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Objective: MindStep™ is an Australian low-intensity cognitive behaviour therapy (LICBT) program for individuals with mild-to-moderate symptoms of anxiety and depression. UK-produced LICBT guided self-help (GSH) materials were originally used in the MindStep™ program. In 2017, Australian LICBT GSH materials were developed to better suit Australian users. This study explored whether the Australian-produced materials continued to achieve the benchmark recovery rates established in the UK and maintained in recent Australian studies. Methods: Binomial logistic regression was conducted using retrospective client data, including the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder 7-item scale, between 2016 and 2019. Results: During time periods in which the Australian-produced materials were used, equivalent rates of reliable recovery and improvement were achieved compared with time periods in which the UK-produced materials were used. Australian-trained LICBT coaches, using Australian-produced LICBT GSH materials, achieve client recovery rates of up to 60%, reliable improvement rates of 58% and reliable recovery rates of 46% (with the probability of recovery increasing with client age). Conclusions: These findings are particularly pertinent with COVID-19 changing the landscape of mental health service delivery, requiring greater flexibility in the use of teleservices to ensure access to effective mental health care for populations that may already experience problems with isolation, access and service engagement. What is known about the topic?: LICBT is an acceptable, feasible and effective treatment approach for people experiencing mild-to-moderate anxiety and depression in Australia. LICBT GSH materials used with clients in Australia originated from the UK. However, according to guidelines, LICBT GSH materials should be contextualised to suit the audience they are being used with. What does this paper add?: This paper demonstrates that LICBT GSH materials tailored to an Australian context can be used in place of UK-produced materials because they yield equivalent and consistent therapeutic outcomes. Although contextualising the LICBT GSH materials for health services users was important, it is likely that the evidence-based cognitive behaviour therapy techniques sitting 'under the hood' of these materials are most important to ensure successful therapeutic outcomes. What are the implications for practitioners?: As we face unprecedented challenges following 2020, the physical, social, psychological and economic impacts of life-changing events must not inhibit access to treatments for common mental health conditions. It is anticipated that more non-traditional, alternative providers of mental health services will be needed to scale-up and respond to increasing demand. This paper shows that the provision of telephone-based LICBT in Australia, by trained coaches using Australian-produced GSH materials, is an evidenced-based support pathway that can reduce the access gap to treatments. [ABSTRACT FROM AUTHOR]

Objective: The climate crisis necessitates urgent decarbonisation. The health sector must address its large carbon footprint. In the present study, we sought healthcare thought leaders' views about a future environmentally sustainable health system. Methods: The present study was a qualitative exploratory study consisting of semistructured, in-depth interviews with 15 healthcare thought leaders from Australia, the UK, the US and New Zealand. Audio recordings of the interviews were transcribed and analysed by matrix display and thematic analysis. Results: Overall, healthcare thought leaders believe that to reduce the carbon footprint of healthcare we need to look beyond traditional 'green' initiatives towards a more fundamental and longer-term redesign. Five main themes and one 'key enabler' (information communication technology) were identified. In this paper we draw on other relevant findings, but chiefly focus on the fifth theme about reshaping the role of healthcare within society and using the size and influence of the health sector to leverage wider health, environmental and societal benefits. Conclusions: These ideas represent potentially low-carbon models of care. The next step would be to pilot and measure the outcomes (health, environmental, financial) of these models. What is known about the topic?: The health sector needs to reduce its large carbon footprint. Traditional 'green' initiatives, such as recycling and improving energy efficiency, are insufficient to achieve the scale of decarbonisation required. What does this paper add?: Healthcare thought leaders surveyed in the present study suggested that we also consider other, non-traditional ways to achieve environmental sustainability. In this paper we discuss their ideas about adopting an anticipatory approach to healthcare using predictive analytics, and using the size and influence of the health sector to effect wider health and environmental benefits. What are the implications for practitioners?: Achieving an environmentally sustainable healthcare system is likely to require broad and fundamental (i.e. transformational) change to the current service model. Health practitioners throughout the sector must be closely engaged in this process. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to demonstrate that any suggestion that there is a need for specific innovation laws is flawed. Innovation is central to good medical practice and is adequately supported by current law. Methods: The paper reviews the nature of medical innovation and outlines recent attempts in the UK to introduce specific laws aimed at 'encouraging' and 'supporting' innovation. The current legal framework is outlined and the role of the law in relation to medical innovation explored. Results: The analysis demonstrates the cyclic relationship between medical advancement and the law and concludes that there is no requirement for specific innovation laws. Conclusions: The law not only supports innovation and development in medical treatment but encourages it as central to a functioning medical system. There is no need to introduce specific laws aimed at medical innovation; to do so represents an unnecessary legal innovation and serves to complicate matters. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore whether a relationship exists between the number of disasters a jurisdiction has experienced and the presence of disaster-specific pharmacy legislation. Methods: Pharmacy legislation specific to disasters was reviewed for five countries: Australia, Canada, UK, US and New Zealand. A binary logistic regression test using a generalised estimating equation was used to examine the association between the number of disasters experienced by a state, province, territory or country and whether they had disaster-specific pharmacy legislation. Results: Three of six models were statistically significant, suggesting that the odds of a jurisdiction having disaster-specific pharmacy legislation increased as the number of disasters increased for the period 2007–17 and 2013–17. There was an association between the everyday emergency supply legislation and the presence of the extended disaster-specific emergency supply legislation AH19093_IE1.gif. Conclusions: It is evident from this review that there are inconsistencies as to the level of assistance pharmacists can provide during times of crisis depending on their jurisdiction and location of practice. It is not a question of whether pharmacists have the skills and capabilities to assist, but rather what legislative barriers are preventing them from being able to contribute further to the disaster healthcare team. What is known about the topic?: The contributing factors to disaster-specific pharmacy legislation has not previously been explored in Australia. It can be postulated that the number of disasters experienced by a jurisdiction increases the likelihood of governments introducing disaster-specific pharmacy legislation based on other countries. What does this paper add?: This study compared five countries and their pharmacy legislation specific to disasters. It identified that as the number of disasters increases, the odds of a jurisdiction having disaster-specific emergency supply or disaster relocation or mobile pharmacy legislation increases. However, this is likely to be only one of many factors affecting the political decisions of when and what legislation is passed in relation to pharmacists' roles in disasters. What are the implications for practitioners?: Pharmacists are well situated in the community to be of assistance during disasters. However, their ability to help patients with chronic disease management or providing necessary vaccinations in disasters is limited by the legislation in their jurisdiction. Releasing pharmacists' full potential in disasters could alleviate the burden of low-acuity patients on other healthcare services. This could subsequently free up other healthcare professionals to treat high-acuity patients and emergencies. [ABSTRACT FROM AUTHOR]

