validity, reliability and clinical feasibility of a Needs Assessment Tool for people with progressive cancer', Psycho-oncology, vol. 19, pp. 726-733.
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Background: Needs assessment is a valuable approach for determining the way health and social services allocate resources to people with cancer and their caregivers. Aim: To assess the reliability, validity and acceptability of a Needs Assessment Tool (NAT) in a palliative care clinical setting.

Sibbritt, D., Byles, J.E. & Tavener, M. 2010, 'Older Australian women's use of dentists: A longitudinal analysis over 6 years', Australasian Journal on Ageing, vol. 29, no. 1, pp. 14-20.
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Aim: To identify factors associated with dentist consultation by older Australian women.

Jiwa, M., Mitchell, G., Sibbritt, D. & Girgis, A. 2010, 'Addressing the needs of caregivers of cancer patients in general practice: A complex intervention', Quality in Primary Care, vol. 18, no. 1, pp. 9-16.
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Background This study aimed to develop an innovation to assist general practitioners (GPs) in Australia to proactively address the needs of caregivers of people with cancer.

Hong, T.K., Trang, N., Dibley, M.J., Sibbritt, D., Binh, P.N. & Hanh, T.T. 2010, 'Factors associated with adolescent overweight/obesity in Ho Chi Minh city', International Journal of Pediatric Obesity, vol. 5, pp. 396-403.
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Objective. To identify factors associated with overweight/obesity among adolescents in Ho Chi Minh City, Vietnam. Methods . In 2004, a cross-sectional survey was conducted using multi-stage cluster sampling. Weight and height of 2 678 students from 31 junior high schools in Ho Chi Minh City were measured. Dietary intake and physical activity were assessed using a validated food frequency questionnaire and a physical activity questionnaire.

Waller, A., Girgis, A., Johnson, C., Mitchell, G., Yates, P., Kristjanson, L., Tattersall, M., Lecathelinais, C., Sibbritt, D., Kelly, B., Gorton, E. & Currow, D. 2010, 'Facilitating needs based cancer care for people with a chronic disease: Evaluation of an intervention using a multi-centre interrupted timeseries design', BMC Palliative Care, vol. 9, no. 2, pp. 1-6.
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Background: Palliative care should be provided according to the individual needs of the patient, caregiver and family, so that the type and level of care provided, as well as the setting in which it is delivered, are dependent on the complexity and severity of individual needs, rather than prognosis or diagnosis [1]. This paper presents a study designed to assess the feasibility and efficacy of an intervention to assist in the allocation of palliative care resources according to need, within the context of a population of people with advanced cancer.

Waller, A., Girgis, A., Johnson, C., Mitchell, G., Yates, P., Kristjanson, L., Tattersall, M., Lecathelinais, C., Sibbritt, D., Kelly, B., Gorton, E. & Currow, D. 2010, 'Facilitating needs based cancer care for people with a chronic disease: Evaluation of an intervention using a multi-centre interrupted time series design.', BMC palliative care, vol. 9, p. 2.
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BACKGROUND: Palliative care should be provided according to the individual needs of the patient, caregiver and family, so that the type and level of care provided, as well as the setting in which it is delivered, are dependent on the complexity and severity of individual needs, rather than prognosis or diagnosis [1]. This paper presents a study designed to assess the feasibility and efficacy of an intervention to assist in the allocation of palliative care resources according to need, within the context of a population of people with advanced cancer. METHODS/DESIGN: People with advanced cancer and their caregivers completed bi-monthly telephone interviews over a period of up to 18 months to assess unmet needs, anxiety and depression, quality of life, satisfaction with care and service utilisation. The intervention, introduced after at least two baseline phone interviews, involved a) training medical, nursing and allied health professionals at each recruitment site on the use of the Palliative Care Needs Assessment Guidelines and the Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C); b) health professionals completing the NAT: PD-C with participating patients approximately monthly for the rest of the study period. Changes in outcomes will be compared pre-and post-intervention. DISCUSSION: The study will determine whether the routine, systematic and regular use of the Guidelines and NAT: PD-C in a range of clinical settings is a feasible and effective strategy for facilitating the timely provision of needs based care. TRIALS REGISTRATION: ISRCTN21699701.

Adams, J., Lui, C., Sibbritt, D., Broom, A., Wardle, J., Homer, C.S. & Beck, S. 2009, 'Women's Use of Complementary and Alternative Medicine During Pregnancy: : A Critical Review Of The Literature', Birth: issues in perinatal care, vol. 36, no. 3, pp. 237-245.
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Background: The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. Methods: A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Results: Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile,""motivation and condition of use,""perception and self-reported evaluation," and "referral and information sources." Conclusions: This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care.

Adams, J., Sibbritt, D. & Young, A.F. 2009, 'A Longitudinal Analysis Of Older Australian Women's Consultations With Complementary And Alternative Medicine (CAM) Practitioners, 1996-2005', Age And Ageing, vol. 38, no. 1, pp. 93-99.
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Objective: to determine the factors associated with complementary and alternative medicine (CAM) use among older Australian women over time. Methods: a longitudinal analysis of postal questionnaires completed in 1996, 1999, 2002 and 2005 as part of the A

Sibbritt, D. & Adams, J. 2009, 'Back pain amongst 8,910 young Australian women: a longitudinal analysis of the use of conventional providers, complementary and alternative medicine (CAM) practitioners and self-prescribed CAM', Clinical Rheumatology, vol. 29, no. 1, pp. 25-32.
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Back problems and back pain are amongst the most prevalent conditions afflicting Australians and carry high direct and indirect costs for the health care systems of all developed countries. A major gap in the research literature on this topic is the longitudinal analysis of health seeking behaviour for people with back pain. All studies to date have been cross-sectional and it is important that the use of different providers (both conventional and complementary and alternative medicine, CAM) is examined over time. This study analysed data from a longitudinal study conducted over a 3-year period on 8,910 young Australian women. Information on health service use, self-prescribed treatments, and health status was obtained from two questionnaires mailed to study participants in 2003 and 2006. We found that there is little difference in the consultation practises or use of self-prescribed CAM between women who recently sought help for back pain and women who had longer-term back pain; the only difference being that women with longer-term back pain consulted more with chiropractors. We conclude that women who seek help for their back pain are frequent visitors to a range of conventional and CAM practitioners and are also high users of self-prescribed CAM treatments. The frequent use of a range of conventional providers and practitioner-based and self-prescribed CAM amongst women with back pain warrants further investigation.

Magin, P., Sibbritt, D. & Bailey, K. 2009, 'The Relationship Between Psychiatric Illnesses and Skin Disease A Longitudinal Analysis of Young Australian Women', ARCHIVES OF DERMATOLOGY, vol. 145, no. 8, pp. 896-902.

Sibbritt, D. 2009, 'The 'n of 1' trial', JOURNAL OF COMPLEMENTARY MEDICINE, vol. 8, no. 6, pp. 21-22.

