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Background: Fire danger rating systems are used daily across Australia to support fire management operations and communications to the general public regarding potential fire danger. Aims: In this paper, we introduce the Australian Fire Danger Rating System (AFDRS), providing a short historical account of fire danger rating in Australia as well as the requirements for an improved forecast system. Methods: The AFDRS combines nationally consistent, spatially explicit fuel information with forecast weather and advanced fire behaviour models and knowledge to produce locally relevant ratings of fire behaviour potential. Key results: A well-defined framework is essential for categorising and defining fire danger based on operational response, the potential for impact and observable characteristics of fire incidents. The AFDRS is modular, supporting continuous and incremental improvements and allowing upgrades to components in response to new science. Conclusions: The AFDRS provides a new method to estimate fire danger based on the best available fire behaviour models, leading to potentially significant improvements in the way fire danger is calculated, forecast and interpreted. Implications: The Australian Fire Danger Rating System was implemented in 2022, the most significant change to fire danger forecasting in Australia in more than 50 years. We introduce the Australian Fire Danger Rating System (AFDRS), providing a history of fire danger rating in Australia and requirement for advancements. We describe development, design principles and the supporting framework of the AFDRS as an introduction to subsequent papers in this series. This article belongs to the Collection Australian Fire Danger Rating System. [ABSTRACT FROM AUTHOR]

Background: The Australian Fire Danger Rating System program (AFDRS) has built a new fire danger rating system for Australia. A live trial of the system's Research Prototype (AFDRSRP), based on fire behaviour thresholds, was run and evaluated between October 2017 and March 2018. Aims: Live trial results are critically analysed, and knowledge gaps and recommendations for future work discussed. Methods: Australian bushfire experts assessed wildfires and prescribed burns across a range of vegetation types and weather conditions. Forecast fire danger ratings calculated using: (1) AFDRSRP; and (2) Forest Fire Danger Index (FFDI) and Grassland Fire Danger Index (GFDI) were compared against ratings derived by expert opinion for each evaluation fire (n = 336). Key results: Overall performance of AFDRSRP was superior to the FFDI/GFDI system (56 vs 43% correct), with a tendency to over-predict rather than under-predict fire potential. AFDRSRP also demonstrated its value to assess fire danger in fuel types not conforming to current grassland or forest models; e.g. for fuels that were grouped to use mallee-heath, spinifex and shrubland fire spread models. Conclusions: The AFDRSRP live trial was successful, outperforming the existing operational fire danger system. Implications: Identified improvements would further enhance AFDRSRP performance, ensuring readiness for operational implementation. A Research Prototype of the Australian Fire Danger Rating System (AFDRSRP) was designed and tested in a live trial. Fire danger ratings derived from the AFDRSRP and FFDI/GFDI systems were compared to expert-derived ratings for 336 fires. In this paper the results of the live trial are presented and discussed. This article belongs to the Collection Australian Fire Danger Rating System. [ABSTRACT FROM AUTHOR]

Aims: We investigate the associations between major Australian climate drivers and extreme weekly fire danger throughout the year. Methods: We use a composite-based approach, relating the probability of top-decile observed potential fire intensity to the positive and negative modes of the El Niño Southern Oscillation, Indian Ocean Dipole, Madden–Julian Oscillation, Southern Annular Mode, split-flow blocking and Subtropical Ridge Tasman Highs, both concurrently and at a variety of lag times. Key results: The chance of extreme fire danger increases over broad regions of the continent in response to El Niño and positive Indian Ocean Dipole events, the negative mode of the Southern Annular Mode, split-flow Blocking Index and Subtropical Ridge Tasman High, and Madden–Julian Oscillation phases 5, 6, 2 and 8 in Austral summer, autumn, winter and spring respectively. These relationships exist not only concurrently, but also when a climate event occurs up to 6 months ahead of the season of interest. Conclusions: These findings highlight the importance of considering the influence of diverse climate drivers, at a range of temporal lag periods, in understanding and predicting extreme fire danger. Implications: The results of this study may aid in the development of effective fire management strategies and decision-making processes to mitigate the impacts of fire events in Australia. This paper explores the relationships between the major forces influencing Australian weather and climate, and the chance of severe fire seasons. The findings could be valuable in decision making and preparation for upcoming fire seasons to avoid more seasons with devastating outcomes such as the 2019–2020 Black Summer. This article belongs to the Collection Fire and Climate. [ABSTRACT FROM AUTHOR]

