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Background: This paper aimed to describe the legal worries of Australian general practitioners (GPs) and nurses regarding end-of-life care provided in the aged care setting. Methods: An analysis of responses to the final, open-ended question of a cross-sectional online survey of GPs and nurses practising in aged care settings in Queensland, New South Wales and Victoria was undertaken. Results: Of the 162 GPs and 61 nurses who gave valid responses to the survey, 92% (151 GPs and 55 nurses) responded to the open-ended question. Participants identified concerns across all relevant areas of end-of-life law. The most common concerns were substitute decision-makers or family member(s) wanting to overrule an Advance Care Directive, requests for futile or non-beneficial treatment and conflict about end-of-life decision-making. Participants often also identified concerns about their lack of legal knowledge and their fear of law or risk related to both end-of-life care generally and providing medication that may hasten death. Conclusions: Australian GPs and nurses working in aged care have broad-ranging legal concerns about providing end-of-life care. Legal concerns and knowledge gaps identified here highlight priority areas for future training of the aged care workforce. The law supports good end-of-life clinical practice by facilitating health care that aligns with the values and goals of patients, including those residing in residential aged care facilities. GPs and nurses here reported broad-ranging legal concerns relevant to providing end-of-life care within aged care, including substitute decision makers/family members wanting to overrule Advance Care Directives, requests for futile or non-beneficial treatment and conflict about decision-making. Participants' concerns can inform end-of-life legal training for aged care GPs and nurses. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic continues to exert a significant toll on the Australian primary healthcare system. Although wellbeing challenges faced by hospital-based healthcare workers are widely discussed, less is known about the experiences of general practitioners (GPs) during the initial phases of the pandemic. This paper reports qualitative survey data from Australian GPs, examining their workplace and psychosocial experiences during the initial months of the pandemic. Methods: An Australia-wide, cross-sectional, online survey of frontline healthcare workers was conducted in 2020. A qualitative approach using content analysis was utilised to examine responses to four free-text questions from GPs. Results: A total of 299 GPs provided 888 free-text responses. The findings reveal that general practice was overlooked and undervalued within the pandemic response, resulting in negative impacts on GP wellbeing. Four themes were identified: (1) marginalisation of GPs; (2) uncertainty, undersupported and undervalued in the workplace; (3) isolation and disrupted personal lives; and (4) strategies to support GPs during times of crises. Key concerns included poor access to personal protective equipment, occupational burnout and poor wellbeing, insufficient workplace support, and conflicting or confusing medical guidelines. Conclusions: Primary healthcare constitutes an essential pillar of the Australian healthcare system. This study presents the many factors that impacted on GP wellbeing during the COVID-19 pandemic. Enabling GP voices to be heard and including GPs in decision-making in preparation for future crises will enhance the delivery of primary care, reducing the burden on hospital services, and help sustain a safe and effective health workforce long term. The COVID-19 pandemic caused significant challenges and wellbeing issues for healthcare workers such as general practitioners (GPs), especially during the initial months in 2020. A large nationwide survey of Australian healthcare workers was undertaken in 2020 to understand their experiences, from which 299 GPs provided free-text survey responses for qualitative analysis. This analysis showed GPs felt marginalised, undervalued and under-supported while working in risky work conditions, pointing to a need for GP voices to be heard to safeguard their wellbeing. [ABSTRACT FROM AUTHOR]

Background: Almost half of Australian after-hours emergency department (ED) presentations are rated as 'non-urgent' by clinicians and are suggested to be managed by community-based services, such as general practice (GP). This paper reports patient reasons for presenting for medical care after hours, and reasons for selection of specific services across a health system. Methods: A cross-sectional survey was conducted across the Australian Capital Territory. Patients voluntarily completed questionnaires in waiting rooms during the after-hours periods of one weekday and one weekend in 2019 at 28/51 extended hours GPs, 3/3 medical deputising services (MDS), 3/3 nurse-led walk-in-clinics (WICs), and 2/2 public emergency departments (EDs). Results: Of 3371 presentations, 1992 patients completed a survey, with 58% from GPs (n = 1149), 16% from WIC (n = 317), 10% from MDS (n = 193), and 17% from EDs (n = 333). Most patients presented with self-rated new issues (n = 987, 49.5%) and were uncertain of the urgency of their issues (n = 723, 36.7%). Common reasons for presenting to WIC, MDS, and EDs included the problem occurring after hours, and patients concern about the issue. Common reasons for presenting to GP were related to personal preference for after-hours care. Conclusions: Patients present to after-hours medical services for both perceived need and convenience. Most patients appear to be self-selecting after-hours services appropriately aligned with advertised services; except for GP patients who were attending after hours for care that is often non-urgent and could be seen in usual working hours. This study should be replicated to account for local health systems, and coronavirus disease 2019 (COVID-19)-related changes to health care. Almost half of Australian after-hours emergency department (ED) presentations are rated as 'non-urgent' by clinicians and are suggested to be managed by community-based services, such as general practice (GP). Our survey shows that patient-perceived urgency and need for care are drivers towards ED and other community services. In contrast, most patients chose after-hours GP for convenience. Public messaging could be adapted to encourage appropriate and timely access to care after hours. [ABSTRACT FROM AUTHOR]

Manufactured home villages (MHVs) are an increasingly popular housing option for older Australians. This paper reports a cross-sectional survey that sought to describe the health status and health service access of MHV residents. The survey tool comprised demographic and health status items, primary healthcare access perceptions and the World Health Organization Quality of Life tool (WHOQOL-BREF). One-hundred-eighty-six MHV residents from regional NSW completed the survey. Hypertension (54.8%) and arthritis (46.5%) were the most prevalent chronic diseases reported. Overall, respondents expressed a high level of satisfaction with the sense of safety and security (82.8%), neighbours (69.4%) and the overall location of the villages (66.7%). There was good to excellent internal consistency of all four WHOQOL-BREF domain scores, with a comparatively lower sample mean score for the 'Physical' and 'Psychological' domains. MHV residents are a significant cohort of older people with high rates of chronic disease and reasonably poor access to transport services, which affects their capacity to access health services. They also have comparatively low levels of quality of physical and psychological life along with low levels of satisfaction with their health. [ABSTRACT FROM AUTHOR]

