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Aims: To present opportunities and a model to redress the under‐representation of rural communities and people in Australian clinical trials. Context: Clinical trials are essential for building and understanding the health evidence base. The lack of representation of rural people in clinical trials is evident in other countries. Examining the Australian New Zealand Clinical Trial Registry (ANZCTR) suggests this is also the case in Australia. Approach: We propose an approach that empowers rurally based academics and clinicians to co‐design clinical trials and increase rural Australians' participation in clinical trials to address this inequality of access. A case study of a decentralised, co‐designed clinical trial is presented to support this approach. Conclusion: Decentralising clinical trials could improve access to clinical trials, strengthen the social capital of rural communities and help address the health inequalities that exist between rural and metropolitan communities. [ABSTRACT FROM AUTHOR]

Aim: We aim to discuss the advantages of supporting clinical nurses' involvement in place‐based research in rural health services. Context: Australian health services are currently struggling with increased demand in services from an aging population, chronic diseases and nursing workforce shortages. This impact is amplified in rural and remote regions of Australia. Approach: Investment in place‐based clinical nursing research provides opportunity for nursing recruitment, career and leadership development, and retention, while addressing local health issues and creating pathways for implementation of evidence‐based practice. Conclusion: Collaboration between rural health services, universities, policy makers and the Rural Health Multidisciplinary Training program will enable the opportunity for establishment and ongoing development of strong research programs in rural health services to address local health issues and workforce needs. [ABSTRACT FROM AUTHOR]

Introduction: Responsiveness of health care systems is a global concept defined as the ability of systems to function in a manner that meets the expectations of individuals, and is under‐studied. In Australia, Aboriginal Community Controlled Health Organisations (ACCHOs) are valued by Aboriginal and Torres Strait Islander Peoples for the provision of holistic culturally safe primary health care and are well positioned to be responsive to community needs. Objective: To develop a conceptual framework examining the responsiveness of a rural ACCHO to the health care needs of Aboriginal and Torres Strait Islander Peoples in their service region. Design: A qualitative interview study using abductive reasoning was conducted. Interviews conducted with Aboriginal clients, key informants, and ACCHO health personnel from two evaluations undertaken in partnership with a rural ACCHO located in Victoria, Australia, were analysed through an iterative process of identifying key concepts from the data and evidence. Key concepts were used to develop a conceptual framework. Findings: Across the two evaluations, 22 participants were involved in data collection and 28 interviews were undertaken. A conceptual framework examining the responsiveness of a rural ACCHO to the health care needs of Aboriginal Peoples within their service region was developed and encompassed three concepts: operating within a complex adaptive system, mechanisms of responsiveness used by the ACCHO, and challenges experienced by the ACCHO when being responsive. Discussion: The developed conceptual framework expands on research supporting the value of ACCHOs in providing holistic culturally safe health care to their communities, particularly in rural settings. A key finding is the importance for ACCHOs to meet the health care needs of their community whilst navigating needs in the context of the broader health care system. When dissonance is encountered between external system components and community needs, challenges can be experienced such as adequately resourcing models of service delivery and maintaining the provision of services. Conclusion: Conceptualising the health care system as a complex adaptive system in which an ACCHO operates and is responsive, highlights the competing demands experienced. Findings expand on mechanisms of responsiveness used at the service–user interface. Future research should examine how the broader health care system can support the role and functions of ACCHOs in being responsive to the health care needs of their communities. [ABSTRACT FROM AUTHOR]

Summary: University departments of rural health are Commonwealth‐funded to improve recruitment and retention of the rural allied health and nursing (including midwifery) workforce, primarily through student placements.We examined publications by university departments of rural health that were focused on allied health and nursing students undertaking placements in rural Australia, to understand the characteristics, main findings and implications of the research conducted.Interprofessional learning was a key feature of placements and placement education, although other activities such as community engagement added to placement experiences.Factors such as quality supervision and being involved in the community contributed to a positive placement experience and increased rural practice intention. Tracking studies showed a relationship between rural placements, rural practice intention and rural practice.Rural placements occurred across a variety of settings and in locations consistent with the policy framework. Embedding university departments of rural health in rural communities enabled staff to build relationships and increase placement capacity. [ABSTRACT FROM AUTHOR]