Background: Wildfire propagation is inherently non-steady, although forecasts of their spread focus on a pseudo-steady state assumption. Aims: To investigate the variability in rate of fire spread of wildfires in southern Australian grassland landscapes, and the effect of landscape features in inhibiting fire propagation. To evaluate the adequacy of grassfire rate of spread models currently used in Australia. Methods: We reconstructed the propagation of six wildfires in grassland fuels and characterised the unsteady nature of rate of spread. We also analysed the effect of barriers to fire spread in slowing or halting wildfire propagation. Key results: Headfire rate of spread in wildfires was observed to be non-steady, with peaks in forward rate of spread being on average 2.6-times higher than mean values. The rate of spread had an average coefficient of variation of 88%. Areas of fuel discontinuity, such as roads, did not stop fires under moderate burning conditions, but resulted in slowing the average rate of fire spread. Conclusions: Analysis of wildfire observations is key to understand fire behaviour features that are not replicable in experimental or modelling environments. Findings from the analysis can support fire-fighting safety awareness and inform landscape fire propagation modelling. This study uses detailed wildfire observation data to describe non-steady headfire rate of spread and the effect of barriers to fire propagation, such as roads, on halting or inhibiting spread. We discuss the implications for wildfire spread modelling and fireline safety. [ABSTRACT FROM AUTHOR]

Background: Knowledge of how fire regimes influence flammability, and its role in shaping future fire regimes, exists mostly at species composition and ecosystem levels. The effect of fire regimes on fuel at the chemical level is poorly known. Aim: We aimed to empirically investigate the association between recent fire history and forest foliage chemistry; and to explore potential implications for forest fuel flammability. Methods: Using an orthogonal study design, we investigated the effects of fire frequency and time since fire on the chemical composition of Eucalyptus pilularis leaves from forest canopies and surface litter in south-eastern Australia. Key results: We found high fire frequency (fire-return interval 10–13 years) was associated with higher C:N, C:P, and C:K ratios in E. pilularis surface litter, and higher C:P in canopy leaves. Conclusions: Nutrients including nitrogen and phosphorous reduce flammability of plant tissues, and hence, the observed differences in leaf nutrients between high and low fire frequency sites could have important implications for future flammability of these forests. Implications: Our study has demonstrated a relationship between fire frequency and leaf nutrient stoichiometry, which may act as a mechanism through which repeated fires could increase fuel flammability. This warrants further investigation in other environments. Knowledge of how past fires may influence the future flammability of ecosystems remains poorly resolved. Here, we report significant effects of past fire frequency on the chemical properties of canopy leaves and leaf litter in a coastal Eucalyptus forest, which may have important implications for future forest flammability. [ABSTRACT FROM AUTHOR]