Tang, H.K., Dibey, M.J., Sibbritt, D., Hoang, N.D.T.H., Phan, T.B.N. & Tran, M.H.T. 2009, 'DIETARY BEHAVIORS AND OVERWEIGHT/OBESITY IN ADOLESCENTS OF HO CHI MINH CITY, VIETNAM', ANNALS OF NUTRITION AND METABOLISM, vol. 55, pp. 79-79.

Tang, H.K., Dibley, M.J., Sibbritt, D., Nguyen Hoang, D.T.H., Phan, T.B.N. & Tran, M.H.T. 2009, 'PREVALENCE OF THE METABOLIC SYNDROME (MetS) IN ADOLESCENTS OF HO CHI MINH CITY, VIETNAM', ANNALS OF NUTRITION AND METABOLISM, vol. 55, pp. 537-538.

Horta, B.L., Sibbritt, D.W., Lima, R.C. & Victora, C.G. 2009, 'Weight catch-up and achieved schooling at 18 years of age in Brazilian males', EUROPEAN JOURNAL OF CLINICAL NUTRITION, vol. 63, no. 3, pp. 369-374.
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Dieu, H.T.T., Dibley, M.J., Sibbritt, D.W. & Hanh, T.T.M. 2009, 'Trends in overweight and obesity in pre-school children in urban areas of Ho Chi Minh City, Vietnam, from 2002 to 2005.', Public health nutrition, vol. 12, no. 5, pp. 702-709.
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OBJECTIVE: To assess the trends in overweight and obesity in pre-school children in urban areas of Ho Chi Minh City (HCMC), Vietnam, over the period 2002 to 2005. DESIGN: Two cross-sectional studies were conducted in 2002 and 2005. Multistage cluster sampling was used in both surveys to select the subjects. Sociodemographic information was collected using a self-administered questionnaire given to parents in 2002 and using an interview-administered questionnaire to parents in 2005. Weight and height were measured using the same standard methods in both surveys. BMI (kg/m2) was calculated and overweight/obesity was defined using the age- and sex-specific BMI cut-off points proposed by the International Obesity Taskforce. SUBJECTS AND SETTING: Children aged 4 to 5 years, attending pre-schools in urban areas of HCMC, Vietnam, in 2002 (n 492) and 2005 (n 670). RESULTS: The prevalence of overweight and obesity almost doubled from 2002 to 2005 (21.4 % and 36.8 %, respectively). The increase was more evident in less wealthy districts than in wealthy districts. The proportion of boys classified as obese in 2005 (22.5 %) was three times that in 2002 (6.9 %). CONCLUSION: The prevalence of overweight and obesity has increased rapidly in children aged 4 to 5 years in urban areas, and especially in less wealthy districts, over a 3-year period. These results signal an urgent need for prevention programmes to control and reverse this rapid upward trend in overweight and obesity in young children in HCMC.

Jiwa, M., O'Shea, C., McKinley, R.K., Mitchell, G., Girgis, A., Sibbritt, D., Burridge, L., Smith, M., Chan She Ping Delfos, W. & Halkett, G. 2009, 'Developing and evaluating interventions for primary care- a focus on consultations in general practice', Australasian Medical Journal, vol. 2, no. 7, pp. 3-7.
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The deployment of decision support aids, electronic referral tools or other novel processes to improve diagnostic or therapeutic performance may also disrupt the flow of the consultation in general practice. Therefore 'innovations' or interventions that may result in changes to the structure of the consultation need to be tested in controlled conditions if they are not to harm patient care in practice. We describe a method for conducting 'Phase 1' studies of such interventions illustrated by a consultation from one of four studies using actor-patient consultations. The recording of actor-patient consultations is technically challenging. There are some limitations in using volunteers whose skills may be unknown. However, the method allows lay and professional observation about the performance of doctors using new tools which may help to refine the innovations or offer insights into how and why some clinical scenarios impact on the doctor-patient consultation. This method is not a substitute for adequately powered clinical trials; however, it offers a practical approach to developing a complex intervention for subsequent formal evaluation.

Watson, J.F., Collins, C.E., Sibbritt, D.W., Dibley, M.J. & Garg, M.L. 2009, 'Reproducibility and comparative validity of a food frequency questionnaire for Australian children and adolescents', International Journal of Behavioral Nutrition and Physical Activity, vol. 6, p. 62.
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Background: Dietary intake during childhood and adolescence is of increasing interest due to its influence on adult health, particularly obesity, cardiovascular disease and diabetes. There is a need to develop and validate dietary assessment methods suitable for large epidemiologic studies of children and adolescents. Limited large scale dietary studies of youth have been undertaken in Australia, due partly to the lack of a suitable dietary intake tool. A self-administered, semi-quantitative food-frequency questionnaire (FFQ), the 'Australian Child and Adolescent Eating Survey' (ACAES), was developed for youth aged 9-16 years. This study evaluated reproducibility and comparative validity of the ACAES FFQ using assisted food records (FRs) as the reference method. Methods: The ACAES FFQ was completed twice (FFQ1 and FFQ2) at an interval of 5 months, along with four one-day assisted FRs. Validity was evaluated by comparing the average of the FRs with FFQ2 (n = 113) as well as with the average of FFQ1 and FFQ2 (n = 101). Reproducibility was evaluated by comparing FFQ1 and FFQ2 (n = 101). The two methods were compared using correlations, Kappa statistics and Bland-Altman plots. Results: Correlation coefficients for comparative validity ranged from 0.03 for retinol to 0.56 for magnesium for transformed, energy-adjusted, deattenuated nutrient data, with correlation coefficients greater than 0.40 for total fat, saturated fat, monounsaturated fat, carbohydrate, sugars, riboflavin, vitamin C, folate, beta-carotene, magnesium, calcium and iron. Correlation coefficients for reproducibility ranged from 0.18 for vitamin A to 0.50 for calcium for transformed, energy-adjusted, deattenuated nutrient data. The ACAES FFQ ranked individuals reasonably accurately, with the comparative validity analysis showing that over 50% of participants were classified within one quintile for all nutrients, with only a small percentage grossly misclassified (0-7%). Conclusion: The ACAES FFQ is the...

Trang, N.H.H.D., Hong, T.K., Dibley, M.J. & Sibbritt, D.W. 2009, 'Factors associated with physical inactivity in adolescents in Ho Chi Minh City, Vietnam.', Medicine and science in sports and exercise, vol. 41, no. 7, pp. 1374-1383.
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PURPOSES: To identify factors associated with physical inactivity among adolescents in Ho Chi Minh City (HCMC). METHODS: A cross-sectional survey was conducted in 2004 among 2684 junior high school students using multistage cluster sampling. Time spent for physical and sedentary activities was collected with a validated questionnaire. Anthropometry, parental/family characteristics, neighborhood, and school environments were also measured. Level of activity was classified as physically active or inactive using standard criteria. Potential risk factors for physical inactivity were identified with hierarchical multivariate logistic regression, stratified by gender. RESULTS: Physical inactivity was positively associated with child's overweight status (odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.9, 3.2), passive transportation (OR = 4.2, 95% CI = 3.3-5.2), not having recess exercises (OR = 1.3, 95% CI = 1.1-5.6), availability of a nearby game shop (OR = 1.8, 95% CI = 1.5-2.2), more time spent playing video games, watching television, and studying after class (OR = 2.3, 95% CI = 1.7-3.1; OR = 1.5, 95% CI = 1.2-1.9; and OR = 1.8, 95% CI = 1.3-2.4, respectively). The following factors decreased the odds of inactivity: schools having one to two sport meetings per year (OR = 0.7, 95% CI = 0.5-1.0), availability of a play yard (OR = 0.7, 95% CI = 0.6-0.9), older age group (OR = 0.2, 95% CI = 0.1-0.2), and male gender (OR = 0.6, 95% CI = 0.5-0.7). In boys, transportation, school sport meeting, availability of game shop near by, family's economic status, parental body mass index status, and time spent watching television were strongly associated with physical inactivity. In girls, time spent for study after class was one of the most important factors related to students' physical inactivity. CONCLUSIONS: Physical activity among adolescents in HCMC is related to household, school, and community factors. These factors and gender differences should be taken into acc...