Aims: There is increasing evidence that diabetes stigma has negative impacts on behavioural and psychological outcomes among people with type 2 diabetes (T2D). However, research has focused largely on Caucasian and certain Asian groups. The aim of this study was to examine associations of diabetes stigma with diabetes distress and self‐care, and investigate the moderating effects of self‐esteem and social support, in Arabic‐speaking communities. Methods: A cross‐sectional study was conducted at 21 outpatient clinics and diabetes‐specialist centres in the United Arab Emirates. Besides the Arabic Type‐2 Diabetes Stigma Assessment Scale, participants completed other validated questionnaires assessing distress, self‐care, social support, and self‐esteem. General linear models were used to estimate the mean difference in diabetes‐specific distress and self‐care for every 1‐point increase in diabetes stigma total score. Results: Among 327 adults with T2D, the mean total score of diabetes stigma was 43.55 ± 13.95. Every 1‐point increase in diabetes stigma was associated with significantly increased diabetes distress (β = 0.113, 95% CI: 0.078 to 0.147; p = 0.003) and decreased self‐care behaviours: diet (β = −0.029, 95% CI: −0.048 to −0.009; p = 0.008), physical activity (β = −0.022, 95% CI: −0.038 to −0.006; p = 0.013) and foot care (β = −0.043, 95% CI: −0.059 to −0.026; p < 0.001). Self‐esteem mitigated the effect of diabetes stigma on diabetes distress. Conclusions: Perceived and experienced diabetes stigma was independently associated with increased diabetes distress and decreased engagement in diabetes self‐care among Arabic‐speaking adults with T2D. These findings are crucial to help clinicians provide more effective assessment and counselling and guide public health interventions to decrease diabetes stigma in these communities. [ABSTRACT FROM AUTHOR]

Introduction: Farmers face a range of factors that negatively influence their mental health and suicide risk, yet have limited access to appropriate support. Behavioural activation (BA) is an evidence‐based therapy that can be effectively delivered by nonclinical workers. Working with members of farming communities to deliver BA to their peers has the potential to overcome many well‐established barriers to mental health help‐seeking and improve outcomes for this at‐risk group. Objective: This paper describes the findings of a co‐design phase informing the development of a peer (farmer)‐led approach for delivering BA for farmers living with depression or low mood. Design: This qualitative study used a co‐design approach involving members of the target community. Focus groups were transcribed and analysed using Thematic Analysis and the Framework approach. Findings: Ten online focus groups with 22 participants were held over 3 months. Four overarching, interlinked themes were identified: (i) filling the gap in rural mental health support; (ii) alignment with the farming context—tailoring how, where and when we engage about mental health; (iii) the 'messenger' is as important as the message; and (iv) sustainability, governance and support. Discussion: Findings suggest BA could be a contextually appropriate model of support for the farming community—given its practical and solution‐focused approach—and could help improve access to support. Having peer workers deliver the intervention was viewed as appropriate. Ensuring governance structures are developed to support peers to deliver the intervention will be essential to facilitate effectiveness, safety and sustainability. Conclusion: Insights gained through co‐design have been critical to the success of developing this new model of support for members of farming communities experiencing depression or low mood. [ABSTRACT FROM AUTHOR]

The authors comment on an editorial wherein Professor Tim Skinner questioned the outcomes of the Rural Health Multidisciplinary Training (RHMT) program for residents of Australian regional, rural and remote communities. Topics include the authors' disagreement that there is no evidence of the impact of the RHMT programs, considerations with respect to evidence to measure the impacts of RHMT programs, and the goal of directors implementing RHMT programs.

Aims: This commentary aims to describe a case of how meaningful co‐design between rural health service leaders and a health service‐embedded research unit can identify emerging research priorities and optimise translation. Context: The challenges facing rural health services are unique, and the important role of health service leaders in the research response is increasingly recognised. Poorly‐designed research can contribute to research waste through reduced applicability of results to rural communities, and an opportunity exists to increase research co‐designed with rural health services through the involvement of research users during study planning. Approach: In early 2020, leaders at a rural Victorian health service approached the embedded health service research unit to request research be conducted on an emerging issue: rural staff well‐being in the face of the COVID‐19 pandemic. This was based on their concern regarding the lack of available COVID‐19‐specific evidence to inform organisational policy. In collaboration with the rural health service executive, a translation‐focused study of staff well‐being with nine rural Victorian health services was developed. Key co‐design activities of the project included involving research end‐users as study investigators and conducting formal stakeholder engagement regarding study design and outcomes. Conclusion: Meaningful co‐design of research with health services is a multifaceted process that can assist researchers and end‐users alike in identifying and responding to emerging health issues. In the rural setting where there is a vital need for impactful health research, we recommend that researchers should consider employing co‐design processes in order to minimise research waste and optimise the translatability of research findings. [ABSTRACT FROM AUTHOR]

