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The industry diversity thesis of economic resilience to economic shocks is embedded in community development policy across Australia. The idea being that in the event of an economic shock some industries will prove more recession‐proof than others. The greater the industry diversity, the greater the likelihood of off‐setting industry effects, resulting in greater economic resilience. The COVID‐19 pandemic and the associated restrictions created a unique natural experiment to explore whether the industry diversity thesis holds true under the conditions of a global health pandemic. In this policy paper, we use JobKeeper applications as a proxy for decreased economic resilience. We explore if Australian local government areas (LGAs) with higher industry diversity had less necessity for JobKeeper. We also briefly consider if concentrations of certain industries acted as a better economic buffer to the COVID‐19 economic shock. We observe that as diversity increases, economic resilience strengthens except for Victoria (where the association is inverted). This observation has important implications for current and future policy formation and implementation across all layers of government. [ABSTRACT FROM AUTHOR]

This paper presents a method to analyze and improve the set of equations constituting a rainfall‐runoff model structure based on a combination of a data assimilation algorithm and polynomial updates to the state equations. The method, which we have called "Data Assimilation Informed model Structure Improvement" (DAISI) is generic, modular, and demonstrated with an application to the GR2M model and 201 catchments in South‐East Australia. Our results show that the updated model generated with DAISI generally performed better for all metrics considered included Kling‐Gupta Efficiency, NSE on log transform flow and flow duration curve bias. In addition, the elasticity of modeled runoff to rainfall is higher in the updated model, which suggests that the structural changes could have a significant impact on climate change simulations. Finally, the DAISI diagnostic identified a reduced number of update configurations in the GR2M structure with distinct regional patterns in three sub‐regions of the modeling domain (Western Victoria, central region, and Northern New South Wales). These configurations correspond to specific polynomials of the state variables that could be used to improve equations in a revised model. Several potential improvements of DAISI are proposed including the use of additional observed variables such as actual evapotranspiration to better constrain internal model fluxes. Plain Language Summary: This paper presents a data‐driven method to improve rainfall‐runoff models used to generate future water resources scenario in climate change studies. The method, which we have called "Data Assimilation Informed model Structure Improvement" (DAISI) is generic, modular, and demonstrated with an application to monthly streamflow simulations over a large data set of catchments in South‐East Australia. Our results show that DAISI improves model performance for a wide range of metrics and increases the sensitivity of the model to climate inputs, which is critical in climate change scenarios. Finally, the improvements identified by DAISI take a simple mathematical form with distinct regional patterns in three sub‐regions of the study domain (Western Victoria, central region, and Northern New South Wales). Several improvements of DAISI are discussed including the inclusion of additional observed variables such as evapotranspiration to better constrain model simulations. Key Points: Data Assimilation Informed model Structure Improvement method diagnoses hydrological model structures by combining data assimilation with a polynomial update of state equationsThe method was applied to the GR2M rainfall‐runoff model with significantly improved streamflow simulations in 201 Australian catchmentsThe method identified updates to state equations with marked regional characteristics that could guide future improvement of GR2M [ABSTRACT FROM AUTHOR]

In Disaster Management (DM), reusing knowledge of best practices from past experiences is envisaged as the best approach for dealing with future disasters. But analysing and modelling processes involved in those experiences is a well-known challenge. But the efficient storage of those processes to allow reuse by others in future DM endeavours is even more challenging and less discussed. Without an efficient process in place, DM knowledge reuse becomes even more remote as the effort incurred gets construed as a hindrance to more pressing activities during the execution of disaster activities. Efficiency has to also be pursued without compromising the effectiveness of the knowledge analysis and reuse. It is important to ensure that knowledge remains meaningful and relevant after it is transformed. This paper presents and validates a DM knowledge analysis framework (DMKAF 2.0) that caters for efficient transformation of DM knowledge intended for reuse. The paper demonstrates that undertaking knowledge transformation and storage in the context of its use is crucial in DM for both, effectiveness and efficiency of the transformation process. Design Science Research methodology guides the research undertaken, by informing enhancements and how the framework is evaluated. A real case study of flood DM from the State Emergency Service of Victoria State Australia is successfully used to validate these enhancements. [ABSTRACT FROM AUTHOR]

Indigenous young people around the world suffer poorer mental health outcomes than their non-Indigenous peers. Currently, how culture matters for health, what cultural practices are used in community to support health and well-being, and how culture is passed on in Aboriginal contemporary life in southeast Australia--the region most affected by settler-colonisation--is not well understood. This paper presents findings from yarns with a representative sample of 44 Indigenous participants working in the field of health and well-being that explored how culture interleaves with health and well-being. It uses grounded theory as the overarching methodology with community participation in all aspects of the project. Participants were nominated through snowball sampling and screened by a governing board of Elders. They included men and women of varied ages with half residing in urban areas and half in rural Victoria, Australia. They had declared affiliations to 31 traditional tribal groups. The yarns were held over Zoom videoconferencing between an Indigenous research assistant who was part of the community, and each participant. Each yarn was recorded, transcribed, coded and analysed by a multi-perspectival team. Culture was viewed as central to individual and communal life and passed on through relationships with people and Country itself. Community members used a wide variety of cultural practices to aid and maintain health and wellbeing in profound ways. Myriad extant obstacles to health and well-being were also described, from experiences of disconnection through to barriers for accessing services. These findings have the potential to shape future holistic care and policy. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has demonstrated how a stochastic disruptive event can dramatically alter community soundscapes. Whilst religious bells have symbolism in many worldwide faiths, the sound emanating from church bells can be considered public domain and therefore, is not exclusive to the church. Pandemic-related interruption of these sounds impacts not only the church involved, but both the surrounding soundscape and any members of the community who ascribe value to these sounds. This paper examines the soundscape of Christian churches in the states of New South Wales and Victoria, to give an Australian perspective one year after the declaration of the COVID-19 pandemic in March 2020. It provides an update of the situation in Australia, building on our previous work from August of that year. In doing so, it explores the activity of church tower bell ringing, and how this "non-essential" activity has been affected, both during and subsequent to the heavy community restrictions applied in Australia. The paper also explores what lengths bellringers have undertaken to be permitted to conduct such activities, such as the use of adaptive measures due to "social distancing", and considers what implications this enforced silence has in similar soundscapes elsewhere in the world. [ABSTRACT FROM AUTHOR]

Background: Calls for the adoption of a systems approach to chronic disease prevention date back at least ten years because of the potential to empower communities to identify and address the complex causes of overnutrition, undernutrition and climate change. Australia, like many countries, has high levels of obesity and extreme climate events. The Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND) trial aims to prevent unhealthy weight gain in children in 10 intervention and two pilot communities in north-east Victoria, Australia using community-based participatory approaches informed by systems science. Intervention activities co-designed in 2019 were disrupted by COVID-19 and bushfires. This paper explores the impacts of these 'shocks' on the local prevention workforce to implement actions within communities. Methods: A case study design involving one-hour online focus groups and an on-line survey (November 2021-February 2022). Purposive sampling was used to achieve diverse representation from RESPOND stakeholders including local council, health services, primary care partnerships and department of health. The focus group interview schedule and survey questions were based on Durlak and DuPre's implementation factors. Results: Twenty-nine participants from seven different communities participated in at least one of nine focus groups to discuss the impacts of COVID-19 and bushfires on localised implementation. Twenty-eight participants (97% of focus group sample) also completed the on-line survey. Implementation of RESPOND stalled or stopped in most communities due to bushfires and/or COVID-19. These shocks resulted in organisational priorities changing, loss of momentum for implementation, redeployment of human resources, culminating in fatigue and exhaustion. Participants reported adaptation of RESPOND, but implementation was slowed due to limited resources. Conclusion: Further research is needed to advance risk management strategies and protect resources within health promotion. System shocks such as bushfires and COVID-19 are inevitable, and despite multiple adaptation opportunities, this intervention approach was not 'shock proof'. [ABSTRACT FROM AUTHOR]

