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Qualitative research about women and birthing people's experiences of fetal monitoring during labour and birth is scant. Labour and birth is often impacted by wearable or invasive monitoring devices, however, most published research about fetal monitoring is focused on the wellbeing of the fetus. This manuscript is derived from a larger mixed methods study, 'WOmen's Experiences of Monitoring Baby (The WOMB Study)', aiming to increase understanding of the experiences of women and birthing people in Australia, of being monitored; and about the information they received about fetal monitoring devices during pregnancy. We constructed a national cross-sectional survey that was distributed via social media in May and June, 2022. Responses were received from 861 participants. As far as we are aware, this is the first survey of the experiences of women and birthing people of intrapartum fetal monitoring conducted in Australia. This paper comprises the analysis of the free text survey responses, using qualitative and inductive content analysis. Two categories were constructed, Tending to the machine, which explores participants' perceptions of the way in which clinicians interacted with fetal monitoring technologies; and Impressions of the machine, which explores the direct impact of fetal monitoring devices upon the labour and birth experience of women and birthing people. The findings suggest that some clinicians need to reflect upon the information they provide to women and birthing people about monitoring. For example, freedom of movement is an important aspect of supporting the physiology of labour and managing pain. If freedom of movement is important, the physical restriction created by a wired cardiotocograph is inappropriate. Many participants noticed that clinicians focused their attention primarily on the technology. Prioritising the individual needs of the woman or birthing person is key to providing high quality woman-centred intrapartum care. Women should be provided with adequate information regarding the risks and benefits of different forms of fetal monitoring including how the form of monitoring might impact her labour experience. [ABSTRACT FROM AUTHOR]

Basic foot care is a real need of people experiencing homelessness. To improve access to foot health for this group, three services structured to provide healthcare support for people experiencing homelessness collaborated in metropolitan Melbourne, Australia: an established nurse-led Homeless Persons Program (HPP), a specialty community health podiatry clinic servicing people experiencing homelessness, and a charity supporting disadvantaged communities providing free socks, foot first aid kits and second-hand footwear for distribution by nurses and podiatrists of participating services. This paper outlines the implementation and evaluation of this collaboration. A four stage implementation approach was used, addressing: 1. Who needs to do what differently? 2. What are the barriers and enablers that need to be addressed? 3. Which intervention components could overcome the modifiable barriers and enhance the enablers? 4. How can the changes be measured? The evaluation prospectively collected information about how HPP nurses referred adults to podiatry, and whether the referred individuals accessed the podiatry clinic, the outcomes of the podiatry visit, and how many received footwear, socks and foot first aid kits provided by the non-profit organisation. Over 1st June 2019 and 31st December 2020, 52 individuals were identified as adults who could potentially benefit from podiatry by the HPP nurses, of which 33 accessed podiatry. Those who did not visit the podiatry clinic were more likely to be born outside of Australia, live in more precarious housing (crisis accommodation and rough sleeping), have slightly more predisposing factors for homelessness, but have fewer medical, psychological and cognitive conditions. A structured approach including processes, education, regular, outreach to youth refuges and formal outcome monitoring enabled foot health care access in people experiencing homelessness. Further research is needed to ascertain how to support participants at risk of foot problems to access podiatry before their foot health issue reaches crisis point. [ABSTRACT FROM AUTHOR]

Although previous studies of today's globalised and competitive research landscape have mentioned the research collaborations of CANZUK countries (i.e., Australia, Canada, New Zealand, and the United Kingdom), none have yet studied them in detail. Further, such studies have used different measures of international research collaboration (IRC), resulting in disparate findings. This paper, therefore, analyses the strengths of CANZUK research collaborations, how those collaborations have changed over time, and assesses the effect of three ways of measures on the results (absolute strength, bilateral similarity, and multilateral similarity). We provide a detailed characterisation of the CANZUK research network and its relationships with partner countries, which reveals that the most collaborative CANZUK countries are the UK and Australia, among other findings. We also confirm that many findings differ depending on which measures are used. We offer an explanation of this difference with reference to the nature of the measures (i.e., what they really measure) and make suggestions for suitable measures in future studies depending on their purpose. Finally, we discuss how this study's findings can be used by research policy makers (in CANZUK and elsewhere) in deciding on research strategy and by researchers in appropriately measuring IRC. [ABSTRACT FROM AUTHOR]

Research has shown that there are significant gaps in hepatitis B knowledge among migrant communities who are at risk of hepatitis B, such as Chinese and Vietnamese communities. Many students studying within Australia come from countries with high prevalence of hepatitis B. However, there is very little research examining hepatitis B knowledge, screening, or vaccination among university students in Australia or worldwide. The aim of this paper was to measure both levels of and demographic differences in hepatitis B screening and knowledge among Chinese and Vietnamese students in Australia. Online surveys were completed by 112 Chinese- and 95 Vietnamese-identifying students in Australia, measuring knowledge of hepatitis B, engagement in screening and vaccination, and demographic characteristics. Results show that although engagement in screening and vaccination for hepatitis B was high, there were significant gaps in knowledge around transmission of hepatitis B. There were also some key demographic differences in screening and knowledge. For instance, those born in Australia were more likely to have been screened compared to those born Mainland China, Hong Kong, or Vietnam. Chinese students born in Australia had lower levels of knowledge compared to those born in Mainland China or Hong Kong. Among both samples, knowing someone living with hepatitis B was associated with higher levels of knowledge. Findings underscore the need for education-based interventions to address the significant gaps that exist in knowledge around hepatitis B, with a specific need for culturally appropriate resources in a range of languages to cater to the diverse communities who may be at risk of hepatitis B. [ABSTRACT FROM AUTHOR]

