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BackgroundWalkIT Arizona was a 2×2 factorial trial examining the effects of goal type (adaptive versus static) and reinforcement type (immediate versus delayed) to increase moderate to vigorous physical activity (MVPA) among insufficiently active adults. The 12-month intervention combined mobile health (mHealth) technology with behavioral strategies to test scalable population-health approaches to increasing MVPA. Self-reported physical activity provided domain-specific information to help contextualize the intervention effects. ObjectiveThe aim of this study was to report on the secondary outcomes of self-reported walking for transportation and leisure over the course of the 12-month WalkIT intervention. MethodsA total of 512 participants aged 19 to 60 years (n=330 [64.5%] women; n=425 [83%] Caucasian/white, n=96 [18.8%] Hispanic/Latinx) were randomized into interventions based on type of goals and reinforcements. The International Physical Activity Questionnaire-long form assessed walking for transportation and leisure at baseline, and at 6 months and 12 months of the intervention. Negative binomial hurdle models were used to examine the effects of goal and reinforcement type on (1) odds of reporting any (versus no) walking/week and (2) total reported minutes of walking/week, adjusted for neighborhood walkability and socioeconomic status. Separate analyses were conducted for transportation and leisure walking, using complete cases and multiple imputation. ResultsAll intervention groups reported increased walking at 12 months relative to baseline. Effects of the intervention differed by domain: a significant three-way goal by reinforcement by time interaction was observed for total minutes of leisure walking/week, whereas time was the only significant factor that contributed to transportation walking. A sensitivity analysis indicated minimal differences between complete case analysis and multiple imputation. ConclusionsThis study is the first to report differential effects of adaptive versus static goals for self-reported walking by domain. Results support the premise that individual-level PA interventions are domain- and context-specific and may be helpful in guiding further intervention refinement. Trial RegistrationPreregistered at clinicaltrials.gov: (NCT02717663) https://clinicaltrials.gov/ct2/show/NCT02717663 International Registered Report Identifier (IRRID)RR2-10.1016/j.cct.2019.05.001

BackgroundAn online version of the Microscale Audit of Pedestrian Streetscapes (Abbreviated) tool was adapted to virtually audit built environment features supportive of physical activity. The current study assessed inter-rater reliability of MAPS Online between in-person raters and online raters unfamiliar with the regions.MethodsIn-person and online audits were conducted for a total of 120 quarter-mile routes (60 per site) in Phoenix, AZ and San Diego, CA. Routes in each city included 40 residential origins stratified by walkability and SES, and 20 commercial centers. In-person audits were conducted by raters residing in their region. Online audits were conducted by raters in the alternate location using Google Maps (Aerial and Street View) images. The MAPS Abbreviated Online tool consisted of four sections: overall route, street segments, crossings and cul-de-sacs. Items within each section were grouped into subscales, and inter-rater reliability (ICCs) was assessed for subscales at multiple levels of aggregation.ResultsOnline and in-person audits showed excellent agreement for overall positive microscale (ICC = 0.86, 95% CI [0.80, 0.90]) and grand scores (ICC = 0.93, 95% CI [0.89, 0.95]). Substantial to near-perfect agreement was found for 21 of 30 (70%) subscales, valence, and subsection scores, with ICCs ranging from 0.62, 95% CI [0.50, 0.72] to 0.95, 95% CI [0.93, 0.97]. Lowest agreement was found for the aesthetics and social characteristics scores, with ICCs ranging from 0.07, 95% CI [-0.12, 0.24] to 0.27, 95% CI [0.10, 0.43].ConclusionsResults support use of the MAPS Abbreviated Online tool to reliably assess microscale neighborhood features that support physical activity and may be used by raters residing in different geographic regions and unfamiliar with the audit areas.