Byles, J., Millar, C.J., Sibbritt, D.W. & Chiarelli, P. 2009, 'Living with urinary incontinence: a longitudinal study of older women.', Age and ageing, vol. 38, no. 3, pp. 333-251.
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BACKGROUND: urinary incontinence carries major social burden and considerable costs for health care systems. OBJECTIVE: the aim of this study was to investigate changes in continence status among a large cohort of older women, and to identify factors associated with incidence of incontinence in later life. SUBJECTS: participants of the Australian Longitudinal Study of Women's Health (ALSWH), aged 70-75 years in 1996 and who have completed four health surveys over the past 10 years. METHODS: continence status across four survey periods, spanning 9 years, were defined according to women's reports of 'leaking urine' at each survey. Generalised estimating equation (GEE) models were used in longitudinal analyses of the factors associated with changing continence status over time. RESULTS: this study presents longitudinal data on the prevalence and incidence of incontinence from a large cohort of older women, over 9 years of follow-up. Over this time, 14.6% (95% CI 13.9-15.3) of the women in the study who had previously reported leaking urine 'rarely' or 'never' developed incontinence, and 27.2% (95% CI 26.2%, 28.3%) of women participating in Survey 4 (S4) in 2005 reported leaking urine 'sometimes' or 'often' at that survey, with women being twice as likely to report incontinence at S4 as they were 6 years earlier. Longitudinal models demonstrated the association between incontinence and dementia (P < 0.001; OR = 2.34; 95% CI 1.64, 3.34), dissatisfaction with physical ability (P < 0.001; OR = 1.70; 95% CI 1.52, 1.89), falls to the ground (P <0.001; OR = 1.23; 95% CI 1.13, 1.33), BMI (P < 0.001; OR = 2.18; 95% CI 1.70, 2.80 for obese), constipation (P < 0.001; OR 1.46; 95% CI 1.34-1.58), urinary tract infection (P < 0.001; OR 2.07; 95% CI 1.89-2.28), history of prolapse (P </= 0.001; OR = 1.53; 95% CI 1.35, 1.74) and prolapse repair (P = 0.002; OR = 1.23; 95% CI 1.08, 1.40). Stroke (P = 0.01), parity (P = 0.017) and hysterectomy (P = 0.026) and number of visits to the ...

Casey, M., Adams, J. & Sibbritt, D. 2008, 'An Examination Of The Clinical Practices And Perceptions Of Professional Herbalists Providing Patient Care Concurrently With Conventional Medical Practice In Australia', Complementary Therapies In Medicine, vol. 16, no. 4, pp. 228-232.
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Objective: To examine the clinical practices and perceptions of herbalists providing patient care concurrently with conventional medical practice. Method: A postal survey was sent to all full members of the National Herbalists Association of Australia (N

Steinsbekk, A., Adams, J., Sibbritt, D., Jacobsen, G. & Johnsen, R. 2008, 'Socio-demographic characteristics and health perceptions among male and female visitors to CAM practitioners in a total population study', Forschende Komplementarmedizin, vol. 15, no. 3, pp. 146-151.
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Background: The aim was to explore the prevalence of visitors to CAM practitioners in a total population with reference to sex, self-rated health status and socio-demographic characteristics. Methods: The paper reports findings from the Nord-Trondelag He

Magin, P., Adams, J., Sibbritt, D., Joy, E. & Ireland, M. 2008, 'Effects of occupational violence on Australian general practitioners provision of home visits and after-hours care: a cross-sectional study', Journal Of Evaluation In Clinical Practice, vol. 14, no. 2, pp. 336-342.
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Occupational violence is increasingly recognized as a problem in general practice, and has been suggested as adversely affecting general practitioners (GPs) provision of services to patients. The aim of this study was to investigate the association of ex

Waller, A., Girgis, A., Currow, D. & Lecathelinais, C. 2008, 'Development of the Palliative Care Needs Assessment Tool (PC-NAT) for use by multi-disciplinary health professionals', PALLIATIVE MEDICINE, vol. 22, no. 8, pp. 956-964.
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Li, M., Dibley, M.J., Sibbritt, D. & Yan, H. 2008, 'Factors associated with adolescents' overweight and obesity at community, school and household levels in Xi'an City, China: results of hierarchical analysis', EUROPEAN JOURNAL OF CLINICAL NUTRITION, vol. 62, no. 5, pp. 635-643.
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Drew, M.K., Sibbritt, D. & Chiarelli, P. 2008, 'No association between previous Caesarean-section delivery and back pain in mid-aged Australian women an observational study', AUSTRALIAN JOURNAL OF PHYSIOTHERAPY, vol. 54, no. 4, pp. 269-272.

Fletcher, R., Vimpani, G., Russell, G. & Sibbritt, D. 2008, 'Psychosocial assessment of expectant fathers', ARCHIVES OF WOMENS MENTAL HEALTH, vol. 11, no. 1, pp. 27-32.
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Huynh, D.T.T., Dibley, M.J., Sibbritt, D.W. & Tran, H.T.M. 2008, 'Energy and macronutrient intakes in preschool children in urban areas of Ho Chi Minh City, Vietnam.', BMC pediatrics, vol. 8, p. 44.
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BACKGROUND: An increasing prevalence of overweight and obesity has been documented in preschool children in Ho Chi Minh City (HCMC), Vietnam. However, little is known about what preschool children in HCMC eat or how well their nutrient intake meets nutrient recommendations. This study aims to describe the energy and macronutrient intake and compare these nutrient intakes with the recommendations for Vietnamese children aged four to five years. METHODS: The data comes from the baseline measurement of a one year follow-up study on obesity in 670 children attending kindergartens in HCMC. Dietary information for each child at the school and home settings was collected using Food Frequency Questionnaires (FFQs), by interviewing teachers and parents or main caregivers. The average energy and nutrient intake in a day was calculated. The proportion of children with energy intake from macronutrients meeting or exceeding the recommendations was estimated based on the 2006 recommended daily allowance (RDA) for Vietnamese children in this age group. RESULTS: The dietary intake of the participants contained more energy from protein and fat, particularly animal protein and fat, and less energy from carbohydrates, than the RDA. Most children (98.1%) had mean energy intake from protein greater than the recommended level of 15%, and no child obtained energy from animal fat that was in accordance with the recommendation of less than 30% of the total fat intake. Nearly one half of children (46.5%) consumed less than the advised range of mean energy intake from carbohydrate (60%-70%). CONCLUSION: In this preschool child population in HCMC, in which obesity is emerging as major public health problem, there is an imbalance in dietary intake. Healthy eating programs need to be developed as a part of an obesity prevention program for young children in HCMC.

