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Introduction: In Australia, children with cerebral palsy and complex disability receive funded supports through the National Disability Insurance Scheme (NDIS). This individualised funding scheme requires parents to navigate and advocate on behalf of their child, supported by expert reports, recommendations, and allied health services. Supports aim to enable participation in all areas of daily life, which may be otherwise largely inaccessible to children with complex disability and their families. This study aimed to explore the experiences of families of children with complex disability after 3 years accessing the NDIS. Methods: A qualitative research design with a demographic questionnaire and in‐depth interview was undertaken. Purposive sampling was used to recruit participants from one organisation providing occupational therapy and other allied health services. Data analysis implemented Braun and Clarke's thematic approach to examine the experiences of participants. Consumer and Community Involvement: This research was conducted with a registered National Disability Insurance Scheme provider to give voice to parent consumers who raise children with complex disability. Findings: Seven mothers and one father (N = 8) of children with complex disability were interviewed. Most parents reported increased success and satisfaction navigating the scheme. Five overall themes were generated from the data: pivotal roles of families, parental empowerment, life‐changing equipment, the fallibility of the scheme, and a critical scheme. Conclusion: Parents reported reliance on the scheme for their child's basic daily care and a more enriched life for their child and family. Parents were grateful for the scheme but experienced inconsistencies, navigation difficulties, and variable choice and control. Most parents had fears about the sustainability of the scheme, translating into uncertainty about their child's future. Allied health professionals, including occupational therapists, are key advocates for children with complex disability and their families. Collaboration through sharing knowledge and skills to support children, their families, and carers is key to empowering parents to navigate the NDIS. PLAIN LANGUAGE SUMMARY The National Disability Insurance Scheme (NDIS) provides funding for people with permanent and significant disability. Children with cerebral palsy (and other complex disability) are lifetime users of the NDIS. For children with complex disability, their families are crucial to ensuring that their daily needs are being met, including providing medication. Previous research indicated that parents rely on the NDIS to support their children; however, there have been various challenges such as long wait times for equipment and difficulty understanding how to use the scheme. This study explored the experiences of families of children with complex disability, after more than 3 years of being an NDIS participant. Eight parents from one therapy service provider completed a short questionnaire about themselves, their child, and their family, followed by an interview with the first author. Four authors (occupational therapists) worked together to design and implement this study. The findings highlighted several key points: the important role of parents as caregivers; parents became more knowledgeable and confident to navigate the NDIS with time; equipment funded by the NDIS was life‐changing; the NDIS has ongoing issues; and the crucial nature of the NDIS. Occupational therapists can be extremely important to families, including with supporting families to navigate the NDIS and advocating for them. Occupational therapists must stay current with their knowledge of the NDIS as they provide lifetime support, including prescribing equipment, technology, and home modifications. [ABSTRACT FROM AUTHOR]

Background: The higher rate of mental illness, including severe psychotic disorders, among people in prisons compared to the general community is well-established. However, there have been no reviews or attempts to pool data on the reported prevalence of mental illness across prisons in Australia and New Zealand. Methods: A systematic search of electronic databases from 1966 to the end of 2020 was conducted to identify studies reporting rates of 'any' mental illness, and separately rates of psychotic illness, among adult men and women in Australian and New Zealand prisons. A meta-analysis was performed according to PRISMA guidelines (PROSPERO ID: CRD42021241946), with separate analyses conducted for lifetime and current prevalence rates. Results: Seventeen studies, with a total of 10,209 people in prison, met inclusion criteria. The pooled lifetime prevalence of 'any' mental illness was 69.0% (95% confidence interval = [0.56, 0.79]), and the pooled lifetime prevalence for psychosis was 9.1% (95% confidence interval = [0.07, 0.12]). Meanwhile, the pooled prevalence for 'any' current mental illness was 54.0% (95% confidence interval = [0.39, 0.68]) and for any current psychosis was 6.4% (95% confidence interval = [0.04, 0.10]). There was substantial heterogeneity between studies, with evidence that lifetime rates of psychosis have increased over time, with true prevalence estimates in 95% of all comparable populations falling between 2.7% and 26.4%. Conclusion: The prevalence of mental illness, including severe psychotic illness, is high in Australian and New Zealand prisons. Furthermore, there is evidence that the prevalence of psychosis may be increasing over time, indicating more effort is needed to ensure diversion of people with mental illness away from the criminal justice system and into healthcare pathways. [ABSTRACT FROM AUTHOR]

Exposure to traumatic and/or violent events is an inherent part of the first responder role, which increases the risk of developing acute and chronic mental health symptoms and conditions. Suicidality for Australian first responders have recently increased with prevalence considered much higher compared with the general population. To inform specific recommendations for Australian first responders, there is a need to establish what evidence is available regarding these issues within the Australian context. The aim of this scoping review was to explore the impacts of trauma on the mental health of Australian first responders, the strategies recommended to address these issues and any unique needs in rural contexts. A scoping review was undertaken following PRISMA guidelines for scoping reviews. Peer‐reviewed articles on Australian first responder mental health from seven databases were screened for inclusion. This review highlights that despite available evidence on the types of traumas and adverse mental health outcomes experienced, less evidence exists pertaining to intervention effectiveness. There are major gaps in evidence within rural and remote contexts which hinders effective planning and delivery of support for rural and regional first responders. Clinicians such as mental health nurses, particularly in rural areas, need to be aware of these gaps which impact planning and delivery of support and are in prime position to ensure screening, interventions and strategies are used and evaluated to determine their suitability for rural first responders. [ABSTRACT FROM AUTHOR]