The concept of commissioning is starting to gain traction in the Australian health system. Primary Care Networks began operations in July 2015 with a remit around commissioning health services. Despite the centrality of this concept, we know relatively little about commissioning in Australia. Other systems have experimented with it for some time, and this paper reviews the evidence and lessons inherent within the international literature. The study defines commissioning, and explores experiences of others who have adopted commissioning approaches and the evidence concerning the outcomes of these experiments. Commissioning is a difficult topic in many senses and its application to a complex area such as health reform can make it even more challenging. Ultimately, this evidence suggests that commissioning is more than simply a technical or operational process, but one that is value-based and relational. This is not to downplay the technical aspects, which in many jurisdictions have resulted in explicit and evidenced-based approaches to planning and priority setting. However, if new commissioning organisations, such as Primary Health Networks, are to have an impact, they need to balance the operational and relational elements of commissioning. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact and cost associated with mental illness. Methods: A rapid review of the literature from Australia, New Zealand, UK and Canada was undertaken. The review included literature pertaining to the cost-of-illness and impact of mental illness as well as any modelling studies. Included studies were categorised according to impact on education, labour force engagement, earlier retirement or welfare dependency. The well-accepted Drummond 10-point economic appraisal checklist was used to assess the quality of the studies. Results: A total of 45 methodologically diverse studies were included. The studies highlight the significant burden mental illness places on all facets of society, including individuals, families, workplaces and the wider economy. Mental illness results in a greater chance of leaving school early, a lower probability of gaining full-time employment and a reduced quality of life. Research from Canada suggests that the total economic costs associated with mental illness will increase six-fold over the next 30 years with costs likely to exceed A$2.8 trillion (based on 2015 Australian dollars). Conclusions: Mental illness is associated with a high economic burden. Further research is required to develop a better understanding of the trajectory and burden of mental illness so that resources can be directed towards cost-effective interventions. What is known about the topic?: Although mental illness continues to be one of the leading contributors to the burden of disease, there is limited information on the economic impact that mental illness imposes on individuals, families, workplaces and the wider economy. What does this paper add?: This review provides a summary of the economic impact and cost of mental illness. The included literature highlights the significant burden mental illness places on individuals, families, workplaces, society and the economy in general. The review identified several areas for improvement. For example, only limited information is available on the impact of attention deficit hyperactivity disorder, anxiety, cognitive function, conduct disorder, eating disorder and psychological distress. There was also a dearth of evidence on the intangible elements of pain and suffering of people and their families with depressive disorders. More research is required to better understand the full extent of the impact of mental illness and strategies that may be implemented to minimise this harm. What are the implications for practitioners?: Knowing the current and future impact of mental illness highlights the imperative to develop an effective policy response. [ABSTRACT FROM AUTHOR]