Background: Specialist care units cater to targeted cohorts of patients, applying evidence-based practice to people with a specific condition (e.g., dementia) or meeting other specific criteria (e.g., children). This paper aimed to collate perceptions of local consumers and health providers around specialist care units, as a model of care that may be considered for a new local healthcare facility. Methods: This was a qualitative study using two-hour workshops and interviews to collect data. Participants were consumers and health providers in the planned facility's catchment: 49 suburbs in metropolitan Australia. Consumers and health providers were recruited through advertisements and emails. An initial survey collected demographic details. Consumers and health providers participated in separate two-hour workshops in which a scenario around the specialist unit model was presented and discussion on benefits, barriers and enablers of the model was led by researchers. Detailed notes were taken for analysis. Results: Five consumer workshops (n = 22 participants) and five health provider workshops (n = 42) were conducted. Participants were representative of this culturally diverse region. Factors identified by participants as relevant to the specialist unit model of care included: accessibility; a perceived narrow scope of practice; coordination with other services; resources and infrastructure; and awareness and expectations of the units. Some factors identified as risks or barriers when absent were identified as strengths and enablers when present by both groups of participants. Conclusions: Positive views of the model centred on the higher perceived quality of care received in the units. Negative views centred on a perceived narrow scope of care and lack of flexibility. Consumers hinted, and providers stated explicitly, that the model needed to be complemented by an integrated model of care model to enable continuity of care and easy transfer of patients into and out of the specialist unit. [ABSTRACT FROM AUTHOR]

Despite their low cost, the use of email invitations to distribute surveys to medical practitioners have been associated with lower response rates. This research compares the difference in response rates from using email approach plus online completion rather than a mailed invitation letter plus a choice of online or paper completion. A parallel randomised controlled trial was conducted during the 11th annual wave of the nationally representative Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of doctors. The control group was invited using a mailed paper letter (including a paper survey plus instructions to complete online) and three mailed paper reminders. The intervention group was approached in the same way apart from the second reminder when they were approached by email only. The primary outcome is the response rate and the statistical analysis was blinded. 18,247 doctors were randomly allocated to the control (9,125) or intervention group (9,127), with 9,108 and 9,107 included in the analysis. Using intention to treat analysis, the response rate in the intervention group was 35.92% compared to 37.59% in the control group, a difference of -1.66 percentage points (95% CI: -3.06 to -0.26). The difference was larger for General Practitioners (-2.76 percentage points, 95% CI: -4.65 to -0.87) compared to other specialists (-0.47 percentage points, 95% CI: -2.53 to 1.60). For those who supplied an email address, the average treatment effect on the treated was higher at -2.63 percentage points (95% CI: -4.50 to -0.75) for all physicians, -3.17 percentage points (95% CI: -5.83 to -0.53) for General Practitioners, and -2.1 percentage points (95% CI: -4.75 to 0.56) for other specialists. For qualified physicians, using email to invite participants to complete a survey leads to lower response rates compared to a mailed letter. Lower response rates need to be traded off with the lower costs of using email rather than mailed letters. [ABSTRACT FROM AUTHOR]

The Consolidated Framework for Implementation Research (CFIR) is a well-established framework for systematically identifying key factors influencing the implementation of programs. To enhance the classification of existing CFIR definitions, as well as its +2/-2 scoring system, this study incorporated the views of relevant experts to: i) improve how themes are scored; and ii) utilise more information regarding the frequency with which themes are identified. This structured, frequency-based approach to the CFIR's scoring process has been trialled as the CFIR-frequency (CFIR-f). Researchers thematically analysed semi-structured interview data from four groups of policy and program experts (N = 24) delivering two family-based therapies in New South Wales (NSW), Australia. Themes identified by less than 50% were excluded from further analysis. Themes identified by 50% or more of expert participants in the four groups were classified as enablers or barriers using clearly defined criteria. Each theme was allocated a score according to how many experts identified it as an enabler or barrier, and then mapped back onto the latest adaptation of the CFIR comprising 67 constructs. The CFIR-f successfully determined three enablers of, and six barriers to, implementation. Enablers included the family-based therapy programs, therapist training and participant monitoring systems. Barriers included referral, data collection and staffing difficulties, NSW adaptation issues and the suitability and safety of the programs for Aboriginal families. The same enablers and barriers were identified using both the CFIR-f and the original scoring approach, and the identified themes were successfully mapped to almost all CFIR constructs (65/67). This paper proposes a more frequency-based approach to CFIR's scoring process (the CFIR-f). By specifically utilising the frequency with which these barriers and enablers are identified, the CFIR-f engenders a list of ranked themes that service providers and policymakers can use to inform their decisions about program modification and implementation. [ABSTRACT FROM AUTHOR]