Frequent presentations to emergency departments contribute to increased service demands and healthcare costs. Literature suggests these adult presentations may be influenced by childhood adversity. This qualitatively driven, mixed methods study explored the self‐perceived role of childhood adversity in the health of adults who frequently attended Australian Emergency Departments and their perceptions of the healthcare they received. Data were collected using validated instruments and semi‐structured interviews with 12 purposefully sampled adults who frequently attended emergency departments. Qualitative data were analysed using interpretive phenomenological analysis. Three major themes were identified—The experience of childhood adversity: articulating challenges related to childhood trauma, and the subsequent impacts on participants' health, behaviours, relationships and sense of control; Pursuing safety: exploring action participants took to keep themselves and others safe, with this requirement extending into adulthood and influencing Emergency Department presentations; and Seeking humanising healthcare: identifying challenges participants experienced while seeking care in the Emergency Department. Participants perceived their mental health to be profoundly affected by their past experiences of trauma, leaving them feeling vulnerable at times and more likely to experience re‐traumatisation in the Emergency Department. Feelings of stigmatisation during Emergency Department encounters led participants to employ self‐protection strategies creating further barriers to recovery. Participants described Emergency Departments as often failing to comprehensively address their healthcare needs. They offered suggestions for more effective care interventions. Findings highlight the need for further research to inform policy and practice when designing and implementing interventions for these adults. Consolidated Criteria for Reporting Qualitative Research (COREQ) guided study reporting. [ABSTRACT FROM AUTHOR]

Objectives: The demand for ED services, both in terms of patient numbers and complexity has risen over the past decades. According to reports, there has been an increase in the ED patient presentation rate from 330 per 1000 to 334 per 1000 between 2018–2019 and 2022–2023. Consequently, new care models have been introduced to address this surge in demand, mitigate associated risks and improve overall safety. Among these models is the concept of 'front loading' clinical care, involving the initiation of interventions at the point of arrival. The present study evaluates the impact of introducing phlebotomists at triage. Methods: We conducted a cross‐sectional survey using purposive sampling at a single quaternary metropolitan ED with an annual census of greater than 90 000, encompassing all clinical staff in the ED. The survey data were analysed quantitatively and complemented by a thematic analysis. Results: The response rate for the questionnaire was 61% (n = 207), with good representation from all ED craft groups. Nearly all the staff (99.5%) reported being aware of the presence of phlebotomists in the ED, whereas only 57% of the staff reported working in triage (P = 0.05, 0.00 to 0.04). 'Valuable/vital resource' featured as a common response. Early decision‐making, patient safety, staff and patient satisfaction emerged as consistent themes. Conclusions: Staff expressed satisfaction that patient care now begins in the waiting room, especially after extended waiting periods prior to cubicle allocation. They assert that this improvement significantly enhances timely treatment and disposition decisions, as well as overall patient satisfaction. [ABSTRACT FROM AUTHOR]

This collaborative study by The Australasian College of Paramedicine's Clinical Practice Guidelines (CPG) Working Group aimed to examine CPG development practices in Australian and New Zealand ambulance services. Employing a qualitative descriptive design, the research utilised thematic analysis to extract insights from interviews with eleven experts actively involved in CPG development. The study embraced a nominalist and constructivist approach, recognising the intricate connection between individual experiences and the realities of CPG development in the paramedic field. Key findings revealed significant heterogeneity in CPG development practices, emphasising a lack of formal training and a substantial reliance on existing guidelines. The study highlighted challenges in project management flexibility, limited research capacity, and inconsistencies in external consultations and resource utilisation. The study recommends adopting project management frameworks, investing in training, and utilising evidence evaluation methodologies like GRADE. It emphasises the need for multidisciplinary teams and formal expertise in evidence synthesis, advocating for targeted training programs. Funding challenges highlight the importance of dedicated budgets and collaborative efforts for resource allocation. Knowledge translation and implementation issues underscore the significance of training programs for evidence evaluation and knowledge translation in overcoming these challenges. [ABSTRACT FROM AUTHOR]

The 'Sit-Stand e-Guide' e-training program, designed to promote appropriate use of sit-stand workstations (SSWs), was evaluated for usability, acceptability and impact on various outcomes among SSW users. Participants from a large municipal organisation (25% male; mean age 45 [SD = 10.6] years) completed questionnaires pre-training (T0, n = 57), immediately post-training (T1, n = 50), and four weeks (T2, n = 46: primary endpoint) and twelve months later (T3, n = 30). High usability, acceptability and usefulness scores were reported at T1. Median [IQR] knowledge (4.4/5 [0.9]) and confidence (4.6/5 [1.0]) significantly increased at T1 compared to baseline (2.8 [1.2]; 3.3 [1.4]) and maintained at T2 and T3. At T2, mean [SD] sitting time (5.3 [1.2] h/workday) and low back discomfort (2.4 [2.3]) significantly decreased compared to baseline (6.1 [1.3] h; 3.4 [2.5] discomfort), SSW usage increased (1.4 [1.4]–2.8 [1.7] transitions), with no significant changes in work performance. Some behavioural changes were sustained at T3. The Sit-Stand e-Guide was acceptable and effective; evaluation across diverse workplaces and workers is now needed. PRACTITIONER SUMMARY: This study evaluated a novel, evidence-based e-training program to support the appropriate use of sit-stand workstations. The Sit-Stand e-Guide showed high usability, acceptability and effectiveness in enhancing workers' knowledge and awareness of sedentary behaviour and the use of their sit-stand workstation. It also improved sit/stand behaviour and low back discomfort. However, for long-term benefits, yearly refresher training is recommended. [ABSTRACT FROM AUTHOR]