Objective: To explore participant experiences of an online co‐design process to develop a web‐based preventative mental health and well‐being intervention targeting primary producers in rural Australia. Setting: Rural Victoria, Australia. Participants: Participants from a primary producer background, including horticulture, fisheries, animal cultivation and farm consultancy, were eligible for the study if they had participated in both the co‐design and beta testing processes for a primary producer platform. Design: A qualitative study using semi‐structured phone‐based interviews was undertaken. A reflexive inductive approach to data analysis was employed to develop themes. Results: Eleven participants were interviewed, with an average age of 51 years, of which 7 were female. Five main themes were developed. These included: (1) participant diversity, (2) impact of online delivery on co‐design participation, (3) experiences of the co‐design process, (4) maintaining a shared vision and goals and (5) acting on the co‐design recommendations. Use of online methods was a clear enabler to engage participants who were geographically dispersed and offers an alternative to more conventional approaches to co‐design using face‐to‐face methods. Some aspects of participant engagement may need a greater focus when conducted online compared with face‐to‐face. Conclusions: Using an online co‐design method to develop a preventative mental health and well‐being web‐based platform for primary producers was novel. Findings address a gap in the literature around the experience of participants engaging in a co‐design process and identify opportunities to improve participant engagement and experience with the online format. [ABSTRACT FROM AUTHOR]

Substantially reduced life expectancy for people with serious mental illness compared with the general population is primarily driven by physical health issues, of which cardiovascular disease is the leading cause. In this narrative review, we examine the evidence base for use of metformin and other antidiabetic agents as a means for reducing this excess cardiometabolic disease burden. Evidence from randomised controlled trials (RCTs) suggests substantial potential for metformin to prevent or manage weight gain and glycaemic impairment induced by atypical antipsychotic medications, whereas the impact of metformin on other cardiometabolic risk factors is less consistent. Evidence from RCTs also suggests potential benefits from glucagon-like peptide-1 receptor agonists (GLP-1RAs), particularly for addressing cardiometabolic risk factors in people using atypical antipsychotic medications, but this is based on a small number of trials and remains an emerging area of research. Trials of both metformin and GLP-1RAs suggest that these medications are associated with a high prevalence of mild-moderate gastrointestinal side effects. The heterogeneous nature of participant eligibility criteria and of antipsychotic and antidiabetic drug regimens, alongside short trial durations, small numbers of participants and paucity of clinical endpoints as trial outcomes, warrants investment in definitive trials to determine clinical benefits for both metformin and GLP-1RAs. Such trials would also help to confirm the safety profile of antidiabetic agents with respect to less common but serious adverse effects. The weight of RCT evidence suggests that an indication for metformin to address antipsychotic-induced weight gain is worth considering in Australia. This would bring us into line with other countries. [ABSTRACT FROM AUTHOR]

Introduction and Objective: Building rural health workforce research capacity is critical to addressing rural health inequalities. Research training is a mainstay research capacity building strategy. This paper describes the delivery and evaluation of a research training program for rural and regional allied health professions (AHPs). Design: A mentored research training program was delivered to AHPs employed public health services in rural and regional Victoria, Australia. The program was evaluated using the Evidence‐Based Practice Knowledge Attitudes and Practice (EBP‐KAP) tool at baseline and 3 months post‐training. Semi‐structured interviews undertaken at 3 and 16 months post‐training explored participants' perspectives of the training, their development and application of EBP and research skills. Survey data were analysed descriptively, and interview data were analysed using a framework approach. Findings: Thirty‐four individuals from 14 organisations attended the first workshop and 31 attended the second. Thirty‐one participants completed the survey at baseline and nine at 3 months post‐training. Sixteen interviews were undertaken with 11 participants, five participating at both time points. Participants had positive EBP attitudes at both time points. Overall, participants' knowledge and incorporation of EBP into their practice, and retrieval of evidence was unchanged 3 months post‐training. Themes identified in the interview data were as follows: (1) individual research capacity enhanced through supported practice, (2) organisational factors influence individuals' progression of research and (3) individual contributions towards research capacity within the organisation. Conclusion: A mentored rural research training program promoted the application of EBP skills at the individual level and contributed to organisational research capacity. [ABSTRACT FROM AUTHOR]