Background Delay discounting is the depreciation in a reward's perceived value as a function of the time until receipt. Monetary incentive programs that provide rewards contingent on meeting daily physical activity (PA) goals may change participants' delay discounting preferences. Purpose Determine if monetary incentives provided in close temporal proximity to meeting PA goals changed delay discounting, and if such changes mediated intervention effects. Methods Inactive adults (n = 512) wore accelerometers during a 12-month intervention where they received proximal monetary incentives for meeting daily moderate-to-vigorous PA (MVPA) goals or delayed incentives for study participation. Delay discount rate and average MVPA were assessed at baseline, end of intervention, and a 24-month follow-up. Using structural equation modeling, we tested effects of proximal versus delayed rewards on delay discounting and whether any changes mediated intervention effects on MVPA. PA self-efficacy was also evaluated as a potential mediator, and both self-efficacy and delay discounting were assessed as potential moderators of intervention effects. Results Proximal rewards significantly increased participants' delay discounting (β = 0.238, confidence interval [CI]: −0.078, 0.380), indicating greater sensitivity to reinforcement timing. This change did not mediate incentive-associated increases in MVPA at the end of the 12-month intervention (β = −0.016, CI: −0.053, 0.019) or at a 24-month follow-up (β = −0.020, CI: −0.059, 0.018). Moderation effects were not found. Conclusions Incentive-induced increases in delay discounting did not deleteriously impact MVPA. This finding may help assuage concerns about using monetary incentives for PA promotion, but further research regarding the consequences of changes in delay discounting is warranted. [ABSTRACT FROM AUTHOR]

Physical activity (PA) is believed to preserve cognitive function in older adulthood, though little is known about these relationships within the context of daily life. The present microlongitudinal pilot study explored within- and between-person relationships between daily PA and cognitive function and also examined within-person effect sizes in a sample of community-dwelling older adults. Fifty-one healthy participants (mean age = 70.1 years) wore an accelerometer and completed a cognitive assessment battery for five days. There were no significant associations between cognitive task performance and participants’ daily or average PA over the study period. Effect size estimates indicated that PA explained 0–24% of within-person variability in cognitive function, depending on cognitive task and PA dose. Results indicate that PA may have near-term cognitive effects and should be explored as a possible strategy to enhance older adults’ ability to perform cognitively complex activities within the context of daily living. [ABSTRACT FROM AUTHOR]

Objectives Poor physical function is associated with negative health and cognitive outcomes. Although nine studies demonstrated that cognitive training reduces age-related declines in physical function, only one study has examined the effects beyond immediate posttest changes. The first aim of this study was to assess the impact of three cognitive training programs on physical function measures across 10 years and the second aim was to examine whether baseline cognitive self-efficacy or depressive symptoms moderated training effects. Method Using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial, older adults in a no-contact control condition (n = 698) were compared to those receiving processing speed (n = 702), memory (n = 703), or reasoning (n = 694) training. Intention-to-treat (ITT) and dosage analyses were conducted for grip strength and Turn 360. Participants were followed up to 10 years posttest. Results There were no significant ITT effects of processing speed, memory, or reasoning training assignment to any physical function outcome (p >.05). Dosage models indicated that there were small age-related attenuation effects in Turn 360 decline with more processing speed training (b = −.011, p <.001), memory training (b = −.011, p <.001), and reasoning training (b = −.012, p <.001). There was no significant transfer to grip strength. These training gains were greater for those with more baseline depressive symptoms who received more processing speed training (b = −.001, p <.001). Discussion This is the first study to demonstrate the effects of cognitive training to complex physical function across 10 years. [ABSTRACT FROM AUTHOR]

There are few studies on interment preferences and practices for people in remote and rural regions of developed countries. This mixed methods study in rural Australia collated data on funeral and interment practices with an ethnographic exploration of the post-death preferences of terminally-ill rural residents. In the region, between February 2015 and May 2016, 44% of decedents were cremated. Burial preferences reflected family traditions, generational connections to historic cemeteries, and the wish to instantiate belonging to people and place. Cremation provided the opportunity for ashes to be scattered at personally-significant places. Funeral planning was important for patients and family caregivers, and funerals are valued rural community rituals. [ABSTRACT FROM AUTHOR]