Adams, J., Sibbritt, D. & Young, A.F. 2007, 'Consultations With A Naturopath Or Herbalist: The Prevalence Of Use And Profile Of Users Amongst Mid-Aged Women In Australia', Public Health, vol. 121, no. 12, pp. 954-957.
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Casey, M., Adams, J. & Sibbritt, D. 2007, 'An examination of the prescription and dispensing of medicines by Western herbal therapists: A national survey in Australia', Complementary Therapies In Medicine, vol. 15, no. 1, pp. 13-20.
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Objective: To describe the patterns of prescription and dispensing of herbal medicines employed by Western herbal practitioners in Australia. Design: A national postal survey sent to all full members of the National Herbalist Association of Australia (NH

Sibbritt, D., Adams, J. & Young, A.F. 2007, 'The characteristics of middle aged Australian women who consult acupuncturists', Acupuncture in Medicine, vol. 25, no. (1-2), pp. 22-28.
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Background Although an increase in the use of acupuncture in recent years has been identified, there are few studies that focus attention upon the characteristics of acupuncture users. This survey aimed at providing a first step towards addressing this significant research gap. Methods This study was conducted as part of the Australian Longitudinal Study on Womenâs Health, and examined the characteristics of acupuncture users among middle aged Australian women between 50 and 55 years old. Data were collected on demographic measures, health status and health service use.

Steinsbekk, A., Adams, J., Sibbritt, D., Jacobsen, G. & Johnsen, R. 2007, 'The Profiles Of Adults Who Consult Alternative Health Practitioners And Or General Practitioners', Scandinavian Journal Of Primary Health Care, vol. 25, no. 2, pp. 86-92.
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Objective. To compare the profiles of people visiting only a general practitioner ( GP), those visiting only a practitioner of complementary and alternative medicine ( CAM), and those visiting both ( GP& CAM). Design. A comparative total population healt

Hong, T.K., Dibley, M.J., Sibbritt, D., Binh, P.N.T., Trang, N.H.H.D. & Hanh, T.T.M. 2007, 'Overweight and obesity are rapidly emerging among adolescents in Ho Chi Minh City, Vietnam, 2002-2004', INTERNATIONAL JOURNAL OF PEDIATRIC OBESITY, vol. 2, no. 4, pp. 194-201.
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Victora, C.G., Sibbritt, D., Horta, B.L., Lima, R.C., Cole, T. & Wells, J. 2007, 'Weight gain in childhood and body composition at 18 years of age in Brazilian males', ACTA PAEDIATRICA, vol. 96, no. 2, pp. 296-300.
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Dieu, H.T.T., Dibley, M.J., Sibbritt, D. & Hanh, T.T.M. 2007, 'Prevalence of overweight and obesity in preschool children and associated socio-demographic factors in Ho Chi Minh City, Vietnam', INTERNATIONAL JOURNAL OF PEDIATRIC OBESITY, vol. 2, no. 1, pp. 40-50.
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Tang, H.K., Dibley, M.J., Sibbritt, D. & Tran, H.M.T. 2007, 'Gender and socio-economic differences in BMI of secondary high school students in Ho Chi Minh City', ASIA PACIFIC JOURNAL OF CLINICAL NUTRITION, vol. 16, no. 1, pp. 74-83.

Duke, J., McEvoy, M., Sibbritt, D., Guest, M., Smith, W. & Attia, J. 2007, 'Vibrotactile threshold measurement for detecting peripheral neuropathy: defining variability and a normal range for clinical and research use', DIABETOLOGIA, vol. 50, no. 11, pp. 2305-2312.
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Sibbritt, D., Adams, J. & Young, A.F. 2007, 'The characteristics of middle aged Australian women who consult acupuncturists.', Acupuncture in medicine : journal of the British Medical Acupuncture Society, vol. 25, no. 1-2, pp. 22-28.

BACKGROUND: Although an increase in the use of acupuncture in recent years has been identified, there are few studies that focus attention upon the characteristics of acupuncture users. This survey aimed at providing a first step towards addressing this significant research gap. METHODS: This study was conducted as part of the Australian Longitudinal Study on Women's Health, and examined the characteristics of acupuncture users among middle aged Australian women between 50 and 55 years old. Data were collected on demographic measures, health status and health service use. RESULTS: The paper reports on 11 202 middle aged women, surveyed in 2001. We estimate that 4.5% of middle aged women consult an acupuncturist. Women who consult an acupuncturist are less likely to be married or living in a de facto relationship, are more likely to have had a major personal illness in the previous year, to have suffered from a variety of symptoms or have significantly lower scores (ie poorer health) on all eight dimensions of the SF-36 health-related quality of life scale. Women who use acupuncture are also higher users of 'conventional' health services. CONCLUSIONS: While the development of a research base and clinical applications for acupuncture are ongoing, health professionals should be aware that acupuncture is currently being used by large numbers of middle aged women. In addition, given the relatively higher prevalence of acupuncture use reported in our study, it is important that further research explores acupuncture use in more detail and the relationship between women's health issues and their use and experience of acupuncture.

Sibbritt, D.W., Byles, J.E. & Regan, C. 2007, 'Factors associated with decline in physical functional health in a cohort of older women.', Age and ageing, vol. 36, no. 4, pp. 382-388.
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OBJECTIVE: To identify minimum criteria to assist the prediction of decline in physical health-related quality of life in the elderly. STUDY DESIGN AND SETTING: Participants were women from the Australian Longitudinal Study on Women's Health, who responded to three separate Surveys conducted in 1996 (when they were aged 70-75 years), 1999 and 2002. Using data from these Surveys, three categories were generated which described current physical health-related quality of life and future physical decline as measured by the physical component summary score (PCS) of the MOS SF-36 quality of life survey. RESULTS: Bivariate analyses reported a large number of variables significantly associated with physical decline (P < 0.001), including age, falls, number of diagnoses, symptoms, doctor visits and medications, days spent in hospital, body mass index, living arrangements and social support. Multivariate analyses, using decision tree analysis, identified three items which accurately predicted 76% of the women who would exhibit physical decline according to our definition. CONCLUSIONS: This study identified a number of variables that may be useful in clinical screening for vulnerability to physical decline.

Sibbritt, D.W., Byles, J.E. & Cockrell, D.J. 2007, 'Prevalence and characteristics of older Australian women who consult dentists.', The Australian journal of rural health, vol. 15, no. 6, pp. 387-388.
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Li, M., Dibley, M.J., Sibbritt, D.W., Zhou, X. & Yan, H. 2007, 'Physical activity and sedentary behavior in adolescents in Xi'an City, China.', The Journal of adolescent health : official publication of the Society for Adolescent Medicine, vol. 41, no. 1, pp. 99-101.
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Physical activity levels were assessed among adolescents in Xi'an City, China, using a validated physical activity questionnaire. Physical activity recommendations were met by 56% of the adolescents and boys were more active than girls. The mean daily sedentary time was 6.4 hours, among which 3 hours was spent doing homework.