Objective: To determine the work location (metropolitan, regional, rural and remote) of graduates in nursing, allied health and oral health disciplines who complete their professional training, end‐to‐end training, in a regional or rural area noting the potential inclusion of a metropolitan‐based placement for speciality practice not available in rural or regional Victoria. Methods: We tracked the place of employment from the Australian Health Practitioners Regulation Agency (AHPRA) of all graduates from a regional/rural tertiary education provider. The student home address at enrolment, locations where they undertook all placements and their current place of work were described using an objective geographical model of access, the Modified Monash Model. Results: Seventy‐five per cent of 5506 graduates were located in the AHPRA database. About one third of graduates were working in metropolitan areas, 1/3 in regional cities and 1/3 in rural areas. Students' origin accounted for 1/3 of variance in current workplace location. The more placement days students completed in regional/ rural areas was also a significant predictor of working in a regional or rural area. Conclusion: End‐to‐end training in regional/rural areas is an effective approach to retaining a regional/rural workforce. Student origin is a strong predictor of working rural or regionally, as is undertaking placements in rural areas. This suggests that priority for rural/ regional student placements should be given to students in end‐to‐end regional/ rural programs and students from a regional/ rural background. [ABSTRACT FROM AUTHOR]

The article offers insights on building rural health service research in Australian rural communities in 2022. Topics discussed include the rural town Colac Area Health's successful building of health research capacity, a research project's provision of increased research skill development among staff and networking with local researchers, and the challenge of funding for sustaining research efforts. Also noted is the importance of collaboration with regional health centers and staff.

Objective: To provide a structured understanding of rural hospital‐based emergency care facility workforce and resources. Design: The resources of regional training hubs were used to survey eligible emergency care facilities in their surrounding region. Setting: Rural emergency care facilities manage more than one third of Australia's emergency presentations. These emergency care facilities include emergency departments and less‐resourced facilities in smaller towns. Participants: Hospital facilities located outside metropolitan areas that report emergency presentations to the Australian Institute of Health and Welfare. Interventions: A survey tool was sent by email. Main outcome measures: Presence of human, diagnostic and other resources as reported on a questionnaire. Results: A completed questionnaire was received from 195 emergency care facilities. Over 60% of Small hospitals had on‐call doctors only. General practitioners/generalists and nurses with extended emergency skills were found in all hospital types. Emergency physicians were present across all remoteness areas, but more commonly seen in larger facilities. All Major/Large facilities and most Medium facilities reported having onsite pathology and radiology. Point of care testing and clinician radiography were more commonly reported in smaller facilities. Among Small hospitals, Very Remote hospitals were more likely than Inner Regional hospitals to have an onsite doctor in the emergency care facility and/or a high dependency unit. Conclusion: Smaller and more remote facilities appear to adapt by using different workforce structures and bedside investigations. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editors discuss the various topics within the issue, including the effects of COVID-19 pandemic in rural Australia, the Rural Health Multidisciplinary Training (RHMT) program, and a rural program for dental students.

Aims: To describe the population distribution and socio‐economic position of residents across all states and territories of Australia, stratified using the 7 Modified Monash Model classifications. The numerical summary, and the methods described, can be applied by a variety of end users including workforce planners, researchers, policy‐makers and funding bodies for guiding future investment under different scenarios, and aid in evaluating geographically focused programs. Context: The Commonwealth Department of Health is transitioning to the Modified Monash Model to objectively describe geographical access. This change applies to the Rural Health Multidisciplinary Training Program, one of the Australian Government's key policies to address the maldistribution of the rural health workforce. Unlike the previously applied Australian Statistical Geography Standard‐Remoteness Areas, a summary of the population in each Modified Monash Model classification is not available, nor is a socio‐economic overview of the communities within these areas. Approach: Spatial analysis of Australian Bureau of Statistics data (Modified Monash Model, population data and the Index of Relative Socio‐economic Advantage and Disadvantage collected or derived from the 2016 census) at the Statistical Area 1—the smallest unit for the release of census data. Conclusion: Linking the Modified Monash Model, a socio‐economic index and granular population data at the national level highlights the disadvantage of many residents in small rural towns (Modified Monash 5). The Modified Monash Model does not exhibit a continuum of the largest population residing in the most accessible classification and the smallest population residing in the least accessible classification that is seen in the Australian Statistical Geography Standard‐Remoteness Areas. Coupled with policy relevance, the advantage of using the Modified Monash Model as the basis for analysis is that it highlights areas that have both a critical mass of residents and differing levels of socio‐economic advantage and disadvantage. This will help end users to target funding to those regions where there is potential to improve access to services for the greatest number of rural residents. [ABSTRACT FROM AUTHOR]