General practitioners (GPs) play a key role in the return-to-work process, and yet their experiences working with workplace Return-to-Work Coordinators (RTWCs) have rarely been studied. The aim of this paper is to provide insights from the GP perspective about their experiences with workplace RTWCs and their preparedness for the role. GPs from Australian states and territories where legislation mandates workplaces employ a RTWC were requested to complete a questionnaire on their experiences with workplace RTWCs. Fifty GPs completed a questionnaire on the preparedness of RTWCs in relation to their role, with 58% (n = 29) indicating RTWCs require more training. A total of 78% (n = 39) of respondents considered RTWCs were important in assisting injured workers return to work, with 98% (n = 49) ranking trustworthiness, respectfulness and ethicalness as the most important or an important trait for a RTWC to possess. Interestingly, 40% (n = 20) of respondents themselves reported having no training in the return-to-work process. GPs acknowledge the importance of the workplace RTWC in the return-to-work process, and the results highlight the need for RTWCs to possess specific traits and undergo appropriate training for the facilitation of a successful return to work for injured workers. [ABSTRACT FROM AUTHOR]

A growing number of Australians are travelling domestically for extended periods. This creates challenges in both continuity of health care and burdens on health services. This paper reports a cross-sectional survey aimed to explore the health needs and health planning of long-term travellers. In total, 316 respondents who had travelled for more than 3 months consecutively in the last year participated. Most respondents were retired (n = 197; 62.3%); however, ages ranged from 26 to 89 years. Nearly half of the respondents or their travel companion had a long-term illness that affected their daily life (n = 135; 42.7%). Nearly half of respondents visited a GP (n = 133; 42.1%), nearly one-quarter visited an Emergency Department (n = 72; 22.8%) and 19.9% (n = 63) visited another health provider while travelling. The level of preparation around health while travelling varied between participants. This study highlights that long-term travellers have significant health needs and are likely to require health services during their extended travel. Additionally, it identifies that currently few strategies are used to plan for health care during travel. This raises issues for rural and remote health services in terms of both capacity and continuity of care. [ABSTRACT FROM AUTHOR]

Many GPs undertake postpartum care for women and their infants. GP follow-up enables early identification and management of problems, education and support for parenting, and reconnection with general practice following the birth. However, there is little information about GPs' understanding of their role in postpartum care and how it is undertaken. This cross-sectional survey of GPs in Southern Queensland, conducted between February and July 2013, describes the involvement of GPs in postpartum care. GPs were posted a 52-item questionnaire adapted from a previous Victorian GP study and were telephoned 2 weeks later. GPs completed the survey on paper or online. The response rate was 17.4% (163 GPs). Approximately 39% were uncertain whether women were happy with the GP-provided postpartum care. GPs' recommendations for the timing of postpartum reviews were inconsistent within and across birthing sectors and consultations took longer than anticipated. Developing guidelines around the timing and appropriate length of postpartum consultations could assist GPs in providing appropriate care for mothers and infants. [ABSTRACT FROM AUTHOR]

Lower back pain is prevalent in the general community. Guidelines recommend against the use of diagnostic imaging unless 'red flags' are present that may indicate a potentially serious cause. This paper reports on a cross-sectional electronic survey to investigate self-reported experiences of lower back pain management among Australian general practice patients. Of the 872 participants, 551 (63%) reported that they had experienced lower back pain in the past 12 months. Approximately 40% of patients who had experienced lower back pain reported that they had consulted their general practitioner (GP) regarding this issue. Among those who sought general practice care, 67% reported being referred for diagnostic imaging. Those who received imaging were more likely to have been prescribed medication by their GP, but received self-management advice at the same rate as those who had not been referred. Rates of self-reported referral for diagnostic imaging were higher than expected, given the low prevalence of potentially serious causes for lower back pain reported in the international literature. However, it remains unclear whether this is due to poor guideline adherence by GPs or lack of specificity in the red flags identified in guidelines. Findings suggest the need for improvements in the provision of evidence-based self-management advice. [ABSTRACT FROM AUTHOR]

Background: The 75+ health assessment has been identified as a suitable trigger to introduce advance care planning (ACP) to general practice patients. Australian general practitioners (GPs) were surveyed to explore their perceptions, attitudes and practices in introducing ACP during 75+ health assessments. Methods: A cross-sectional postal survey of Australian GPs covering their personal, professional and workplace characteristics, their current practice regarding ACP within a 75+ health assessment, and their attitude towards ACP. Multivariate logistic regression was used to analyse the factors associated with routinely discussing ACP as part of the 75+ health assessment. Results: A total of 185 (19.2%) out of 964 eligible GPs returned a completed survey. Most GPs reported that patients interested in ACP were supported by the GPs or the practice nurse. Two factors, (1) attitude that ACP is an essential component of the 75+ health assessment, and (2) regional or rural location of the practice, had a statistically and clinically significant association with the GP's self-reported discussion of ACP during 75+ health assessments. Conclusions: GPs showed a high level of support and involvement in discussing ACP during 75+ health assessments. ACP support during 75+ health assessments was often provided directly by the GP or via the practice nurse. Given the international evidence that ACP training programs improve skills and knowledge, and foster positive attitudes towards ACP, there is an important need to continue funding ACP training programs for GPs and practice nurses. The 75+ health assessment has been identified as a suitable trigger to introduce advance care planning (ACP) to general practice patients. Our cross-sectional survey of 185 Australian GPs showed that (1) most patients interested in ACP were supported by general practices, and (2) the attitude that ACP is an essential component of the 75+ health assessment and regional/rural location were associated with GPs' discussion of ACP during 75+ health assessments. More support and funding may be required to follow up on these important discussions. [ABSTRACT FROM AUTHOR]

Significant gaps remain between recommendations of evidence-based guidelines and primary health care practice in Australia. This paper aims to evaluate factors associated with the use of guidelines reported by Australian GPs. Secondary analysis was performed on a survey of primary care practitioners which was conducted by the Commonwealth Fund in 2009: 1016 general practitioners responded in Australia (response rate 52%). Two-thirds of Australian GPs reported that they routinely used evidence-based treatment guidelines for the management of four conditions: diabetes, depression, asthma or chronic obstructive pulmonary disease and hypertension -- a higher proportion than in most other countries. Having non-medical staff educating patients about self-management, and a system of GP reminders to provide patients with test results or guideline-based intervention or screening tests, were associated with a higher probability of guidelines use. Older GP age was associated with lower probability of guideline usage. The negative association with age of the doctor may reflect a tendency to rely on experience rather than evidence-based guidelines. The association with greater use of reminders and self-management is consistent with the chronic illness model. [ABSTRACT FROM AUTHOR]