ObjectivesMethodResultsDiscussionAccording to the World Health Organisation (WHO), more than one in four young people globally experience a mental health issue each year. Alongside traditional care undertaken by hospitals, the justice system, and community care, schools also provide care for students with mental health issues. As a result of increased numbers of students presenting in school with undiagnosed disorders and behavioural and learning problems, schoolteachers have been asking for more mental health training. We sought to explore teachers’ needs for a mental health teacher-training curriculum to support students with mental health issues.A qualitative method was used consisting of 18 in-depth interviews with currently serving teachers from Catholic, Independent and Public schools in Australia. Data were analysed using thematic content analysis.Data revealed that the immediate requirement for training is knowledge of mental health. However, we found this to be insufficient to support teachers and found instead that a multidimensional model was needed comprising of training in the following areas: mental health management skills; training to deliver mental health programs in class; working with and partnering with external agencies, including roles and referral protocolsls; as well as caring teachers own mental health.We developed a multidimensional model for teacher training and for other school staff to meet the increasing demand on schools to manage students’ mental health issues in their classrooms. [ABSTRACT FROM AUTHOR]

Background: Medical and mental health conditions have a reciprocal relationship, with each impacting the other. Consultation–liaison psychiatry (CLP) is a sub-speciality that addresses psychiatric comorbidities in the general hospital system and positively impacts hospital resources through its service aspects of 'consultation' and 'liaison'. This multi-faceted evaluation aims to describe and evaluate the characteristics of a regional CLP service. Methods: Retrospective evaluation of all referrals accepted by CLP between May 2021 and 2022 were reviewed through the hospital's electronic records. An evaluation tool was designed to assess multiple aspects of care, including the source of referrals, the reasons for referral, patient demographics, how quickly the patient was seen, information on their mental health, and the details and timeframe of CLP involvement. Findings: There were 147 patients included in this study. Doctors were the primary referrers (92%). A total of 94% of patients were reviewed within 24 h of the referral being received. Referral reasons were balanced across diagnostic clarification/review, medication review, and risk review. A large proportion of referrals were aged > 60 years. There was a large proportion of patients who lived rurally, requiring hospital transfer. CLP involvement was primarily required to provide a diagnosis (91% of patients) and provide pharmacological management advice (88%). Conclusions: The CLP service currently operates with limited resources, and without additional support, the sustainability of the service will become increasingly challenged due to population ageing. It is essential that we address this issue to ensure that the community's needs are met effectively. [ABSTRACT FROM AUTHOR]

Introduction: Non-attendance (NA) causes additional burden on the outpatient services due to clinician time and other resources being wasted, and it lengthens wait lists for patients. Telehealth, the delivery of health services remotely using digital technologies, is one promising approach to accommodate patient needs while offering more flexibility in outpatient services. However, there is limited evidence about whether offering telehealth consults as an option can change NA rates, or about the preferences of hospital outpatients for telehealth compared to in-person consults. We model patient preferences with a Maximum Entropy Inverse Reinforcement Learning (IRL) behaviour model, allowing for the calculation of general population- and demographic-specific relative preferences for consult modality. The aim of this research is to use real-world data to model patient preferences for consult modality using Maximum Entropy IRL behaviour model. Methods: Retrospective data were collected from an immunology outpatient clinic associated with a large metropolitan hospital in Brisbane, Australia. We used IRL with the Maximum Entropy behaviour model to learn outpatient preferences for appointment modality (telehealth or in-person) and to derive demographic predictors of attendance or NA. IRL models patients as decision making agents interacting sequentially over multiple time-steps, allowing for present actions to impact future outcomes, unlike previous models applied in this domain. Results: We found statistically significant (α = 0.05) within-group preferences for telehealth consult modality in privately paying patients, patients who both identify as First Nations individuals and those who do not, patients aged 50–60, who did not require an interpreter, for the general population, and for the female population. We also found significant within-group preferences for in-person consult modality for patients who require an interpreter and for patients younger than 30. Discussion: Using the Maximum Entropy IRL sequential behaviour model, our results agree with previous evidence that non-attendance can be reduced when telehealth is offered in outpatient clinics. Our results complement previous studies using non-sequential modelling methodologies. Our preference and NA prediction results may be useful to outpatient clinic administrators to tailor services to specific patient groups, such as scheduling text message consult reminders if a given patient is predicted to be more likely to NA. [ABSTRACT FROM AUTHOR]