Solar PV enables the conversion of solar energy into electricity and has become a clean energy technology for economic development. The advantages and disadvantages of solar photovoltaic vary among CPTPP member nations; nevertheless, since the CPTPP's implementation, fewer researchers have evaluated the member countries' solar photovoltaic goods' level of international competitiveness. In order to correct the flaw that the RCA index can only be studied from trade volume, this study adopts the IRCA index method and the revised CMS model, which integrates a number of variables to analyze the competitiveness of solar photovoltaic in each country. The study's findings indicate that: (1) the structural effect has a significant impact on export growth, particularly during the epidemic period, when Australia's contribution rate reached 106.58%; (2) the competitiveness effect has a lesser impact on export growth, and the epidemic led to a decline in competitiveness, with Japan's contribution rate reaching -262.85%; (3) the second-order effect has a declining trend in its contribution rate of export growth; (4) the export competitiveness of solar PV products differs between CPTPP countries, with power supply products having the most export competitiveness and solar cells having a steady comparative advantage in a weaker state. Apart than Japan, the remaining nations' comparative advantages for PV products are less than 1. Based on the above research findings, this paper puts forward the corresponding policy recommendations. [ABSTRACT FROM AUTHOR]

Charities play an increasingly important role in helping people experiencing poverty. However, institutionalized charity shifts the burden of poverty reduction away from the state and exposes recipients to stress and stigma. In this paper, we examine whether the need for institutionalized charity can be offset through enhanced state support. As in other countries, the Australian government responded to the COVID-19 pandemic by substantially increasing the level of income support to citizens through several temporary payments. We draw on this natural experiment and time-series data from the two largest charity organizations in Queensland, Australia to examine how these payments altered the demand for institutionalized charity. We model these data using difference-in-difference regression models to approximate causal effects. By exploiting the timing and varying amounts of the payments, our analyses yield evidence that more generous income support reduces reliance on charity. Halving the demand for charity requires raising pre-pandemic income-support by AUD$42/day, with supplements of approximately AUD$18/day yielding the greatest return on investment. [ABSTRACT FROM AUTHOR]

Australia's headspace initiative is world-leading in nation-wide youth mental healthcare reform for young people aged 12 to 25 years, now with 16 years of implementation. This paper examines changes in the key outcomes of psychological distress, psychosocial functioning, and quality of life for young people accessing headspace centres across Australia for mental health problems. Routinely collected data from headspace clients commencing an episode of care within the data collection period, 1 April 2019 to 30 March 2020, and at 90-day follow-up were analysed. Participants came from the 108 fully-established headspace centres across Australia, and comprised 58,233 young people aged 12–25 years first accessing headspace centres for mental health problems during the data collection period. Main outcome measures were self-reported psychological distress and quality of life, and clinician-reported social and occupational functioning. Most headspace mental health clients presented with depression and anxiety issues (75.21%). There were 35.27% with a diagnosis: overall, 21.74% diagnosed with anxiety, 18.51% with depression, and 8.60% were sub-syndromal. Younger males were more likely to present for anger issues. Cognitive behavioural therapy was the most common treatment. There were significant improvements in all outcome scores over time (P<0.001). From presentation to last service rating, over one-third had significant improvements in psychological distress and a similar proportion in psychosocial functioning; just under half improved in self-reported quality of life. Significant improvement on any of the three outcomes was shown for 70.96% of headspace mental health clients. After 16 years of headspace implementation, positive outcomes are being achieved, particularly when multi-dimensional outcomes are considered. A suite of outcomes that capture meaningful change for young people's quality of life, distress and functioning, is critical for early intervention, primary care settings with diverse client presentations, such as the headspace youth mental healthcare initiative. [ABSTRACT FROM AUTHOR]

As a case study of the responses of natural history museums to changing scientific and funding environments, we analysed research publications of Australia's Natural History Museums (ANHMs) 1981–2020. Using Scopus, 9,923 relevant documents 1981–2020 were identified, mainly research papers but with a growing proportion of reviews. The number of documents published increased over tenfold from 39 (1981) to 553 (2020), likely driven by collaborations (rising from 28.5% of documents 1981–1985 to 87.2% of documents 2016–2020), contributions from retired staff, and volunteer support. The mean length of documents (pages) ranged from a low of 15.3 in 2001–2005 to a high of 17.4 in 1991–1995, but this statistically significant result was trivial in practical terms. The sources (i.e., journals, book titles, conference proceedings) in which ANHM authors published changed over time, with growing proportions of publications in journals covering molecular ecology/phylogenetics and biological conservation. We identified the major areas of study canvassed within the corpus of publications by developing structural topic models based on patterns of word use in document titles, abstracts and keyword lists. The topics discovered included study subjects traditional for natural history museums (new taxa, phylogeny, systematics, animal morphology, palaeontology, minerals), new directions (molecular genetics, ecology, biological conservation) and marine biology (probably reflecting Australia's large coastline). Most citations came from Australia, USA and UK, although in 2016–2020 only 27.9% of citing documents included an Australian author. Growth in numbers of documents and collaborations, as well as use of documents internationally over a period of great change in scientific and funding environments, indicate an enduring legacy of ANHM research, grounded on the intrinsic value of the collections. [ABSTRACT FROM AUTHOR]