Objective: To describe the distribution of 3 allied health professionals—occupational therapists, physiotherapists and podiatrists—in South Australia stratified by the Modified Monash Model and the Index of Relative Socio‐Economic Disadvantage. Design: A descriptive data linkage cross‐sectional study. Setting: The state of South Australia, Australia. Participants and main outcome measures: Distribution of the 3 registered allied health professional groups stratified by Modified Monash Model and Index of Relative Socio‐Economic Disadvantage. Results: The largest proportion of the 3 allied health professional groups (occupational therapists, physiotherapists and podiatrists) were found in areas classified as Modified Monash 1 and Modified Monash 2 (86.5%). The lowest proportion of allied health professionals were found in Modified Monash 7. The largest number of allied health professionals per 10 000 population was found in areas classified as Modified Monash 1 and Modified Monash 2. The lowest number of allied health professionals per 10 000 population was found in Modified Monash 7 areas. The largest number of allied health professionals per 10 000 population was found in areas with Index of Relative Socio‐Economic Disadvantage quintile 2, while the lowest number of allied health professionals per 10 000 population was found in areas with Index of Relative Socio‐Economic Disadvantage quintile 1. Conclusions: The distribution of allied health professionals according to geographical remoteness, socio‐economic disadvantage and per 10 000 population varies widely in South Australia. The number of allied health professionals per 10 000 population was lowest in rural and remote/very remote areas, explaining the typically poor access to allied health services for communities in these areas. The number of allied health professionals per 10 000 population according to Index of Relative Socio‐Economic Disadvantage was variable within the context of both urban and rural areas. [ABSTRACT FROM AUTHOR]

Commercial fishers face a range of stressors that impact physical and mental health. However, there is limited research on the level of mental ill‐health among fishers and on the nature of stressors that contribute to their psychological distress. This paper focuses on the experiences of commercial wild‐catch fishers and analyses the results of an Australian national survey conducted in 2017 (n = 872) (Appendix S1). We first assess underlying themes in perceived stressors, identifying three distinct categories termed 'traditional risks', 'modern uncertainties' and 'future concerns'. Second, we assess the level of self‐reported psychological distress, demonstrating higher occurrence of high to very high psychological distress among commercial fishers in comparison with the national population. Third, we examine the relationship between different groups of stressors and psychological distress, finding that stronger perceptions of both 'traditional risks' and 'modern uncertainties' are associated with greater levels of psychological distress among fishers. Fourth, recognizing diversity within the industry, we examine differences in these relationships among skippers and crew (work role), and inshore versus offshore fishers (fishing location). Our analysis demonstrates that 'traditional risks' and 'modern uncertainties' differentially impact on fisher mental health and depend on the individual's role in the industry and their fishing location. The findings suggest that changes to factors associated with modern uncertainty stressors—including government management techniques, red tape, media representation and political support—could significantly improve mental health in the commercial fishing sector. [Correction added on 09 June 2021, after first online publication: Abstract has been corrected in this version.] [ABSTRACT FROM AUTHOR]

Objective: To determine the student characteristics and clinical school training pathways that are associated with postgraduate rural practice. Design: A cross‐sectional observational study. Setting: Deakin University's School of Medicine, encompassing 3 rural and 2 metropolitan clinical schools, including a rural longitudinal integrated clerkship (LIC) year. Participants: A total of 948 School of Medicine medical graduates (2011‐2018) who had an Australian Health Practitioners Regulation Agency registered work location in Australia (September 2019). Main outcome measure(s): Graduates' work locations were linked with admission and clinical school training data and analysed for significant associations. Results: Graduates completing a rural LIC year and a regional rural clinical school year were 7 times more likely to be working rurally than metropolitan trainees. A small number of rural background (RB) students completed a rural LIC and rural clinical school year, 66.7% of whom were practising rurally. Further associations with rural practice were attending a rural clinical school for 2 years or a rural LIC for 1 year, student having a RB, rurally bonded course placement and being an international student. Conclusion: The significant influence of a rural LIC year on graduate rural work location is noteworthy, especially when undertaken by students from a RB in combination with a second regional rural clinical school year. These findings support the strategic alignment of rural student selection with rural clinical school training pathways to achieve the greatest impact on rural graduate workforce outcomes. [ABSTRACT FROM AUTHOR]