Introduction. New Zealand's health care system faces significant shortages in health care workers. To address workforce challenges and meet the population's health needs, health care systems around the world have introduced new clinical roles, such as physician associates/assistants (PAs) into existing health care teams. Aim. This article aims to examine the benefits, challenges, and broader implications of regulating PAs in the context of New Zealand's primary care sector, with a specific emphasis on how it may impact general practice. Methods. A range of literature surrounding the role, impact, and perception of PAs were selected and included in this article. Results. The PA profession can significantly strengthen New Zealand's primary care workforce, improving patient access and continuity of care. However, the global deployment of PAs has faced scrutiny due to concerns about its potential risks to patient safety and the overall viability of such a role. Discussion. If regulated, the PA profession can reshape New Zealand's primary care, offering a partial solution to current medical staff shortages. Trained under a generalised medical model similar to doctors, PAs possess the necessary skills to perform both routine and non-routine medical tasks. This dual capability can significantly improve primary care service provision, reduce existing workloads, and allow for a more efficient deployment of doctor expertise. However, medico-legal issues and the supervisory burden can impede widespread integration into general practice. Despite challenges, the success of the PA role relies on mutual trust, respect, and support from other clinical team members within primary health care. [ABSTRACT FROM AUTHOR]

Objective. The objective of this paper was to evaluate breakaway technique training with neuroscience nursing staff as a measure of increased confidence and safety in managing aggression. Methods. A quasi experimental design was used in a sample of neuroscience nursing staff (n=31), participating in 2×1h breakaway technique workshops. The workshops consisted of supervised skills training in safe breakaway techniques. A pre- and postintervention-matched questionnaire measuring confidence and safety around managing aggressive patients, and exposure to and confidence in dealing with breakaways, was self administered. Results. Statistically significant increases in confidence and safety in working with aggressive patients, and confidence levels for safe breakaways were reported. Qualitative comments demonstrated a desire for ongoing skills workshops. Conclusions. This study provides early evidence of the importance of incorporating breakaway training into existing training programs which aim to minimise and manage aggression and violence in generalist settings. What is known about the topic? Workplace violence is acknowledged internationally as a major occupational problem within healthcare and is reportedly increasing. The need for extensive training programs for healthcare staff is supported in the literature. What does this paper add? This would appear to be the first evaluation of breakaway training with a population of neuroscience nursing staff. Significant increases in confidence in managing aggression can be demonstrated following brief practical skills training. What are the implications for practitioners? This study provides early evidence for incorporating breakaway training into mandatory training programs for generalist health staff. Generalist health services may consider employing certified trainers to facilitate this specific skills training. [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]

Environmental context: It is useful to know the concentration of 'labile', or chemically active, metal in soils because it can be used to predict metal solubility and environmental impact. Several methods for extracting the labile metal from soils have been proposed, and here we have tested two of these to see how well the resulting data can be used to model metal solubility. Such mixed approaches can be applied to different soil types with the potential to model metal solubility over large areas. Rationale: Predicting terrestrial metal dynamics requires modelling of metal solubility in soils. Here, we test the ability of two geochemical speciation models that differ in complexity and data requirements (WHAM/Model VII and POSSMs), to predict metal solubility across a broad range of soil properties, using differing estimates of the labile soil metal concentration. Methodology: Using a dataset of UK soils, we characterised basic properties including pH and the concentrations of humic substances, mineral oxides and metals. We estimated labile metal by extraction with 0.05 mol L−1 Na2H2EDTA and by multi-element isotopic dilution (E- value). Dissolved concentrations of Ni, Cu, Zn, Cd and Pb were estimated in 0.01 mol L−1 Ca(NO3)2 soil suspensions using the total metal ({ M }total), the EDTA-extracted pool ({ M }EDTA) and the E- value ({ M } E ) as alternative estimates of the chemically reactive metal concentration. Results: Concentrations of { M }EDTA were highly correlated with values of { M } E , although some systematic overestimation was seen. Both WHAM/Model VII and POSSMs provided reasonable predictions when { M }EDTA or { M } E were used as input. WHAM/Model VII predictions were improved by fixing soil humic acid to a constant proportion of the soil organic matter, instead of the measured humic and fulvic acid concentrations. Discussion: This work provides further evidence for the usefulness of speciation modelling for predicting soil metal solubility, and for the usefulness of EDTA-extracted metal as a surrogate for the labile metal pool. Predictions may be improved by more robust characterisation of the soil and porewater humic substance content and quality. Environmental context. It is useful to know the concentration of 'labile', or chemically active, metal in soils because it can be used to predict metal solubility and environmental impact. Several methods for extracting the labile metal from soils have been proposed, and here we have tested two of these to see how well the resulting data can be used to model metal solubility. Such mixed approaches can be applied to different soil types with the potential to model metal solubility over large areas. This article belongs to the collection Dedication to Prof. Edward Tipping. [ABSTRACT FROM AUTHOR]