This paper proposes a spatiotemporal clustering algorithm and its implementation in the R package spotoroo. This work is motivated by the catastrophic bushfires in Australia throughout the summer of 2019-2020 and made possible by the availability of satellite hotspot data. The algorithm is inspired by two existing spatiotemporal clustering algorithms but makes enhancements to cluster points spatially in conjunction with their movement across consecutive time periods. It also allows for the adjustment of key parameters, if required, for different locations and satellite data sources. Bushfire data from Victoria, Australia, is used to illustrate the algorithm and its use within the package. [ABSTRACT FROM AUTHOR]

Aim: To describe post‐neonatally acquired (PNN) cerebral palsy (CP) in terms of temporal trends in prevalence, clinical and sociodemographic profiles, known causes and associations between causes, and sociodemographic variables. Method: Numerator data, a count of children with PNN‐CP confirmed at 5 years of age (n = 523), was drawn from two Australian state CP registers (birth years 1973–2012). Poisson regression was used to investigate temporal trends in the prevalence of PNN‐CP by 5‐year intervals, calculated per 10 000 live births. Using data from all state and territory Australian CP registers (n = 469), distributions of clinical characteristics, PNN‐CP causes, and sociodemographic factors were tabulated (birth years 1995–2012). χ2 and logistic regression analyses were used to assess associations between sociodemographic profile, Australian reference data, and known causes. Results: A significant temporal decline in PNN‐CP in Victoria (p = 0.047) and Western Australia (p = 0.033) was observed. The most common proximal causes of PNN‐CP were cerebrovascular accidents (34%, n = 158), infection (25%, n = 117), and non‐accidental injuries (12%, n = 58). Children born to teenage mothers, Aboriginal and/or Torres Strait Islander mothers, or children born in remote areas were over‐represented in this cohort compared with reference data (all p ≤ 0.001). Infectious causes were strongly associated with teenage motherhood (odds ratio 3.0 [95% confidence interval 1.1–8.2], p = 0.028) and remote living (odds ratio 4.5 [95% confidence interval 2.0–10.2], p < 0.001). Interpretation: Although prevalence of PNN‐CP has declined, the over‐representation of priority populations, and the relative severity of a condition that is largely preventable, suggest the need for more specific primary preventive measures and support. What this paper adds: Prevalence of post‐neonatally acquired (PNN) cerebral palsy (CP) in Australia significantly declined between 1973 and 2012.Cerebrovascular accidents are the most common proximal cause of PNN‐CP.Children born in remote areas are at greater risk of PNN‐CP. [ABSTRACT FROM AUTHOR]

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Wind energy is a rapidly expanding renewable technology with massive global investments; however, operating turbines are associated with bat strikes globally, and evidence suggests that without intervention, wind farm collisions could drive some common species to extinction. One widely regarded method for reducing strike mortality is operational mitigation, or curtailment, where turbine operation is restricted at low wind speeds. Despite an increasing number of studies in the Northern Hemisphere demonstrating curtailment effectiveness, no empirical studies have yet been conducted in Australia. This paper reports the findings of a curtailment study implemented at the Cape Nelson North wind farm in southwest Victoria, Australia. Conservation detection dog teams conducted mortality surveys between January and April in 2018 (before; pre‐curtailment) and 2019 (after; during curtailment). Results were consistent with similar studies in the USA and Europe, as curtailment significantly reduced pooled species mortality by 54%. Bat calls did not decline during the study period, and thus were not an explanation for the reduction in fatalities. This study demonstrates that curtailment is a valid method for reducing bat turbine collision in south‐eastern Australia. Consideration should be given to curtailment as a means to reduce bat turbine impacts in Australia, particularly at sites with known endangered and threatened populations, as we act to reduce anthropogenic climate change and its time‐sensitive negative consequences. [ABSTRACT FROM AUTHOR]

Background: Community engagement or community involvement in Aboriginal health research is a process that involves partnering, collaborating and involving Aboriginal and Torres Strait Islander people or potential research participants to empower them to have a say in how research with Aboriginal communities is conducted. In the context of Aboriginal health, this is particularly important so that researchers can respond to the priorities of the community under study and conduct research in a way that is respectful of Aboriginal cultural values and beliefs. One approach to incorporating the principals of community engagement and to ensure cultural oversight and guidance to projects is to engage a community reference group. The aim of this study was to describe the process of establishing an Aboriginal community reference group and terms of reference. The community reference group was established to guide the research activities of a newly formed research collaboration aiming to to develop osteoarthritis care that meets the needs of Aboriginal and Torres Strait Islander people in Australia. Methods: Adopting a Participatory Action Research approach, this two-phase study was conducted in Victoria, Australia. In phase one, semi-structured research yarns (a cultural form of conversation used as a data gathering tool) were conducted collaboratively by Aboriginal and non-Aboriginal co-investigators to explore Aboriginal health stakeholder perspectives on establishing a community reference group and terms of reference. In phase two, recommendations in phase one were identified to invite members to participate in the community reference group and to ratify the terms of reference through a focus group. Data were analyzed using a framework analysis approach. Results: Thirteen people (eight female, four male) participated in phase one. Participants represented diverse professional backgrounds including physiotherapy, nursing, general practice, health services management, hospital liaison, cultural safety education, health research and the arts. Three themes were identified in phase one; Recruitment and Representation (trust and relationships, in-house call-outs, broad-spectrum expertise and Aboriginal majority); Purpose (community engagement, research steering, knowledge dissemination and advocacy) and; Function and Logistics (frequency and format of meetings, size of group, roles and responsibilities, authority, communication and dissemination). In phase two, six Aboriginal people were invited to become members of the community reference group who recommended changes which were incorporated into the seven domains of the terms of reference. Conclusion: The findings of this study are captured in a 10-step framework which describes practical strategies for establishing a community reference group and terms of reference in Aboriginal health research. Plain English Summary: Community engagement or community involvement in Aboriginal health research is a process that involves partnering with Aboriginal and Torres Strait Islander people or potential research participants to empower them to have a say in how research with Aboriginal communities is carried out. In the context of Aboriginal health, this is particularly important so that researchers can respond to the priorities of the community and conduct research in a way that respectful of Aboriginal cultural values and beliefs. One approach to community engagement in research is to form a community reference group to provide input to the research project. Although using a community reference group is considered to be an effective way to involve community members in research, often there are practical challenges in setting up and sustaining such a group. In this paper, we set out to describe an approach used to set up a community reference group for a new Aboriginal health research project exploring joint pain in Aboriginal and Torres Strait Islander people. This involved interviewing 13 health professionals and researchers (12 who identified as Aboriginal and one who identified as Aboriginal and Torres Strait Islander) about how to best go about setting up a community reference group. We used recommendations from these participants to inform who we approached to be members of the group and how the group would function. In describing the process we used to establish a community reference group, we were able to design a 10-step practical guide which may help other research groups who are looking to conduct new, ethical Aboriginal health research projects. [ABSTRACT FROM AUTHOR]

Australia's natural capital is under growing cumulative pressure from land use change and intensive agriculture, fishery, forestry, and urban sprawl. This consequently reduces the benefits and services that it provides. This paper firstly assessed how current trends of land-use change have an impact on the natural capital loss in South Victoria, Australia during 2006-2016. Then in order to increase natural capital inherent value and to ensure that natural capital is multifunctional, a system of Blue-Green Infrastructure is designed within the current natural capital of Tarwin Lower, in Victoria. Given that natural capital area is declining in Australia, incorporating designed elements into existing natural capital to create multifunctional natural capital, enables maximising the supply and value of ecosystem services in order to meet the demands of a growing population. Here, three ecosystem services (stormwater abatement, water quality improvement, and water supply services) were compared in terms of existing natural capital or with integrated Blue-Green Infrastructure elements to create multifunctional natural capital system. The results indicate that planning Blue-Green Infrastructure will enhance multiple aspects of regional sustainability and resilience in the Tarwin catchment and will maximise the multifunctionality of the natural capital. Finally, the paper simulates the cost-benefit analysis for the implementation of Blue-Green Infrastructure to show that it is a cost-effective and sustainable solution to cope with the current demographic, economic and agricultural trends, which affect natural capital. This paper confirms that in order to provide ecosystem services for extra demands of growing inhabitants, Blue-Green Infrastructure networks require to be extended in the Victoria State of Australia to compensate natural capital and ecosystem service losses due to the regional and urban development. [ABSTRACT FROM AUTHOR]