Objective: Combined, nursing and allied health constitute most of the Australian health workforce; yet, little is known about graduate practice destinations. University Departments of Rural Health have collaborated on the Nursing and Allied Health Graduate Outcomes Tracking to investigate graduate entry into rural practice. Design: Data linkage cohort study. Setting: Monash University and the University of Newcastle. Participants: Graduates who completed their degree in 2017 across seven disciplines. Main outcome measure(s): The outcome variable was Australian Health Practitioner Regulation Agency principal place of practice data. Explanatory variables included discipline, age, gender, location of origin, and number and duration of rural placements. Result: Of 1130 graduates, 51% were nurses, 81% females, 62% under 21 years at enrolment, 23% of rural origin, 62% had at least one rural student placement, and 23% had over 40 cumulative rural placement days. At the time of their second Australian Health Practitioner Regulation Agency registration, 18% worked in a 'Rural principal place of practice.' Compared to urban, rural origin graduates had 4.45 times higher odds ratio of 'Rural principal place of practice.' For graduates who had <20 cumulative rural placement days, compared to zero the odds ratio of 'Rural principal place of practice' was the same (odds ratio = 1.10). For those who had 20‐40 rural placement days, the odds ratio was 1.93, and for >40 rural placement days, the odds ratio was 4.54). Conclusion: Rural origin and more rural placement days positively influenced graduate rural practice destinations. Outcomes of cumulative placements days may compare to immersive placements. [ABSTRACT FROM AUTHOR]

Objective: Linking enrolment and professional placement data for students' from 2 universities, this study compares characteristics across universities and health disciplines. The study explores associations between students' location of origin and frequency, duration and type of placements. Design: Retrospective cohort data linkage. Setting: Two Australian universities, Monash University and the University of Newcastle. Participants: Students who completed medical radiation science, nursing, occupational therapy, pharmacy or physiotherapy at either university between 2 February 2017 and 28 February 2018. Interventions: Location of origin, university and discipline of enrolment. Main outcome measure(s): Main measures were whether graduates had multiple rural placements, number of rural placements and cumulative rural placement days. Location of origin, discipline and university of enrolment were the main explanatory variables. Secondary dependent variables were age, sex, socio‐economic indices for location of origin, and available placements. Results: A total of 1,315 students were included, of which 22.1% were of rural origin. The odds of rural origin students undertaking a rural placement was more than 4.5 times greater than for urban origin students. A higher proportion of rural origin students had multiple rural placement (56.0% vs 14.9%), with a higher mean number of rural placement days. Public hospitals were the most common placement type, with fewer in primary care, mental health or aged care. Conclusions: There is a positive association between rural origin and rural placements in nursing and allied health. To help strengthen recruitment and retention of graduates this association could be further exploited, while being inclusive of non‐rural students [ABSTRACT FROM AUTHOR]

Abstract: Aims: Breast conserving surgery rates are affected by many factors including distance to radiotherapy and tumor‐related features. Numerous studies have found women who must travel further for radiotherapy are more likely to choose mastectomy and avoid radiotherapy. We examined relationships between socioeconomic group, distance to radiotherapy services and mastectomy rates across a range of rural and metropolitan settings. Methods: We used a dataset extracted from the Evaluation of Cancer Outcomes Barwon South Western Registry, which captured data on new breast cancer diagnoses in the southwest region of Victoria, Australia. Using logistic regression, we modeled treatment choice of women with early breast cancer (mastectomy vs breast conserving surgery) using explanatory variables that included distance to radiotherapy, and area‐level socioeconomic data from the Australian Bureau of Statistics, while controlling for clinical factors. Results: Mastectomy was associated with tumor size, nodal burden and younger age at surgery. Distance to a radiotherapy center was also strongly associated with increased rates of mastectomy for women who traveled 100–200 km for radiotherapy (odds ratio = 1.663; P = 0.03) compared to the reference group who were within 100 km of radiotherapy. No socioeconomic differences were seen between the two groups. Conclusion: A strong association between distance to radiotherapy and the type of surgery for early breast cancer was found. Improving access to radiotherapy therefore has the potential to improve breast cancer outcomes for women in regional Australia. [ABSTRACT FROM AUTHOR]

Aim: The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalized for heart failure. Methods: Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996-2009). Of all identified blood cancer patients (N = 23 434), 8339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7522 adults. Time-varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. Results: Of those who were subsequently hospitalized for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non-heart failure counterparts, a difference which was much greater than that between the adult groups. Conclusion: The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population. [ABSTRACT FROM AUTHOR]

In the cases of Jennings and colleagues5 and Beks and colleagues,6 the authors captured information on study location and then assigned a geographic category. National analysis of the Modified Monash Model, population distribution and a socio- economic index to inform rural health workforce planning. Of the reviews identified,2-7 the Modified Monash Model (MMM) is yet to be applied.10 With seven categories, the MMM builds upon the five categories of the ASGS-RA and uses population and road distance to add further granularity. [Extracted from the article]