Environmental context: Ammonia emissions from inorganic nitrogen fertilisers used in agriculture can impact air quality, human health and ecology. This study quantifies such emissions and their controlling factors from UK and Ireland agricultural soils. Emissions are variable and, from non-urea fertilisers, substantially exceed maximum emission factors used by the UK Department for Environment, Food and Rural Affairs. This suggests that UK emission factors need to be refined further, with consideration of inter alia land-use, fertiliser type, soil pH and chemical inhibitors. Rationale: Ammonia (NH3) emissions from inorganic nitrogen (N) fertilisers applied to agricultural soils have negative implications for environmental quality and human health. Despite this, efforts to reduce NH3 emissions in the UK have achieved limited success. This study aims to provide an overview of NH3 emissions from UK and Ireland agricultural soils receiving N fertilisers, their regulating factors and the potential role of inhibitors in reducing current NH3 losses. Methodology: A systematic literature search was performed to identify relevant experimental data and studies, and the extracted data (total of 298 field fertilisation events) were categorised and analysed systematically. Results: NH3 emissions ranged from −4.00 to 77.00% of applied fertiliser-N lost as NH3. In addition to fertiliser type, NH3 losses were also significantly affected by land-use type and soil pH. Urease and combined urease and nitrification inhibitors significantly reduced emissions by 74.50 and 70.00% compared to uninhibited-urea respectively. Discussion: In addition to fertiliser types, land-use and soil pH were found as factors for consideration as modifiers to the maximum NH3 emission factor (EFmax) values currently used in the UK, in order to improve estimations of NH3 emissions, particularly from non-urea fertilisers. This is imperative as NH3 losses exceeded current EFmax limits, particularly in the case of non-urea fertilisers, by ~34%, implying that NH3 emissions estimated from UK synthetic fertiliser require further refinements. NH3 losses are not completely inhibited, inhibitors cannot be solely relied upon for tackling NH3 emissions from UK and Ireland fertiliser usage and further research is needed into alternative mitigation methods to further reduce NH3 losses. Environmental context. Ammonia emissions from inorganic nitrogen fertilisers used in agriculture can impact air quality, human health and ecology. This study quantifies such emissions and their controlling factors from UK and Ireland agricultural soils. Emissions are variable and, from non-urea fertilisers, substantially exceed maximum emission factors used by the UK Department for Environment, Food and Rural Affairs. This suggests that UK emission factors need to be refined further, with consideration of inter alia land-use, fertiliser type, soil pH and chemical inhibitors. This article belongs to the collection Dedication to Prof. Edward Tipping. [ABSTRACT FROM AUTHOR]

Background The aim of this review is to explore acceptability, barriers, and facilitators to PrEP use among African migrants in high-income countries.Methods: A systematic review was conducted to explore reasons that contribute to low PrEP uptake in this population. Three online databases, abstracts from key conferences and reference lists of relevant studies articles published between the 2 July 2018 and 3 March 2019 were searched. Narrative synthesis was performed on quantitative data and thematic synthesis was performed on qualitative data.Results: Of 1779 titles retrieved, two cross-sectional studies (United States (US) (n = 1), United Kingdom (UK) (n = 1)) and six qualitative studies (US (n = 2), UK (n = 3), Australia (n = 1)) met inclusion criteria. PrEP acceptability was reported in one cross-sectional article and two qualitative articles. Cross-sectional studies measured acceptability and willingness to use PrEP; in one study, 46% of African migrant men found PrEP use acceptable, and following PrEP education, another study categorised 60% of participants as willing to use PrEP if it were cost-free. Qualitative studies reported mixed acceptability, with higher acceptability reported for serodiscordant couples. Barriers and facilitators to PrEP use were coded into five themes: cultural aspects of stigma; knowledge gap in health literacy; risks unrelated to HIV transmission; practical considerations for PrEP use; and the impact of PrEP use on serodiscordant couples.Conclusions: Several common barriers to PrEP use, including stigma, health literacy and risk perception and cost, were identified. Findings were limited by there being no published data on uptake. Additional work is needed to understand PrEP acceptability and uptake among African migrants. [ABSTRACT FROM AUTHOR]

Objective. The objective of this research is to appraise current practice in hospitals against the ‘Framework to achieve value in healthcare’ (the Framework) and to identify additional contributory factors that support or hinder its application. Methods. A multi-site case study was undertaken with five hospitals in Australia, the USA and UK using purposeful sampling to identify hospitals to participate. Data collection took place between September and November 2022. The hospitals included in the study had Process Improvement (PI) programs of more than 5 years duration, with strong executive engagement and broad outcomes measurement, including financial benefits. All hospitals were acute public hospitals or private, not for profit. Results. All hospitals indicated current practice according to Steps 1–5 for some part of their PI programs. All hospitals indicated that they were more likely to include financial benefits measurement for activities aimed specifically at improving cost rather than reducing non-value adding activities or improving the value of clinical care. Step 5 (reinvestment of cost savings) of the Framework is dependent on the accomplishment of Step 4 (measurement and realisation of financial benefits) and the contributory elements are important in supporting hospitals to utilise the Framework. Conclusions. The ‘Framework to achieve value in healthcare’ provides a practical guide for hospitals to reduce non-value adding activities, improve the value of clinical care and reduce costs. Further research is indicated to establish its reliability in hospitals in other countries and hospitals that do not have an established PI program. [ABSTRACT FROM AUTHOR]