Background: The RUBY randomised controlled trial was found to be effective in promoting breastfeeding continuation, in the setting of a high income country, through a program of proactive telephone-based peer support in the first 6 months postpartum. This paper explores women's experiences of receiving the peer support intervention in the RUBY trial. Methods: Ten in-depth, face-to-face interviews were conducted between December 2015 and November 2016 in Metropolitan Melbourne, and regional Victoria, Australia. Participants were women who received the peer support intervention in the RUBY trial and were between 11 and 15 months postpartum at the time of interview. Interviews were underpinned by social support theories and were analysed using inductive thematic analysis. Results: A global theme of 'non-judgemental support and guidance' was identified, which included five organising themes. Four of the organising themes centred on the support from the peer, in which women felt the support was a 'positive experience with empathy and understanding', 'non-judgemental', 'practical advice', and a 'social connection that was more than just breastfeeding'. In contrast to the support from peers was the theme 'not all support from family and friends is supportive'. Conclusion: Participants, including those who considered that they had adequate and available family and friend support for breastfeeding, valued and appreciated the non-judgemental, empathetic and understanding support from peers. This support, facilitated by the anonymity of the telephone-based program, allowed open and honest conversations, normalising women's experiences and helping them feel less alone in their challenges with breastfeeding and transition to motherhood. These findings can inform the design, and upscaling, of innovative and sustainable peer support models, ensuring delivery of effective and engaging support with a broad population reach. [ABSTRACT FROM AUTHOR]

A broad consensus exists that Australian economic activity is too heavily concentrated in capital cities, and regional employment creation should be encouraged. Given the magnitude of international migration to Australia, it is important to determine the impact of migration on regional development by investigating business ownership and job creation by international migrants in regional areas. This paper examines the probability that regional migrant business owners are employers – and thereby employment generators – using a multivariate logit model. We find that migrant business owners with staff are more likely to be male, married and live in regional NSW, metropolitan Victoria and regional and metropolitan Queensland. [ABSTRACT FROM AUTHOR]

Background and purpose: Two hubs are designated to provide endovascular clot retrieval (ECR) for the State of Victoria, Australia. In an earlier study, Google Maps application programming interface (API) was used to perform modeling on the combination of hospitals optimizing for catchment in terms of current traveling time and road conditions. It is not known if these findings would remain the same if the modeling was performed with a large-scale transport demand model such as Victorian Integrated Transport Model (VITM). This model is developed by the Victorian State Government Transport has the capability to forecast travel demand into the future including future road conditions which is not possible with a Google Maps based applications. The aim of this study is to compare the travel time to potential ECR hubs using both VITM and the Google Maps API and model stability in the next 5 and 10 years. Methods: The VITM was used to generate travel time from randomly generated addresses to four existing ECR capable hubs in Melbourne city, Australia (i.e., Royal Melbourne Hospital/RMH, Monash Medical Center/MMC, Alfred Hospital/ALF, and Austin Hospital/AUS) and the optimal service boundaries given a delivering time threshold are then determined. Results: The strategic transport model and Google map methods were similar with the R 2 of 0.86 (peak and off peak) and the Nash-Sutcliffe model of efficiency being 0.83 (peak) and 0.76 (off-peak travel). Futures modeling using VITM found that this proportion decreases to 82% after 5 years and 80% after 10 years. The combination of RMH and ALF provides coverage for 74% of cases, 68% by 5 years, and 66% by 10 years. The combination of RMH and AUS provides coverage for 70% of cases in the base case, 65% at 5 years, and 63% by 10 years. Discussion: The results from strategic transport model are similar to those from Google Maps. In this paper we illustrate how this method can be applied in designing and forecast stroke service model in different cities in Australia and around the world. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the positive impact that the creation of food processing hubs can have on "smart specialisation" on the economic development of regional Australia. The analysis looks at two existing developments in Australia, as well as providing an economic evaluation of another "regional hub" that is currently being proposed. Our paper provides an economic impact analysis of the proposed establishment of a food processing hub in Victoria. It presents an analysis on its impact both at a regional level (Gippsland), and more widely across Australia. [ABSTRACT FROM AUTHOR]

Objective: In Australia, the National Disability Strategy provides a framework to guide actions and investment to achieve equity in social inclusion and economic participation for people with disability. We investigated the social outcomes of school leavers with cerebral palsy (CP) in Victoria, Australia and explored the determinants of desirable outcomes. Methods: We used the Victorian CP Register to invite all adults with CP aged 18–25 years (n = 649). On-line and/or paper-based surveys explored participation in education, employment, community activities, living situation, relationships and life satisfaction. Functional and health status data were collected. Social outcomes were summarized descriptively and compared between individuals with CP and non-disabled peers aged 18–25 years from the Household Income and Labor Dynamics in Australia dataset. Within the CP cohort we explored whether physical and mental health and level of functioning were associated with social outcomes. In addition, a descriptive comparison was undertaken between the social outcomes of the current CP cohort with that of a previously reported 2007 cohort. Results: Ninety participants (57% male; mean age 22.4 years (SD: 2.2) in 2020; 61.1% self-reported) provided data for analyses; response rate 16.9%. CP characteristics were similar between respondents and non-respondents. In comparison to similar aged peers, 79.8% had completed secondary school (compared to 83.2%); 32.6% (compared to 75.8%) were in paid work; 87.5% (compared to 48.2%) were living in their parental home; and 3.4% (compared to 31.6%) were married or partnered. Individuals with CP and higher levels of functional capacity and better physical health were more likely to undertake post-secondary education. Higher levels of functional capacity and physical health, as well as lower mental health status were associated with being employed. Conclusions: While foundational education completion rates were similar to non-disabled peers, significant gaps in social outcomes remain, including residence in the parental home and single status. While addressing these issues is challenging, substantial efforts are needed to reduce these disparities—work that needs to be done in collaboration with people with CP and their families. [ABSTRACT FROM AUTHOR]

Background: Increasingly, strength-based approaches to health and wellbeing interventions with Aboriginal and Torres Strait Islander Australians are being explored. This is a welcome counter to deficit-based initiatives which can represent a non-Indigenous view of outcomes of interest. However, the evidence base is not well developed. This paper presents the protocol for evaluating a strengths-based initiative which provides life coaching services to Aboriginal and Torres Strait Islander community housing tenants. The study aims to evaluate the effect of life coaching on social and emotional wellbeing (SEWB) of tenants in three Victorian regions.Methods: The More Than a Landlord (MTAL) study is a prospective cohort study of Aboriginal Housing Victoria tenants aged 16 years and over that embeds the evaluation of a life coaching program. All tenant holders in one metropolitan and two regional areas of Victoria are invited to participate in a survey of SEWB, containing items consistent with key categories of SEWB as understood and defined by Aboriginal and Torres Strait Islander peoples, and key demographics, administered by Aboriginal and Torres Strait Islander peer researchers at baseline, 6 and 18 months. Survey participants are then invited to participate in strengths based life coaching, using the GROW model, for a duration of up to 18 months. Indigenous life coaches provide tenants with structured support in identifying and making progress towards their goals and aspirations, rather than needs. The study aims to recruit a minimum of 200 survey participants of which it is anticipated that approximately 73% will agree to life coaching.Discussion: The MTAL study is a response to Aboriginal and Torres Strait Islander community and organisational requests to build the evidence base for an initiative originally developed and piloted within an Aboriginal controlled organisation. The study design aligns with key principles for research in Indigenous communities in promoting control, decision making and capacity building. The MTAL study will provide essential evidence to evaluate the effectiveness of strengths-based initiatives in promoting SEWB in these communities and provide new evidence about the relationship between strengths, resilience, self-determination and wellbeing outcomes.Trial Registration: This trial was retrospectively registered with the ISRCTN Register on the 12/7/21 with the study ID: ISRCTN33665735 . [ABSTRACT FROM AUTHOR]