Duke, J.M., Sibbritt, D.W. & Young, A.F. 2007, 'Is there an association between the use of oral contraception and depressive symptoms in young Australian women?', Contraception, vol. 75, no. 1, pp. 27-31.
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PURPOSE: The purpose of this study was to explore the relationship between oral contraceptive pill (OCP) use and the experience of depressive symptoms among a representative sample of young Australian women. METHODS: The study sample comes from the Australian Longitudinal Study on Women's Health. Analysis was confined to women in the youngest cohort who responded to Survey 2, which was conducted in 2000 (n=9688) when they were aged between 22 and 27 years, and to Survey 3, which was conducted in 2003 (n=9081) when they were aged between 25 and 30 years. RESULTS: After adjusting for potential confounders, the odds of a nonuser experiencing depressive symptoms is not significantly different from that of an OCP user [odds ratio=1.05; 95% confidence interval (95% CI)=0.90-1.21]. Women who used OCP for reasons other than contraception were 1.32 (95% CI=1.07-1.62) times as likely to be depressed than women who used OCP for contraception. The percentage of women who reported experiencing depressive symptoms declined as the number of years of OCP use increased (p=.009). CONCLUSIONS: The results of this study suggest that, after adjusting for confounders, there is no independent effect of OCP use on depressive symptoms in young Australian women.

Sibbritt, D., Adams, J. & Young, A.F. 2006, 'A profile of middle-aged women who consult a chiropractor or osteopath: Findings from a survey of 11,143 Australian women', Journal Of Manipulative And Physiological Therapeutics, vol. 29, no. 5, pp. 349-353.
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Purpose: The aim of this study is to examine the prevalence of chiropractic and osteopathy use and the profile of chiropractor/osteopath users among middle-aged Australian women. Methods: This article reports on research conducted as part of the Australi

Li, M., Dibley, M.J., Sibbritt, D. & Yan, H. 2006, 'An assessment of adolescent overweight and obesity in Xi'an City, China', INTERNATIONAL JOURNAL OF PEDIATRIC OBESITY, vol. 1, no. 1, pp. 50-58.
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Bowe, S., Young, A.F., Sibbritt, D. & Furuya, H. 2006, 'Transforming the SF-36 to account for death in longitudinal studies with three-year follow-up', MEDICAL CARE, vol. 44, no. 10, pp. 956-959.
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Li, M., Dibley, M.J., Sibbritt, D. & Yan, H. 2006, 'Factors associated with adolescents' physical inactivity in Xi'an City, China', MEDICINE AND SCIENCE IN SPORTS AND EXERCISE, vol. 38, no. 12, pp. 2075-2085.
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Li, M., Yan, H., Dibley, M.J., Chang, S.Y. & Sibbritt, D. 2006, '[Prevalence of overweight and obesity and its associated risk factors in students aged 11-17 in Xi'an in 2004].', Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae, vol. 28, no. 2, pp. 234-239.

OBJECTIVE: To assess the magnitude of overweight and obesity and its associated sociodemographic factors in adolescents attending junior high schools in Xi'an, Shanxi province. METHODS: A total of 1 804 adolescents attending junior high schools in Xi'an (age: 11-17 years) were enrolled randomly from 30 schools in 6 districts in Xi'an. Overweight and obesity was categorized with body mass index (BMI) cutoffs from Working Group of Obesity in China (WGOC). Underweight was defined by BMI-Z < or = -2 s. Sociodemographic information was collected from the parents of the survey participants using self-administered, structured and precoded questionnaires. RESULTS: Overall 17.4% of adolescents were overweight or obese (overweight 11.2%; obesity 6.2%), but there was a marked gender difference in the prevalence with 20.2% of boys versus 14.4% of the girls being overweight or obese. The prevalence of underweight was 2.7%. In a multivariate model, age, residence, household wealth, and parents' BMI were significantly associated with overweight and obesity (P < 0.05). After having been adjusted for age and gender, the odds ratio of an adolescent being overweight and obese was 2.7 (95% CI: 1.8-4.0) folds higher in urban areas than in rural areas, and was 1.6 (95% CI: 1.04-2.5) folds higher for adolescents from rich families than those from poor families. An adolescent with one or both parents overweight was 1.8 (95% CI: 1.3-2.5) more likely to be overweight themselves compared to those with normal weight parents. CONCLUSIONS: Overweight and obesity is a major public health problem in adolescents in Xi'an. Overweight and obesity is more prevalent in younger boys from richer families living in urban districts and those whose parents were either overweight or obese.

Sibbritt, D., Isbister, G.K. & Walker, R. 2006, 'Emergency department performance indicators that encompass the patient journey.', Quality management in health care, vol. 15, no. 1, pp. 27-38.

OBJECTIVE: The study aimed to provide a recommended list of performance indicators from routinely collected data that measure most aspects of the patient journey through the emergency department (ED). METHODS: Data from a large tertiary ED were used to investigate the proposed performance indicators, which fell into 7 categories: background information, time from arrival to triage, time from triage to treatment, length of stay, readmission rate, left without being seen, and deaths in the ED. MAIN RESULTS: Category 1 patients were triaged, treated, and discharged rapidly. For category 2 patients, the times from arrival to triage increased but times from triage to treatment were relatively stable. Patients in categories 3 and 4 were not triaged rapidly and both the arrival to triage and triage to treatment processes were unstable and deteriorating. The average time to treatment for patients treated outside recommended times was unstable and increasing for categories 2, 3, and 4. The number of patients who left without being seen was stable except for 2 periods, and the readmission rate was stable except for 1 period of increase. CONCLUSION: The performance indicators use only routinely collected data and clearly identify the areas in which this ED performed poorly.

Adams, J., Sibbritt, D. & Young, A.F. 2005, 'Naturopathy/herbalism consultations by mid-aged Australian women who have cancer', European Journal of Cancer Care, vol. 14, no. 5, pp. 443-447.
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Complementary and alternative medicine (CAM) is now a significant practice issue for those delivering cancer care with a range of CAM being utilized by a significant number of patients with cancer. While various studies have explored the prevalence of CA

Magin, P., Adams, J., Sibbritt, D., Joy, E. & Ireland, M. 2005, 'Experiences of occupational violence in Australian urban general practice: a cross-sectional study of GPs', Medical Journal of Australia, vol. 183, no. 7, pp. 352-356.
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Objective: To establish the prevalence and characteristics of occupational violence in Australian urban general practice, and examine practitioner correlates of violence. Design, setting and participants: Cross-sectional questionnaire survey mailed to al

Girgis, A., Adams, J. & Sibbritt, D. 2005, 'The use of complementary and alternative therapies by patients with cancer', Oncology Research, vol. 15, no. 5, pp. 281-289.
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The aim of this research was to assess the prevalence and predictors of complementary and alternative therapy (CAT) use among cancer patients in Australia. A total of 1492 cancer patients attending nine major public cancer treatment centers in New South