Indigenous people have long maintained that strong cultural identities are critical to health and wellbeing. The purpose of this systematic review is to examine whether interventions that entail strategies to enable expression of cultural identities for Australian Indigenous peoples are associated with measurable improvements in health and wellbeing. Peer-reviewed articles that reported quantitatively expressed health and wellbeing outcomes involving Indigenous Australian participants only were included. The cultural intervention component was defined and assessed by Indigenous researchers on the team. A narrative analysis was conducted. The protocol was registered on PROSPERO (CRD420 15027387). Thirteen articles describing eleven studies were identified, including one randomised control trial (RCT), one cluster RCT and two studies with non-randomised controls. Other studies reported on case series or cross-sectional studies. All except two studies described multiple intervention strategies. Eight studies showed significant improvement in at least one psychosocial, behavioural or clinical measure, with two showing a positive direction of effect and one showing no improvement. Publication bias may discourage researchers to report negative findings of these interventions. Although studies vary in quality, this review provides evidence that interventions that include opportunities for expression of cultural identities can have beneficial effects for Australian Indigenous peoples. [ABSTRACT FROM AUTHOR]

Background: GPs are integral to the COVID-19 vaccination rollout, providing education and administering vaccines. We sought to describe how counselling relating to COVID-19 vaccination was impacting Australian general practice consultations. Methods: We conducted an online, mixed-methods, cross-sectional survey of Australian community-based primary care from 7 to 15 July 2021. This survey, number 15 in a series of recurrent cross-sectional surveys conducted over a 14-month period, explored how counselling relating to COVID-19 vaccination was impacting general practice consultations, through multiple selection and open text responses; it also included questions on respondent and practice characteristics, and pandemic-related stress and strain. We calculated descriptive statistics for quantitative variables, and analysed free-text responses using an inductive content analysis approach. Results: We received 73 responses (72 GPs) across all states/territories. Discussions with patients about COVID-19 vaccines and vaccination were common, increasing the duration of routine consultations by 6 min on average (s.d. 2.9). Respondents described the impact of the resulting time pressures, and the stress and challenges of participating in COVID-19 vaccine communication and administration. Although our results are illuminating, they are limited by the small sample, with some different characteristics from national estimates, an uncertain response rate and the inability to pilot the survey prior to distribution. Conclusions: The significant impact on general practice consultation from COVID-19 vaccine counselling is on a background of ongoing pandemic-related stress and strain. With a strong track record of population vaccination, GPs are well-placed to deliver COVID-19 immunisations to the Australian population. However, they must be represented in planning and coordination, to reduce the overall burden on primary care. The COVID-19 vaccination program is a crucial element of the Australian pandemic management plan and goal to return to 'normal' life, and primary care is a vital player in vaccine provision. Integrating new population-wide vaccinations into existing general practice has had a significant, but not well-documented, impact on primary care. Our study describes the experiences of general practice in Australia nearly 5 months into the vaccine rollout. [ABSTRACT FROM AUTHOR]

Background: People with severe mental illness have a higher rate of premature death than the general population, largely due to primary care preventable diseases. There has been little research on the health profile of this population attending Australian general practices. Methods: In this nationwide cross-sectional study, MedicineInsight data for adult patients regularly attending general practices in 2018 were analysed to estimate the prevalence of schizophrenia or bipolar disorders (SBD) and investigate the health profile of people with SBD compared with other patients. Multilevel models clustered by practice (n = 565) and patient, and practice characteristics were created. Results: The prevalence of recorded SBD was 1.91% (95% CI = 1.88%–1.94%) among the 618 849 patients included. Patients with recorded SBD were more likely than other patients to have records of health risk factors, particularly smoking (aOR = 3.8, 95% CI = 3.6–3.9) and substance use (aOR = 5.9, 95% CI = 5.6–6.3), and higher probabilities of comorbidities including cardiovascular diseases (aOR = 1.3, 95% CI = 1.2–1.4), cancer (aOR = 1.1, 95% CI = 1.0–1.2), diabetes mellitus type 2 (aOR = 2.2, 95% CI = 2.0–2.3), chronic kidney diseases (aOR = 1.7, 95% CI = 1.5–2.0), chronic liver diseases (aOR = 3.3, 95% CI = 2.6–4.0) and chronic respiratory diseases (aOR = 1.7, 95% CI = 1.7–1.8). Conclusions: The higher prevalence of health risk factors and comorbidities among patients with recorded SBD underscores the need for proactive health risk monitoring and preventive care to address this health inequity. People with severe mental illness die about 20 years earlier than those in the general population, mostly due to preventable diseases. Data on those who attend general practice in Australia are lacking. This study describes higher rates of socioeconomic disadvantage, risk factors such as smoking and chronic diseases such as diabetes mellitus type 2 relative to other patients. The results add further weight to the call for more proactive preventive care for people with severe mental illness to address this health inequity. [ABSTRACT FROM AUTHOR]

The role of the General Practitioner (GP) in testing for and managing men with prostate cancer (PCa) is significant. Very few studies have explored the attitudes and practices of Australian GPs in the context of the role of PCa testing. In this study, a 46-item web-based questionnaire was used to assess self-reported PCa testing attitudes and practices of GPs. This questionnaire was circulated to divisions of general practice and Medicare locals for further distribution to their GP members across Australia. GPs from all states and territories participated, and a total of 136 GPs completed the survey. Of the responding GPs, 57% always or usually offered PCa testing to asymptomatic men ≤70 years of age and 60% of GPs always or usually included a digital rectal examination (DRE). Many (80%) of the GPs stated that the current PCa testing guidelines were not clear. PCa testing was offered opportunistically by 56% while 39% offered testing at the patient's request. The results captured in this study represent a snapshot of GP attitudes and practices from across Australia. The results presented indicate a wide variation in the approaches to PCa testing in general practice across Australia, which in most part appear to be related to the lack of clarity of the current prostate cancer testing guidelines. [ABSTRACT FROM AUTHOR]

Many rural communities in New South Wales (NSW), Australia, have poor-quality water supplies. The lack of a palatable alternative increases the risk of the high consumption of sugar-sweetened beverages, a significant contributor to adverse health outcomes. This disproportionately effects Aboriginal people living in these towns, who are also profoundly affected by the social determinants of health. Therefore, examining health inequalities linked to water access is important. This study investigated the availability of drinking water fountains in rural and remote communities in NSW. Telephone interviewer-assisted surveys were conducted with 32 representatives from local government councils or Local Aboriginal Land Councils in NSW from communities with a population of <5000 and an Aboriginal population of at least 3%. The results were analysed descriptively. Towns and communities with a higher population of Aboriginal people and lower median weekly income were less likely to have access to free refrigerated and filtered water within the community or at local schools compared with towns and communities with a lower Aboriginal population and higher median weekly income. The availability of free, clean and refrigerated water in rural and remote communities is critical to reducing the consumption of sugar-sweetened beverages and the promotion of water as the preferred drink. Limited access to free, clean and refreshing tap water can increase reliance on sugar-sweetened beverages. This study found that access to clean, refrigerated and filtered drinking water is more likely in larger communities with a lower proportion of Aboriginal people, indicating that Aboriginal people living in smaller communities have their socioeconomic disadvantage compounded, potentially increasing reliance on sugar-sweetened beverages and widening the health gap between Aboriginal and non-Aboriginal people. Health promotion initiatives must take into consideration access to clean and refreshing tap water. [ABSTRACT FROM AUTHOR]