Background: Law purports to regulate end-of-life care but its role in decision-making by doctors is not clear. This paper, which is part of a three-year study into the role of law in medical practice at the end of life, investigates whether law affects doctors' decision-making. In particular, it considers whether the fact that the law differs across Australia's three largest states - New South Wales (NSW), Victoria and Queensland - leads to doctors making different decisions about withholding and withdrawing life-sustaining treatment from adults who lack capacity. Methods: A cross-sectional postal survey of the seven specialties most likely to be involved in end-of-life care in the acute setting was conducted between 18 July 2012 and 31 January 2013. The sample comprised all medical specialists in emergency medicine, geriatric medicine, intensive care, medical oncology, palliative medicine, renal medicine and respiratory medicine on the AMPCo Direct database in those three Australian states. The survey measured medical specialists' level of legal compliance, and reasons for their decisions, concerning the withholding or withdrawal of lifesustaining treatment. Multivariable logistic regression was used to examine predictors of legal compliance. Linear regression was used to examine associations between the decision about life-sustaining treatment and the relevance of factors involved in making these decisions, as well as state differences in these associations. Results: Response rate was 32% (867/2702). A majority of respondents in each state said that they would provide treatment in a hypothetical scenario, despite an advance directive refusing it: 72% in NSW and Queensland; 63% in Victoria. After applying differences in state law, 72% of Queensland doctors answered in accordance with local law, compared with 37% in Victoria and 28% in NSW (p < 0.001). Doctors reported broadly the same decision-making approach despite differences in local law. Conclusions: Law appears to play a limited role in medical decision-making at the end of life with doctors prioritising patient-related clinical and ethical considerations. Different legal frameworks in the three states examined did not lead to different decisions about providing treatment. More education is needed about law and its role in this area, particularly where law is inconsistent with traditional practice. [ABSTRACT FROM AUTHOR]

Background: Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women's satisfaction with care across the maternity continuum.Methods: Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating.Results: Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88% in the caseload group and 74% in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95% CI 2.79, 4.03), intrapartum care (OR 2.14; 95% CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95% CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95% CI 2.64, 3.85).Conclusion: For women at low risk of medical complications, caseload midwifery increases women's satisfaction with antenatal, intrapartum and postpartum care.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN012607000073404 (registration complete 23rd January 2007). [ABSTRACT FROM AUTHOR]

Storm-water management is a common concern in rural catchments where development-related growth causes increases of storm-water flows. Greater magnitude and frequency of storm-water create greater challenges for mitigating storm-water damage and improving water quality. The concept of Blue-Green Infrastructure (BGI) as a solution incorporates a wide range of applicable components with the aim of minimizing the effect of catchment development on flow regimes without changing the watershed morphology. BGI components manage storm-water by decreasing impermeable cover and expanding natural and semi-natural systems to store water or recharge and filter storm-water into the ground. In this paper, guidelines for designing a pond as a component of BGI are provided and, configuration and size of the pond are determined. Moreover, the impacts of the designed pond on storm-water peak flow and quality are assessed for the Tarwin catchment, State of Victoria, Australia. The results indicate that the introduction of the pond would have reduced outfall inflow by 94 % and would have achieved the reduction of 88.3, 75.5 and 50.7 % for total suspended solids, total phosphorus, and total nitrogen respectively, during the extreme weather event in June 2012. [ABSTRACT FROM AUTHOR]

This paper presents findings from an interdisciplinary project undertaken in Victoria, Australia, investigating the barriers and facilitators to supported decision-making (SDM) for people living with diagnoses including schizophrenia, psychosis, bipolar disorder, and severe depression; family members supporting them; and mental health practitioners, including psychiatrists. We considered how SDM can be used to align Australian laws and practice with international human rights obligations. The project examined the experiences, views, and preferences of consumers of mental health services, including people with experiences of being on Community Treatment Orders (CTOs), in relation to enabling SDM in mental health service delivery. It also examined the perspectives of informal family members or carers and mental health practitioners. Victoria currently has high rates of use of CTOs, and the emphasis on SDM in the Mental Health Act, 2014, is proposed as one method for reducing coercion within the mental health system and working towards more recovery-oriented practice. Our findings cautiously suggest that SDM may contribute to reducing the use of CTOs, encouraging less use of coercive practices, and improving the experience of people who are subject to these orders, through greater respect for their views and preferences. Nonetheless, the participants in our study expressed an often ambivalent stance towards CTOs. In particular, the emphasis on medication as the primary treatment option and the limited communication about distressing side effects, alongside lack of choice of medication, was a primary source of concern. Fears, particularly among staff, about the risk of harm to self and others, and stigma attached to complex mental health conditions experienced by consumers and their families, represent important overarching concerns in the implementation of CTOs. Supporting the decision-making of people on CTOs, respecting their views and preferences about treatment, and moving towards reducing the use of CTOs require system-wide transformation and a significant shift in values and practice across mental health service delivery. [ABSTRACT FROM AUTHOR]

Background: Rural Australian populations experience an increased burden of ischaemic heart disease (IHD) compared to their metropolitan counterparts, similar to other developed countries, globally. Policy and other efforts need to address and acknowledge these differences in order to reduce inequalities in health burden. This paper examines rural health policy makers’ perceptions and use of evidence in efforts to reduce the burden of IHD in rural areas. Methods: Policy makers and government advisors (n = 21) who worked with, or advised on, rural health policy at local, state and federal government levels, with specific focus on the state of Victoria (n = 9) were identified from publicly available documents and subsequent snowball sample. Semi-structured qualitative interviews were conducted in regards to the use of evidence in policy to prevent IHD and thematic analysis undertaken applying two theoretical perspectives: context-based evidence-based policy making and the conceptual framework for understanding rural and remote health. Results: The rural context, particularly low resourcing, was seen as limiting potential for evidence based policy at local government (LG) level. Lower levels of political pressure and education were seen as constraints to evidence-based policy in rural communities. Participants described the potential for policy to have a greater impact on reducing heart disease in rural areas though they felt under-resourced and out of touch with the scientific evidence. Scientific studies were less valued than local anecdote to prioritise specific policy. At all levels (local, state and federal) low self-efficacy in interpreting evidence and perceived lack of relevance inhibited development of evidence informed policy. Conclusion: The rural context constrains the use of scientific evidence in policy making for the prevention of heart disease in rural areas in Australia with multiple factors influencing the capacity for evidenced based health policy. This is similar to findings at the international scale and is for consideration across other developed countries that experience inequalities in IHD disease burden between rural and urban populations. [ABSTRACT FROM AUTHOR]

This paper is concerned with onomastic palimpsests in Victoria, Australia, focusing in particular on the 1870s, when the deliberate erasure of colonial names and their replacement with Indigenous names was at the forefront of government policy. In contextualizing this reinstatement of Indigenous toponyms, the paper highlights the agency of parliamentarian and government minister Hon. Robert Ramsay. The primary sources of data are newspaper articles and official government reports. The methodology used is “thick description”. The findings reveal that the government’s efforts were grounded in the collection and collation of place names and vocabulary from Aboriginal people in the previous decade by district surveyors and other local officials. Consistent with recent campaigns in Victoria, the sustained efforts by governments in the 1870s were driven by a desire to remove duplication, erase inappropriate non-Aboriginal place names, and preserve Aboriginal place names. The campaign is unparalleled in the history of Victoria’s toponymic administration. [ABSTRACT FROM PUBLISHER]

Background: Organisational health literacy is a promising area of research that enables a focus on how systems and services can be designed in ways that are responsive to populations with varying states and levels of health literacy, knowledge, and practices, including African refugees. The challenge is how organisations and professionals do this in practice, and research in this area is in its early stages. This qualitative study examined barriers to implementing health literacy responsive care practices in primary health care settings in Australia. It also offered suggestions to potentially address the barriers to improving organisational health literacy. Methods: Refugees (n = 19), primary health care professionals (n = 14), and other key stakeholders (n = 19) were recruited through convenience and snowball strategies from three states in Australia: New South Wales, Victoria, and Queensland. All but one participant was interviewed face-to-face via Zoom. Semi-structured interview guides were used to guide the conversations. Transcriptions from audio recordings were analysed using directed content analysis. Results: Thirteen themes were extracted from the data. Themes were organised into the following categories: structural and systemic, organisational context, individual professional level, individual patient level, and socio-community level. Major structural and system-level factors affecting organisational health literacy included rigid systems and structures and limited time. Key organisation-level factors included inflexible organisational processes and policies, institutionalised othering, discrimination and racism, and lack of interpreters. Individual professional factors were poor communication with patients and cultural knowledge gaps. Linguistic issues and service mistrust were key individual patient-level factors. Socio-community factors included limited community engagement. Participants identified potential solutions to help services navigate out of the barriers and improve their response to health literacy. Conclusion: The findings suggest that mainstream services and organisations could improve timely and appropriate health care access and utilisation for refugees through strategies such as designing services and health literacy programs with refugee communities, promoting health literacy champions in the workforce, integrating health literacy and culturally responsive care plans and strategies into organisational priorities. [ABSTRACT FROM AUTHOR]