Sibbritt, D., Adams, J. & Young, A. 2005, 'A longitudinal analysis of mid-aged women's use of complementary and alternative medicine (CAM) in Australia, 1996-1998.', Women & Health, vol. 40, no. 4, pp. 41-56.
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Complementary and Alternative Medicine (CAM) has become increasingly popular amongst healthcare consumers worldwide. As such, CAM is now an important public health issue with serious implications for healthcare organization and delivery. While previous studies have provided a profile of CAM users, there remains very limited analysis of CAM consumption over time. The purpose of this paper is to describe the changing use of CAM practitioners over time by 11,454 mid-age women in the Australian Longitudinal Study on Women's Health. Over the study period (19961998), 10% of women adopted the use of CAM and 9% relinquished CAM. The predominant factor found to be predictive of CAM adoption was changes in health status. Specifically, those women experiencing more illness over time are more likely to adopt CAM than those experiencing no change or better health. CAM relinquishment was associated with use of non-prescription medications, where women were more likely to relinquish CAM if they never used non-prescription medications or if they stopped taking non-prescription medications. This paper constitutes an exploratory investigation into CAM use over time. As such, there is need for further research to provide in-depth examination of the adoption and relinquishment of CAM use over a longer time period.

Chiarelli, P., Bower, W., Wilson, A., Attia, J. & Sibbritt, D. 2005, 'Estimating the prevalence of urinary and faecal incontinence in Australia: systematic review', AUSTRALASIAN JOURNAL ON AGEING, vol. 24, no. 1, pp. 19-27.
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Watson, T.A., Callister, R., Taylor, R.D., Sibbritt, D.W., MacDonald-Wicks, L.K. & Garg, M.L. 2005, 'Antioxidant restriction and oxidative stress in short-duration exhaustive exercise.', Medicine and science in sports and exercise, vol. 37, no. 1, pp. 63-71.
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PURPOSE: To determine the effect of dietary antioxidant restriction on oxidative stress, antioxidant defenses, and exercise performance in athletes. Oxidative stress has been shown to increase during exercise. To alleviate oxidative stress, a high intake of antioxidant rich foods or supplements may be required in trained athletes. METHODS: Plasma oxidative stress and antioxidant defenses were examined in 17 trained athletes who underwent two separate exercise tests. Before the initial exercise test participants followed their habitual (high) antioxidant (H-AO) diets. Then they followed a 2-wk restricted-antioxidant (R-AO) diet before the second exercise test. Blood was taken at rest, after submaximal and high-intensity exhaustive exercise, and after 1 h of recovery. RESULTS: The R-AO diet induced a threefold reduction in antioxidant intake when compared with habitual-antioxidant (H-AO) diets. F(2)-isoprostane concentration (marker of oxidative stress) was significantly higher after submaximal exercise (38%), exhaustion (45%), and 1 h of recovery (31%) when following the R-AO diet compared with the H-AO diet. Rate of perceived exertion was increased on the R-AO diet whilst exercise time to exhaustion was not affected. Total antioxidant capacity and circulating antioxidant concentrations, although not significantly different, tended to be lower when following the R-AO diet. CONCLUSION: Athletes regularly participating in up to 40 min of acute high-intensity exercise may require higher intakes of exogenous antioxidants to defend against increased oxidative stress during exercise, which can be met through an adequate intake of high-antioxidant foods. Thus, there seems no valid reason to recommend antioxidant supplements to athletes participating in acute high-intensity exercise events up to 40 min in duration, except in those known to be consuming a low-antioxidant diet for prolonged periods.

Isbister, G.K., Downes, F., Sibbritt, D., Dawson, A.H. & Whyte, I.M. 2004, 'Aspiration pneumonitis in an overdose population: Frequency, predictors, and outcomes', CRITICAL CARE MEDICINE, vol. 32, no. 1, pp. 88-93.
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Isbister, G.K., O'Regan, L., Sibbritt, D. & Whyte, I.M. 2004, 'Alprazolam is relatively more toxic than other benzodiazepines in overdose', BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, vol. 58, no. 1, pp. 88-95.
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Sibbritt, D. & Gibberd, R. 2004, 'The effective use of a summary table and decision tree methodology to analyze very large healthcare datasets.', Health care management science, vol. 7, no. 3, pp. 163-171.

Very large datasets typically consists of millions of records, with many variables. Such datasets are stored and maintained by organizations because of the perceived potential information they contain. However, the problem with very large datasets is that traditional methods of data mining are not capable of retrieving this information because the software may be overwhelmed by the memory or computing requirements. In this article we outline a method that can analyze very large datasets. The method initially performs a data reduction step through the use of a summary table, which is then used as a reference dataset that is recursively partitioned to grow a decision tree.

Hope-Allan, N., Adams, J., Sibbritt, D. & Tracy, S. 2004, 'The use of acupuncture in maternity care: a pilot study evaluating the acupuncture service in an Australian hospital antenatal clinic.', Complementary therapies in nursing & midwifery, vol. 10, no. 4, pp. 229-232.
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This paper outlines an exploratory study charting the circumstances of use and patient perspectives regarding the acupuncture service offered in an antenatal clinic at an Australian public hospital. Study participants were recruited from women attending the antenatal clinic. Upon completion of their course of acupuncture treatment, 52 women were given a questionnaire, of which 37 (71%) were completed and returned. Of the 37 women who attended the acupuncture clinic, 18 (49%) had previously used at least one form of complementary medicine/therapy. The most common reason for treatment was physiological symptoms including back pain, symphysis pubis dysfunction and sciatica. All 37 women stated that the acupuncture improved their well-being and this finding was statistically significant (P<0.001). These findings are offered as a means of identifying potential issues for future investigation in this under-researched area.

Isbister, G.K. & Sibbritt, D. 2004, 'Developing a decision tree algorithm for the diagnosis of suspected spider bites.', Emergency medicine Australasia : EMA, vol. 16, no. 2, pp. 161-166.

OBJECTIVE: To develop a diagnostic algorithm (decision tree) to improve the ability to identify or predict medically important spider bites (funnel-web and redback spiders) from information about the circumstances and initial clinical effects of spider bites. METHODS: A dataset of definite spider bites with expert identification of all spiders was used from a previous Australia-wide prospective study. Spider bites were categorized as: big black spider (BBS), redback spider (RED) and other spider (OTH). Big black spider included funnel-web spiders (most medically significant), but also other spiders of similar appearance. Fifteen predictor variables were based on univariate analysis from previous studies and clinical experience. They included information about the circumstances and early clinical effects of bites. The data were analyzed using CART (Classification and Regression Trees), a 'decision tree' algorithm used to create a tree-like structure to describe a data set. RESULTS: Of 789 spider bites there were 49 (6.2%) bites by BBS, 68 (8.6%) bites by RED and 672 (85.2%) bites by OTH. A decision tree was developed that included six predictor variables (fang marks/bleeding; state/territory; local diaphoresis; month; time of day; and proximal or distal bite region). The decision tree accurately classified 47 out of the 49 (96%) BBS, and no funnel-web spiders were incorrectly classified (100% sensitivity). Two hundred and forty-four of 789 were classified as OTH and included no BBS. CONCLUSIONS: A decision tree based on a small amount of information about the circumstances and early clinical effects of spider bites safely predicted all funnel-web spider bites. Application of this algorithm would allow the early institution of appropriate treatment for funnel-web spider bites and the immediate discharge of 31% as other spider bites (reassurance only).