Background: Climate projections signal longer fire seasons and an increase in the number of dangerous fire weather days for much of the world including Australia. Aims: Here we argue that heatwaves, dynamic fire–atmosphere interactions and increased fuel availability caused by drought will amplify potential fire behaviour well beyond projections based on calculations of afternoon forest fire danger derived from climate models. Methods: We review meteorological dynamics contributing to enhanced fire behaviour during heatwaves, drawing on examples of dynamical processes driving fire behaviour during the Australian Black Summer bushfires of 2019–20. Results: Key dynamical processes identified include: nocturnal low-level jets, deep, unstable planetary boundary layers and fire–atmosphere coupling. Conclusions: The future scenario we contend is long windows of multi-day fire events where overnight suppression is less effective and fire perimeters will expand continuously and aggressively over multiple days and nights. Implications: Greater overnight fire activity and multi-day events present strategic and tactical challenges for fire management agencies including having to expand resourcing for overnight work, manage personnel fatigue and revise training to identify conditions conducive to unusually active fire behaviour overnight. Effective messaging will be critical to minimise accidental fire ignition during heatwaves and to alert the community to the changing fire environment Heatwaves, dynamic fire–atmosphere interactions and increased fuel availability caused by drought are likely to amplify fire behaviour under climate change. We review meteorological dynamics contributing to enhanced fire behaviour during heatwaves using examples from the 2019–20 Australian Black Summer bushfires and examine potential challenges posed for future fire management. [ABSTRACT FROM AUTHOR]

Background: The Australian Fire Danger Rating System (AFDRS) was implemented operationally throughout Australia in September 2022, providing calculation of fire danger forecasts based on peer-reviewed fire behaviour models. The system is modular and allows for ongoing incorporation of new scientific research and improved datasets. Aims: Prior to operational implementation of the AFDRS, a Research Prototype (AFDRSRP), described here, was built to test the input data and systems and evaluate the performance and potential outputs. Methods: Fire spread models were selected and aligned with fuel types in a process that captured bioregional variation in fuel characteristics. National spatial datasets were created to identify fuel types and fire history in alignment with existing spatial weather forecast layers. Key results: The AFDRSRP demonstrated improvements over the McArthur Forest and Grass Fire Danger systems due to its use of improved fire behaviour models, as well as more accurately reflecting the variation in fuels. Conclusions: The system design was robust and allowed for the incorporation of updates to the models and datasets prior to implementation of the AFDRS. A spatially explicit forecast calculation system was designed and implemented to assess a new fire danger rating system for Australia based on fire behaviour models, weather inputs and a national fuel spatial data layer. This article is part of a collection about the Australian Fire Danger Rating System. This article belongs to the Collection Australian Fire Danger Rating System. [ABSTRACT FROM AUTHOR]

Background: Fire simulators are increasingly used to predict fire spread. Australian fire agencies have been concerned at not having an objective basis to choose simulators for this purpose. Aims: We evaluated wildland fire simulators currently used in Australia: Australis, Phoenix, Prometheus and Spark. The evaluation results are outlined here, together with the evaluation framework. Methods: Spatial metrics and visual aids were designed in consultation with simulator end-users to assess simulator performance. Simulations were compared against observations of fire progression data from 10 Australian historical fire case studies. For each case, baseline simulations were produced using as inputs fire ignition and fuel data together with gridded weather forecasts available at the time of the fire. Perturbed simulations supplemented baseline simulations to explore simulator sensitivity to input uncertainty. Key results: Each simulator showed strengths and weaknesses. Some simulators displayed greater sensitivity to different parameters under certain conditions. Conclusions: No simulator was clearly superior to others. The evaluation framework developed can facilitate future assessment of Australian fire simulators. Implications: Collection of fire behaviour observations for routine simulator evaluation using this framework would benefit future simulator development. Australian fire and land management agencies use fire simulators to predict characteristics of fires in the landscape, and require evaluation of simulator accuracy. Simulations of fire spread were assessed against observations. Inputs were perturbed to evaluate simulator sensitivity. Against the evaluation measures, no simulators proved universally superior to the others. [ABSTRACT FROM AUTHOR]