Simple Summary: Free-roaming cats in urban areas are a source of nuisance complaints. In Australia, legislation relating to requirements that cat owners microchip and contain their cats on their property has been largely ineffective in reducing the number of free-roaming cats, because most are strays with no owner. Cats causing nuisance complaints are typically trapped and impounded, but only 7% of cats entering local government facilities are reclaimed by owners, with the remaining either rehomed or euthanized. Many healthy cats are euthanized, negatively impacting the staff involved. In 2013, the city of Banyule in Victoria funded and implemented a free program for cat sterilization, microchipping, and registration. The program was largely targeted at low-socioeconomic suburbs with the highest cat-related complaints and microtargeted at "hot-spots". Free transport of cats was offered to community members if needed. Stray cats fed by community members enrolled in the program became owned. Over 8 years, 33.0 cats/1000 residents were sterilized in the three target suburbs (average 4.1 cats/1000 per year). Key findings were city-wide decreases in impoundments by 66%, euthanasia by 82%, and cat-related calls by 36% over 8 years, with savings to council of AU $440,660 for an outlay of AU $77,490. In most states of Australia, local governments (councils) are responsible for the enforcement of legislation relating to domestic cats. Traditional methods used for cat management based on trap–adopt or euthanize programs have been ineffective, with cat-related calls and cat impoundments continuing to increase, resulting in many healthy cats being euthanized. This has detrimental effects on the mental health of animal management officers, staff in shelters and council facilities, and cat caregivers. The city of Banyule, Victoria, implemented a free cat sterilization, microchipping, and registration (licensing) program in 2013/14. Initially, it was targeted at three low-socioeconomic suburbs with the highest cat-related calls and intake, and was microtargeted at call locations. An average of 4.1 cats/1000 residents per year were sterilized over eight years. The program included stray cats being fed by caregivers, provided they took ownership. The program was later expanded city-wide. Over eight years, city-wide cat intake decreased by 66%, euthanasia by 82%, and cats reclaimed by owners increased from 6% of intake (2012/13) to 16% (2020/21). Cat-related calls decreased in the target area by 51%, and city-wide by 36%. The council realized cost savings of AU $440,660 associated with reduced costs for cat-related calls to council (AU $137,170) and charges from the contracted welfare agency (AU $303,490), for an outlay of AU $77,490 for sterilization costs. Instead of the traditional management of urban cats, proactive management based on targeted sterilization should be utilized by government and animal welfare agencies in Australia and internationally. These types of programs are effective at reducing cat intake and euthanasia and are cost-effective. [ABSTRACT FROM AUTHOR]

Prior to its introduction in Australia, many people opposed euthanasia—or voluntary assisted dying as it is known—because of its potentially detrimental impact on grief and bereavement outcomes for family members and carers. We examine the novel experiences of grief and bereavement of VAD for family members and carers who were going through, had gone through, or were contemplating VAD, juxtaposing the international literature on grief and bereavement. As such, 42 semistructured interviews with family members and carers were undertaken in the state of Victoria, which was the first jurisdiction to legislate in favour of VAD. Interviews explored many themes around end‐of‐life decision‐making in order to ascertain the ways in which VAD helped or hindered grief and bereavement processes. A thematic analysis of the interview data was undertaken using QSR NVivo software. Four key themes were identified: values and meaning‐making, expression of a continuing bond, anticipatory grief, and the burden of care associated with supporting loved ones going through VAD. These themes were juxtaposed with the key literature on grief and bereavement to demonstrate how VAD presents novel challenges for carers. We argue that while VAD deaths share similar characteristics to other deaths; in some respects, grief and bereavement outcomes for family members and carers are unique. For family members and carers helping a loved one go through VAD, they were able to derive a sense of meaning from fulfilling their wishes and striving for them to have a "good death"; they were able to maintain a bond with them through advocacy of VAD and unique rituals; and they were able to plan and prepare effectively by knowing the exact time of death. Family members and carers also noted that VAD presents some significant challenges for grief and bereavement, especially in terms of the impact of VAD on familial relationships and burdens associated with moral predicaments. Nonetheless, VAD was generally viewed positively by family members and carers, who expressed gratitude for mitigating their loved one's suffering. [ABSTRACT FROM AUTHOR]

Background: Return to work (RTW) is important for recovery post-injury. Fear of (re)injury is a strong predictor of delayed RTW, and therefore much attention has been given to addressing injured workers' fear beliefs. However, RTW is a socially-negotiated process and it may be important to consider the wider social context of the injured worker, including the beliefs of the key people involved in their RTW journey.Methods: This paper involves data collected as part of a wider study in which semi-structured interviews explored RTW from the perspectives of 93 key stakeholders: injured workers, GPs, employers and insurance case managers in Victoria, Australia. Inductive analysis of interview transcripts identified fear of (re)injury as a salient theme across all stakeholder groups. This presented an opportunity to analyse how the wider social context of the injured worker may influence fear and avoidance behaviour. Two co-authors performed inductive analysis of the theme 'fear of (re)injury'. Codes identified in the data were grouped into five categories. Between and within category analysis revealed three themes describing the contextual factors that may influence fear avoidance and RTW behaviour.Results: Theme one described how injured workers engaged in a process of weighing up the risk of (re)injury in the workplace against the perceived benefits of RTW. Theme two described how workplace factors could influence an injured workers' perception of the risk of (re)injury in the workplace, including confidence that the source of the injury had been addressed, the availability and suitability of alternative duties. Theme three described other stakeholders' reluctance to accept injured workers back at work because of the fear that they might reinjure themselves.Conclusions: Our findings illustrate the need for a contextualised perspective of fear avoidance and RTW behaviour that includes the beliefs of other important people surrounding the injured worker (e.g. employers, family members, GPs). Existing models of health behaviour such as The Health Beliefs Model may provide useful frameworks for interventions targeting the affective, cognitive, social, organisational and policy factors that can influence fear avoidance or facilitate RTW following injury. [ABSTRACT FROM AUTHOR]

Simple Summary: Jumps racing is a form of Thoroughbred horse racing that involves hurdles and steeples and typically longer distances and heavier weights compared with flat racing, which does not incorporate obstacles. The continuation of jumps racing remains contentious due to the higher risk of fatalities, falls and injuries for horses, compared with flat racing. In Australia, jumps racing is carried out only in the state of Victoria after a legislated ban on jumps racing in South Australia in 2022. Jumps races account for only 1.8% of Thoroughbred horse races in Victoria. This study compared the incidence of fatalities, falls and injuries in horses participating in hurdle and steeplechase races with those participating in flat races at the same race meets, for all jumps races in the 2022 and 2023 Thoroughbred horse jumps racing seasons in Victoria, Australia. Overall, horse fatalities, falls and injuries occurred at higher rates in jumps races compared with flat races during the study period. Jumps racing is a form of Thoroughbred horse racing that involves hurdles and steeples and typically longer distances, and heavier weights compared with flat racing, which does not incorporate obstacles. In Australia, jumps racing is carried out only in Victoria, one of eight states and territories. The continuation of jumps racing is contentious due to the higher risk of fatalities, falls and injuries for horses, compared with flat racing. While measures have been introduced by the industry to improve the safety of riders and horses, the rates of fatalities, falls and injuries in horses participating in jumps races have not been collectively reported in Australia since the 2012 to 2014 race seasons. Although information on individual horse fatalities, falls and injuries is published by Racing Victoria in Stewards' Reports, the data are not aggregated, and so cannot readily be used to assess trends or evaluate the efficacy of safety measures introduced by the industry. The aim of this study was to determine the fatality, fall and injury rates for horses participating in hurdle and steeplechase races in Victoria in the 2022 and 2023 Thoroughbred horse jumps racing seasons compared with horses participating in flat races at the same race meets. Data on horse fatalities, falls and injuries were extracted from the published Racing Victoria race results and Stewards' Reports for the jumps races (n = 150) and corresponding flat races (n = 157) held at the 38 jumps race meets in Victoria in 2022 and 2023. Overall, horse fatalities, falls and injuries occurred at higher rates in jumps races compared with flat races during the study period. The rate of horse fatalities in jumps races was 3.3 per 1000 starts, with no fatalities in flat races. The rate of horse falls in hurdle races was 24 per 1000 starts and 41.6 per 1000 starts in steeplechase races, comparable with rates previously reported in the 2012 to 2014 seasons. There were no falls in flat races. Horse injuries occurred at a rate of 68.9 per 1000 starts in jumps races compared with 18.8 per 1000 starts in flat races. In hurdle and steeplechase races, veterinary clearance being required following horse injury was 5.4 times (OR 5.4, 95% CI 2.8–10.2) and 7.2 times (OR 7.2, 95% CI 3.3–15.6) more likely, respectively, compared with flat races. The risk of trauma was 4 times more likely in hurdle and steeplechase races (OR 4.8, 95% CI 1.7–13.3 and OR 4.1, 95% CI 1.2–13.4, respectively) and the risk of lameness was increased by 2.5 times in hurdles (OR 2.5, 95% CI 1.2–5.2) and 5.1 times in steeplechase races (OR 5.1, 95% CI 2.3–11.5), compared with flat races. These findings support concerns about the welfare of horses involved in jumps racing and of the need for further safety measures to reduce these risks. [ABSTRACT FROM AUTHOR]