Preconception care (PCC) entails counselling and interventions to optimise health before pregnancy. Barriers to this service delivery include access and time. Primary healthcare nurses (PHCNs) are uniquely placed to deliver PCC. The aim of this study was to understand PHCNs' knowledge, practice and attitudes to PCC. A cross-sectional study was performed of a convenience sample of PHCNs in Australia who were seeing people of reproductive age. Recruitment was via the Australian Primary Health Care Nurses Association (APNA) electronic communication platforms. The 18-item, online, anonymous survey captured demographics, as well as PCC knowledge, practices and attitudes. Descriptive statistics were used to describe our findings. In all, 152 completed surveys were received. Of all respondents, 74% stated they discuss PCC in their practice, although only 13% do so routinely. Of these, more preconception discussions are held with women than with men. In total, 95% of respondents identified at least one barrier to delivery of PCC, with lack of time and knowledge being the most common. The findings of this study can inform targeted strategies, including education programs and resources, and consideration of incentives to support PHCNs deliver PCC. This study identifies areas for improvement at the individual, organisational and health system levels to enhance the role of PHCNs in PCC Preconception care can improve pregnancy outcomes, childhood health and the health of future generations, but many men and women in Australia are not receiving this service. Primary health care nurses are the largest workforce in primary health in Australia and are ideally placed to deliver preconception care. Collaborative education programs, the development of resources and consideration of financial incentives for primary care practices can enhance the primary health care nurses' capacity to provide preconception care. [ABSTRACT FROM AUTHOR]

The aim of this cross-sectional study was to understand patients' perceived importance of clinic- and clinician-related factors and contextual characteristics that shape the importance ratings for factors patients consider when accessing oral health care. This study was conducted at Griffith University Dental Clinic, Gold Coast, Australia. Patients answered a self-administered questionnaire on demographics and perceived need for attendance, which constituted the explanatory variables. In the second part of the questionnaire, patients were asked to rate the importance of 17 items related to the provision and quality of oral health services using a five-point scale. Exploratory factor analysis (EFA) was conducted to determine the dimensionality of the questionnaire. The questionnaire was completed by 298 patients. The importance of some of the clinician-related factors, such as 'concern for patients' and 'access to specialist care', were associated with sex, age and employment status. EFA revealed a two-factor structure, which consisted of items related to clinician characteristics and clinic environment characteristics. Female participants had higher importance scores for clinic environment characteristics (mean (±s.d.) 38.00 ± 4.86 vs 35.45 ± 6.30; P < 0.05) and clinician characteristics (32.39 ± 2.85 vs 31.33 ± 3.39; P < 0.05) than male participants. In conclusion, various clinician- and clinic-related aspects were considered important for the provision and quality of oral health services, with the importance of these factors associated with some contextual characteristics. Application of Andersen's behavioural model of health services use provided a framework that offers important insights into patient beliefs and perceptions towards oral health services and can serve as a baseline for future studies in dental clinics across Australia. It is important to assess patient-rated importance of factors related to the provision of oral health services and contextual characteristics that determine the ratings of importance so that the utilisation of oral health services can be improved. This study explored the contextual characteristics that determine a patient's importance ratings for clinic- and clinician-related factors. The findings provide future directions for changes to improve the delivery and utilisation of oral health services. [ABSTRACT FROM AUTHOR]

Although there is growing recognition of the effects of living with sleep disorders and the important role of primary care in their identification and management, studies indicate that the detection of sleep apnoea (OSA) and insomnia may still be low. This large representative community-based study (n = 2977 adults) used logistic regression models to examine predictors of self-reported OSA and current insomnia and linear regression models to examine the association of these sleep conditions with both mental and physical components of health-related quality of life (HRQoL) and health service use. Overall, 5.6% (95% confidence interval (CI) 4.6-6.7) and 6.8% (95% CI 5.7-7.9) of subjects selfreported OSA (using a single-item question) and current insomnia (using two single-item questions) respectively. Many sociodemographic and lifestyle predictors for OSA and insomnia acted in different directions or showed different magnitudes of association. Both disorders had a similar adverse relationship with physical HRQoL, whereas mental HRQoL was more impaired among those with insomnia. Frequent consultations with a doctor were associated with a lower physical HRQoL across these sleep conditions; however, lower mental HRQoL among those frequently visiting a doctor was observed only among individuals with insomnia. The adverse relationship between sleep disorders and physical and mental HRQoL was substantial and should not be underestimated. [ABSTRACT FROM AUTHOR]

This study investigated maternal and child health (MCH) nurse family violence clinical practices, practice gaps and future family violence training needs. Descriptive analysis was conducted of routine data collected as part of a larger MCH nurse family violence training project conducted in 2018. A purposive sample of routine data (2017–18) was analysed from six Victorian metropolitan and four regional and rural areas that were experiencing high rates of violence, as indicated by police reports. Descriptive statistics and regression analyses were used to identify rates of nurse family violence screening, safety planning and referral, with practice differences analysed across locations. MCH nurses ask only one in two clients about family violence at the mandated 4-week postnatal clinic visit. Overall, metropolitan nurses screen for family violence at higher rates than rural nurses. Safety planning rates were low (1.3%), suggesting that screening is not translating to disclosure rates equivalent to state-wide prevalence (~14–17%) or police data. Nurse referrals are even lower (<1%), with practice differences noted across reporting systems. Despite data collection limitations, analysis of routine data shows significant gaps in nurse family violence screening and response practices. This evidence reinforces the need for systems changes to address family violence and other maternal health and social issues. MCH nurses have been conducting family violence screening since 2009, yet these practices are poorly researched and understood. Only half the women attending MCH services are screened at the 4-week recommended visit. Asking rates are lower in rural areas. Disclosures and referrals are low, indicating significant barriers for nurses to address and women to discuss abuse in this setting. If sustainable family violence practices are to be achieved, MCH nurses require additional system support including ongoing family violence training. [ABSTRACT FROM AUTHOR]