Introduction. The global prevalence of diabetes is a pressing public health concern. Over 400 million individuals live with the effects of the disease, predominantly in low- and middleincome countries. In Aotearoa New Zealand (NZ), over 300 000 people have diabetes, resulting in a population rate of 43.1 per 1000. Enabling nurses to prescribe diabetes medications enhances accessibility and improves health outcomes for large sections of the population. Aim. This rapid review was undertaken to investigate the influence of nurse prescribing on health care delivery for individuals with diabetes in NZ, Australia, the United Kingdom, and Canada, countries sharing comparable health care systems and multicultural backgrounds. Methods. The review protocol was published on PROSPERO. In November 2022, a search was conducted across multiple databases to locate relevant literature and resources constrained to the last decade (from January 2012 to November 2022). Utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, data extraction was systematically structured, while rigorous appraisal processes upheld selection quality. Results. Fifteen publications were identified as meeting predefined inclusion and exclusion criteria. The review of these articles revealed four main themes: the impact of nurse prescribing on clinical outcomes, levels of patient satisfaction, implications for health care service provisions, and identification of barriers and facilitators associated with nurse prescribing. Discussion. This report identifies outcomes of nurse prescribing, concluding it provides a potential avenue for enhancing access to and alleviating the burden on health care systems. [ABSTRACT FROM AUTHOR]

Introduction. In Australian general practitioner (GP) training, feedback and reflection on inpractice experience is central to developing GP registrars' (trainees') clinical competencies. Patient encounter tracking and learning tools (PETALs) that encompass an audit of consecutive patient consultations, feedback, and reflection are used to determine registrars' in-practice exposure and have been suggested as a tool for learning within a programmatic assessment framework. However, there is limited qualitative literature on the utility of PETALs in GP training. Aim. To provide greater understanding of how PETALs are used in GP training, using Registrars' Clinical Encounters in Training (ReCEnT) as a case study. Methods. Medical educators, supervisors, and registrars from two Australian regional GP training organisations participated in focus groups and interviews, designed to explore participants' perceptions of ReCEnT's utility. Data were analysed using reflexive thematic analysis. Results. Eight themes were identified that enhance our understanding of: how ReCEnT reports are used (reassuring registrars, facilitating self-reflection, identifying learning needs), what enables ReCEnT to reach its full potential (a culture of reflection, meaningful discussions with supervisors and medical educators, valuing objective data), and differences in understanding about ReCEnT's role in a programmatic assessment framework (as a tool for learning, as 'one piece of the puzzle'). Discussion. The findings were used to develop a Structure-Process-Outcomes model to demonstrate how ReCEnT is currently used and explores how it can be used for learning, rather than of learning, in a programmatic assessment framework for GP training. ReCEnT's longitudinal format has potential for enhancing learning throughout training. [ABSTRACT FROM AUTHOR]

Aim. The aim of the study was to establish whether two previously described barriers to effective in-consultation assistance-seeking by general practice (GP) vocational specialist trainees (ie concern about patient impressions of their competence, and discomfort presenting to supervisors in front of patients) influenced the frequency of trainee in-consultation assistanceseeking from their supervisor. Methods. This was a cross-sectional study nested in the Registrar Clinical Encounters in Clinical Training ongoing cohort study of Australian GP trainees. Trainee participants completed contemporaneous records of 60 consecutive patient consultations, including whether supervisory assistance was sought. Trainees also completed a cross-sectional survey including items eliciting their beliefs about patient impressions and their own discomfort in seeking in-consultation supervisory assistance. These were factors of interest in multivariable logistic regression analyses; the outcome factor in both regression models was the seeking of inconsultation supervisory assistance. Results. In 2018, 778 trainees (778/876, response rate 89%) completed the cross-sectional survey. No association was found between the odds of inconsultation help-seeking and perceived decrease in patient impressions of trainee competence (OR = 1.09; 95% CI: 0.91, 1.31; P = 0.36) or higher comfort presenting outside patients' hearing (OR = 0.9; 95% CI: 0.77, 1.05; P = 0.19). Discussion. Contrary to expected utility models of helpseeking, trainees may not consider personal discomfort or impression management to be important enough, compared to patient safety and other considerations, to influence decisions regarding in-consultation help-seeking. Clinical supervisors should, nevertheless, consider the potential personal costs to trainees and maintain trainee self-esteem and confidence by providing in-consultation assistance in front of patients as comfortably and effectively as possible. [ABSTRACT FROM AUTHOR]