Attia, J.R., Nair, B.R., Sibbritt, D.W., Ewald, B.D., Paget, N.S., Wellard, R.F., Patterson, L. & Heller, R.F. 2004, 'Generating pre-test probabilities: a neglected area in clinical decision making.', The Medical journal of Australia, vol. 180, no. 9, pp. 449-454.

OBJECTIVE: To assess the accuracy and variability of clinicians' estimates of pre-test probability for three common clinical scenarios. DESIGN: Postal questionnaire survey conducted between April and October 2001 eliciting pre-test probability estimates from scenarios for risk of ischaemic heart disease (IHD), deep vein thrombosis (DVT), and stroke. PARTICIPANTS AND SETTING: Physicians and general practitioners randomly drawn from College membership lists for New South Wales and north-west England. MAIN OUTCOME MEASURES: Agreement with the "correct" estimate (being within 10, 20, 30, or > 30 percentage points of the "correct" estimate derived from validated clinical-decision rules); variability in estimates (median and interquartile ranges of estimates); and association of demographic, practice, or educational factors with accuracy (using linear regression analysis). RESULTS: 819 doctors participated: 310 GPs and 288 physicians in Australia, and 106 GPs and 115 physicians in the UK. Accuracy varied from about 55% of respondents being within 20% of the "correct" risk estimate for the IHD and stroke scenarios to 6.7% for the DVT scenario. Although median estimates varied between the UK and Australian participants, both were similar in accuracy and showed a similarly wide spread of estimates. No demographic, practice, or educational variables substantially predicted accuracy. CONCLUSIONS: Experienced clinicians, in response to the same clinical scenarios, gave a wide range of estimates for pre-test probability. The development and dissemination of clinical decision rules is needed to support decision making by practising clinicians.

Parvathy, M., Sibbritt, D.W. & Adams, J. 2004, 'The use of herbal medicines for the treatment of menopausal symptoms. A pilot study of women attending general practice.', Australian family physician, vol. 33, no. 11, pp. 955-956.
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Shah, N.C., Sibbritt, D.W., Heaney, S. & Sharples, J. 2004, 'Sphygmomanometers: An audit in general practice', Australian Family Physician, vol. 33, no. 11, pp. 952-954.

Background The accuracy of sphygmomanometers used in Australian general practice is unknown but potentially important. Method We measured the accuracy of sphygmomanometers in general practice in the Hunter region of New South Wales using a gold standard. Practices were recruited by an advertisement in the division newsletter. Results Sixty practices (35%) volunteered. A total of 404 instruments were checked. Over 95% of sphygmomanometers were within 4 mmHg of gold standard sphygmomanometer across the clinical pressure range. Mercury sphygmomanometers were more accurate than aneroid (p<0.01). There was no significant association between accuracy and age, calibration, or visual inspection of the instruments. DISCUSSION This study demonstrated a high accuracy rate of the sphygmomanometers checked, especially those sphygmomanometers that were mercury.

Adams, J., Easthope, G. & Sibbritt, D. 2003, 'Exploring the relationship between womens health and the use of complementary and alternative medicine', Complementary Therapies In Medicine, vol. 11, no. 3, pp. 156-158.
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In this paper we identify the need for further research exploring the relationship between complementary and alternative medicine (CAM) use and womens health. We offer our personal thoughts on the direction such future research might take outlining a num

Adams, J., Sibbritt, D., Easthope, G. & Young, A.F. 2003, 'The profile of women who consult alternative health practitioners in Australia', Medical Journal of Australia, vol. 179, no. 6, pp. 297-300.
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Objectives: To compare the characteristics of complementary and alternative medicine (CAM) users and non-users among Australian women. Design: Cross-sectional postal questionnaire conducted during 1996, forming the baseline survey of the Australian Longi

Sibbritt, D., Adams, J., Easthope, G. & Young, A.F. 2003, 'Complementary and alternative medicine (CAM) use among elderly Australian women who have cancer', Supportive Care in Cancer, vol. 11, no. 8, pp. 548-550.
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The use of complementary and alternative medicine (CAM) in the general population has grown considerably in recent years. However, little is known about the prevalence of CAM use amongst women with cancer. Our research provides the first step in addressi

Dunkley, E.J.C., Isbister, G.K., Sibbritt, D., Dawson, A.H. & Whyte, I.M. 2003, 'The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity', QJM-AN INTERNATIONAL JOURNAL OF MEDICINE, vol. 96, no. 9, pp. 635-642.
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Watson, J.F., Collins, C.E., Dibley, M.J., Garg, M.G. & Sibbritt, D. 2003, 'Design considerations in the development of a food-frequency questionnaire for school-aged children.', Asia Pacific journal of clinical nutrition, vol. 12 Suppl, p. S24.

Background - Recent estimates of child and adolescent obesity are between 20% and 23%, with this rate continuing to increase. Effective prevention and treatment requires an understanding of the factors involved, including the role of dietary intake. Food frequency questionnaires (FFQs) are the most practical and economic method for assessing dietary intakes in large epidemiologic studies. There is currently no widely accepted FFQ for school-aged children in Australia and this gap has been acknowledged as an important area for future research. Objective - To develop and pre-test a FFQ for assessing the dietary intakes of children and adolescents aged between 9 and 16 years in the Hunter Region, NSW. Design - Focus groups were held with 61 school-aged students. Pre-testing was undertaken in another sample of 44 school-aged children and included a qualitative survey. Outcomes - The focus group results were used to refine the food list. Subsequent pre-testing identified difficulties encountered by the children during completion of the FFQ and some small changes were made to the food list, the formatting and language of the FFQ. Conclusion - The FFQ takes between 15 and 30 minutes to complete and is a feasible method for assessing the dietary intakes of Australian youth.

Watson, T.A., Callister, R., Taylor, R., Sibbritt, D., MacDonald-Wicks, L.K. & Garg, M.L. 2003, 'Antioxidant restricted diet increases oxidative stress during acute exhaustive exercise.', Asia Pacific journal of clinical nutrition, vol. 12 Suppl, p. S9.