Introduction: Effective primary healthcare services have been identified by the World Health Organization as the most equitable approach to enhancing universal healthcare. Robust models of mentoring for registered nurses (RNs) transitioning to primary healthcare roles have yet to be described in the Australian context. A robust mentoring model can support RNs to fulfill their potential, bridging the gap between theory and practice. In 2015, the peak body for nurses in primary health care (PHC) began developing a transition to practice program, including embedded mentoring to support newly graduated and more experienced registered and enrolled nurses. This quality improvement study reports the experiences and perspectives of nurses participating as mentors in two separate offerings of the program delivered between 2019 and 2021. Method: A two-phase concurrent mixed methods evaluation utilized data from pre- and post online surveys and post program meetings. Quantitative items underwent descriptive analyses. Thematic analysis of free-text responses and comments was conducted independently by two researchers. Mentors voluntarily provided self-report data and were informed that data is routinely collected to support continuous quality improvement processes for all programs. An Information Sheet informed mentors of data usage, confidentiality, and options to withdraw without penalty from the program at any time. Results: Seventy-nine mentors were recruited to support two groups of nurses (N = 111). Mentor self-rated overall satisfaction with program participation was 86.67% (very or extremely satisfied). Mentors described being "witness to mentee growth," "having facilitated access to learning" and receiving "unexpected benefits" including personal and professional growth and enhanced enthusiasm for their role in PHC. Conclusion: The embedded mentoring reported in this article combined a focus on skills acquisition and professional identity with the provision of a range of resources and support activities. Sustainable mentoring programs will be an important mechanism for supporting the expanding roles required of nurses working in primary health. [ABSTRACT FROM AUTHOR]

Background: Insufficient sleep is potentially an important modifiable risk factor for obesity and poor physical activity and sedentary behaviours among children. However, inconsistencies across studies highlight the need for more objective measures. This paper examines the relationship between sleep duration and objectively measured physical activity, sedentary time and weight status, among a sample of Victorian Primary School children.Methods: A sub-sample of 298 grades four (n = 157) and six (n = 132) Victorian primary school children (aged 9.2-13.2 years) with complete accelerometry and anthropometry data, from 39 schools, were taken from a pilot study of a larger state based cluster randomized control trial in 2013. Data comprised: researcher measured height and weight; accelerometry derived physical activity and sedentary time; and self-reported sleep duration and hypothesised confounding factors (e.g. age, gender and environmental factors).Results: Compared with sufficient sleepers (67 %), those with insufficient sleep (<10 hrs/day) were significantly more likely to be overweight (OR 1.97, 95 % CI:1.11-3.48) or obese (OR 2.43, 95 % CI:1.26-4.71). No association between sleep and objectively measured physical activity levels or sedentary time was found.Conclusion: The strong positive relationship between weight status and sleep deprivation merits further research though PA and sedentary time do not seem to be involved in the relationship. Strategies to improve sleep duration may help obesity prevention initiatives in the future. [ABSTRACT FROM AUTHOR]

Introduction: Voluntary assisted dying (VAD) is increasingly being legalised internationally. In Australia, all six states have now passed such laws, with Victoria being the first in 2019. However, early research in Victoria on the patient experience of seeking VAD shows that finding a connection to the VAD system is challenging. This study analyses the causes of this 'point of access' barrier. Methods: We conducted semi‐structured qualitative interviews with family caregivers and a person seeking VAD, with participants recruited via social media and patient interest groups. Data were thematically analysed. We also undertook documentary analysis (content and thematic) of publicly available reports from the oversight body, the Voluntary Assisted Dying Review Board. Results: We interviewed 32 family caregivers and one patient across 28 interviews and analysed six Board reports. Finding a point of access to the VAD system was reported as challenging in both interviews and reports. Four specific barriers to connecting with the system were identified: (1) not knowing VAD exists as a legal option; (2) not recognising a person is potentially eligible for VAD; (3) not knowing next steps or not being able to achieve them in practice; and (4) challenges with patients being required to raise the topic of VAD because doctors are legally prohibited from doing so. Conclusion: Legal, policy and practice changes are needed to facilitate patients being able to find a connection to the VAD system. The legal prohibition on doctors raising the topic of VAD should be repealed, and doctors and institutions who do not wish to be involved in VAD should be required to connect patients with appropriate contacts within the system. Community awareness initiatives are needed to enhance awareness of VAD, especially given it is relatively new in Victoria. Patient or Public Contribution: Families and a patient were the focus of this research and interviews with them about the experience of seeking VAD were the primary source of data analysed. This article includes their solutions to address the identified point of access barriers. Patient interest groups also supported the recruitment of participants. [ABSTRACT FROM AUTHOR]

The fossil record for Cretaceous birds in Australia has been limited to rare skeletal material, feathers, and two tracks, a paucity shared with other Gondwanan landmasses. Hence the recent discovery of 27 avian footprints and other traces in the Early Cretaceous (Barremian-Aptian, 128–120 Ma) Wonthaggi Formation of Victoria, Australia amends their previous rarity there, while also confirming the earliest known presence of birds in Australia and the rest of Gondwana. The avian identity of these tracks is verified by their tridactyl forms, thin digits relative to track lengths, wide divarication angles, and sharp claws; three tracks also have hallux imprints. Track forms and sizes indicate a variety of birds as tracemakers, with some among the largest reported from the Early Cretaceous. Although continuous trackways are absent, close spacing and similar alignments of tracks on some bedding planes suggest gregariousness. The occurrence of this avian trace-fossil assemblage in circumpolar fluvial-floodplain facies further implies seasonal behavior, with trackmakers likely leaving their traces on floodplain surfaces during post-thaw summers. [ABSTRACT FROM AUTHOR]

Objective: Government policy guidance in Victoria, Australia, encourages schools to provide affordable, healthy foods in canteens. This study analysed the healthiness and price of items available in canteens in Victorian primary schools and associations with school characteristics. Design: Dietitians classified menu items (main, snack and beverage) using the red, amber and green traffic light system defined in the Victorian government's School Canteens and Other School Food Services Policy. This system also included a black category for confectionary and high sugar content soft drinks which should not be supplied. Descriptive statistics and regressions were used to analyse differences in the healthiness and price of main meals, snacks and beverages offered, according to school remoteness, sector (government and Catholic/independent) size, and socio-economic position. Setting: State of Victoria, Australia Participants: A convenience sample of canteen menus drawn from three previous obesity prevention studies in forty-eight primary schools between 2016 and 2019. Results: On average, school canteen menus were 21 % 'green' (most healthy – everyday), 53 % 'amber' (select carefully), 25 % 'red' (occasional) and 2 % 'black' (banned) items, demonstrating low adherence with government guidelines. 'Black' items were more common in schools in regional population centres. 'Red' main meal items were cheaper than 'green'% (mean difference –$0·48 (95 % CI –0·85, –0·10)) and 'amber' –$0·91 (–1·27, –0·57)) main meal items. In about 50 % of schools, the mean price of 'red' main meal, beverages and snack items were cheaper than 'green' items, or no 'green' alternative items were offered. Conclusion: In this sample of Victorian canteen menus, there was no evidence of associations of healthiness and pricing by school characteristics except for regional centres having the highest proportion of 'black' (banned) items compared with all other remoteness categories examined. There was low adherence with state canteen menu guidelines. Many schools offered a high proportion of 'red' food options and 'black' (banned) options, particularly in regional centres. Unhealthier options were cheaper than healthy options. More needs to be done to bring Victorian primary school canteen menus in line with guidelines. [ABSTRACT FROM AUTHOR]