Background. Strongly varying timescales of pyrogenic carbon (PyC) degradation have been observed across depositional settings. To date, PyC degradation in UK peatlands has had limited investigation. Aims. This study aims to evaluate how PyC recalcitrance relates to differing production characteristics, fuels and duration of exposure in UK peatlands. Methods. PyC samples produced from key peatland vegetation types were exposed on a peatland surface to assess molecular (by Fourier-transform infrared), leachable carbon (water-extractable organic carbon) and elemental (C, H, N, O) changes occurring over a year. Key results. PyC degradation phases were observed: (1) very rapid (=1 month) loss of leachable carbon; (2) longer-term (1-12 months) changes to PyC characteristics indicative of soil interactions. 'Severity' had a significant effect on all measured variables. Conclusions. This study indicates that PyC is susceptible to changes within short timescales in UK peatlands, particularly low-temperature PyC, but that stabilisation through soil matrix interactions may occur over longer periods (>1 year). Implications. The findings indicate that UK peatland wildfire carbon cycling research should consider early pulses of carbon to the wider environment, as well as longer-term C storage in PyC. [ABSTRACT FROM AUTHOR]

Background: Additional approaches to HIV prevention and management, such as Nudgeathons, are required to increase access to HIV pre-exposure prophylaxis (PrEP) among overseas-born men who have sex with men (MSM). Methods: In September 2021, we conducted a 4-h online Nudgeathon, wherein four teams co-designed behaviourally informed adverts to improve PrEP access and uptake for overseas-born MSM. After the Nudgeathon, eight of 17 invited Nudgeathon attendees were interviewed about their experience. We conducted a qualitative content analysis of interview data to highlight participants' experiences of the co-design process. Results: We identified three major themes: (1) what worked well; (2) group dynamics; and (3) improvement and future directions. The Nudgeathon about PrEP was a positive learning experience, with valuable contributions and overall satisfaction with the end-products. The online format was perceived as less costly than if the Nudgeathon was hosted in person, and suitable for participants from different geographical regions. In-person Nudgeathons with international attendees would require costs for flights, accommodation, function room hire and catering. Within groups, sharing personal experiences essential to co-designing concepts. However, less information on how to create nudges and more information before the Nudgeathon was preferred. Conclusion: Our evaluation finds that Nudgeathons are fast and efficient in developing potential solutions to complex issues related to HIV prevention. We evaluated a 4-h online Nudgeathon aimed to co-design a digital advertisement campaign for HIV pre-exposure prophylaxis (PrEP) among overseas-born men who have sex with men. All interviewees were satisfied with the end-product they co-designed with their group, which proved to be as productive in co-designing solutions as past Nudgeathons conducted in person, lasting 1–2 days. Online co-design workshops can be a fast and efficient option for developing potential solutions to sensitive issues, such as PrEP. [ABSTRACT FROM AUTHOR]

The article presents an analysis of the extent and nature of hybridity in England's National Health Service (NHS). Topics include the risks and opportunities provided by the hybridity and its implications for general medical practice in the country. It is suggested that newer forms of hybridity can provide greater community engagement, diverse professional influence, and social entrepreneurship and facilitate the use of technological innovation.