Past research has stressed the role of age and generation in climate change discourse, worries, and willingness to act. Therefore, the present paper aimed to examine the role of chronological age (as an arbitrary factor, which represents ageism) in lay people's climate change-related attitudes, feelings, and behavioral intentions. Two experiments in different countries, Australia and Israel, were conducted for this purpose. The first study examined the impact of the age of the speaker, who provides information about the climate crisis and the second examined the impact of the age of the group being blamed for the situation. Outcome variables included perceived responsibility and motivation for the current climate situation in study 1 and perceived climate change-related attitudes, feelings, and behavioral intentions in study 2. In study 1 (n = 250, Australia), the age of the speaker, a climate activist, varied randomly to test the hypothesis that a younger activist would be more influential and increase motivation and responsibility to act compared to an older activist. In study 2 (n = 179, Israel), the age (young vs. old) of the group identified as being responsible for the climate crisis varied randomly, to test the hypothesis that people would be more willing to identify older people as being responsible for the current climate situation, and this would impact climate change-related attitudes, feelings, and behavioral intentions. Both studies resulted in null effects. Additionally, there was no interaction between the age of the respondent and the age of the source of the message or the age group being blamed by the message. The present study has failed to show that strategies that emphasize intergenerational conflict and ageism impact people's attitudes, feelings, and behavioral intentions towards the current climate situation. This possibly can serve as an instigator for strategies that emphasize intergenerational solidarity, rather than conflict, as a guiding principle in future campaigns that advocate climate change adaptation and mitigation measures. [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]

While spillover across equity markets has been extensively investigated, volatility spillover across sectors has largely been under-examined in the current literature. This paper estimates the sectoral volatility using the ARMA-GARCH model and its spillover across Australian sectors on the VAR framework during the 2010–2021 period. We then identify breakpoints in market volatility during the Covid-19 pandemic using a wavelet methodology. We find that volatility spillover across Australian sectors is very significant at 60 per cent from 2010 to 2019, reaching 90 per cent during the Covid-19 pandemic in 2020. The spillover then reverts to its pre-pandemic level in 2021. Consumer Staples and Industrials are the significant risk transmitters, whereas Financials and Real estates are the most significant risk absorbers. Our findings also indicate that Real Estate, Health Care, and Financials record the most significant increase in volatility of more than 300 per cent. Policy implications regarding risk management across Australian sectors have emerged, particularly during extreme events such as the pandemic. [ABSTRACT FROM AUTHOR]

Objective: Bariatric surgery is an effective treatment for type 2 diabetes and morbid obesity. This paper analyses the clinical and patient-reported outcomes of patients treated through the Bariatric Surgery Initiative, a health system collaboration providing bariatric surgery as a state-wide public service in Queensland, Australia. Research design and methods: A longitudinal prospective cohort study was undertaken. Eligible patients had type 2 diabetes and morbid obesity (BMI ≥ 35 kg/m2). Following referral by specialist outpatient clinics, 212 patients underwent Roux-en-Y gastric bypass or sleeve gastrectomy. Outcomes were tracked for a follow-up of 12-months and included body weight, BMI, HbA1c, comorbidities, health-related quality of life, eating behaviour, and patient satisfaction. Results: Following surgery, patients' average body weight decreased by 23.6%. Average HbA1c improved by 24.4% and 48.8% of patients were able to discontinue diabetes-related treatment. The incidence of hypertension, non-alcoholic steatohepatitis, and renal impairment decreased by 37.1%, 66.4%, and 62.3%, respectively. Patients' emotional eating scores, uncontrolled eating and cognitive restraint improved by 32.5%, 20.7%, and 6.9%, respectively. Quality of life increased by 18.8% and patients' overall satisfaction with the treatment remained above 97.5% throughout the recovery period. Conclusions: This study confirmed previous work demonstrating the efficacy of publicly funded bariatric surgery in treating obesity, type 2 diabetes and related comorbidities, and improving patients' quality of life and eating behaviour. Despite the short follow-up period, the results bode well for future weight maintenance in this cohort. [ABSTRACT FROM AUTHOR]

Virtual healthcare has the potential to increase access to allied health for people living in rural areas, but challenges in delivery of such models have been reported. The COVID-19 pandemic provided an opportunity for a rural practice of physiotherapists and exercise physiologists to transition service delivery to a virtual model of care which utilised a combination of phone, video, an exercise app and/or paper handouts. This study aimed to evaluate the uptake and outcomes from virtual delivery of allied health services, and to describe patient and clinician experiences of the virtual model of care. A parallel convergent mixed methods study was conducted. De-identified data from patients who were offered the virtual service between 15 March 2020 and 30 September 2020 were extracted from the database of the rural practice, as were data from patients attending the practice in-person during the same time in 2019 to serve as a historical comparison. De-identified data from a monthly survey tracking clinician experiences of delivering care virtually was also obtained from the practice. Quantitative data were presented descriptively. Between-group differences were compared using independent samples t-tests, and within-group longitudinal changes compared using paired t-tests. Semi-structured interviews were conducted among a purposive sample of patients using the virtual service, and focus groups conducted among clinicians providing this model of care. Qualitative data were recorded and transcribed verbatim, then thematic analysis conducted. During the study period, the practice delivered 4% (n = 242) consultations virtually. Thirty-seven of the 60 patients (62%) using the virtual service were new referrals. Patients attended fewer sessional appointments virtually and a smaller proportion of patients reported high satisfaction with virtual care, compared to those who received in-person care the previous year (p <.05). Clinician confidence in delivering virtual care did not change significantly over time (p>.05), though clinicians not providing virtual care in a given month perceived their lower confidence than those who did provide virtual care (p <.05). Five themes influencing the success of virtual allied health provision emerged from patient interviews and clinician focus groups: adaptation of program elements for virtual delivery, conduct of virtual treatment, clinician flexibility, patient complexity and communication. The theme of communication influenced all the other themes. Virtual healthcare is a potential solution to address lack of access to allied health practitioners in rural areas, but may not suit all patients. Establishing a therapeutic relationship and ensuring people have access to adequate resources prior to virtual care delivery will optimise successful adoption of virtual care models. A hybrid model incorporating limited in-person consultations with virtual consultations appears a more viable option. [ABSTRACT FROM AUTHOR]