Background: Historical records of fire weather phenomena provide valuable insights into spatial and temporal trends which can inform further research and are important tools for planning. Aims: We outline a 19-year climatology of a Research Prototype (AFDRSRP), of the new Australian Fire Danger Rating System, documenting its spatial and temporal characteristics. Methods: The analysis utilises the Australian Bureau of Meteorology's high-resolution reanalysis suite (BARRA), together with fuel data provided by Australian fire agencies. We examine the spatial and temporal distribution of the AFDRSRP. Distributions are categorised by fuel type, analysing relative variability across time and space. Key results: The results validate the broad behaviour of the new system and provide insight into the variation of fire danger throughout Australia, adding detail to the understanding of timing of peak fire danger both diurnally and annually. Conclusions: While the AFDRSRP differs from the operational system in its fire danger rating categories and tuning of algorithms, it nonetheless provides useful insights into the operational implementation. Implications: These results will be essential for planning during fire seasons. We present a 19-year climatology of the Australian Fire Danger Rating System: Research Prototype (AFDRSRP), recently implemented operationally throughout Australia. The climatology describes the typical spatial and temporal behaviour of the AFDRSRP. It is important for users to improve familiarity with the new system, and to ensure it performs as expected. This article belongs to the Collection Australian Fire Danger Rating System. [ABSTRACT FROM AUTHOR]

Background: Development of the Australian Fire Danger Rating System began in 2017 with a project aimed at demonstrating the feasibility of a new fire danger rating system through a Research Prototype (AFDRSRP) that accounted for variability in Australian vegetation types, was nationally applicable, modular and open to continuous improvement. Aims: In this manuscript, we identify and define transition points and categories for the AFDRSRP. We discuss user responses to the categorisation during a live trial evaluation of the AFDRSRP and reflect on limitations and potential improvements. Methods: A review of available literature, broad consultation with stakeholders and reanalysis of fire impact data were used to determine suitable thresholds for categorising fire danger within the AFDRSRP. Key results: Fire danger categories within the AFDRSRP reflect transitions in fire behaviour that result in application of different fire management strategies or are associated with variation in serious consequences and impacts. Conclusions: The AFDRSRP incorporated the best available science, supported by a well-defined framework for categorising and defining fire danger making it suitable for application across Australian fire jurisdictions and range of fuel types. Implications: The framework allows fire managers to assess the accuracy and appropriateness of forecasted fire danger. We identify and present defined categories and thresholds for the Australian Fire Danger Rating System: Research Prototype based on reflecting transitions in fire behaviour that result in application of different fire management strategies or associated with variation in potential for serious consequences and impacts. This article belongs to the Collection Australian Fire Danger Rating System. [ABSTRACT FROM AUTHOR]

Background. Many species use hollows or cavities that form in trees. The effect of an increasing fire frequency on hollow-bearing trees is unclear. Aims. To predict the effects of increasing fire frequency on the abundance of hollow-bearing trees and identify how to make forests more resilient to these changes. Methods. We simulated how increasing fire frequency will affect the abundance of hollow-bearing trees in forests of south-eastern Australia and conducted a sensitivity analysis to identify which variables affect these predictions. Key results. Other things being equal, we found a negative relationship between the number of hollow-bearing trees and increasing fire frequency. However, we identified scenarios where the number of hollow-bearing trees remained stable, or increased, with frequent fires. Conclusions. Hollow-bearing trees will decline where frequent fires co-occur with high rates at which trees collapse (or are removed) and/or where there are not a sufficient number of suitable mature trees in which new hollows can be excavated by fire. Implications. The impact of increasing fire frequency on hollowdependent fauna is likely to be greatest in forests where regeneration is inhibited, a large number of trees are removed before they form hollows, and/or where rates of collapse among trees is elevated. [ABSTRACT FROM AUTHOR]