Objective: Hepatitis B is sexually transmitted among men who have sex with men (MSM) and has previously been endemic in some populations of MSM. Presence of anti-hepatitis B core (anti-HBc) determines previous or ongoing infection. We aimed to establish the prevalence and associations of anti-HBc in our clinic population of MSM.Method: A cross-sectional study of newly attending MSM to determine the prevalence and associations of testing positive for anti-HBc using our clinic database from 2012 to 2019. We used crude odds ratios to identify any associations.Results: There were 3342/5842 (58%) newly attending MSM who were tested for anti-HBc between 2012 and 2019. Of the 3342 MSM tested for anti-HBc, the median age was 30years (interquartile range 23-43), 442 (13%) were living with HIV, 10 (0.3%) were HBsAg positive, 62 (1.9%) had past/current hepatitis C, 401 (12%) had a positive syphilis enzyme immunoassay (EIA), 455 (14%) were diagnosed with either gonorrhoea or chlamydia and 1080 (32%) were non-UK born. A total of 331 (10%, 95% confidence interval (CI)=8.9-11.0) tested positive for anti-HBc and the proportion testing positive reduced significantly throughout the study period (P<0.004). Testing positive for anti-HBc was associated with age >30years (OR=8.2, 95% CI=5.9-11.4, P<0.0001), having past/current hepatitis C (odds ratio (OR)=5.0, 95% CI=3.0-8.6, P<0.0001), having a positive syphilis EIA (OR=5.9, 95% CI=4.4-7.3, P<0.0001) and being non-UK born (OR=1.4, 95% CI=1.1-1.8, P<0.006). There were no associations with HIV status or having a diagnosis of gonorrhoea or chlamydia.Conclusion: Although reducing, the prevalence of anti-HBc remains endemic in MSM locally and further efforts are needed to enhance hepatitis B prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Improving sexual health and blood-borne virus (BBV) outcomes continue to be of high priority within the United Kingdom (UK) and it is evident that the media can and do impact the public health agenda. This paper presents the first large-scale exploration of UK national newsprint media representations of sexual health and BBVs. Methods: Using keyword searches in electronic databases, 677 articles published during 2010 were identified from 12 national (UK-wide and Scottish) newspapers. Content analysis was used to identify manifest content and to examine the tone of articles. Results: Although there was a mixed picture overall in terms of tone, negatively toned articles, which focussed on failures or blame, were common, particularly within HIV/AIDS, hepatitis B and C, and other sexually transmissible infection coverage (41% were assessed as containing negative content; 46% had negative headlines). Differences were found by newspaper genre, with 'serious' newspaper articles appearing more positive and informative than 'midmarket' newspapers or 'tabloids'. Across the sample, particular individuals, behaviours and risk groups were focussed on, not always accurately, and there was little mention of deprivation and inequalities (9%). A gender imbalance was evident, particularly within reproductive health articles (71% focussed on women; 23% on men), raising questions concerning gender stereotyping. Conclusions: There is a need to challenge the role that media messages have in the reinforcement of a negative culture around sexual health in the UK and for a strong collective advocacy voice to ensure that future media coverage is positively portrayed. [ABSTRACT FROM AUTHOR]

The Australian government has announced major reforms with the move to a primary maternity care model. The direction of the reforms remains contentious; with the Australian Medical Association warning that the introduction of non-medically led services will compromise current high standards in maternity services and threaten the safety of mothers and babies. The purpose of this paper is to conduct a critical review of the literature to determine whether there is convincing evidence to support the safety of non-medically led models of primary maternity care. Twenty-two non-randomised international studies were included representing midwifery-led care, birth centre care and home birth. Comparative outcome measurements included: perinatal mortality; perinatal morbidity; rates of medical intervention in labour; and antenatal and intrapartum referral and transfer rates. Findings support those of the three Cochrane reviews, that there is sufficient international evidence to support the conclusion of no difference in outcomes associated with low risk women in midwifery-led, birth centre and home birth models compared with standard hospital or obstetric care. These findings are limited to services involving qualified midwives working within rigorous exclusion, assessment and referral guidelines, limiting the number of urgent intrapartum transfers that come with increased risk of perinatal mortality. What is known about the topic? Systematic reviews of maternal and perinatal outcomes associated with midwifery-led care when compared to conventional intrapartum hospital care concluded that these non-medically led models of care are associated with several benefits for low risk women and their babies with no identified adverse effects. What does this paper add? The finding of no difference in outcomes associated with midwifery-led, birth centre and home birth compared with standard hospital or obstetric care is limited to international studies involving women in the care of qualified midwives working within rigorous guidelines for practice involving inter-professionally agreed exclusion, assessment and referral criteria. What are the implications for practitioners? Midwives caring for women in non-medically led models are urged to be vigilant to the need for early detection and prompt action in the event of unforseen complications to avoid an over emphasis on normality. This decreases the likelihood of urgent intrapartum transfers that come with an increased risk of perinatal mortality. [ABSTRACT FROM AUTHOR]

This paper examines the impact of direct payments on social isolation. We define what social isolation means, and then evaluate the role of direct payments in the provision of social services in the United Kingdom. Social isolation is a particular problem for older people. In Australia there are an increasing number of older residents who are isolated, but would benefit from having greater choice in terms of how they access and receive social services. Increased access to direct payments could help to reduce waiting lists for traditional social services and address gaps in service provision. [ABSTRACT FROM AUTHOR]

The article informs about the burnout crisis in the NHS, particularly among General Practitioners (GPs), with 71% of UK GPs reporting severe burnout symptoms. Topic include impact on the healthcare system's backbone, calls for targeted interventions, such as streamlining administrative tasks and providing mental health support, and stresses the imperative need for sustainable solutions to ensure the well-being of healthcare providers and the overall survival of the NHS.