Background: Pregnant women are at an increased risk of hospitalisation, admission to the intensive care unit, mechanical ventilation, and death from SARS-CoV-2 infection. The aim of this study is to determine the predictive factors associated with COVID-19 vaccine uptake during pregnancy over time in a population with a high background uptake of maternal influenza and pertussis vaccination. Methods: This is a population-based, cohort study of all pregnant women who gave birth in Victoria, Australia between 1 July 2021 and 30 June 2022. Data from the Victorian Perinatal Data Collection were analysed using univariable and multivariable logistic regression. Results: This study reports on 77,719 women who gave birth over a 12 month period, of whom 49,281 (63.4%) received a COVID-19 vaccine, 54,887 (70.6%) received an influenza vaccination and 63,594 (81.8%) received a pertussis vaccine by the time of delivery. Pregnant women aged >30 years (aOR 1.31 CI 1.27, 1.36), who had >=8 antenatal visits (aOR 1.08 CI 1.04, 1.12), and those who received influenza vaccine (aOR 1.23 CI 1.19, 1.28) were more likely to have received a COVID-19 vaccine. Those who smoked (aOR 0.7 CI 0.66, 0.74), were First Nations (aOR 0.83 CI 0.74, 0.93) and those who gave birth in public hospitals (aOR 0.65 CI 0.63, 0.68) were less likely to receive COVID-19 vaccine in the first 12 months of the rollout. Conclusion: Maternal age, smoking, parity and Indigenous status were factors associated with delayed and sustained lower coverage, even in a population with background maternal influenza and pertussis coverage of 70.6% and 81.8%, respectively. [ABSTRACT FROM AUTHOR]

Background: World-wide, health service providers are moving towards innovative models of clinical home-based care services as a key strategy to improve equity of access and quality of care. To optimise existing and new clinical home-based care programs, evidence informed approaches are needed that consider the complexity of the health care system across different contexts. Methods: We present a protocol for working with health services and their partners to perform rapid identification, prioritisation, and co-design of content-appropriate strategies to optimise the delivery of healthcare at home for older people in rural and regional areas. The protocol combines Systems Thinking and Implementation Science using a Consensus Mapping and Co-design (CMC) process delivered over five workshops. Discussion: The protocol will be implemented with rural and regional healthcare providers to identify digital and non-digital solutions that have the potential to inform models of service delivery, improve patient experience, and optimise health outcomes. The combination of system and implementation science is a unique approach for optimising healthcare at home for older populations, especially in the rural context where need is high. This is the first protocol to integrate the use of systems and implementation science into one process and articulating these methods will help with replicating this in future practice. Results of the design phase will translate into practice through standard health service planning methods to enhance implementation and sustainability. The delivery of the protocol will include building capacity of health service workers to embed the design, implementation, and evaluation approach into normal practice. This protocol forms part of the DELIVER (Delivering Enhanced heaLthcare at home through optImising Virtual tools for oldEr people in Rural and regional Australia) Project. Funded by Australia's Medical Research Future Fund, DELIVER involves a collaboration with public health services of Western Victoria, Australia. [ABSTRACT FROM AUTHOR]

Background: Residential aged-care facilities in Australia emerged as the high-risk setting the COVID-19 outbreaks due to community transmission. The vulnerable aged-care residents of these facilities suffered due to low hospital transfers and high mortality and morbidity rates. This study aimed to monitor and report the burden of COVID-19 in residential aged-care facilities across Australia and the impact of hospital transfer policies on resident hospitalisation during the first year of the pandemic. Methods: We conducted a retrospective cohort study by collecting data from weekly aged-care outbreak reports published by open sources and official government sources between 1st March and 20th November 2020. A comprehensive line list of outbreaks was created using open-source data. The line list included the name of the facility, location, COVID-19 cases among residents, & staff, resident hospitalisations, mode of transmission, number of resident deaths, and state policies involving resident hospitalisation. We also searched the websites of these facilities to collect data on their COVID-19 policies for the residents, staff, and visitors. Statistical analyses were performed on the data obtained. Results: 126 aged-care COVID-19 outbreaks were identified in Australia during the study period. The incidence rate of COVID-19 infections among aged-care residents in Australia was (1118.5 per 100,000 resident population) which is 10 times higher than the general population (107.6 per 100,000 population). The hospitalisation rate for aged-care residents in Australia was 0.93 per 100,000 population. The hospitalisation rate of aged-care residents in Victoria was 3.14 per 100,000 population despite having the highest COVID-19 cases. Excluding South Australia, all states followed ad-hoc case-by-case hospital transfer policies for aged-care residents. Conclusion: This study documented a higher risk of COVID-19 infection for aged-care residents and workers but found low hospitalisation rates among residents across Australia. The hospitalisation rates in Victoria were higher than the national average but low when considering the COVID-19 infection rates in the state. The hospitalisation rates could have been impacted due to the state hospital transfer policies at that time. Immediate transfer of infected residents to hospitals may improve their survival and reduce the risk of infection to the other residents, as healthcare settings have more advanced infection control measures and are well-equipped with trained staff and resources. [ABSTRACT FROM AUTHOR]

Background: Breast cancer survival in Australia varies according to socio‐economic status (SES) and between rural and urban places of residence. Part of this disparity may be due to differences in prognostic factors at the time of diagnosis. Methods: Women with invasive breast cancer diagnosed from 2008 until 2012 (n = 14,165) were identified from the Victorian Cancer Registry and followed up for 5 years, with death from breast cancer or other causes recorded. A prognostic score, based on stage at diagnosis, cancer grade, whether the cancer was detected via screening, reported comorbidities and age at diagnosis, was constructed for use in a mediation analysis. Results: Five‐year breast cancer mortality for women with breast cancer who were in the lowest quintile of SES (10.3%) was almost double that of those in the highest quintile (5.7%). There was a small survival advantage (1.7% on average, within each socio‐economic quintile) of living in inner‐regional areas compared with major cities. About half of the socio‐economic disparity was mediated by prognostic factors, particularly stage at diagnosis and the presence of comorbidities. The inner‐regional survival advantage was not due to differences in prognostic factors. Conclusions: Part of the socio‐economic disparity in breast cancer survival could be addressed by earlier detection in, and improved general health for, more disadvantaged women. Further research is required to identify additional causes of socio‐economic disparities as well as the observed inner‐regional survival advantage. [ABSTRACT FROM AUTHOR]

The incidence of pyro-cumulonimbus (pyroCb) caused by extreme wildfires has increased markedly in Australia over the last several decades. This increase can be associated with a dangerous escalation of wildfire risk and severe stratospheric pollution events. Atmospheric and fuel conditions are important influences on pyroCb occurrence, but the exact causal relationships are still not well understood. We used the Continuous Haines Index (C-Haines) to represent atmospheric instability and the Fuel Moisture Index (FMI) to represent fuel moisture to provide better insight into the effects of atmospheric and fuel conditions on pyroCb occurrence over southeast Australia. C-Haines and FMI were related to the probability of pyroCb occurrence by employing a logistic regression on data gathered between 1980 and 2020. Emphasis is placed on investigating the independent effects and combined effects of FMI and C-Haines, as well as assessing their potential to predict whether a pyroCb develops over a fire. The main findings of this study are: (1) high C-Haines and low FMI values are representative of favorable conditions for pyroCb occurrence, but C-Haines can offset the effect of FMI—the addition of C-Haines to the logistic model muted the significance of FMI; (2) among the components of C-Haines, air temperature lapse rate (CA) is a better predictor of pyroCb occurrence than the dryness component (CB); (3) there are important regional differences in the effect of C-Haines and FMI on pyroCb occurrence, as they have better predictive potential in New South Wales than in Victoria. [ABSTRACT FROM AUTHOR]