Financial incentives can increase physical activity (PA), but differences in the immediacy of reward delivery and individual differences in delay discount rates (i.e., higher discount values associated with less tolerance for delayed rewards) may explain differential responding. The current study tested whether delay discount rate moderated the relative effectiveness of immediate financial rewards on increasing daily PA. Inactive, overweight adults (ages 18–60, N = 96) were randomized to receive either smaller, immediate goal-contingent rewards or larger, delayed rewards for participation. Delay discount rates were derived for those who completed the Monetary Choice Questionnaire (N = 85). Linear mixed models tested interactions between discount rate and intervention arm on changes in mean daily Fitbit-measured steps from baseline to intervention phases, and rates of change during the intervention phase. Across all groups, participants increased by 2258 steps/day on average from baseline to intervention and declined by 9 steps/day across the 4-month intervention phase. The mean increase in daily steps was greater for immediate reward-arm participants across all discount rates. Descriptive exploration of reward effects by delay discount rate suggested that the magnitude of reward effects decreased at higher discount rates. During the 4-month intervention phase, rates of decline in daily steps were similar in both reward arms, but declines became more pronounced at higher discount rates. Overall, intervention efficacy decreased with less tolerance for delays. The importance of financial reward immediacy for increasing PA appears to increase with greater delay discount rates. [ABSTRACT FROM AUTHOR]

Over the last twenty years, attention deficit hyperactivity disorder (ADHD) has emerged as a disorder of importance in childhood. Prescription of psychostimulants for ADHD escalated in many countries through the [...]

The article discusses a study which examined age-related differences in relationship magnitude between physical function and cognition in healthy older adults. Topics covered include how the time-varying effects modeling (TVEM) was used in the study, the role of increased age in the associations between grip strength and all cognitive domains, and inconsistencies found with regards to the relationships between physical and cognitive performance.

Objective: Nervoza is a commonly-used illness category among Macedonian Australians. Although nervoza belongs broadly to the category of 'nerve illnesses' little is known of its meaning among Macedonian immigrants, and whether there is intergenerational attrition in its meaning and use. We aimed to explore how nervoza and its treatment are perceived by members of the Macedonian community in Australia. Design: In-depth interviews in Macedonian with 18 participants from the Macedonian community in Melbourne, Australia. Results: Nervoza is a layered concept relating shame, emotional experience and nerves, used as an idiom of distress and sadness in the presence of acute and chronic stressors. Nervoza develops in both the social world (through poverty, grief or the loss of war), and in the psyche of distressed and isolated people. It is viewed as dangerous on many levels: to physical health, as a 'gateway condition' to long-term psychological illnesses such as depression and schizophrenia, and to the person's social well-being. The normalised treatment for nervoza in Macedonia - benzodiazepines - is the subject of significant medical control in Australia. Conclusion: For sufferers of nervoza, the social self is both medicalized and stigmatised. Health services in Australia are often considered marginal in the management of nervoza. Second generation Macedonians viewed the concept as unhelpful, and possibly increasing the stigmatisation of mental illnesses. The lack of knowledge about, and underutilisation of, mental health services and support groups in the Macedonian Australian community should be the focus of community-based inter-generational health literacy initiatives. [ABSTRACT FROM AUTHOR]

Background: In rural settings, relationships between place and self are often stronger than for urban residents, so one may expect that rural people would view dying at home as a major feature of the ‘good death’. Aim: To explore the concept of the ‘good death’ articulated by rural patients with life-limiting illnesses, and their family caregivers. Design: Ethnography, utilising open-ended interviews, observations and field-notes. Participants: In total, 12 rural (town and farm) patients with life-limiting illnesses, 18 family caregivers and 6 clinicians, in the Snowy Monaro region of New South Wales, Australia, participated in this study over the course of the deaths of the patients. Interviews were transcribed and analysed with observational data using an emergent thematic process. Results: A ‘safe death’ was central to a ‘good death’ and was described as a death in which one could maintain (1) a connection with one’s previous identity; (2) autonomy and control over decisions regarding management of end-of-life care and (3) not being overwhelmed by the physical management of the dying process. For all participants, the preferred place of death was the ‘safe place’, regardless of its physical location. Conclusion: Safety, in this study, is related to a familiar place for death. A home death is not essential for and does not ensure a ‘good death’. We all have a responsibility to ensure all places for dying can deliver the ‘safe death’. Future research could explore the inter-relationships between safety and preference for home or home-like places of death. [ABSTRACT FROM AUTHOR]