International students within Australia are disproportionately affected by adverse sexual and reproductive health (SRH) outcomes. Chinese international students represent the majority of international students in Australia, and a large proportion of students in other high-income countries such as the United States and the United Kingdom, making them an important priority group. However, the SRH issues of this priority group have received little attention from international researchers. This review provides an overview of global studies surrounding the SRH knowledge, attitudes and behaviours of Chinese international students studying abroad. Ten articles were deemed relevant and findings from both the qualitative and quantitative data synthesis were categorised into six codes: (1) knowledge; (2) sources of information; (3) attitudes; (4) behaviours; (5) barriers; and (6) recommendations. The findings provide valuable understanding to inform the development of targeted, culturally sensitive and inclusive health promotion initiatives and policies. It is recommended that further research is conducted in this field to reduce evident health disparities. [ABSTRACT FROM AUTHOR]

Environmental context: Pesticide losses from land to surface waters have the potential to cause ecological damage. Furthermore, pesticides in surface waters present a major challenge for water companies accessing these waters for the domestic supply, in terms of complying with water quality regulations. Here, we evaluate the potential of field- and ditch-scale free-surface constructed wetland systems for reducing pesticide transfers from land to surface waters. Pesticides make important contributions to agriculture but losses from land to water can present problems for environmental management, particularly in catchments where surface waters are abstracted for drinking water. 'On-line' constructed wetlands have been proposed as a potential means of reducing pesticide fluxes in drainage ditches and headwater streams. Here, we evaluate the potential of two free-surface constructed wetland systems to reduce pesticide concentrations in surface waters using a combination of field monitoring and dynamic fugacity modelling. We specifically focus on metaldehyde, a commonly used molluscicide that is moderately mobile and has been regularly detected at high concentrations in drinking water supply catchments in the UK over the past few years. We also present data for the herbicide metazachlor. Metaldehyde losses from the upstream catchment were significant, with peak concentrations occurring in the first storm events in early autumn, soon after application. Concentrations and loads appeared to be minimally affected by transit through the monitored wetlands over a range of flow conditions. This was probably due to short solute residence times (quantified via several tracing experiments employing rhodamine WT – a fluorescent dye) exacerbated by solute exclusion phenomena resulting from patchy vegetation. Model analyses of different scenarios suggested that, even for pesticides with short aquatic half-lives, wetland systems would need to exhibit much longer residence times (RTs) than those studied here in order to deliver any appreciable attenuation. If the ratio of wetland surface area to the area of the contributing catchment is assumed to be a surrogate for RT (i.e. not accounting for solute exclusion), then model predictions suggest that this needs to be greater than 1 % to yield load reductions of 3 and 7 % for metaldehyde and metazachlor respectively. Environmental context. Pesticide losses from land to surface waters have the potential to cause ecological damage. Furthermore, pesticides in surface waters present a major challenge for water companies accessing these waters for the domestic supply, in terms of complying with water quality regulations. Here, we evaluate the potential of field- and ditch-scale free-surface constructed wetland systems for reducing pesticide transfers from land to surface waters. [ABSTRACT FROM AUTHOR]

Background Pre-exposure prophylaxis (PrEP) was introduced in Sexual Health Services of the Welsh National Health Service (NHS Wales) in July 2017 as a 3-year pilot service.Methods: Data were collected through the pre-existing Sexual Health in Wales Surveillance System, to which codes were added to capture PrEP eligibility, outcome of offer of PrEP, reasons for declining and adherence. Eligibility categories were defined based on nationally agreed criteria: men who have sex with men (MSM) and transgender people at high risk of HIV acquisition; partners of HIV-positive individuals not known to be virally suppressed; and heterosexuals reporting condomless intercourse with a HIV-positive individual not known to be virally suppressed.Results: During the first 6 months, 516 people were eligible, 96% of which were MSM. Overall, 57% of those eligible (296/516) started PrEP. Reasons for declining PrEP were given by 88 (56%) of 157 people; 50 (57%) of whom did not believe themselves to be at risk. Of the available adherence assessments, 89% considered that all risk episodes had been covered. Persistence at 3 months was assessed for 141 people, of which 93 (66%) were still using PrEP. There were no HIV diagnoses in people taking PrEP during the first 6 months. Twenty-nine people were diagnosed with 37 episodes of sexually transmissible infections (STIs) while on PrEP. STI incidence was 105.7 per 100 person-years.Conclusions: The early trend indicates that implementation of PrEP is progressing as planned, and the service has been utilised by clients. This analysis can help refine implementation, inform planning and research around uptake, use and effect in Wales and internationally. [ABSTRACT FROM AUTHOR]

Nurse-led weight management programs, like the Counterweight Program in the United Kingdom, may offer a way for Australian general practices to provide weight management support to adults who are overweight or obese. During Counterweight, nurses provide patients with six fortnightly education sessions and three follow-up sessions to support weight maintenance. This study examined the feasibility, acceptability and perceived value of the Counterweight Program in the Australian primary care setting using a mixed-methods approach. Six practice nurses, from three general practices, were trained and subsidised to deliver the program. Of the 65 patients enrolled, 75% (n = 49) completed the six education sessions. General practitioners and practice nurses reported that the training and resource materials were useful, the program fitted into general practices with minimal disruption and the additional workload was manageable. Patients reported that the program created a sense of accountability and provided a safe space to learn about weight management. Overall, Counterweight was perceived as feasible, acceptable and valuable by Australian practice staff and patients. The key challenge for future implementation will be identifying adequate and sustainable funding. An application to publically fund Counterweight under the Medicare Benefits Schedule would require stronger evidence of effectiveness and costeffectiveness in Australia. [ABSTRACT FROM AUTHOR]