Introduction: There is a need within counselling and psychotherapy to ensure their ability to respond to endemic presences such as the COVID-19 pandemic, by utilising rapid technological advances without compromising effectiveness. To do so, existing research about online group therapy must be built upon to provide a comprehensive understanding of the efficacious delivery of this therapy modality. Thus, a systematic review was conducted to collate what is currently known in the published and grey literature on online group therapy, using the PRISMA framework. Thirty-three articles were identified as including information regarding facilitating group therapy online. After appraising each article using appropriate quality appraisal tools, a thematic analysis was conducted on the papers, arriving at seven main themes summarising the main findings regarding online versus in-person groups, group planning, counselling micro skills, group processes, ethics, technology, and unique online therapy issues. There is a growing but incomplete body of knowledge that informs the group therapist regarding the ethical delivery of groups online. A more comprehensive review can enable group therapists to feel confident they are across best practice guidelines. Limitations and research implications are considered. [ABSTRACT FROM AUTHOR]

Language is important in health policy development. Policy changes in Australia to increase cervical screening offers a timely case example to explore the function of inclusive language in health policy. Gender and sexuality diverse people with a cervix have been largely invisible within health promotion programs, which has led to reduced awareness of, and access to, cervical screening. Twenty-eight semi-structured interviews were conducted with 29 key informants between April and October 2022 about the role of inclusive language in cervical screening policy, promotion, and delivery in the context of a national program to promote cervical screening. Three themes were identified from what key informants believed to be the role of inclusive language: (1) the common goal of inclusive language as policy advocacy for broader inclusivity; (2) the inevitable partiality of inclusive language in policy as an opportunity to start conversation; and (3) policy as a bridge between essential but diffuse components of the health sector with multidirectional influences. Inclusive language was seen to operationalise equity in health policy within the broader aim of eliminating cervical cancer among under-screened populations. [ABSTRACT FROM AUTHOR]

We investigated whether injecting drug use was a risk factor for methicillin resistance among inpatients with Staphylococcus aureus bloodstream infections (SABSIs) at an Australian health service. In 273 inpatients, 46 (16.9%) of SABSIs were methicillin‐resistant S. aureus (MRSA). MRSA was more frequent in those who had injected drugs in the past 6 months (20.6%) compared with other inpatients (15.7%). Injecting drug use was associated with a 4.82‐fold (95% confidence interval = 1.54–16.29) increased odds of MRSA after accounting for confounders. [ABSTRACT FROM AUTHOR]

COP‐28, the United Nations' Climate Change Conference, hosted by the United Arab Emirates, ended on 12 December 2023. At the convention, Australia released its National Health and Climate Strategy, committing to low‐carbon, climate‐responsive care. The Strategy will need new policies, projects and investments and a fit‐for‐purpose health workforce. This is a tall order considering healthcare's challenges. Everyone has a role, including clinicians, healthcare agencies, policymakers, politicians, patients and the providers and manufacturers in the supply chain. Clinicians' groups, policymakers and federal and state departments of health have an opportunity to lead climate change reform by considering climate change impacts across clinical practice and health policy. [ABSTRACT FROM AUTHOR]

Objective: The impact of eating disorders in adolescents extends to the whole family, particularly the parents. These parents are uniquely positioned as their children's case manager, feeder, and advocator, often with little experience or training to guide them. This investigation aimed to develop an in-depth understanding of the experience of parents seeking help for children with eating disorders. Method: Semi-structured interviews were conducted with eight parents who had accessed treatment for their child's eating disorder within the past 3 years through the Australian health system. Interpretative phenomenological analysis was used to understand their experience. Results: Two main themes and six subthemes were identified: Parental Gauge on High ("trusting parental instincts", "desperation for a compass and map" and "discarded expertise"), and Disappointment in the Healthcare System ("GP's casual responses to serious cases", "treatment lucky dip" and "the whirlwind of re-engagement"). Conclusions: The findings highlight the difficulties in identifying symptoms and seeking initial help as well as the ongoing toll on parents to navigate the health system and support their children. Findings of the study suggest a need for ongoing, inclusive, and holistic support to help parents navigate care for their children. KeyPoints: What is already known about this topic: Early intervention for eating disorders improves prognosis, however there is often a delay in seeking treatment. In adolescents, this delay is often due to parents not recognising symptoms or not understanding the seriousness of disordered eating behaviour. Parents play a key role in recognising symptoms, seeking help, and providing ongoing support. What this topic adds: Parents felt that health professionals locked them out of their children's treatment and dismissed their input. Limited (or no) training on how to feed their children made mealtimes traumatic for parents and children, further worsening distress and limiting their children's intake. Parents felt dissatisfaction with healthcare in Australia, particularly about GP's dismissal of symptoms and difficulty navigating the public system. [ABSTRACT FROM AUTHOR]