This paper reports on a laboratory experiment designed specifically to test the influence of national pride on tax honesty while using a physiological marker to observe emotional responses to patriotic priming. Participants were exposed to one of three framing videos before earning income in a real effort task and were given the chance to declare their taxable income. We find that psychological priming through exposure to symbols of Australian national pride and national identity had a positive effect on the level of tax compliance among Australian but not non-Australians. In addition, non-Australians report lower tax compliance ratios in the treatment groups than in the control group which may indicate an outgroup effect. When exploring the potential of a physiological marker of national pride we observe two different types of physiological responses to the activation and effects of national pride and its impact on tax compliance among Australians. Iconic images activate the parasympathetic nervous system while sports scenes activate the sympathetic nervous system, but both types of images and responses are positively associated with tax compliance. In addition, we find that non-Australians resident in the country for more than a year report a higher level of tax compliance, and that there are some similarities in heart rate variability (HRV) responses between Australian citizens born in the country and those born overseas who have been in Australia for a longer period. Overall, the results support the proposition that identifying with an ingroup at a national level is important for tax compliance. [ABSTRACT FROM AUTHOR]

This study establishes a new method for estimating the monthly Average Population Present (APP) in Australian regions. Conventional population statistics, which enumerate people where they usually live, ignore the significant spatial mobility driving short term shifts in population numbers. Estimates of the temporary or ambient population of a region have several important applications including the provision of goods and services, emergency preparedness and serve as more appropriate denominators for a range of social statistics. This paper develops a flexible modelling framework to generate APP estimates from an integrated suite of conventional and novel data sources. The resultant APP estimates reveal the considerable seasonality in small area populations across Australia's regions alongside the contribution of domestic and international visitors as well as absent residents to the observed monthly variations. The modelling framework developed in the paper is conceived in a manner such that it can be adapted and re-deployed both for use with alternative data sources as well as other situational contexts for the estimation of temporary populations. [ABSTRACT FROM AUTHOR]

Background: Patient interest in the use of cannabis-based medicines (CBMs) has increased in Australia. While recent policy and legislative changes have enabled health practitioners to prescribe CBMs for their patients, many patients still struggle to access CBMs. This paper employed a thematic analysis to submissions made to a 2019 Australian government inquiry into current barriers of patient access to medical cannabis. Methods: We identified 121 submissions from patients or family members (n = 63), government bodies (n = 5), non-government organisations (i.e., professional health bodies, charities, consumer organisations or advocacy groups; n = 25), medical cannabis and pharmaceutical industry (n = 16), and individual health professionals, academics, or research centres (n = 12). Data were coded using NVivo 12 software and thematically analysed. The findings were presented narratively using a modified Levesque's patient-centred access to care framework which includes: i) appropriateness; ii) availability and geographic accessibility; iii) acceptability; and iv) affordability. Results: Submissions from government agencies and professional health bodies consistently supported maintaining the current regulatory frameworks and access pathways, whereas an overwhelming majority of patients, advocacy groups and the medical cannabis industry described the current regulatory and access models as 'not fit for purpose'. These differing views seem to arise from divergent persepctives on (i) what and how much evidence is needed for policy and practice, and (ii) how patients should be given access to medical cannabis products amidst empirical uncertainty. Notwithstanding these differences, there were commonalities among some stakeholders regarding the various supply, regulatory, legislative, financial, and dispensing challenges that hindered timely access to CBMs. Conclusions: Progress in addressing the fundamental barriers that determine if and how a patient accesses and uses CBMs needs i) a 'system-level' reform that gives due consideration to the geographic disparity in access to prescribers and medical cannabis, and ii) reframing societal and health professional's views of CBMs by decoupling recreational vs medical cannabis. [ABSTRACT FROM AUTHOR]