Introduction. Patients with chronic pain (CP) are frequent users of general practitioners (GPs). Aim. This study aimed to assess factors associated with the rate of GP visits related to pain in patients with CP. Methods. This study used data collected by adult specialist pain management services (SPMS) that participated in the electronic Persistent Pain Outcomes Collaboration (ePPOC) in Australia. Adult patients (18 years or older) with CP (duration greater than 3 months) who were referred to SPMS from the calendar year 2015–2021 were included (N = 84 829). Results. Patients who reported severe anxiety, stress, pain, pain interference, pain catastrophising and severely impaired pain self-efficacy were more likely to seek help from a GP. Patients with longer pain duration had a lower rate of GP visits. The rate of GP visits was 1.22 (IRR = 1.22, 95% CI: 1.19, 1.26) times higher in patients with severe pain severity, compared to patients with mild pain severity. Patients who used opioids were more likely to visit a GP (IRR = 1.32, 95% CI: 1.30, 1.34) than those who were not using opioids. Discussions. More than half of the adult CP patients had greater than three GP visits in the 3 months before referral. This study would indicate that some patients may attend their GP to seek an opioid prescription. Given the rising use of opioids nationally, future study is required on opioid users’ GP visitation practices. Additionally, the inverse association between pain duration and the rate of GP visits warrants further exploration. [ABSTRACT FROM AUTHOR]

Introduction. Low back pain (LBP) is common and a significant cause of morbidity. Many patients receive inappropriate imaging for LBP in primary care. Aim. To explore the incidence and type of spinal imaging conducted for LBP patients referred from general practice for specialist surgical opinion, and evaluate whether imaging conformed to clinical guidelines. Methods. Audit of a sequential cohort (n = 100) of new LBP patients referred from primary care for specialist opinion at a suburban Australian capital city independent Spinal Centre. Results. In the 6 months before referral, 90% (95% CI 83–95%) of patients underwent spinal imaging. Imaging was performed in 95% of those who did and 79% of those who did not meet guidelines for radiological investigation. 35% of patients were inappropriately imaged and 3% inappropriately not imaged. Spinal computed tomography (CT) imaging was used in 52% of patients, magnetic resonance imaging (MRI) in 42% and image-guided lumbar spinal interventional procedures in 28%. Discussion. Most patients with LBP referred for surgical opinion have diagnostic radiological investigations whether or not it is indicated by clinical guidelines. The more frequent use of spinal CT compared to MRI may be due to idiosyncrasies of the Australian Medicare Benefits Schedule (MBS) rebate system. The findings of this pilot study provide support for the changes recommended by the 2016 MBS Review Taskforce on LBP that permit GP access to subsidised lumbar MRI, while constraining access to lumbar CT, and provide novel data about spinal imaging and practice in this cohort of patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Eye conditions are common presentations in Australian general practice, with the potential for serious sequelae. Pre-vocational ophthalmology training for General Practitioner (GP) trainees is limited. AIM: To describe the rate, nature and associations of ophthalmic problems managed by Australian GP trainees, and derive implications for education and training. METHODS: Cross-sectional analysis from an ongoing cohort study of GP trainees' clinical consultations. Trainees recorded demographic, clinical and educational details of consecutive patient consultations. Descriptive analyses report trainee, patient and practice demographics. Proportions of all problems managed in these consultations that were ophthalmologyrelated were calculated with 95% confidence intervals (CI). Associations were tested using simple logistic regression within the generalised estimating equations (GEE) framework. RESULTS: In total, 884 trainees returned data on 184,476 individual problems or diagnoses from 118,541 encounters. There were 2649 ophthalmology-related problems, equating to 1.4% (95% CI: 1.38-1.49) of all problems managed. The most common eye presentations were conjunctivitis (32.5% of total problems), eyelid problems (14.9%), foreign body (5.3%) and dry eye (4.7%). Statistically significant associations were male trainee; male patient and patient aged 14 years or under; the problem being new and the patient being new to both trainee and practice; urban and of higher socioeconomic status practice location; the practice nurse not being involved; planned follow up not arranged; referral made; in-consultation information sought; and learning goals generated. DISCUSSION: Trainees have comparable ophthalmology exposure to established GPs. However, associations with referral and information-seeking suggest GP trainees find ophthalmic problems challenging, reinforcing the critical importance of appropriate training. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Patients are interested in receiving text messages (texts) related to their health care. However, anecdotes are emerging of associated problems and it is possible that many of the potential pitfalls are not recognised. AIM: To assess clinicians' attitudes and behaviours towards text messaging (texting) with patients. METHODS: A voluntary, anonymous, online survey was created and distributed to general practitioners and physiotherapists in New Zealand and to Sports Medicine Fellows and Sports Medicine Registrars in New Zealand and Australia. RESULTS: In total, 322 clinicians completed the survey. Texting behaviours relating to accuracy, privacy and security were identified. A range of sensitive and important medical information was frequently conveyed and at times forwarded to third parties. The clinicians generally felt uneasy communicating this way and some felt pressured into it. Most thought that guidelines are insufficient and that they had not received sufficient education on the issues. Most were interested in further education. CONCLUSION: This study has demonstrated frequent texting between clinicians and patients. It has highlighted potential risks to the privacy, accuracy and security of medical information. Current guidelines and education may be insufficient. Clinicians were interested in receiving readily available best practice guidelines and education regarding texting. [ABSTRACT FROM AUTHOR]