Chapter 5 concludes there is a need for a longitudinal, linked database to address rural workforce planning that utilises public data sources, noting medicine was covered by all primary data sources identified, yet only three covered all health professions.3 The Nursing and Allied Health Graduate Outcome Tracking (NAHGOT) study is a research collaboration between the University of Newcastle, Monash University and Deakin University that addresses issues of scale and relevance to national health workforce policy. Keywords: Rural health services EN Rural health services 141 141 1 08/03/21 20210801 NES 210801 To the Editor: Recruitment and retention of a sustainable rural health workforce was one of four issues highlighted by Osborne in a recent I MJA i supplement.1 Chapter 4 of the Supplement describes a need for longitudinal methods to evaluate recruitment and retention of nursing and allied health professionals, noting challenges around scale and links to policy.2 Comparative efforts examining the medical workforce in Australia are more advanced (eg, the Medical Schools Outcomes Database). [Extracted from the article]

The article highlights a report which examines participants' medical school selection data and academic performance in the Deakin University (DU), Bachelor of Medicine Bachelor of Surgery (BMBS) course; and the comparison between rural and metropolitan background students. Topics discussed include that rural origin students have a lower grade point average than their urban peers on entry to medical school but once admitted perform comparably.

CHAPTER 1: RETAIL INITIATIVES TO IMPROVE THE HEALTHINESS OF FOOD ENVIRONMENTS IN RURAL, REGIONAL AND REMOTE COMMUNITIES: Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia.Study Design: Rapid review of articles published between January 2000 and May 2020.Data Sources: We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries.Data Synthesis: Twenty-one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co-design to generate community ownership and branding.Conclusion: Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. CHAPTER 2: WHICH INTERVENTIONS BEST SUPPORT THE HEALTH AND WELLBEING NEEDS OF RURAL POPULATIONS EXPERIENCING NATURAL DISASTERS?: Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries.Study Design: We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references.Data Sources: We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence.Data Synthesis: Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle.Conclusion: There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people's health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community-based and integrated care services. CHAPTER 3: THE IMPACT OF BUSHFIRE ON THE WELLBEING OF CHILDREN LIVING IN RURAL AND REMOTE AUSTRALIA: Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia.Study Design: Literature review completed using rapid realist review methods, and taking into consideration the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for systematic reviews.Data Sources: We sourced data from six databases: EBSCOhost (Education), EBSCOhost (Health), EBSCOhost (Psychology), Informit, MEDLINE and PsycINFO. We developed search terms to identify articles that could address the research question based on the inclusion criteria of peer reviewed full text journal articles published in English between 1983 and 2020. We initially identified 60 studies and, following closer review, extracted data from eight studies that met the inclusion criteria.Data Synthesis: Children exposed to bushfires may be at increased risk of poorer wellbeing outcomes. Findings suggest that the impact of bushfire exposure may not be apparent in the short term but may become more pronounced later in life. Children particularly at risk are those from more vulnerable backgrounds who may have compounding factors that limit their ability to overcome bushfire trauma.Conclusion: We identified the short, medium and long term impacts of bushfire exposure on the wellbeing of children in Australia. We did not identify any evidence-based interventions for supporting outcomes for this population. Given the likely increase in bushfire events in Australia, research into effective interventions should be a priority. CHAPTER 4: THE ROLE OF NATIONAL POLICIES TO ADDRESS RURAL ALLIED HEALTH, NURSING AND DENTISTRY WORKFORCE MALDISTRIBUTION: Objective: Maldistribution of the health workforce between rural, remote and metropolitan communities contributes to longstanding health inequalities. Many developed countries have implemented policies to encourage health care professionals to work in rural and remote communities. This scoping review is an international synthesis of those policies, examining their effectiveness at recruiting and retaining nursing, dental and allied health professionals in rural communities.Study Design: Using scoping review methods, we included primary research - published between 1 September 2009 and 30 June 2020 - that reported an evaluation of existing policy initiatives to address workforce maldistribution in high income countries with a land mass greater than 100 000 km2 .Data Sources: We searched MEDLINE, Ovid Embase, Ovid Emcare, Informit, Scopus, and Web of Science. We screened 5169 articles for inclusion by title and abstract, of which we included 297 for full text screening. We then extracted data on 51 studies that had been conducted in Australia, the United States, Canada, United Kingdom and Norway.Data Synthesis: We grouped the studies based on World Health Organization recommendations on recruitment and retention of health care workers: education strategies (n = 27), regulatory change (n = 11), financial incentives (n = 6), personal and professional support (n = 4), and approaches with multiple components (n = 3).Conclusion: Considerable work has occurred to address workforce maldistribution at a local