Abstract: Residential aged care (RAC) is a significant provider of end‐of‐life care for people aged 65 years and older. Rural residents perceive themselves as different to their urban counterparts. Most studies describing place of death (PoD) in RAC are quantitative and reflect an urban voice. Using a mixed‐methods design, this paper examines the PoD of 80 RAC residents (15 short‐stay residents who died in RAC during respite or during an attempted step‐down transition from hospital to home, and 65 permanent residents), within the rural Snowy Monaro region, Australia, who died between 1 February 2015 and 31 May 2016. Death data were collected from local funeral directors, RAC facilities, one multi‐purpose heath service and obituary notices in the local media. The outcome variable was PoD: RAC, local hospital or out‐of‐region tertiary hospital. For the permanent RAC residents, the outcome of interest was dying in RAC or dying in hospital. Cross tabulations by PoD and key demographic data were performed. Pearson Chi squared tests and exact p‐values were used to determine if any of the independent variables were associated with PoD. Using an ethnographic approach, data were collected from 12 face‐to‐face, open‐ended interviews with four RAC residents, with a life expectancy of ≤6 months, and six family caregivers. Interviews were audio‐recorded, transcribed and analysed thematically. Fifty‐one (78.5%) of the permanent residents died in RAC; 21.5% died in hospital. Home was the initial preferred POD for most interviewed participants; most eventually accepted the transfer to RAC. Long‐term residents considered RAC to be their “home”—a familiar place, and an important part of their rural community. The participants did not consider a transfer to hospital to be necessary for end‐of‐life care. Further work is required to explore further the perspectives of rural RAC residents and their families, and if transfers to hospital are avoidable. [ABSTRACT FROM AUTHOR]

Abstract: The ‘good death’ is one objective of palliative care, with many ‘good death’ viewpoints and research findings reflecting the urban voice. Rural areas are distinct and need special consideration. This scoping review identified and charted current research knowledge on the ‘good’ rural death through the perspectives of rural residents, including rural patients with a life‐limiting illness, to identify evidence and gaps in the literature for future studies. A comprehensive literature search of English language articles (no date filter applied) was conducted in 2016 (2 January to 14 February) using five library databases. Reference lists of included articles, recent issues of eight relevant journals and three grey literature databases were also hand‐searched. Twenty articles (for 17 studies and one systematic review) were identified after a two‐phase screening process by two reviewers, using pre‐determined inclusion criteria. Data from each study were extracted and charted, analysed using a thematic analysis of the included articles' content, and with a quantitative analysis of the scoping review. These papers revealed data collected from rural patients with a life‐limiting illness and family caregivers, rural healthcare providers, the wider rural community, rural community leaders and rural health administrators and policy makers. Rural locations were heterogeneous. Residents from developed and developing countries believe a ‘good death’ is one that is peaceful, free of pain and without suffering; however, this is subjective and priorities are based on personal, cultural, social and religious perspectives. Currently, there is insufficient data to generalise rural residents' perspectives and what it means for them to die well. Given the extreme importance of a ‘good death’, there is a need for further studies to elicit rural patient and family caregiver perspectives. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the place of death of residents in a rural region of New South Wales. Design: Cross‐sectional quantitative study using death data collected from local funeral directors (in person and websites), residential aged‐care facilities, one multipurpose heath service and obituary notices in the local media (newspapers/radio). Setting: Snowy Monaro region (New South Wales Australia). Participants: Residents, with advanced frailty or one of 10 conditions amenable to palliative care, who died between 1 February 2015 and 31 May 2016. Main outcome measure: Place of death. Results: Of 224 deaths in this period, 138 were considered amenable to palliative care. Twelve per cent of these deaths occurred in a private residence, 38% in the usual place of residence and 91% within the region. Conclusion: Most rural residents with conditions amenable to palliative care died in the region. Most did not die in their usual place of residence. Further qualitative work is needed to determine palliative care patients’ and family caregivers’ preferences for, and the importance placed on, place of death. While there may be a need to support an increase in home deaths, local rural hospitals and residential aged‐care facilities must not be overlooked as a substitute for inpatient hospices. [ABSTRACT FROM AUTHOR]