Background - Foods high in antioxidants are considered to play a major role in defending the body against oxidative stress during exercise. Objective - To investigate the effects of short-term restriction of high-antioxidant foods on oxidative stress markers and antioxidant defences during acute exercise. Design - Antioxidant rich foods were restricted in 17 athletes exercised to exhaustion and blood antioxidant and oxidative stress markers were examined. Participants followed habitual diets high in antioxidants prior to an initial exercise test and then followed a two-week restricted-antioxidant (R-AO) diet before a second exercise test. During both exercise tests blood samples were taken pre-exercise, post sub-maximal exercise, post exhaustion and with one hour recovery. Outcomes - The R-AO diet reduced antioxidant intake 3-fold when compared to habitual-antioxidant (H-AO) intakes. F2-isoprostanes (oxidative stress marker) was significantly increased following sub-maximal exercise (38%), exhaustive exercise (45%) and one hour recovery (31%) on the R-AO diet compared to the H-AO diet. F2-isoprostanes during exercise when following the H-AO diet remained relative unchanged from rest. Total antioxidant capacity and circulating anti-oxidants were not significantly affected by the R-AO diet, but tended to be lower. Exercise performance was not affected by the R-AO diet. Conclusions - Trained athletes may require higher intakes of exogenous antioxidants to defend against increased oxidative stress during exercise, which can be met through a diet rich in high antioxidant foods.

Sibbritt, D. & Gibberd, R. 1996, 'The annual variation in activity and funding for acute public hospitals in NSW, 1988-89 to 1992-93.', Australian health review : a publication of the Australian Hospital Association, vol. 19, no. 1, pp. 52-67.

Casemix-based funding was introduced into the Victorian health system without an assessment of the annual variation in inpatient activity. Before undertaking such a funding reform, it would be appropriate to determine the level of annual variation in inpatient activity for individual hospitals that could be attributable to chance or random variation. If the annual random variation is not accounted for, then casemix-based funding may actually lead to inefficiencies. For this study, hospital inpatient activity and funding data for 120 acute public hospitals from New South Wales for the years 1988-89 to 1992-93 were used to estimate the standard deviation of the annual random variation in activity and gross operating payment. Through linear regression, estimates of the standard deviation of random variation about the underlying trend were obtained for each hospital. The results showed that, depending on the size of the hospital, total diagnosis related group cost weights have a standard deviation in the range of 2 to 16 per cent of total activity, whilst gross operating payment has an equivalent standard deviation that ranges from 1 to 10 per cent annually. The magnitude of the variation would suggest that funding of hospitals should either be based on average activity over several years or based on bands of activity in order to reduce the potential random variation in funding levels.

Sibbritt, D.W. 1995, 'Validation of a 28 day interval between discharge and readmission for emergency readmission rates.', Journal of quality in clinical practice, vol. 15, no. 4, pp. 211-220.

For the majority of studies on hospital readmission rates, a readmission is deemed to have occurred if a patient was admitted within 28 days of the previous discharge date. This time period, however, has rarely been justified clinically or statistically and certainly not in Australia. In examining the patterns of readmissions to NSW public acute hospitals, this study provides statistical support for the use of a 28 day interval for total readmissions. The same finding applies to the four admission categories of medical, surgical, paediatrics, and obstetrics and gynaecology.

Fahey, P. & Sibbritt, D. 1994, 'Statistical tools for understanding variation: the allocation of operating suite time.', Journal of quality in clinical practice, vol. 14, no. 4, pp. 177-186.

Australian hospitals are becoming increasingly familiar with the 'new' tools for continuous quality improvement. In particular, many are becoming increasingly competent in establishing and supporting quality improvement teams for process evaluation and improvement. The main problems with such teams now seems to arise in relation to the analysis and interpretation of data on the process. This paper provides an example of the types of analyses and interpretations required of today's quality improvement practitioner in health care.

Sibbritt, D.W. 1994, 'Readmissions of day-only patients in NSW acute hospitals.', Journal of quality in clinical practice, vol. 14, no. 1, pp. 31-38.

Day-only admissions have increased substantially over the last decade. With the increase in numbers, it is necessary to consider the quality of care of the patients undergoing a day-only admission. The readmission rate can be used as one such guide to quality of care. For several large Sydney hospitals, the percentage of patients readmitted was consistent across all lengths of stay (approximately 9%). When considering those type of admissions that are more suited to day surgery units, the readmission rate was 4.4%. This is suggestive of conservative selection criteria for day surgery unit patients.

Sibbritt, D.W. 1992, 'Trends and projections for day only admissions in NSW acute hospitals.', Australian clinical review, vol. 12, no. 3, pp. 115-124.

The rapid increase in the number of day only admissions during the last decade has led to an increased awareness of this type of hospital admission. Health planners are now interested in which procedures are causing the increase in the day only activity and how best to accommodate it in the future. To address these issues, routinely collected hospital data were used to analyse trends in day only admissions and to extrapolate future demand via regression models. The results suggest that day only admissions will constitute 45% of all admissions to NSW acute hospitals by the year 2001. Detailed review of patient caseloads suggest that 13.5% of all patients will be potentially treatable through day surgery units, as opposed to general wards, by 2001. Assuming 80% of these potential patients actually do get treated in day surgery units, then the workload generated could be accommodated within 30 day surgery facilities.

Sibbritt, D., Adams, J. & Casey, M. 1991, 'Australian herbalists' perceptions of professional clinical support.', Australian Journal of Medical Herbalism, vol. 18, no. 3, pp. 93-98.
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Objective: To describe the perceptions held by members of the National Herbalists Association of Australia (NHAA) regarding the levels of intraprofessional support available to them upon entering clinical practice. Design: A national postal survey sent to all full members of the NHAA. Setting Nationwide herbal clinics of NHAA practitioners in Australia. Main outcome measures: Rating scales of perceptions of support (1=very supportive, 2=somewhat supportive, 3=a little supportive, 4=not supportive) provided by the respondents in regard to their educational institution, professional association (NHAA) and other practitioners, reported as frequencies and means. Results: Herbalists appear to receive most support from informal interprofessional relationships with other practitioners (mean=2.13) and some support from their professional association (mean=2.35). The majority of herbalists do not perceive their training institution (mean=3.18) as being very supportive. Conclusion: The survey results show a significant degree of consistency in attitudes across Australia by members of the NHAA towards perceptions of available postgraduate support. The survey data indicates that support available to herbalists when entering clinical practice is on an informal, practitioner to practitioner basis, as opposed to the result of any formal structures. This research highlights how herbalists perceive formal support structures available to them as postgraduates as insufficient.

Other

Rao, A., Hickman, L., Sibbritt, D. & Phillips, J.L. 2014, 'Palliative care patients may benefit from biofield (energy) therapies'.

Selected Peer-Assessed Projects

Fit for the future: safeguarding the health and wellbeing of the Australian nursing workforce to sustain future healthcare service delivery

Navigating Back Pain Care: a Sociological Study of Women's Illness Pathways Within and Between Intersecting Social Worlds

Therapeutic pluralism in pregnancy, labour and birthing: decision-making, communication and inter-professional dynamics

The rise of complementary self-care: A national sociological study of women's strategies for coping and living with chronic illness

Australian Chiropractic Research Network (ACORN) Longitudinal Program

Birth Costing The Place of Birth in NSW

Cost Utility of Massage for the Management of Low Back Pain in Australia

Recommendations for the use of complementary and alternative medicine (CAM) for the prevention of stroke: a synthesis and communication of evidence to key stakeholders.

Examining insider perspectives and experiences regarding approaches to stroke prevention in aged care facilities: a focus upon complementary and alternative medicine approaches