The prevalence of dementia is increasing globally, with an estimated 139 million people expected to be living with dementia by 2050. Across numerous countries, substandard care for people with dementia is evident, with quality improvement needed. Recently, a focus on patient-reported experience measures (PREMs) has been utilised in healthcare services as a method of evaluating the care experiences provided and determining areas of improvement. The literature is scarce regarding the feasibility and acceptability of implementing PREMs with people with moderate to advanced dementia. This scoping review aimed to identify PREMs that have been used with vulnerable populations including people with cognitive impairment, mental health concerns, and children, outline dimensions included, and determine adaptions made to the PREMs to improve acceptability of the instruments for vulnerable populations. A database search of Medline was conducted to identify 36 studies including 32 PREMs. The PREMs identified covered a range of dimensions, most frequently care effectiveness, care environment, and patient involvement. The most common adaption to the PREMs was simplification of wording and sentence structure. Several measures conflated patient outcomes and patient satisfaction with patient experience, limiting utility for improving patient experience specifically. While several PREMs have been used with people with dementia, challenges in their implementation and their applicability to specific settings limit their use more broadly. Evidently, there is a need for development of a PREM for people with moderate to advanced dementia that is applicable across healthcare settings and is appropriately adapted for varying cognitive and communicative barriers. [ABSTRACT FROM AUTHOR]

Background Internationally, person-centred care (PCC) is embedded in the language of regulations and mandated to be practised in residential aged care (RAC). Despite this, PCC has not been fully adopted in RAC in Australia and internationally, and concerns about the quality of care persist. Over the past 2 decades, Montessori for dementia and ageing has been introduced in RAC to support and inform a cultural change towards PCC. This study aimed to examine the intersection between the goals and approaches of Montessori and PCC in RAC. Methods This qualitative descriptive study reports on a secondary analysis of qualitative data from focus groups (FGs) and interviews with residents, family-members, staff, and volunteers from eight RAC homes in Victoria, Australia. Sixteen FGs and 36 interviews were conducted. A qualitative deductive approach using researcher-developed Montessori for dementia and ageing framework for data analysis was applied. Results Findings provide support for the intersection between PCC and Montessori with participants' descriptions of PCC aligning with many of the goals and approaches of Montessori. Participants most commonly described Montessori approaches of engagement in daily tasks with purposeful roles and promoting cognitive abilities through multi-sensory stimulation. Least frequently-described approaches included focusing on residents' strengths/abilities, maintaining function, using familiar objects, and guided repetition. Conclusions Findings have important implications for practice to use Montessori as a vehicle that supports and upskills the workforce to deliver care that is person-centred. Future research must examine the resources required to support the implementation and sustainability of Montessori as a vehicle for PCC. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to identify and explore the unmet needs of adolescents and young adults living with endometriosis. Design: An open‐ended online survey was conducted, with questions derived from prior research looking at areas of unmet need in healthcare, career and work, financial, information, psychological, social and cultural domains. Setting and Population: Self‐selecting 18‐25 year olds with surgically diagnosed endometriosis (self‐reported) currently living in Australia were included as participants. Methods: Invitation to participate in an open‐ended online survey was shared through the social media of Australian endometriosis organisations and the Royal Women's Hospital, Melbourne. Surveys were analysed qualitatively through template analysis. Main Outcome Measures: Recording of the unmet supportive care needs of this population was carried out. Results: One hundred and thirty‐one respondents fit the eligibility criteria of being aged 18–25 years (median age 23 years). Most were born in Australia (94%), university‐educated (54%) and lived in a metropolitan setting (69%). There was a range of unmet needs that were presented across education, work, healthcare and relationships. Group‐specific challenges were identified: doctors either over‐ or underemphasising future fertility; disrupted sexual and romantic life due to painful sex; managing pain in the classroom and workplace where periods are taboo; and being gender‐queer in gynaecological medical spaces. Conclusions: The increasingly young age at which patients are receiving an endometriosis diagnosis precipitates a shift in patient care. The treatment decisions that are being made must be reflective of the unique needs of the adolescents who carry the burden of the disease. Clinicians are advised to be aware of and discuss needs with their patients. Patient or Public Contribution: The nine open‐ended questions in this survey were developed from data from a preliminary series of interviews with endometriosis patients in a tertiary women's healthcare centre. In asking these data‐informed questions to the online endometriosis community, patients across broader sociocultural demographics and disease states (including less symptomatic endometriosis) have provided a broader understanding of their supportive care needs. [ABSTRACT FROM AUTHOR]