The article focuses on trend in general practice towards diversification of the GP's professional role. Topics include examines in addition to clinical practice, many GPs choose to work in other health areas and considered this intention manifests in general practice training, with GP trainees expressing interest in developing portfolio careers.

Introduction. Engagement of general practitioners (GPs) is essential to improving rates of diagnosis and treatment of viral hepatitis, as traditional tertiary hospital-based models of care often face challenges. Aim. We investigated Australian general practitioners' perceptions of a community-based model of care for patients with viral hepatitis. Methods. We conducted a mixed methods study using survey questionnaires (23 GPs) and an open-ended interview guide (10 GPs) at primary care clinics in Brisbane, Queensland, Australia. Quantitative data were analysed using descriptive statistics in Stata 15.1 and qualitative data were analysed using thematic analysis following an inductive approach. Results. Patient loss to follow up and high cost of diagnostic tests were identified as the biggest challenges to providing care for patients with viral hepatitis. Most GPs interviewed believe a more community-based model of care with support to GPs may improve uptake of care and increase both GP and patient engagement. General practitioners felt a community-based model of care could also improve viral hepatitis testing and follow-up rates. Discussion. For Australian GPs, improving patient retention and diagnostics access were key pressure points in the viral hepatitis care pathway. A broader and more profound capacity-building allows community-based viral hepatitis care to be sustainable. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Nutrition care refers to nutrition-related advice or counselling provided by health professionals in an attempt to improve the nutrition behaviour of patients. AIM: The aim of this study was to describe the practices of a sample of Australian general practitioners (GPs) when providing nutrition care to adult patients. METHODS: Eighteen GPs (13 male, 5 female) were observed by fourth-year medical students during their general practice rotation. Each GP was observed for five consultations that included nutrition care, totalling 90 observed consultations. In each consultation, students completed a 31-item nutrition care checklist of nutrition care practices that could feasibly occur in a standard consultation. Each practice was marked with either a 'yes' (completed), 'no' (did not complete) or 'completed by practice nurse prior to or after the consultation'. RESULTS: Twenty-eight nutrition care practices were observed at least once. The most frequently observed practices were measuring and discussing blood pressure (76.7%; n=69), followed by general questions about current diet (74.4%; n=67). Approximately half of the consultations included a statement of a nutrition-related problem (52.2%; n=47), and the provision of nutrition advice that focused on a nutrient (45.6%; n=41) or food group (52.2%; n=47). Consultations with male GPs, as well as GPs with more than 25 years of experience, were associated with an increased number of nutrition care practices per consultation. DISCUSSION: The GPs performed nutrition care practices in varying frequencies. Further research is required to identify the most effective GP nutrition care practices to improve the nutrition behaviour of patients. [ABSTRACT FROM AUTHOR]