Objective The aim of the present study was to try to understand the breadth and comprehensiveness of a regional operating model (ROM) developed within the Victorian Department of Health's North West Metropolitan Region office in Melbourne, Australia. Methods A published literature search was conducted, with additional website scanning, snowballing technique and expert consultation, to identify existing operating models. An analytical grid was developed covering 16 components to evaluate the models and assess the exhaustiveness of the ROM. Results From the 34 documents scoped, 10 models were identified to act as a direct comparator to the ROM. These concerned models from Australia (n = 5) and other comparable countries (Canada, UK). The ROM was among the most exhaustive models, covering 13 of 16 components. It was one of the few models that included intersectoral actions and levers of influence. However, some models identified more precisely the planning tools, prioritisation criteria and steps, and the allocation mechanisms. Conclusions The review finds that the ROM appears to provide a wide coverage of aspects of planning and integrates into a single model some of the distinctive elements of the other models scoped. [ABSTRACT FROM AUTHOR]

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

Quality mental health care is based on the integration of care across organisations and disciplines. The aims of this study were, first, to assess the extent, characteristics and reported outcomes of publications concerned with youth mental health service integration in Australia and internationally; and second, to investigate the study design quality of evaluative interventions and determine whether the studies report on the cost-effectiveness of the integration in order to inform the reform of youth mental health services by Queensland Health. A systematic search of the peer-reviewed literature and a narrative synthesis were undertaken of English language publications from 21 electronic databases. Inclusion criteria were: published 1998-2014 (inclusive); peer-reviewed research; focused on mental health services integration; reported data for youth aged 12-25 years. The methodological quality of evaluative interventions was assessed using the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project (EPHPP). Twenty-five studies met the inclusion criteria: one (4%) was classified as a measurement research, 13 (52%) as descriptive, and 11 (44%) as interventions including five (45%) evaluative interventions. Four out of the five evaluative interventions reported positive effects of youth mental health service integration. Particular problems included ambiguity of definitions, absence of economic or cost analyses and insufficient consumer involvement. The methodological quality of the interventions was variable with, on average, a moderate level of selection bias and study design. Despite a slight increase in the number of studies in the last couple of years, there are important gaps in the evidence base for youth mental health service integration processes. The relatively small number of evaluative studies and lack of economic evaluations point to the need for additional research in this important area. [ABSTRACT FROM AUTHOR]

Australian Primary Health Networks could pioneer local health service reform for children and young people living in out-of-home care. Significant maltreatment, the leading cause of placement of 0-17-year-olds under the protective canopy of foster, kinship and residential care (described collectively as out-of-home care) left more than 50 000 children vulnerable to poor health outcomes in 2013-14. Opportunistic health care is inadequate to meet the chronic and complex health needs of maltreated children. This article reviews some critical lessons from English commissioning and US healthcare marketplace reforms in an attempt to better meet the needs of children and young people in out-of-home care. It identifies key questions that Australian Primary Health Networks would need to resolve if they were to follow overseas trends and adopt health service commissioning as a means to provide more effective and efficient health care for this at-risk population. [ABSTRACT FROM AUTHOR]

The article offers information that Medical advocacy group the Royal New Zealand College of General Practitioners With a long history of supporting GPCME, they provide scientific and clinically sound teaching. events. It also mentions that The NICE guidelines are quoted for the safety/harm of the Lightning Process. The claimed harms come from a qualitative study where possibly two people claimed they were harmed.

Charles Henry Brian Priestley (known as Bill)was born and educated in England. After completing the Mathematical Tripos at the University of Cambridge, he joined the Meteorological Office in 1939. In 1946, aged 31 years, he took up an Australian appointment with the Council for Scientific and Industrial Research (CSIR, later to become CSIRO) to establish and develop a group to undertake research in meteorological physics. Thereafter he was based in Melbourne, Australia. The group earned world recognition, particularly for its investigations of turbulent transfer in the lower atmosphere, and evolved to become the CSIRO Division of Atmospheric Research. Priestley's own early research focused on large-scale atmospheric systems, including substantial work on global-scale transport, and later on small-scale atmospheric convection and heat transfer, in which he established some significant results. He had a leading role in the development of the atmospheric sciences in Australia, and was strongly involved in international meteorology. His career with CSIRO extended to 1977, and he finally retired from all professional commitments in the mid-1980s. After several years of declining health, he died on 18 May 1998, seven weeks before he turned 83. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to a study by J. E. Parker and colleagues about influences on medical students' attitudes to general practice as a career.