Objective: Physical functioning is closely associated with cognition. The current study assessed the impact of three cognitive training programs on objective measures of physical functioning across 5 years. Method: Older adults randomized to a processing speed (n = 702), reasoning (n = 694), or memory (n = 703) training intervention were compared with those randomized to a no-contact control condition (n = 698). Intention-to-treat (ITT) and treatment-received/dosage (time-varying number of training sessions) analyses were conducted. Results: There were no transfer effects in the ITT analyses. Treatment-received models demonstrated that training sessions (i.e., higher dosage) across all intervention arms transferred to better maintained Digit Symbol Copy and Turn 360 performance relative to the control group. More reasoning training transferred to better grip strength. Discussion: This is the first study to demonstrate differential longitudinal cognitive training transfer effects to three performance-based physical functioning measures. Future research should investigate mechanisms of far-transfer effects. [ABSTRACT FROM AUTHOR]

Background: Many patients with chronic physical illnesses have co-morbid psychological illnesses, which may respond to interprofessional collaborative care. Continuing education programs frequently focus on skills and knowledge relevant for individual illnesses, and unidisciplinary care. This study evaluates the impact of "Mind the Gap", an Australian interprofessional continuing education program about management of dual illnesses, on practitioners' knowledge, use of psychological strategies and collaborative practice.Methods: A 6-h module addressing knowledge and skills needed for patients with physical and psychological co-morbid illnesses was delivered to 837 practitioners from mixed health professional backgrounds, through locally-facilitated workshops at 45 Australian sites. We conducted a mixed-methods evaluation, incorporating observation, surveys and network analysis using data collected, before, immediately after, and three months after training.Results: Six hundred forty-five participants enrolled in the evaluation (58 % GPs, 17 % nurses, 15 % mental health professionals, response rate 76 %). Participants' knowledge and confidence to manage patients with psychological and physical illnesses improved immediately. Among the subset surveyed at three months (response rate 24 %), referral networks had increased across seven disciplines, improvements in confidence and knowledge were sustained, and doctors, but no other disciplines, reported an increase in use of motivational interviewing (85.9 % to 96.8 %) and mindfulness (58.6 % to 74 %).Conclusions: Interprofessional workshops had an immediate impact on the stated knowledge and confidence of participants to manage patients with physical and psychological comorbidities, which appears to have been sustained. For some attendees, there was a sustained improvement in the size of their referral networks and their use of some psychological strategies. [ABSTRACT FROM AUTHOR]

Background: The primary health care sector delivers the majority of health care in western countries through small, community-based organizations. However, research into these healthcare organizations is limited by the time constraints and pressure facing them, and the concern by staff that research is peripheral to their work. We developed Q-RARA—Qualitative Rapid Appraisal, Rigorous Analysis—to study small, primary health care organizations in a way that is efficient, acceptable to participants and methodologically rigorous. Methods: Q-RARA comprises a site visit, semi-structured interviews, structured and unstructured observations, photographs, floor plans, and social scanning data. Data were collected over the course of one day per site and the qualitative analysis was integrated and iterative. Results: We found Q-RARA to be acceptable to participants and effective in collecting data on organizational function in multiple sites without disrupting the practice, while maintaining a balance between speed and trustworthiness. Conclusions: The Q-RARA approach is capable of providing a richly textured, rigorous understanding of the processes of the primary care practice while also allowing researchers to develop an organizational perspective. For these reasons the approach is recommended for use in small-scale organizations both within and outside the primary health care sector. [ABSTRACT FROM AUTHOR]

Background. One in thirty-five Australians has poor proficiency in English, and may need language support in health consultations. Australia has the world's most extensive system of fee-free provision of interpreters for doctors, but the degree of uptake relative to need is unknown. Objective. To assess the current unmet and projected future needs for interpreters in Australia in Medicare-funded medical consultations. Method. Secondary analysis of Australian Census, Medicare and Translating and Interpreting Service (TIS) datasets. Age-specific rates of non-Indigenous populations who had self-reported poor proficiency in English were applied to age-specific attendances to general practitioners (GPs) and private specialists to estimate the need for language-assisted consultations in 2006-07. The proportion of services where language assistance was used when needed was estimated through aggregate data from the Medicare and TIS datasets. Results. We estimate that interpreters from the national fee-free service were used for patients with poor proficiency in English is less than 1 in 100 (0.97%) Medicare-funded consultations. The need for interpreters will escalate in future, particularly among those over 85 years. Discussion. Doctors currently underuse interpreters. Increasing the use of interpreters requires education and incentives, but also sustained investment in systems, infrastructure and interpreters to meet the escalation in demand as the population ages. INSET: What is known about this topic?. [ABSTRACT FROM AUTHOR]