Introduction: Safe spaces are an alternative to emergency departments, which are often unable to provide optimum care for people experiencing emotional distress and/or suicidal crisis. At present, there are several different safe space models being trialled in Australia. However, research examining the effectiveness of safe space models, especially in community settings, is rare. In this paper, we present a protocol for a study in which we will investigate the implementation, effectiveness, and sustainability of safe space models as genuine alternatives for people who might usually present to the emergency department or choose not to access help due to past negative experiences. Material and methods: We will use a mixed methods, co-designed study design, conducted according to the principles of community-based participatory research to obtain deep insights into the benefits of different safe space models, potential challenges, and facilitators of effective practice. We developed the study plan and evaluation framework using the RE-AIM framework, and this will be used to assess key outcomes related to reach, effectiveness, adoption, implementation, and maintenance. Data collection will comprise quantitative measures on access, use, satisfaction, (cost) effectiveness, distress, and suicidal ideation; and qualitative assessments of service implementation, experience, feasibility, acceptability, community awareness, and the fidelity of the models to service co-design. Data will be collected and analysed concurrently throughout the trial period of the initiatives. Discussion: This study will enable an extensive investigation of safe spaces that will inform local delivery and provide a broader understanding of the key features of safe spaces as acceptable and effective alternatives to hospital-based care for people experiencing emotional distress and/or suicidal crisis. This study will also contribute to a growing body of research on the role and benefits of peer support and provide critical new knowledge on the successes and challenges of service co-design to inform future practice. [ABSTRACT FROM AUTHOR]

Drowning is a global public health problem, but accurately estimating drowning risk remains a challenge. Coastal drowning comprises a significant proportion of the drowning burden in Australia and is influenced by a range of behavioural factors (e.g. risk perception, knowledge, attitudes and behaviours) that are poorly understood. These factors, along with those that impact exposure (e.g. coastal visitation and activity participation) all impact on drowning risk. While excellent mortality and morbidity data exists in Australia, a lack of coastal participation data presents challenges to identifying high-risk groups or activities and prioritising prevention efforts. This methods paper describes the development and evolution of an ongoing, annual, nationally representative online survey as an effective tool used to capture valuable data about the Australian population's relationship with the coast. This paper explores how the survey is structured (12–14 sections spanning multiple topics and themes), the different question types used (including open text, 4-digit responses and categorical questions), the sample size (1400–1600 respondents), sampling strategy (using demographic quota sampling which can then be post-weighted to the population if required) and how topics and themes have changed over time to enhance the quality of data collected (i.e., wording changes to enhance participant comprehension or data usability and changing issue-specific 'feature' topics of interest such as campaign evaluation). How the survey is implemented online is described, both practically through to third-party recruitment processes and ethically to maximise anonymity of respondents and ensure data quality. Interim analyses indicate the impact of considering exposure when calculating fatal drowning rates, especially by activity (e.g., crude boating drowning rate 0.12 per 100,000 population vs 0.95 per 100,000 exposed population [relative risk = 8.01; 95% confidence interval: 4.55–14.10]). This study highlights lessons learned in the process of conducting a nationally representative coastal participation survey as well as the strengths and limitations of adopting this approach. Data collected will provide more detailed information on the skills, behaviours, knowledge and attitudes of coastal activity participants. Analyses of this unique dataset will inform research that will underpin development and evaluation of coastal drowning prevention initiatives prioritising those most at risk. It is hoped that the methods detailed within this study may be useful for other countries to develop similar approaches to understanding their own population. [ABSTRACT FROM AUTHOR]

Overweight and obesity has reach pandemic levels, with two-thirds (67%) of adult Australians classified as overweight or obese. As two of the most significant behavioral risk factors for obesity are modifiable (diet and exercise), there exists an opportunity for treatment through workplace health promotion initiatives. As one of Australia's largest industries with its own unique workplace factors, the mining industry has previously reported higher than population levels of overweight and obesity. This represented an opportune setting to test the RESHAPE workplace wellness program. RESHAPE is an eight-step framework (based on the WHO 'Health Workplace Framework and Model') which aims to provide a sustained approach to wellness in the workplace. This paper presents baseline findings from a pilot study that aimed to implement RESHAPE at three mine sites in NSW, Australia, and investigates the issue of overweight and obesity in the coal mining industry. Across three mine sites, 949 coal miners were examined cross-sectionally on a range of workplace, wellness, health, diet, and exercise factors using a paper-based survey. This was a predominantly male sample (90.4%) with the majority (59.2%) of participants aged 25–44 years. Self-reported height and weight measures indicated that less than 20 percent (18.9%) of participants were in a healthy BMI range, while there were effectively equal numbers of overweight (40.9%) and obese (39.1%) participants. Only 3.5% of participants met the daily recommendation for vegetables (5 serves) and shift-workers had greater association with elevated BMI compared to non-shift workers (B = 1.21, 95% CI: 0.23, 2.20, p = 0.016). Poor nutrition is likely to be a key component in elevated levels of overweight and obesity within this industry, with workplace factors compounding challenges workers face in implementing health behavior change. Future studies would benefit from assessing diet and physical activity knowledge in relation to recommendations and serving sizes. [ABSTRACT FROM AUTHOR]

This paper's aim is to propose a mediation framework and test whether lifestyle choices and social capital are pathways through which locus of control (LoC) affects subjective well-being. Using longitudinal data for Australia, we find that life satisfaction and mental health are explained by direct and indirect effects of LoC. The direct effect is positive, indicating that individuals with an internal LoC have higher levels of life satisfaction and mental health. We also show that physical activity and social interaction are two pathways linking an internal LoC to higher levels of well-being. Our findings provide new insights into the relationship between LoC and subjective well-being and suggest that, if the aim of policy is to improve well-being, the focus should be on enabling people to develop an internal LoC. This may lead to higher well-being both through the identified channels and, more importantly, through the direct channel of LoC. [ABSTRACT FROM AUTHOR]