Background The availability of multidisciplinary care for the management of chronic pain is uncommon outside specialist clinics. The present study aims to determine the physical intervention use of patients participating in an online psychological pain management program and whether exposure to physical interventions in these patients alters treatment outcomes compared with patients who do not access physical interventions. Methods Data were obtained from 2 previously published randomized controlled trials of an online psychological pain management program. Physical intervention exposure (categories: none, 1–3 sessions, 4+ sessions) was assessed at baseline, after treatment, and at 3-month follow-up. Primary outcomes included depression, anxiety, pain intensity, and pain-related disability. Generalized estimating equation models were used to compare treatment outcomes among those with different physical intervention frequencies and periods of exposure. We assessed whether changes in primary outcomes differed (moderated) by the period and category of physical intervention exposure. Results Of the patients (n  = 1074) who completed the baseline questionnaire across both randomized controlled trials, 470 (44%) reported physical intervention use at baseline, 383 (38%) reported physical intervention use after treatment, and 363 (42%) reported physical intervention use at 3-month follow-up. On average, there were moderate–large reductions from baseline to after treatment with respect to all outcomes (Cohen's d  = 0.36–0.82). For all outcomes, the interaction of time by physical intervention exposure was statistically nonsignificant. Conclusion A substantial proportion of patients who participated in a psychologically informed pain management program were establishing, continuing, or stopping additional physical interventions. The frequency of and period of exposure to physical interventions did not appear to moderate treatment outcomes. Clinical trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12613000252718 and ACTRN12615001003561). The website for registration information is https://www.anzctr.org.au [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to develop the Remote Health Value Framework to evaluate the models of healthcare provision for workers in the oil and gas sector, predominantly situated in rural and remote areas. Methods: The framework was co-designed with the leadership team in one global oil and gas company using a multi-criteria decision analysis approach with a conjoint analysis component. This was used to elicit and understand preferences and trade-offs among different value domains that were important to the stakeholders with respect to the provision of healthcare for its workers. Preference elicitation and interviews were conducted with a mix of health, safety, and environment (HSE) team and non-HSE managers and leaders. Results: Out of five presented value domains, participants considered the attribute 'Improving health outcomes of employees' the most important aspect for the model of healthcare which accounted for 37.3% of the total utility score. Alternatively, the 'Program cost' attribute was least important to the participants, accounting for only 11.0% of the total utility score. The marginal willingness-to-pay analysis found that participants would be willing to pay A$9090 per utile for an improvement in a particular value attribute. Conclusions: This is the first value framework for healthcare delivery in the oil and gas industry, contextualised by its delivery within rural and remote locations. It provides a systematic and transparent method for creating value-based healthcare models. This approach facilitates the evaluation of healthcare investments, ensuring they align with value domains prioritised by the HSE and leadership teams. What is known about the topic? It has been challenging for oil and gas companies to deliver and evaluate value-based healthcare services to improve workers' wellbeing, supplementing essential emergency services and occupational health. What does this paper add? The Remote Health Value Framework (RHVF), developed and tested in this work, offers a blueprint for designing and evaluating models of care considering the companies' and workers' priorities. What are the implications for practitioners? The RHVF's application has the potential to improve industry standards, enabling a data-driven approach to healthcare investments that closely align with both corporate objectives and employee wellbeing. [ABSTRACT FROM AUTHOR]

The article discusses the updated Osteoarthritis of the Knee Clinical Care Standard aimed at enhancing care for Australians suffering from knee osteoarthritis.

The aim of this article is to identify challenges for advanced practitioners within the district nursing services in remote and rural areas and the impact of the new Scottish GP contract. Advanced nurse practitioners (ANPs) working within the community providing care in patients' homes have a wide skill base to draw upon. However, community care is often not reviewed or studied to identify the impact it makes to patients and the wider community. This article looks at a review of the qualitative research provided by a search on CINAHL, Medline, PsychINFO and Google scholar between 2019 to 2023. Studies needed to be about advanced practice in remote and rural areas with a focus on district or community nursing. A separate search was conducted for reviews on the new Scottish GP contract and the impact on services this has had, using the same search engines and between the same dates. Articles that were based on ANPs working in GP practices were excluded. [ABSTRACT FROM AUTHOR]

Introduction: People living with young-onset dementia and their care-partners are at risk of a range of adverse mental health outcomes and social isolation. There are few interventions aimed at supporting couples affected by young-onset dementia, which poses unique psychosocial challenges for younger people. Methodology: This pre-post interventional mixed methods pilot study aimed to assess the feasibility and acceptability of an online group program for people with young-onset dementia and their care-partners living at home in Australia. The Music And Psychology and Social connections (MAPS) program aimed to address: (1) the challenges and changes associated with young-onset dementia; and (2) coping and wellbeing. The program involved six weekly two-hour sessions co-facilitated by a psychologist and music therapist, and a private Facebook group. The primary outcomes of feasibility and acceptability were assessed through a post-program focus group, separate individual feedback sessions with each couple, and a program evaluation questionnaire. Thematic analysis was conducted on the focus group transcripts and field notes from couple feedback sessions. We also examined the preliminary utility of MAPS in improving mental health and social connectedness, using quantitative pre-post-measures. Results: Five couples completed the MAPS program. The most common dementia type was Alzheimer's Disease. Participant attendance was 87% across all sessions. Qualitative findings supported acceptability of the program with four emergent themes: being connected to others with shared experiences; reframing thoughts and feelings about dementia; music as a therapeutic tool; and benefits of MAPS. Conclusion: The high retention rate, qualitative findings and positive program evaluation suggest MAPS may be a promising, feasible and acceptable program for couples affected by young-onset dementia. [ABSTRACT FROM AUTHOR]

Purpose: Treatment for oral cancer has debilitating effects on speech and swallowing, however, little is known about current speech-language pathology practice. Method: An online survey of speech-language pathologists (SLPs) was disseminated via emails to speech pathology departments, social media platforms, and professional online forums. Survey questions captured demographics, service delivery, type and timing of speech and swallowing interventions, and influences and barriers to practice. Result: Forty-three SLPs working in Australia (n = 41) and New Zealand (n = 2) completed the survey. SLPs recommended speech and swallowing compensatory strategies significantly more frequently than active intervention. Swallowing outcomes measures were either instrumental (n = 31, 94%) or performance ratings (n = 25, 76%), whereas speech was measured informally with judgements of intelligibility (n = 30, 91%). SLPs used a range of supports for their decision making, particularly expert opinion (n = 81, 38.2%). They reported time and staffing limitations (n = 55, 55%) and a lack of relevant evidence (n = 35, 35%) as the largest barriers to evidence-based service delivery. Conclusion: There is variability amongst SLPs in Australia and New Zealand regarding rehabilitation of speech and swallowing for people with oral cancer. This study highlights the need for evidence-based guidelines outlining best practice for screening processes, active rehabilitation protocols, and valid outcome measures with this population. [ABSTRACT FROM AUTHOR]