Background: Although physician burnout has received considerable attention, there is little research of doctors who thrive while working in challenging conditions.Aim: To describe attitudes to work and job satisfaction among Australian primary care practitioners who have worked for more than 5 years in areas of social disadvantage.Method: Semi-structured interviews were conducted with 15 primary health care practitioners working in Aboriginal health, prisons, drug and alcohol medicine, or youth and refugee health. The interviews explored attitudes towards work and professional satisfaction, and strategies to promote resilience.Results: All doctors were motivated by the belief that helping a disadvantaged population is the 'right thing' to do. They were sustained by a deep appreciation and respect for the population they served, an intellectual engagement with the work itself, and the ability to control their own working hours (often by working part-time in the field of interest). In their clinical work, they recognised and celebrated small gains and were not overwhelmed by the larger context of social disadvantage.Conclusion: If organisations want to increase the numbers of medical staff or increase the work commitment of staff in areas of social disadvantage, they should consider supporting doctors to work part-time, allowing experienced doctors to mentor them to model these patient-appreciative approaches, and reinforcing, for novice doctors, the personal and intellectual pleasures of working in these fields. [ABSTRACT FROM AUTHOR]

Medical receptionists have been shown to play a key role in general practice as the first point of contact for patients. They frequently make decisions about appointment allocation which effectively prioritise access to medical care, but may have limited tools or structures to assist them with this. We report the methods of a study evaluating a customisable tool (POPGUNS - Prioritisation of Patients: A Guide for Non-clinical Staff) to support safe prioritisation of patients. This paper reports methodological challenges in a study of this nature where contamination of the study population is an early complication, no current gold standard exists to define safe triaging, contextual differences between practices lead to inter-practice variation, and proxy outcomes (improvement in receptionist response to written scenarios of varying urgency) are used. We have attempted to respond to these challenges by: observing the determinants of inter-practice variation; developing a multi-member panel to constitute appropriate standards for practices; and monitoring self-reported prioritisation decisions by practice receptionists through the use of simulated patients. [ABSTRACT FROM AUTHOR]

This article discusses a study which reviewed the literature on different models of clinical governance and their relevance to primary health care in Australia. The study assessed the potential contributions of the models to quality and safety. It used different data sources, including electronic databases, scanning reference lists of articles and consultation with experts. It discovered the fragmentation of the evidence base for clinical governance and the focus given by clinical governance on process rather than outcomes.

The article presents information on a study which looked at the evolving roles of practice nurses in Australia as well as the impact of nurses on general practice function. It mentions the two components of the study including its exploration of the scope and contextual determinants of nurse roles. The researchers were able to identify six roles of nurses in general practice such as patient carer and problem solver.

Background: The International Health Regulations (2005) and the emergence and global spread of infectious diseases have triggered a re-assessment of how rich countries should support capacity development for communicable disease control in low and medium income countries (LMIC). In LMIC, three types of public health training have been tried: the university-based model; streamed training for specialised workers; and field-based programs. The first has low rates of production and teaching may not always be based on the needs and priorities of the host country. The second model is efficient, but does not accord the workers sufficient status to enable them to impact on policy. The third has the most potential as a capacity development measure for LMIC, but in practice faces challenges which may limit its ability to promote capacity development. Discussion: We describe Australia's first Master of Applied Epidemiology (MAE) model (established in 1991), which uses field-based training to strengthen the control of communicable diseases. A central attribute of this model is the way it partners and complements health department initiatives to enhance workforce skills, health system performance and the evidence-base for policies, programs and practice. Summary: The MAE experience throws light on ways Australia could collaborate in regional capacity development initiatives. Key needs are a shared vision for a regional approach to integrate training with initiatives that strengthen service and research, and the pooling of human, financial and technical resources. We focus on communicable diseases, but our findings and recommendations are generalisable to other areas of public health. [ABSTRACT FROM AUTHOR]