Patients with diabetes require regular examination for eye disease, usually in primary care settings. Guidelines recommend patients with at least moderate non-proliferative diabetic retinopathy (NPDR) be referred to an ophthalmologist for treatment; however, poorly targeted referrals lead to access blocks. The quality of new referrals associated with diabetes to a public ophthalmology service in Sydney, New South Wales, Australia, were assessed for referral completeness and targeting. A cross-sectional audit of medical records for new patients referred to Westmead Hospital Eye Clinic in 2016 was completed. Completeness of medical and ophthalmic information in referrals and subsequent patient diagnosis and management in 2016–17 was recorded. Sub-analyses were conducted by primary care referrer type (GP or optometrist). In total, 151 new retinopathy referrals were received; 12% were sent directly to a treatment clinic. Information was incomplete for diabetes status (>60%), medical (>50%) and ophthalmic indicators (>70%), including visual acuity (>60%). GP referrals better recorded medical, and optometrists (37%) ophthalmic information, but information was still largely incomplete. Imaging was rarely included (retinal photos <1%; optical coherence tomography <3%). Median appointment wait-time was 124 days; 21% of patients received treatment (laser or anti-vascular endothelial growth factor) at this or the following encounter. Targeting referrals for ocular complication of diabetes to public hospitals needs improvement. Education, feedback and collaborative care mechanisms should be considered to improve screening and referral in primary care. Diabetic retinopathy (DR) is a leading cause of blindness, and moderate DR (or above) requires management with an ophthalmologist. However, public eye clinics have access blocks. High quality referrals are needed to make decisions regarding the urgency of patient care for ocular complications associated with diabetes. Primary care-initiated referrals are poorly targeted to tertiary care. To improve diabetic retinopathy screening and management, strategies should focus on education and feedback for primary care providers as well as integration of care. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is the highest cause of years lived with a disability in Australia and the most frequent musculoskeletal condition for which patients seek primary care. The aims of this study were to: (1) evaluate the current practices and perspectives of Australian GPs and physiotherapists managing acute back pain; and (2) explore alignment of care with clinical guidelines. This was a prospective cross-sectional Internet survey conducted from March 2018 to May 2018 of experienced Australian GPs and physiotherapists. Descriptive statistics were used to analyse all quantitative outcomes. Two hundred primary care practitioners (72% physiotherapists and 28% GPs) from all States and Territories of Australia completed the survey. Most primary care practitioners were familiar with clinical guidelines for acute back pain management and reported delivery of many of the core components of guideline-based care, including education, advice about favourable prognosis, encouraging activity and self-management and discouraging prolonged bed rest. Deviations from guideline-based care were common, including provision of analgesic medication, passive therapies and using radiological imaging. Australian primary care clinicians in this sample were aware of back pain guidelines and typically implement care that is consistent with guideline-based recommendations. Divergences from these guidelines may indicate that primary care practitioners are delivering evidence-based and person-centred care that integrates clinicians' judgement with patients' preferences and guideline-based evidence. Low back pain (LBP) is the most burdensome condition globally and experts have recently advocated for clinicians to deliver high-value care based on clinical guidelines. However, the current practices and perspectives of primary care practitioners delivering care for acute LBP in Australia are unknown. This study found that when managing acute back pain, most GPs and physiotherapists included key components of guideline-based care, although a person-centred approach often required alternative management strategies. [ABSTRACT FROM AUTHOR]

After-hours general practitioner (GP) services can reduce emergency department demand, which is currently increasing in Australia. Understanding GP after-hours care may assist in service planning. From April 2014 to March 2015, 986 GPs recorded 38 275 consultations with start and finish times in the Bettering the Evaluation and Care of Health (BEACH) study, a national, cross-sectional, representative study of GP activity. GP and patient characteristics and the content of encounters in usual-hours and after-hours were compared. Significantly more after-hours than usual-hours encounters were with: GPs aged 60+ years; in metropolitan practices; and practices with 10+ GPs. Patients seen after-hours were more often: male; aged 15–64 years; new to practice; and less likely to hold a Commonwealth Concession Card. They were more likely to be prescribed antibiotics and less likely to: have chronic problems managed; be referred; receive psycholeptic or psychoanaleptic prescription; and undergo a procedure. Throat symptoms, fever and injury were more common reasons for encounter, while infections and injury were more frequently managed problems after-hours. The patient mix, GP characteristics, problems managed and management actions in after-hours care differ from those in usual-hours care in Australia. This greater understanding of after-hours care is the first step to informed resource allocation to improve the delivery of after-hours primary care. This study aimed to understand what happens at after-hours general practitioner services as it has been shown that these after-hours services can reduce emergency department demand. The patient mix, GP characteristics, problems managed and management actions in after-hours care differ significantly from those in usual-hours care in Australia. This greater understanding of after-hours care is the first step to informed resource allocation to improve the delivery of after-hours primary care. [ABSTRACT FROM AUTHOR]

Health behaviour during midlife is linked to health outcomes in older age. Primary healthcare providers (PHCPs) are ideally placed to provide health-promoting information opportunistically to women in midlife. The aim of this study was to explore PHCPs views about the menopause-related care needs of migrant women from low- and middle-income countries and what they perceive as barriers and enablers for providing this. Of the 139 PHCPs who responded to an anonymous online survey, less than one-third (29.9%) routinely offered menopause-related information during consultations with migrant women. Most agreed that short appointments times (70.8%), lack of culturally and linguistically appropriate menopause information (82.5%) and lack of confidence in providing menopause-related care (32.5%) are barriers for providing comprehensive menopause-related care to migrant women. To overcome these, a menopause-specific Medicare item number and a one-stop website with health information in community languages were suggested. These findings suggest that menopause-related care is not routinely offered by PHCPs to migrant women from low- and middle- income countries and that their capacity to do this may be improved with adequate educational and structural support. [ABSTRACT FROM AUTHOR]

This study aimed to examine the prevalence and perceived barriers to uptake of advance care planning (ACP), including appointment of an enduring guardian (EG) and completion of an advance care directive (ACD) among Australian adults attending hospital outpatient clinics. Sociodemographic correlates of not completing ACP were also assessed. A cross-sectional survey exploring the uptake of ACP was conducted with outpatients and their accompanying persons aged >18 years (n = 191) at one regional hospital in New South Wales, Australia. Rates of completion of an ACD and appointment of an EG were 20% (n = 37) and 35% (n = 67) respectively. The most common reason for non-completion of an ACD and not appointing an EG was: 'didn't think I needed this'. Younger age was associated with not having appointed an EG (OR 3.8, 95% CI 1.2–12.1, P = 0.02). No sociodemographic characteristics were significantly associated with non-completion of ACDs. Uptake of ACP is suboptimal among outpatients. Community-based healthcare providers are well positioned to promote ACP with outpatients. This study investigated uptake of advance care planning, including completing an advance care directive and appointing an enduring guardian, among Australian adults attending hospital outpatient clinics. Only 20% of participants had completed an advance care directive, and 35% had appointed an enduring guardian. Uptake of advance care planning may be improved with community education and training of community-based care providers in supporting advance care planning. [ABSTRACT FROM AUTHOR]