level, underpinned by good practice guidelines, but rarely at scale or with explicit links to coherent overarching policy. To achieve policy aspirations, multiple synergistic evidence-based initiatives are needed, and implementation must be accompanied by well designed longitudinal evaluations that assess the effectiveness of policy objectives. CHAPTER 5: AVAILABILITY AND CHARACTERISTICS OF PUBLICLY AVAILABLE HEALTH WORKFORCE DATA SOURCES IN AUSTRALIA: Objective: Many data sources are used in Australia to inform health workforce planning, but their characteristics in terms of relevance, accessibility and accuracy are uncertain. We aimed to identify and appraise publicly available data sources used to describe the Australian health workforce.Study Design: We conducted a scoping review in which we searched bibliographic databases, websites and grey literature. Two reviewers independently undertook title and abstract screening and full text screening using Covidence software. We then assessed the relevance, accessibility and accuracy of data sources using a customised appraisal tool.Data Sources: We searched for potential workforce data sources in nine databases (MEDLINE, Embase, Ovid Emcare, Scopus, Web of Science, Informit, the JBI Evidence-based Practice Database, PsycINFO and the Cochrane Library) and the grey literature, and examined several pre-defined websites.Data Synthesis: During the screening process we identified 6955 abstracts and examined 48 websites, from which we identified 12 publicly available data sources - eight primary and four secondary data sources. The primary data sources were generally of modest quality, with low scores in terms of reference period, accessibility and missing data. No single primary data source scored well across all domains of the appraisal tool.Conclusion: We identified several limitations of data sources used to describe the Australian health workforce. Establishment of a high quality, longitudinal, linked database that can inform all aspects of health workforce development is urgently needed, particularly for rural health workforce and services planning. CHAPTER 6: RAPID REALIST REVIEW OF OPIOID TAPERING IN THE CONTEXT OF LONG TERM OPIOID USE FOR NON-CANCER PAIN IN RURAL AREAS: Objective: To describe interventions, barriers and enablers associated with opioid tapering for patients with chronic non-cancer pain in rural primary care settings.Study Design: Rapid realist review registered on the international register of systematic reviews (PROSPERO) and conducted in accordance with RAMESES standards.Data Sources: English language, peer-reviewed articles reporting qualitative, quantitative and mixed method studies, published between January 2016 and July 2020, and accessed via MEDLINE, Embase, CINAHL Complete, PsycINFO, Informit or the Cochrane Library during June and July 2020. Grey literature relating to prescribing, deprescribing or tapering of opioids in chronic non-cancer pain, published between January 2016 and July 2020, was identified by searching national and international government, health service and peek organisation websites using Google Scholar.Data Synthesis: Our analysis of reported approaches to tapering conducted across rural and non-rural contexts showed that tapering opioids is complex and challenging, and identified several barriers and enablers. Successful outcomes in rural areas appear likely through therapeutic relationships, coordination and support, by using modalities and models of care that are appropriate in rural settings and by paying attention to harm minimisation.Conclusion: Rural primary care providers do not have access to resources available in metropolitan centres for dealing with patients who have chronic non-cancer pain and are taking opioid medications. They often operate alone or in small group practices, without peer support and access to multidisciplinary and specialist teams. Opioid tapering approaches described in the literature include regulation, multimodal and multidisciplinary approaches, primary care provider support, guidelines, and patient-centred strategies. There is little research to inform tapering in rural contexts. Our review provides a synthesis of the current evidence in the form of a conceptual model. This preliminary model could inform the development of a model of care for use in implementation research, which could test a variety of mechanisms for supporting decision making, reducing primary care providers' concerns about potential harms arising from opioid tapering, and improving patient outcomes. [ABSTRACT FROM AUTHOR]

The article presents a report on colorectal cancer and adenoma rates among regional National Bowel Cancer Screening Program participants. Topics discussed include reduction of absolute colorectal cancer mortality rate; colonoscopy at the Warrnambool Base Hospital; and prevention and treatment of the same.

The article discusses the implementation of an embedded research model at Brophy Family and Youth Services in southwest Victoria, Australia. The model aims to support staff in generating evidence regarding service outcomes and build research capacity. The article highlights the challenges faced in conducting research in rural areas and the need for evidence in the community services sector. The activities of the embedded researcher at Brophy have focused on establishing an agency-wide approach to monitoring, evaluation, and research, and have received support and interest from staff and leadership. The article suggests that this model may be useful for other community service organizations. The document is a report commissioned by the Queensland Government Department of Communities, Disability Services and Seniors and the Australian Government Department of Social Services, providing a guide for evaluating place-based approaches and the role of occupational therapy in research. [Extracted from the article]