Background: Although primary health care, and in particular, general practice will be at the frontline in the response to pandemic influenza, there are no frameworks to guide systematic planning for this task or to appraise available plans for their relevance to general practice. We aimed to develop a framework that will facilitate planning for general practice, and used it to appraise pandemic plans from Australia, England, USA, New Zealand and Canada. Methodology/Principal Findings: We adapted the Haddon matrix to develop the framework, populating its cells through a multi-method study that incorporated the peer-reviewed and grey literature, interviews with general practitioners, practice nurses and senior decision-makers, and desktop simulation exercises. We used the framework to analyse 89 publiclyavailable jurisdictional plans at similar managerial levels in the five countries. The framework identifies four functional domains: clinical care for influenza and other needs, public health responsibilities, the internal environment and the macroenvironment of general practice. No plan addressed all four domains. Most plans either ignored or were sketchy about noninfluenza clinical needs, and about the contribution of general practice to public health beyond surveillance. Collaborations between general practices were addressed in few plans, and inter-relationships with the broader health system, even less frequently. Conclusions: This is the first study to provide a framework to guide general practice planning for pandemic influenza. The framework helped identify critical shortcomings in available plans. Engaging general practice effectively in planning is challenging, particularly where governance structures for primary health care are weak. We identify implications for practice and for research. [ABSTRACT FROM AUTHOR]

In June, 2019, delegates from more than 65 countries attended the first international Global Health Security conference in Sydney to debate how to strengthen global health security and contain epidemics at source.[1] The Sydney Statement[1] on global health security, announced as a "product of this conference", was presented in its final form on the first day of the conference with seven guiding principles, including reference to the values of "integrity of international norms, respect for human rights, and social justice...[and] transparent decision making". Global health security is an energising way of framing risk, of mobilising resources, increasing provision of development assistance for health,[2] and clarifying the international obligations of nation states. [Extracted from the article]

The article discusses a study which described the health service attendance patterns of urban Aboriginal and Torres Strait Islander Australians using the survey results of attendance in 2006. Established in 1988, the Winnunga Nimmityjah Aboriginal Health Service (WNAHS) is an Aboriginal community-controlled health service that is governed by an Aboriginal Board. Examples of data collected include patient demographic characteristics, reason for the consultation, the problems managed during consultation, and investigation and management of each problem.

The article reflects on the need for language-sensitive health systems in Australia for cardiovascular health for all. It states that a large number of patients who do not have English as their first language are treated by Australian clinicians everyday. It also mentions about the studies conducted in the country on the relationship between linguistic diversity and health outcomes.

Little change over the decades has been seen in adults meeting moderate-to-vigorous physical activity (MVPA) guidelines. Numerous individual-level interventions to increase MVPA have been designed, mostly static interventions without consideration for neighborhood context. Recent technologies make adaptive interventions for MVPA feasible. Unlike static interventions, adaptive intervention components (e.g., goal setting) adjust frequently to an individual's performance. Such technologies also allow for more precise delivery of "smaller, sooner incentives" that may result in greater MVPA than "larger, later incentives". Combined, these factors could enhance MVPA adoption. Additionally, a central tenet of ecological models is that MVPA is sensitive to neighborhood environment design; lower-walkable neighborhoods constrain MVPA adoption and maintenance, limiting the effects of individual-level interventions. Higher-walkable neighborhoods are hypothesized to enhance MVPA interventions. Few prospective studies have addressed this premise. This report describes the rationale, design, intervention components, and baseline sample of a study testing individual-level adaptive goal-setting and incentive interventions for MVPA adoption and maintenance over 2 years among adults from neighborhoods known to vary in neighborhood walkability. We scaled these evidenced-based interventions and tested them against static-goal-setting and delayed-incentive comparisons in a 2 × 2 factorial randomized trial to increase MVPA among 512 healthy insufficiently-active adults. Participants (64.3% female, M age = 45.5 ± 9.1 years, M BMI = 33.9 ± 7.3 kg/m2, 18.8% Hispanic, 84.0% White) were recruited from May 2016 to May 2018 from block groups ranked on GIS-measured neighborhood walkability and socioeconomic status (SES) and classified into four neighborhood types: "high walkable/high SES," "high walkable/low SES," "low walkable/high SES," and "low walkable/low SES." Results from this ongoing study will provide evidence for some of the central research questions of ecological models. [ABSTRACT FROM AUTHOR]