Workers' living standards have recently deteriorated in the service sector throughout the world, although a few decades ago, service was among the fastest growing sectors in industrialised nations. However, in recent years, in service sectors tourism especially has been drying up. This paper examines the symmetric and asymmetric effects of tourism, market capital, financial development, and trade on service sector employment in Australia from the period 1991–2019. The results of the cointegration tests, notably the ARDL and NARDL bound tests, reveal that the variables are related in the long run. The positive effect of tourist arrival on service sector employment in Australia is confirmed by long-run estimates from both ARDL and NARDL approaches. Similarly, both approaches also confirm the long-run positive relation of financial development. However, while ARDL shows long-run negative and positive associations of market capital and trade, respectively, the opposite is found in the case of the NARDL approach. As a result, policy proposals like planning and initiating tools for ensuring consistent international arrivals and easing of entry requirements have been recommended by this study to assist Australia in enhancing service sector employment, thus promoting economic development. [ABSTRACT FROM AUTHOR]

Introduction: Quality of life (QoL), mental wellbeing, and physical function are often diminished among people with chronic disease. Tai Chi is a moderate form of exercise that may be effective in improving chronic disease management. This protocol paper outlines a trial to determine the therapeutic effects of a Tai Chi program on chronic disease management. Methods and analysis: This study will be a pilot, interventional, single-blind, two-armed, randomised, parallel, and controlled trial involving a 12-week Tai Chi program for Australian adults. Forty people aged 18 years and older, diagnosed with one or more chronic disease from general community will be recruited. All participants will be randomised to either a 12-week Tai Chi program or a waiting list control group. The Tai Chi program will involve 12 weeks of group Tai Chi sessions, with 45 minutes per session, twice a week. The primary outcome will be QoL as measured by mean scores on the 12-item Short Form Health Survey (SF-12v2) and the EuroQoL (EQ-5D). The secondary outcomes will include anxiety as measured by mean score on the generalised anxiety disorder 7 (GAD-7) survey; depression as measured by mean score on the patient health questionnaire (PHQ-9); work productivity and activity assessment (WPAI:SHP); pain (if any) as measured by mean scores on the visual analogue scale (VAS) and the McGill pain questionnaire (MPQ). These primary and secondary outcomes will be self-administered via two online assessments prior to (T0) and post-intervention (T1). Objective measures as additional secondary outcomes, will also be carried out by the research team including flexibility as measured by the finger to floor distance (FFD); obesity as measured by mean scores on body mass index (BMI); vital signs (blood pressure, heart rate, respiratory rate, temperate, and oxygen saturation) as measured by a blood pressure monitor, tympanic, and pulse oximetry device, and these outcomes will be measured at T0 and T1 in the ECU Holistic Health Research Clinic. People diagnosed with pre-diabetes or diabetes, their glycosylated haemoglobin (HbA1C) and fasting (before breakfast) blood glucose level (BGL) will also be measured via test kits at T0 and T1 in the clinic. Linear mixed modelling will be conducted to assess changes in outcomes. Statistical significance will be set at an alpha level of 0.05 with a medium effect size. All analyses will be conducted using R version 4.1. Qualitative data will be analysed using template thematic analysis. Ethics and dissemination: Ethical approval has been obtained from the Edith Cowan University (ECU) Human Research Ethics Committee (2021-03042-WANG). Research findings will be disseminated to the public, health professionals, researchers, and healthcare providers through conference presentations, lay summaries, and peer-reviewed publications. This study will provide an updated evidence on a safe, sustainable, and inexpensive non-pharmacological approach in the management of chronic disease, the number one burden of disease in Australia. Trial registration: Trial registration number:ACTRN12622000042741p. [ABSTRACT FROM AUTHOR]

Introduction: Addressing disparities in arthritis care is an important yet unmet health need for Aboriginal and Torres Strait Islander people in Australia (respectfully Aboriginal people herewith). Despite the significant prevalence and burden of arthritis within Aboriginal communities, access to care for arthritis is low. One means to reduce existing disparities in health care is to address current challenges relating to the appropriateness and acceptability of health care information resources for Aboriginal people. Health information sources can help to empower patients and their families to have greater involvement in their care and to engage in self-management of their condition. Despite an extensive range of arthritis information resources being available, currently no resources have been culturally adapted and developed in collaboration with Aboriginal consumers with arthritis. This paper outlines the processes that will be undertaken within the Staying Moving, Staying Strong project. This project aims to develop culturally secure arthritis information for Aboriginal people with osteoarthritis, rheumatoid arthritis, lupus and gout. Methods and analysis: The overarching principle guiding this project is cultural security, referring to the incorporation of processes such that the research will not compromise the cultural rights, values and expectations of Aboriginal people. This project will prioritise partnerships, community engagement, community benefit, sustainability, transferability, and capacity building and therefore uphold the cultural rights and values of Aboriginal people. In this six-phase project we will; 1) Establish a community reference group and advisory committee; 2) Explore the health information needs and preferences of Aboriginal people with arthritis; 3) Synthesise the existing key recommendations in high quality clinical practice guidelines on arthritis care; 4) Culturally adapt key clinical recommendations; 5) Develop culturally appropriate arthritis resources and; 6) Qualitatively evaluate the developed resources. [ABSTRACT FROM AUTHOR]