Introduction. Primary care prevention strategies that support and provide tools for general practice have the potential to slow and reverse rates of overweight and obesity. Aim. To test the effectiveness of a novel 12-week, online, structured, evidence-based weight management and lifestyle modification programme in general practices. Methods. Between August 2018 and March 2020, participants with a body mass index (BMI) ≥ 25 were recruited from general practices in the Hunter New England and Central Coast Primary Health Network region of Australia. Practices were randomly assigned to deliver a ‘low-intensity’ (LI) or ‘high-intensity’ (HI) variant of the programme. Practitioners were trained in programme delivery. The intervention involved weekly progress and accountability checks and scripted education sessions on evidenced-based nutrition, physical activity and lifestyle modification. The trial included follow-up evaluations at 6 and 12 months. Results. In total, 695 participants were recruited from 26 practices. At the end of the 12-week programme, participants in the HI treatment arm lost an average of 3.2 kg (s.d. 3.8) and 29% (50/172) achieved clinically significant weight loss (>5% of initial body weight). Positive results were maintained at evaluations by participants in the HI treatment arm who attended, but only 31% of participants at 6 months and 21% at 12 months were followed up. Discussion. Participant engagement and retention and practitioner workload burden are key factors in the design of weight management programmes in primary care. Many lessons can be obtained as a result of this trial, and programme adjustments have been identified to improve its delivery model. [ABSTRACT FROM AUTHOR]

Vulnerability during the coronavirus disease 2019 (COVID-19) pandemic is an emotional state that affects all of us globally. The Italian experience shows that our general practitioners (GPs) seem to have a higher rate of death due to COVID-19 infection than other physicians. This article discusses clinical ethics questions related to the vulnerability of GPs and the communityduringthepandemic inItaly: the total lackof, or the inadequateprotectionofpersonal protective equipment, the increased use of virtual medicine, and the value of a solid synergy between hospitals and territorial systems. We provide a few examples of experiences in other affected countries and populations (Indigenous communities in Brazil, Australia and Germany). In conclusion, we offer some reflections on the crucial role of communication in dealing with vulnerability issues during this COVID-19 pandemic period. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Health consciousness highlights the readiness of individuals to undertake health actions and take responsibility for their health and the health of others. AIM: To examine the health consciousness of Australians and its association with health status, health-care utilisation and sociodemographic factors. METHODS: This quantitative cross-sectional study was a part of a larger project aiming to engage the general public in health-care decision-making. Adults from Queensland and South Australia (n = 1529) were recruited to participate by a panel company. The questionnaire included the Health Consciousness Scale (HCS), health status, health-care utilisation, sociodemographic and socioeconomic variables. RESULTS: The health consciousness of Australians was relatively low (mean score = 21), compared to other international administrations of the HCS, and further investigations revealed that more health-conscious people tended to live in South Australia, be female and single, experience poorer physical and mental health and were more frequent users of health-care services. DISCUSSION: The general approach to health in this sample of the Australian public may reflect 'here and now' concerns. It appears that an attitude of 'she'll be right, mate' prevails until a change in an individual's health status or their exposure to the health system demands otherwise. These findings need to be investigated further to see if they are confirmed by others and to clarify the implications for primary health programmes in Australia in redressing the public's apparent apathy. [ABSTRACT FROM AUTHOR]

The article presents a speech by Dr. Garry Nixon, Director of Division of Health Sciences at Dunedin School of Medicine, University of Otago, New Zealand, delivered at the RNZCGP Conference July 2017 in New Zealand in which he discussed rural generalism, state of the rural hospital medical workforce and initiatives of the University of Otago.