The prevalence of type 2 diabetes (T2D) is increasing worldwide and there is a need to identify communities with a high-risk profile and to develop appropriate primary care interventions. This study aimed to predict future T2D risk and identify community-level geographic variations using general practices data. The Australian T2D risk assessment (AUSDRISK) tool was used to calculate the individual T2D risk scores using 55 693 clinical records from 16 general practices in west Adelaide, South Australia, Australia. Spatial clusters and potential 'hotspots' of T2D risk were examined using Local Moran's I and the Getis-Ord Gi* techniques. Further, the correlation between T2D risk and the socioeconomic status of communities were mapped. Individual risk scores were categorised into three groups: low risk (34.0% of participants), moderate risk (35.2% of participants) and high risk (30.8% of participants). Spatial analysis showed heterogeneity in T2D risk across communities, with significant clusters in the central part of the study area. These study results suggest that routinely collected data from general practices offer a rich source of data that may be a useful and efficient approach for identifying T2D hotspots across communities. Mapping aggregated T2D risk offers a novel approach to identifying areas of unmet need. [ABSTRACT FROM AUTHOR]

Risky alcohol use places those with existing chronic conditions at increased risk of medical complications. Yet, there is little research assessing the alcohol consumption among this group. The aim of this study is to assess the prevalence of risky drinking among people with a range of chronic diseases. As part of the 2013 National Drug Strategy Household Survey (NDSHS), 22 684 Australians aged ≥18 years answered questions about their experience of chronic diseases and their drinking patterns. Nearly 18% (CI: 17.2–19.3) of people with chronic disease reported drinking at a long-term risky level, roughly the same rate as those without chronic disease (19.3%, (CI: 18.6–20.2)). Nearly one-quarter, 24% (CI: 23.0–25.3), of people with chronic diseases drank at levels of increased short-term risk, significantly less than the rest of the sample. Respondents with mental illness were more likely to drink at risky levels than the rest of the sample, while the reverse was true of those with diabetes. Overall, those with chronic diseases have similar drinking patterns to the rest of the population, despite increased risks associated with this consumption. Regular screening and subsequent brief interventions for those with chronic disease, particularly mental illness and cancer, are recommended. [ABSTRACT FROM AUTHOR]

This large (>1000) cross-sectional study investigates patient-reported primary care experiences of older people with chronic illness. Previous research has found that approximately half of patients with chronic illness receive optimal chronic illness care and outcomes in Australian general practice. A survey was administered via a double opt-in panel method to people aged ≥55 years who have one or more self-reported major chronic diseases (diabetes and/or chronic heart, kidney, lung, mental health and/or musculoskeletal conditions). Health professionals were found to be important to the majority of Australians surveyed. Well-known chronic illness support resources such as care plans and recalls/reminders were reported to be wanting by up to 50 per cent of respondents. Across all chronic illness groups, <42 per cent of respondents reported the provision of information on community resources and 25 per cent reported not having a sound understanding about their medications. Regular local surveys for older people with chronic illness would allow a timely understanding of primary care experiences, needs and preferences of this group, to support quality improvement and drive enhanced patient outcomes. [ABSTRACT FROM AUTHOR]

Polypharmacy is increasing among older Australians, raising their risk of experiencing medication-related harm. As part of the prescribing continuum, deprescribing is a strategy proposed to reduce inappropriate polypharmacy. This study explored factors that influence deprescribing among Australian GPs using a new 21-item survey to measure GP attitudes and practices. The 85 GP responses indicated that many factors are supportive of deprescribing. GPs suggest that they are willing to explore their older patients' deprescribing preferences; they believe that they have enough information about the potential harms and benefits of medication to inform their deprescribing decisions and are confident to communicate this information to their patients. GPs did not consider their patients would interpret deprescribing as being 'given up on'. Limited time to review medications, poor communication between prescribers and a perception that other prescribers do not respect their role as overall coordinators of their older patients' medications were considered by respondents to be unsupportive of deprescribing. Overall, despite GPs reporting many supportive factors for deprescribing, the influence of unsupportive factors appears to remain strong, as deprescribing is not routinely considered in practice. [ABSTRACT FROM AUTHOR]

The negative health consequences of tobacco and risky alcohol consumption are compounded when used concurrently. Australian preventative health guidelines recommend that general practitioners (GPs) assess and provide evidence-based intervention. No studies, however, have examined the accuracy of GP detection of concurrent tobacco use and risky alcohol consumption or the factors associated with accurate detection. This study aimed to examine the: (i) accuracy of GP detection of concurrent tobacco and risky alcohol use compared to patient self-report; and (ii) GP and patient characteristics associated with accurate detection following a single clinical encounter. Patients attending 12 Australian general practices completed a survey assessing smoking and alcohol consumption. For each participating patient, GPs completed a checklist to indicate the presence of these risk factors. GP judgements were compared to patient self-report. Fifty-one GPs completed a health risk checklist for 1332 patients. Only 23% of patients who self-reported concurrent tobacco and risky alcohol use identified by their GP. Patients who visited their GP four to six times in the last year were most likely to have concurrent tobacco and risky alcohol use were identified. It is imperative to establish systems to increase detection of preventative health risks in general practice to enable the provision of evidence-based treatments. [ABSTRACT FROM AUTHOR]

Australian guidelines recommend annual screening and monitoring of chronic kidney disease (CKD) in people with type 2 diabetes (T2D). A cross-sectional study utilising data from NPS MedicineWise MedicineInsight program from June 2015 to May 2016 was undertaken to explore: (1) the proportion of patients with T2D attending general practice who have had screening for, or ongoing monitoring of, CKD; (2) the proportion of patients without a documented diagnosis of CKD who have pathology consistent with CKD diagnosis; and (3) the patient factors associated with screening and the recording of a diagnosis of CKD. Of 90 550 patients with T2D, 44 394 (49.0%) were appropriately screened or monitored. There were 8030 (8.9%) patients with a recorded diagnosis of CKD, whereas 6597 (7.3%) patients had no recorded diagnosis of CKD despite pathology consistent with a diagnosis. Older age and diagnosis of hypertension or hyperlipidaemia were associated with increased odds of CKD diagnosis being recorded. Older patients, males, those with recorded diagnoses of hypertension or hyperlipidaemia and those who had their medical record opened more frequently were more likely to be screened appropriately. Screening and monitoring of CKD appears suboptimal. Research to explore barriers to screening, recording and monitoring of CKD, and strategies to address these, is required. [ABSTRACT FROM AUTHOR]