Purpose: There is limited research on speech-language pathology (SLP) weekend service provision across Australian healthcare services. Therefore, this study aimed to examine weekend SLP services in Australian healthcare services and explore SLP manager perspectives regarding the provision of these services. Method: A mixedmethods, cross-sectional survey design was employed. SLP managers (or their facility representatives) from Australian healthcare services completed the survey. Quantitative data were analysed using descriptive statistics and qualitative data using qualitative content analysis. Result: Data from 67 participants were analysed. More than half of the participants' facilities (n = 39, 58.2%) provided a weekend speech pathology service. Most of these facilities were publicly funded (n = 62, 92.5%) and located in metropolitan areas (n = 41, 61.2%). Nearly two-thirds of facilities employed a dedicated speech-language pathologist for weekend service provision (n = 25/38, 65.8%). Service eligibility criteria were highly variable across sites. More than half (n = 37, 52.2%) of participants predicted a future need for increased weekend SLP services to service subacute wards and to enable access to senior clinicians. Conclusion: There is variability in weekend SLP service provision, eligibility criteria, and staffing profiles in healthcare facilities around Australia. Further research is required to understand how to inform optimal service delivery models for equitable client care and determine the value of weekend SLP services. [ABSTRACT FROM AUTHOR]

Purpose: There are inadequate resources available to support lesbian, gay, bi + , trans and gender diverse, intersex and queer (LGBTIQ) people experiencing family violence in Australia. Government funding agencies and mainstream family violence service providers regularly state that there is insufficient evidence to justify investment in more inclusive services. This article explores practitioner perceptions of such claims. Method: 21 practitioners from mainstream and specialist LGBTIQ family violence services were interviewed about structural challenges associated with implementing LGBTIQ-inclusive family violence services. Participants' accounts highlight the political tensions and material repercussions of epistemic definitions of 'evidence' as they pertain to LGBTIQ individuals' experiences of violence within policy environments. Utilizing Carol Bacchi's feminist policy analysis framework, we ask 'what is the problem represented to be?', examining participant perceptions about how evidence is currently positioned in policy and resourcing decisions pertaining to LGBTIQ family violence, and discuss its implications. Results: Participants overwhelmingly called for more investment in research and data gathering about family violence against LGBTIQ people and provision of effective supports. Even allowing for this, participants indicated that there is also already enough existing knowledge to justify urgent expansion of LGBTIQ-inclusive services. Conclusions: Expanded provision of services and generating a more robust evidence base about LGBTIQ family violence service needs are critically important and intertwined issues. However, the way that they are currently sequenced in policy and broader sector conversations, where 'enough' evidence is required in order to justify increased services, is inhibiting progress on both. [ABSTRACT FROM AUTHOR]

Background: Opioid-related harms and opioid use disorder (OUD) are health priorities requiring urgent policy responses. There have been many calls for improved OUD care in primary care, as well as increasing involvement of primary care providers in countries like Canada and Australia, which have been experiencing high rates of opioid-related harms. Methods: Using Starfield's 4Cs conceptualization of primary care functions, we examined how and why primary care systems may be suited towards, or pose challenges to providing OUD care, and identified health system opportunities to address these challenges. We conducted 14 semi-structured interviews with 16 key informants with experience in opioid use policy in Canada and Australia. Results: Primary care was identified to be an ideal setting for OUD care delivery due to its potential as the first point of contact in the health system; the opportunity to offer other health services to people with OUD; and the ability to coordinate care with other health providers (e.g. specialists, social workers) and thus also provide care continuity. However, challenges include a lack of resources and support for chronic disease management more broadly in primary care, and the prevailing model of OUD treatment, where addictions care is not seen as part of comprehensive primary care. Additionally, the highly regulated OUD policy landscape is also a barrier, manifesting as a 'regulatory cascade' in which restrictive oversight of OUD treatment passes from regulators to health providers to patients, normalizing the overly restrictive nature and inaccessibility of OUD care. Conclusions: While primary care is an essential arena for providing OUD care, existing sociocultural, political, health professional, and health system factors have led to the current model of care that limits primary care involvement. Addressing this may involve structurally embedding OUD care into primary care and strengthening primary care in general. [ABSTRACT FROM AUTHOR]

