To evaluate the effects of behavioral interventions on the sleep/wakefulness of infants, parent and infant stress, and later child emotional/behavioral problems, and parent-child attachment. METHODS:A total of 43 infants (6-16 months, 63% girls) were randomized to receive either graduated extinction (n = 14), bedtime fading (n = 15), or sleep education control (n = 14). Sleep measures included parent-reported sleep diaries and infant actigraphy. Infant stress was measured via morning and afternoon salivary cortisol sampling, and mothers' self-reported mood and stress. Twelve months after intervention, mothers completed assessments of children's emotional and behavioral problems, and mother-child dyads underwent the strange situation procedure to evaluate parent-child attachment.RESULTS: Significant interactions were found for sleep latency (P < .05), number of awakenings (P < .0001), and wake after sleep onset (P = .01), with large decreases in sleep latency for graduated extinction and bedtime fading groups, and large decreases in number of awakenings and wake after sleep onset for the graduated extinction group. Salivary cortisol showed small-to-moderate declines in graduated extinction and bedtime fading groups compared with controls. Mothers' stress showed small-to-moderate decreases for the graduated extinction and bedtime fading conditions over the first month, yet no differences in mood were detected. At the 12-month follow-up, no significant differences were found in emotional and behavioral problems, and no significant differences in secureinsecure attachment styles between groups.CONCLUSIONS: Both graduated extinction and bedtime fading provide significant sleep benefits above control, yet convey no adverse stress responses or long-term effects on parent-child attachment or child emotions and behavior. Women's and Children's Health Network, Adelaide, South Australia, Australia Dr Gradisar provided co-conception and design of the study, supervision of most of the analyses and conducted the rest of analyses, signifi cant contribution to the interpretation of analyses, and was main contributor to writing of manuscript; Dr Jackson provided co-conception and design of the study, collected most of the data (pretreatment to 3 months), conducted most of the analyses, provided signifi cant input to the literature reviewed, was a minor contributor to writing of the manuscript, and provided critical evaluation of manuscript drafts; Dr Spurrier provided co-conception and design of the study, critical evaluation of manuscript drafts, and interpretation of fi ndings; Ms Gibson provided input into study design, collected most of the 12-month follow-up data, and provided interpretation of fi ndings and critical evaluation of manuscript drafts; Dr Whitham provided input into the study design, conducted data scoring and analyses of 12-month 2 Large declines in nocturnal wakefulness occur (on average) over the first 6 months of age, and plateau thereafter, 2, 5 occurring after 24-hour circadian rhythm stabilization ...

Participation in regular physical activity has a variety of health benefits including increased levels of function and independence for people who are ageing. The inclusion of motor learning principles into exercise programs is proposed to increase functional benefits. The presence of these principles in the Feldenkrais Method (FM) suggests this may be a beneficial program for the ageing population. Objective: A proof of concept study was conducted to determine the effectiveness of an eight week movement class based on the FM when compared to a generic balance class. Method: A pseudo-randomized controlled pilot study was conducted in an Australian community based organization of healthy people post-retirement, n=22. Self-perceived health and functional status were measured by the Short-Form 36 (SF-36) and Patient-Specific Functional Scale (PSFS) respectively. Objective functional assessment, by a blinded assessor, included the Timed Up and Go Test (TUGT), Functional Reach Test (FRT), Single Leg Stance time (SLS) and Walk on Floor Eyes Closed (WOFEC) measures. Results: There was a significant time effect for all measures except the WOFEC. Post hoc analysis demonstrated significant improvements for both the FM and generic groups in the SF-36, PSFS and FRT and for the FM group only in the SLS test. Conclusions: Classes based on the FM are effective in improving health and functional measures in a healthy ageing population, equally so with the generic class. Considerations for future research include a randomized controlled trial in a rehabilitation setting, with a larger sample size and appropriate measures to detect relevant change in functional levels.

This paper describes the older people's mental health workforce development, policy development and implementation process and quantifies the rural service delivery and access impacts over a 15‐year period in New South Wales. It highlights the factors that are considered to be critical to successful rural service development such as commitment to funding parity, investment in strong local service leadership, and development of innovative, locally adapted rural service models. Building on these foundations, the Older People's Mental Health Program in New South Wales was able to address key challenges relating to service access in rural health and develop new, sustainable specialist older people's mental health service networks. A sustained focus on policy and implementation which explicitly supports rural older people's mental health service enhancement, and development of evidence‐based models of care, has significantly improved access to specialist mental health care for older people in rural areas. It has delivered 23 new rural older people's mental health community teams and a 440% increase in the number of people accessing these teams. It has also doubled the number of acute inpatient units and established new specialist mental health‐residential aged care partnership services in rural New South Wales. It has resulted in increased access to services for the “older old,” while not diminishing older people's rates of access to general adult mental health services. It has also supported innovative, sustainable rural service models such as “hub and spoke” models and step‐up step‐down inpatient services that build on existing health and hospital infrastructure and link geographically dispersed specialist clinicians and services together in rural service delivery.

There is no nationally accepted pathway of care for this vulnerable group or understanding of what constitutes an adequate statewide mental health service.

With already wide disparities in physical health and life expectancy, COVID-19 presents people with mental illness with additional threats to their health: decreased access to health services, increased social isolation, and increased socio-economic disadvantage. Each of these factors has exacerbated the risk of poor health and early death for people with mental illness post-COVID-19. Unless effective primary care and preventative health responses are implemented, the physical illness epidemic for this group will increase post the COVID-19 pandemic. This perspective paper briefly reviews the literature on the impact of COVID-19 on service access, social isolation, and social disadvantage and their combined impact on physical health, particularly cancer, respiratory diseases, heart disease, smoking, and infectious diseases. The much-overlooked role of poor physical health on suicidality is also discussed. The potential impact of public health interventions is modelled based on Australian incidence data and current research on the percentage of early deaths of people living with mental illnesses that are preventable. Building on the lessons arising from services’ response to COVID-19, such as the importance of ensuring access to preventive, screening, and primary care services, priority recommendations for consideration by public health practitioners and policymakers are presented.