Accompanying population ageing is an increase in the number of older Australians living with multiple health conditions and disabilities (Australian Institute of Health and Welfare 2014). This study sought to examine the barriers to accessing healthcare faced by older Australians. Utilising the 2014 Australian Bureau of Statistics General Social Survey, it was found that 6% of respondents aged 50 years and over reported experiencing a barrier to accessing healthcare within the previous 12 months. Those with multiple health conditions are at a considerably higher risk of experiencing a barrier to healthcare (21% with four or more disabilities) compared with people with no or fewer health conditions, and this risk persists once wide-ranging control variables are included. Long waiting times or unavailability of appointments (43%) were the main type of barriers to accessing healthcare, followed by cost (23%). Points-of-care barriers experienced included accessing GPs, specialists and hospital sector care. Respondents who experienced a barrier were more likely to have low levels of trust in the healthcare system compared with people who had no experience of barriers to healthcare, and were more likely to have a perception of experiencing discrimination or unfair treatment in a healthcare setting. [ABSTRACT FROM AUTHOR]

Group-based education has the potential to substantially improve the outcomes of individuals with type 2 diabetes mellitus (T2DM) and reduce the enormous burden that chronic diseases place on healthcare systems worldwide. Despite this proven effectiveness, the utilisation of group services for the management of T2DM by Australian dietitians is surprisingly low. This study surveyed a sample of 263 Australian dietitians to explore the utilisation of group-based education for T2DM, as well as dietitians' preferences for practice and training. The results of this study indicate that Australian dietitians are currently under-utilising group-based education programs for the management of T2DM, with the primary reasons identified as a lack of training provided to dietitians in the area, limited access to facilities suitable for conducting group education, the perceived poor cost-effectiveness of these programs, and the lack of evidence-based practice guidelines for the group-based management of persons with T2DM. Additionally, the majority of preferences for further training were for either face-to-face or web-based formal training conducted over 3-6 h. Clear, evidence-based practice guidelines and training resources for group education for the management of T2DM are needed in order to encourage better utilisation of group-based education by Australian dietitians. [ABSTRACT FROM AUTHOR]

Annual chlamydia testing is recommended for all sexually active Australians aged 15-29 years; however, the testing rate is below recommended levels. Three surveys at a Melbourne music festival were conducted over 2012-14 to identify correlates of sexually transmissible infection (STI) testing among young people at risk of STIs. In total, 3588 participants were recruited; 72% reported having sex in the past year. Based on sexual behaviours, 38% of sexually active participants were classified as at risk of contracting STIs. In the past year, at-risk participants had significantly higher odds of reporting a STI test (37%) than participants classified as not at risk (24%) (OR = 1.9; CI = 1.6-2.3). Among at-risk participants, correlates of STI testing in the past year included being aged 20-24 years, visiting a GP, higher knowledge levels, earlier sexual debut and reporting more than five lifetime partners. Testing rates in our sample did not meet levels required to reduce chlamydia prevalence. However, the testing rate was higher in at-risk participants than participants who were not at risk. Future programs aiming to increase chlamydia testing should improve knowledge and promote the importance of testing after risk exposure, particularly among 16- to 19-year-olds. [ABSTRACT FROM AUTHOR]

Primary healthcare research strives for high-quality, priority-driven research to inform policy and practice. This relies on a robust and sustainable workforce to tackle complex problems faced in primary health care locally and globally. The current study investigated characteristics, experiences and career paths of the Australian primary healthcare research workforce. Thirty-seven former Research Higher Degree students from University Departments of General Practice and Rural Health completed a survey. Number of provisions for researchers and career path clarity were associated with job satisfaction. Motivators to stay in research included job satisfaction, research in role descriptions, and identification of problems requiring change. Barriers related to funding, time, and other work roles taking priority were identified. Comparisons were made between participants self-identifying as working in primary healthcare research ('stayers'; n = 22) and those no longer part of this workforce ('leavers'; n = 15). Leavers were more likely to be in permanent full-time work whereas stayers had experienced more career progression and mentoring. This study raises challenges faced by primary healthcare researchers and will inform strategies for supporting the sustainability of this workforce. [ABSTRACT FROM AUTHOR]

Although we do know that out-of-pocket healthcare expenditure is relatively high in Australia, little is known about what health conditions are associated with the highest out-of-pocket expenditure, and whether the cost of healthcare acts as a barrier to care for people with different chronic conditions. Cross-sectional analysis using linear and logistic regression models applied to the Commonwealth Fund international health policy survey of adults aged 18 years and over was conducted in 2013. Adults with asthma, emphysema and chronic obstructive pulmonary disease (COPD) had 109% higher household out-of-pocket healthcare expenditure than did those with no health condition (95% CI: 50-193%); and adults with depression, anxiety and other mental health conditions had 95% higher household out-of-pocket expenditure (95% CI: 33-187%). People with a chronic condition were also more likely to forego care because of cost. People with depression, anxiety and other mental health conditions had 7.65 times higher odds of skipping healthcare (95% CI: 4.13-14.20), and people with asthma, emphysema and chronic obstructive pulmonary disease had 6.16 times higher odds of skipping healthcare (95% CI: 3.30-11.50) than did people with no health condition. People with chronic health conditions in Canada, the United Kingdom, Germany, France, Norway, Sweden and Switzerland were all significantly less likely to skip healthcare because of cost than were people with a condition in Australia. The out-of-pocket cost of healthcare in Australia acts as a barrier to accessing treatment for people with chronic health conditions, with people with mental health conditions being likely to skip care. Attention should be given to the accessibility and affordability of mental health services in Australia. [ABSTRACT FROM AUTHOR]