Background: Aboriginal language interpreters are under-utilised in healthcare in northern Australia. Self-discharge from hospital is an adverse outcome occurring at high rates among Aboriginal people, with poor communication thought to be a contributor. We previously reported increased Aboriginal interpreter uptake and decreased rates of self-discharge during implementation of a 12-month hospital-based intervention. Interrupted time-series analysis showed sudden increase and up-trending improvement in interpreter use, and a corresponding decrease in self-discharge rates, during a 12-month intervention period (April 2018—March 2019) compared with a 24-month baseline period (April 2016 –March 2018). This paper aims to investigate reasons for these outcomes and explore a potential causal association between study activities and outcomes. Methods: The study was implemented at the tertiary referral hospital in northern Australia. We used the Template for Intervention Description and Replication (TIDieR) as a framework to describe intervention components according to what, how, where, when, how much, tailoring, modifications and reach. Components of the study intervention were: employment of an Aboriginal Interpreter Coordinator, 'Working with Interpreters' training for healthcare providers, and championing of interpreter use by doctors. We evaluated the relative importance of intervention components according to TIDieR descriptors in relation to outcomes. Activities independent of the study that may have affected study findings were reviewed. The relationship between proportion of hospital separations among Aboriginal people ending in self-discharge and numbers of Aboriginal interpreter bookings made during April 2016-March 2019 was tested using linear regression. 'Working with Interpreters' training sessions were undertaken at a regional hospital as well as the tertiary hospital. Training evaluation comprised an anonymous online survey before the training, immediately after and then at six to eight months. Survey data from the sites were pooled for analysis. Results: Employment of the Aboriginal Interpreter Coordinator was deemed the most important component of the intervention, based on reach compared to the other components, and timing of the changes in outcomes in relation to the employment period of the coordinator. There was an inverse association between interpreter bookings and self-discharge rate among Aboriginal inpatients throughout the baseline and intervention period (p = 0.02). This association, the timing of changes and assessment of intercurrent activities at the hospital indicated that the study intervention was likely to be casually related to the measured outcomes. Conclusions: Communication in healthcare can be improved through targeted strategies, with associated improvements in patient outcomes. Health services with high interpreter needs would benefit from employing an interpreter coordinator. [ABSTRACT FROM AUTHOR]

There is increasing international interest in place-based approaches to improve early childhood development (ECD) outcomes. The available data and evidence are limited and precludes well informed policy and practice change. Developing the evidence-base for community-level effects on ECD is one way to facilitate more informed and targeted community action. This paper presents overall final findings from the Kids in Communities Study (KiCS), an Australian mixed methods investigation into community-level effects on ECD in five domains of influence–physical, social, governance, service, and sociodemographic. Twenty five local communities (suburbs) across Australia were selected based on 'diagonality type' i.e. whether they performed better (off-diagonal positive), worse (off-diagonal negative), or 'as expected' (on-diagonal) on the Australian Early Development Census (AEDC) relative to their socioeconomic profile. The approach was designed to determine replicable and modifiable factors that were separate to socioeconomic status. Between 2015–2017, stakeholder interviews (n = 146), parent and service provider focus groups (n = 51), and existing socio-economic and early childhood education and care administrative data were collected. Qualitative and quantitative data analyses were undertaken to understand differences between 14 paired disadvantaged local communities (i.e. on versus off-diagonal). Further analysis of qualitative data elicited important factors for all 25 local communities. From this, we developed a draft set of 'Foundational Community Factors' (FCFs); these are the factors that lay the foundations of a good community for young children. [ABSTRACT FROM AUTHOR]

Road crash fatality is a universal problem of the transportation system. A massive death toll caused annually due to road crash incidents, and among them, vulnerable road users (VRU) are endangered with high crash severity. This paper focuses on employing machine learning-based classification approaches for modelling injury severity of vulnerable road users—pedestrian, bicyclist, and motorcyclist. Specifically, this study aims to analyse critical features associated with different VRU groups—for pedestrian, bicyclist, motorcyclist and all VRU groups together. The critical factor of crash severity outcomes for these VRU groups is estimated in identifying the similarities and differences across different important features associated with different VRU groups. The crash data for the study is sourced from the state of Queensland in Australia for the years 2013 through 2019. The supervised machine learning algorithms considered for the empirical analysis includes the K-Nearest Neighbour (KNN), Support Vector Machine (SVM) and Random Forest (RF). In these models, 17 distinct road crash parameters are considered as input features to train models, which originate from road user characteristics, weather and environment, vehicle and driver condition, period, road characteristics and regions, traffic, and speed jurisdiction. These classification models are separately trained and tested for individual and unified VRU to assess crash severity levels. Afterwards, model performances are compared with each other to justify the best classifier where Random Forest classification models for all VRU modes are found to be comparatively robust in test accuracy: (motorcyclist: 72.30%, bicyclist: 64.45%, pedestrian: 67.23%, unified VRU: 68.57%). Based on the Random Forest model, the road crash features are ranked and compared according to their impact on crash severity classification. Furthermore, a model-based partial dependency of each road crash parameters on the severity levels is plotted and compared for each individual and unified VRU. This clarifies the tendency of road crash parameters to vary with different VRU crash severity. Based on the outcome of the comparative analysis, motorcyclists are found to be more likely exposed to higher crash severity, followed by pedestrians and bicyclists. [ABSTRACT FROM AUTHOR]