Candida auris is an emerging global healthcare-associated pathogen. During July-December 2018, four patients with C. auris were identified in Victoria, Australia, all with previous overseas hospitalization. Phylogenetic analysis revealed putative transmission between 2 patients and suspected overseas acquisition in the others. Vigilant screening of at-risk patients is required. [ABSTRACT FROM AUTHOR]

Background: Research suggests that rates of mental illness are similar in rural and urban Australia, although there are significant workforce shortages in rural regions along with higher rates of chronic disease and obesity and lower levels of socioeconomic status. However, there are variations across rural Australia and limited local data on mental health prevalence, risk, service use and protective factors. This study describes the prevalence of self-reported mental health problems of psychological distress and depression, in a rural region in Australia and aims to identify the factors associated with these problems. Methods: The Crossroads II study was a large-scale cross-sectional study undertaken in the Goulburn Valley region of Victoria, Australia in 2016–18. Data were collected from randomly selected households across four rural and regional towns and then screening clinics from individuals from these households. The main outcome measures were self-reported mental health problems of psychological distress assessed by the Kessler 10 and depression assessed by Patient Health Questionnaire-9. Unadjusted odd ratios and 95% confidence intervals of factors associated with the two mental health problems were calculated using simple logistic regression with multiple logistic regression using hierarchical modelling to adjust for the potential confounders. Results: Of the 741 adult participants (55.6% females), 67.4% were aged ≥ 55 years. Based on the questionnaires, 16.2% and 13.6% had threshold-level psychological distress and depression, respectively. Of those with threshold-level K-10 scores, 19.0% and 10.5% had seen a psychologist or a psychiatrist respectively while 24.2% and 9.5% of those experiencing depression had seen a psychologist or a psychiatrist, respectively in the past year. Factors such as being unmarried, current smoker, obesity, were significantly associated with a higher prevalence of mental health problems whereas physical activity, and community participation reduced the risk of mental health problems. Compared to rural towns, the regional town had higher risk of depression which was non-significant after adjusting for community participation and health conditions. Conclusions: The high prevalence of psychological distress and depression in this rural population was consistent with other rural studies. Personal and lifestyle factors were more relevant to mental health problems than degree of rurality in Victoria. Targeted lifestyle interventions could assist in reducing mental illness risk and preventing further distress. [ABSTRACT FROM AUTHOR]

Our recent study compared monitoring data collected using surrogate metrics during 2014–2018 inclusive with baseline data from 2007 to evaluate the trajectory of the population status of the threatened heath skink Liopholis multiscutata in Victoria. The heath skink is a secretive burrowing species that is a habitat specialist and exists in north‐western Victoria as a few small and highly disjunct populations on large dunes in semi‐arid heathland or mallee. We re‐assessed the trajectories of the Victorian populations with additional monitoring data collected in 2021 and found continuing decline across all four Victorian heath skink populations. Urgent management intervention is required to arrest this decline, likely due to predation, reduced availability of habitat and life history and demographic traits that make this species susceptible to decline. [ABSTRACT FROM AUTHOR]

Our transformation of global environments into human-dominated landscapes has important consequences for wildlife. Globally, wildlife is interacting with humans or impacted by human activities, which often results in negative outcomes such as population declines, disruption of social bonds, biodiversity loss, imperilment of threatened species, and harm to individual animals. Human and non-human threats to wildlife can be challenging to quantify and tend to be poorly understood especially over large spatial scales and in urban environments. The extent to which such damage is mitigated by reactive approaches (e.g., wildlife rescue) is also not well understood. We used data from the main state-based Wildlife Emergency Response Services (WERS) in Victoria, Australia to address these issues. The data, which describe tens of thousands of cases of threats to wildlife annually over a ten-year period, allowed a detailed characterisation of the type and extent of threats in the state. We identified the main common and threatened species impacted by various threats and showed that the vast majority of them were anthropogenic (e.g., vehicle collisions, cat attacks, and entanglements). The extent to which different taxonomic groups and species were impacted by various threats differed and threats were dependent on locations. The Greater Melbourne area was identified as a hotspot for threats to wildlife. The WERS was able to source service providers for thousands of animals annually, facilitating their assessment, release into the wild and rehabilitation. However, every year, thousands of animals died or were euthanased and thousands more were left unattended. WERS case reports are increasing and there is a growing service–demand gap. Whilst studies reporting on the demand and response of WERS are rare, situations in other parts of Australia and the world might be similar. This highlights the urgent need to understand and mitigate human and non-human threats to wildlife, particularly in urban environments, where the rate of biodiversity loss is high. We discuss opportunities and barriers to doing so. [ABSTRACT FROM AUTHOR]

Background: In Australia, maternity care services provide care for pregnant and postpartum women and their newborns. The COVID-19 pandemic forced these services to quickly adapt and develop policies and procedures for dealing with transmission in health care facilities, as well as work under public health measures to counter its spread within the community. Despite well-documented responses and adaptations by healthcare systems, no studies have examined the experiences of maternity service leaders through the pandemic. This study aimed to explore the experiences of maternity service leaders, to understand their perspectives on what happened in health services and what was required of a leader during the COVID-19 pandemic in one Australian state. Methods: A longitudinal qualitative study collected data from 11 maternity care leaders during the pandemic in the state of Victoria. Leaders participated in a series of interviews over the 16-month study period, with a total of 57 interviews conducted. An inductive approach to developing codes allowed for semantic coding of the data, then a thematic analysis was conducted to explore patterned meaning across the dataset. Results: One overarching theme, 'challenges of being a maternity service leader during the pandemic', encompassed participant's experiences. Four sub-themes described the experiences of these leaders: (1) needing to be a rapid decision-maker, (2) needing to adapt and alter services, (3) needing to filter and translate information, and (4) the need to support people. At the beginning of the pandemic, the challenges were most acute with slow guideline development, rapid communications from the government and an urgent need to keep patients and staff safe. Over time, with knowledge and experience, leaders were able to quickly adjust and respond to policy change. Conclusion: Maternity service leaders played an important role in preparing and adapting services in accordance with government directives and guidelines while also developing strategies tailored to their own health service requirements. These experiences will be invaluable in designing high quality and responsive systems for maternity care in future crises. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study was to explore, analyse, and describe the patterns of public dental service utilisation among the refugee populations in Victoria, Australia, and determine their predictors at the individual and contextual levels. Methods: Data on the refugees who attended Victorian public dental services between July 2016 to June 2020 was gathered from the Dental Health Program dataset. Latent profile analysis was used to identify discrete groups among the refugee clientele with similar mean utilisation patterns across six indicator variables describing the attributes of dental services received and the site of care provision, over the study period. Multilevel multinomial logistic regression analysis was performed to examine the individual and contextual level correlates of the identified utilisation patterns. Results: Six distinct profiles of public dental service utilisation were identified among the study population (n = 25,542). The largest group comprised refugees predominantly using restorative services under general course of care (38.10%), followed by extraction services under emergency course of care (23.50%). Only a small proportion were estimated as having a higher mean utilisation of preventive services under general course of care (9.10%). Multilevel analysis revealed that the following variables had a significant association with refugee utilisation pattern: at the individual-level – demographic and ethnic attributes including age, gender, region of birth, preferred language for communication, use of language interpreter services, and type of eligibility card; at the contextual-level – characteristics of refugees' neighbourhood of residence including urbanicity, socioeconomic disadvantage, delivery of Refugee Health Program at the community health centres, and spatial accessibility to public dental services via driving and public transit modes of travel. Conclusions: The study represents a significant step towards the development of an evidence-based knowledge around public dental service utilisation among Victorian refugees. Overall, the study findings reiterate the critical need for targeted strategies to promote the importance of routine dental visits, oral disease prevention, and timely intervention among refugee groups. [ABSTRACT FROM AUTHOR]