The hypothesis of this study was that those refugee children with Helicobacter pylori are thinner than their noninfected counterparts. This cross-sectional study investigated the height and weight of newly arrived refugee children up to age 19 years, who were screened for H. pylori using a stool antigen test at the Migrant Health Service in Adelaide between August 2010 and October 2013. Of 460 children, 21% were infected with H. pylori. After adjusting for vitamin B12 and iron levels, ethnicity, age and sex, the odds of being thin in the 10- to 19-year-old age group was 4.28-fold higher (95% CI 1.48-12.4) if they were H. pylori positive compared with those who were H. pylori negative. The difference between the two groups is statistically significant (P = 0.01). Screening and treatment for H. pylori in the general population in developed countries is not recommended unless there are symptoms such as dyspepsia or risk of peptic ulcer, duodenal ulcer or gastric cancer. Given the findings of this study, a recommendation could be made that newly arrived refugee children who are thin should be tested for H. pylori. Thinness in children may influence their cognitive ability, school performance, physical endurance and hence their ability to successfully settle into their new country. [ABSTRACT FROM AUTHOR]

Integrated care models have the potential to reduce fragmentation in the health system and improve outcomes for people with type 2 diabetes. A pilot evaluation of an integrated care model for people with type 2 diabetes in Melbourne, Australia, is reported on. Two studies were conducted: (1) a 6-month pilot randomised controlled trial (n = 56) evaluating the impact of the integrated care model relative to hospital outpatient clinics; and (2) a cross-sectional study (n = 92) of patients attending the two services. The primary outcome was diabetes-specific distress; secondary outcomes were perceived quality of diabetes care, diabetes-specific self-efficacy and glycated haemoglobin (HbA1c). There was no effect of service setting on diabetes-specific distress. Participants from the integrated care setting perceived the quality of diabetes care to be higher than did participants from the hospital clinics. Significant HbA1c improvements were observed over time, but with no effect of service setting. The model holds promise for people with type 2 diabetes who need more specialist/multidisciplinary care than can be provided in primary care. Patients' evaluations of the quality of diabetes care received at the integrated care service are very positive, which is likely to be one of the key strengths of the integrated model. [ABSTRACT FROM AUTHOR]

There is increasing interest in the use of brief screening tools to improve detection of depression in the primary care setting. The aim of the present study was to compare the accuracy of the two-item Patient Health Questionnaire (PHQ-2) against the nine-item Patient Health Questionnaire (PHQ-9) for detecting depression among general practice patients. A cross-sectional sample of 3626 adults attending 12 Australian general practices was recruited. Participants completed the PHQ-2 and PHQ-9 via a touchscreen computer. Depression was defined as a PHQ-9 score ≥ 10. The area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value were calculated. The PHQ-2 had good overall accuracy relative to the PHQ-9 for discriminating between cases and non-cases of depression, with an AUC of 0.92 (95% confidence interval 0.90-0.93). The PHQ-2 threshold of ≥3 was the best balance between sensitivity (91%) and specificity (78%) for detecting possible cases of depression. For clinical use, the optimal threshold was ≥2, with only 2% of possible cases missed. [ABSTRACT FROM AUTHOR]

This study explored current physiotherapy practice trends for management of children who are overweight or obese. The professional needs of physiotherapists working with this population were also assessed, including the perceived need for physiotherapy clinical guidelines for prevention and management of children with obesity. Across-sectional survey design was used, with questionnaires purposefully distributed through 13 key physiotherapy services throughout Australia. Snowball sampling resulted in completed questionnaires from 64 physiotherapists who provided services to children. Half (n = 33,52%)of respondents provided services specifically to overweight or obese children. Of those providing services, one-quarter had prior training specific to working with this population. Most used multi-disciplinary models (n = 16, 76%) and provided under 5 h of obesity-related services each week (n = 29, 88%). Half (n = 16, 49%) used body mass index as an outcome measure but more (n = 25, 76%) used bodyweight. Only 14 (42%) assessed motor skills. The majority of respondents (n = 57, 89%) indicated a need for physiotherapy guidelines to best manage overweight and obese children. Professional development priorities included: 'Educating children and families', 'Assessment methods' and 'Exercise prescription' for overweight and obese children. This data provides workforce intelligence to guide future professional training and inform development of clinical guidelines for physiotherapists in prevention and management of children with obesity and related chronic disease. [ABSTRACT FROM AUTHOR]

The objective of the study was to examine associations between family history of premature cardiovascular disease (CVD), knowledge of CVD risk and protective factors, and health behaviours. The design was via administration of a questionnaire to 307 participants from four general practice centre waiting rooms in the Sydney West area. The most recognised CVD risk factor was smoking (97.7%) and the most recognised CVD protective factor was omega-3 fatty acids (78.5%). After adjustment for age, sex, education attainment and personal history of CVD, a strong family history of premature CVD was associated with being more likely to interpret a blood pressure of 130/85 as a CVD risk factor (OR 2.77, 95% CI 1.07-7.14), but less likely to identify being an ex-smoker (compared with never having smoked before) as a risk factor (OR 0.32, 95% CI 0.12-0.90). Those with a strong family history of premature CVD, on average, had smoked 0.82 pack years more than those with an average family history of premature CVD (s.e. 4.22, P = 0.04). In conclusion, there continues to be both strengths and deficits in the community's overall knowledge of CVD risk and protective factors, and a strong family history of premature CVD appears to be an independent risk factor for smoking. [ABSTRACT FROM AUTHOR]

Adolescents engage in a complex range of low energy-consuming and active behaviours not easily captured by single behavioural measures. This study aims to describe the associations among adolescent active and low energy behaviours. Data were obtained from adolescents aged 12-16 years (n=1532) participating in a nationally representative survey. Thirty-nine variables measuring activities were stratified by sex and age and then analysed using principal components analysis with Varimax rotation. Four components were derived for younger girls (21.7% of the variance) and younger boys (20.2%), six for older girls (29.7%) and five for older boys (25.6%). Academic-related behaviours positively correlated with each other and negatively with television use for all age-sex groups. Computer use correlated positively with academic-related behaviours for older boys but negatively with active behaviours for younger boys and girls. Active behaviours correlated positively with each other. For older girls, low energy expenditure, household-based behaviours were negatively correlated with active behaviours. Computer use appears to differ across age groups, and leisure and academic use should be differentiated. The positive associations among different active behaviours and their negative associations with home-based, low energy expenditure behaviours are of interest for intervention development. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the quality of palliative care delivered to residential aged care facilities in rural southern Australia. Topics covered include the factors affecting the quality of palliative care such as workforce shortages, the transfer of unstable residents with a reasonable prognosis and the need for provision of targeted education for health care providers.

The article discusses a study which examined the perception of Queensland general practitioners (GPs) on managing the growing problem of childhood obesity. Topics covered include the barriers to identification of childhood obesity, the challenges in managing childhood obesity such as lack of financial incentive and the percentage of GPs who indicated awareness of the National Health and Medical Research Council guidelines for management of obese children.