Background: A wide variation of emergency medical system configurations across countries has limited the value of comparison of quality and performance measures in the past. Furthermore, lack of quantitative data on EDs prevents definition of the problems and possibilities for data driven improvement of quality of care. Therefore, the objective is to describe and compare Emergency Department (ED) populations and characteristics, and their outcomes in the Netherlands, Denmark and Australia, using a recently developed template for uniform reporting of standardized measuring and describing of care provided in the ED (structure, staffing and governance, population, process times and outcomes). Methods: This international multicenter cohort included all consecutive ED visits from National Quality Registries or Databases from participating sites from three countries. Patient and ED characteristics (using the template for uniform reporting) and relevant clinical outcomes were described and compared per country. Results: We included 212,515 ED visits in the Netherlands, 408,673 in Denmark and 556,652 in Australia. Patient characteristics differed markedly, with Australian ED patients being younger, less often triaged as "immediate", and less often triaged with the high-risk chief complaints "feeling unwell" compared to Danish and Dutch patients. ED characteristics mainly differed with respect to the mean annual census per ED (Netherlands 26,738 (SD 2630), Denmark 36,675 (SD 12974), Australia 50,712 (4884)), median (IQR) lengths of stay of patients discharged home (Netherlands 2.1 (1.4–3.1); Denmark 2.8 (1.7–5.0); Australia 3.3 (2.0–5.0) hrs) and proportion of hospitalizations (ranging from 30.6 to 39.8%). In-hospital mortality was 4.0% in Australia, higher compared to the Netherlands and Denmark (both 1.6%). Not all indicators of the framework were available in all registries. Conclusions: Patient and ED characteristics and outcomes varied largely across countries. Meaningful interpretation of outcome differences across countries could be improved if quality registries would more consistently register the measures of the recently developed template for uniform reporting. [ABSTRACT FROM AUTHOR]

Introduction/Objective: The objective of the study was to develop an understanding of the perceptions of people with Parkinson's disease and clinical academics on the implementation of a regional interdisciplinary model of care. Methods: A qualitative descriptive study was undertaken. A PD interdisciplinary clinic was conducted in an Australian regional location. As a novel variation, in this clinic, 4 clinical academics consulted simultaneously offering a long, 3-h appointment. Following the clinic, we conducted 2 focus groups with all clinical academics and 6 semi-structured interviews with people with PD and carers. Data were analyzed using Elo & Kyngäs' inductive content analysis approach. Results: An overarching main category namely, "interdisciplinary care proved valuable to regional people with PD and clinical academics," and 3 generic-categories including "identifying interdisciplinary care as a viable option in regional locations," "current care provision is disempowering and burdensome," and "regional residing people with PD and their carers seek locally accessible healthcare with PD skilled clinicians" were identified. Conclusion: Our findings suggest the implementation of interdisciplinary care to regional healthcare systems is valued by clinical academics and people with PD and carers. Further research is required to establish how interdisciplinary care can be implemented in regional Australia and its effects on practice changes, patient outcomes, and quality of life. [ABSTRACT FROM AUTHOR]

Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40–65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups. Plain language summary: Sexual health and sexual wellbeing services for midlife women in high income countries Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives. Access to Sexual Health and Sexual Wellbeing (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective of this systematic review was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high income countries. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their HealthCare Professionals (HCPs), and the over-arching effect of stigma, social connections, and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities, and financial incentives for under-served groups to access services. The appetite for education about SHSW and SHSW services among midlife women and their HCPs should be capitalised upon, and utilised to improve research, public health messaging, interventions and access to holistic services, particularly for midlife women from under-served groups. [ABSTRACT FROM AUTHOR]

Background: Explanations provided by healthcare professionals contribute to patient beliefs. Little is known about how healthcare professionals explain chronic breathlessness to people living with this adverse sensation. Methods: A purpose-designed survey disseminated via newsletters of Australian professional associations (physiotherapy, respiratory medicine, palliative care). Respondents provided free-text responses for their usual explanation and concepts important to include, avoid, or perceived as difficult to understand by recipients. Content analysis coded free text into mutually exclusive categories with the proportion of respondents in each category reported. Results: Respondents (n = 61) were predominantly clinicians (93%) who frequently (80% daily/weekly) conversed with patients about breathlessness. Frequent phrases included within usual explanations reflected breathlessness resulting from medical conditions (70% of respondents) and physiological mechanisms (44%) with foci ranging from multifactorial to single-mechanism origins. Management principles were important to include and phrases encouraging maladaptive beliefs were important to avoid. The most frequent difficult concept identified concerned inconsistent relationships between oxygenation and breathlessness. Where explanations included the term 'oxygen', a form of cognitive shortcut (heuristic) may contribute to erroneous beliefs. Conclusions: This study presents examples of health professional explanations for chronic breathlessness as a starting point for considering whether and how explanations could contribute to adaptive or maladaptive breathlessness beliefs of recipients. [ABSTRACT FROM AUTHOR]

Background: A dramatic decline in mental health of people worldwide in the early COVID-19 pandemic years has not recovered. In rural and remote Australia, access to appropriate and timely mental health services has been identified as a major barrier to people seeking help for mental ill-health. From 2020 to 2021 a care navigation model, Navicare, was co-designed with rural and remote communities in the Greater Whitsunday Region of Central Queensland in Australia. The Exploration, Preparation, Implementation and Sustainment (EPIS) framework was used to design and guide multiple aspects of a multisite study, The Bridging Study, to evaluate the implementation of Navicare in Australia. Methods: A community-engaged hybrid effectiveness-implementation study design will focus on the tailored implementation of Navicare at three new sites as well as monitoring implementation at an existing site established since 2021. Study outcomes assessed will include sustained access as the co-primary outcome (measured using access to Navicare mental health referral services) and Proctor's Implementation Outcomes of feasibility, acceptability, appropriateness, adoption, fidelity, implementation cost, and sustainability. Data collection for the implementation evaluation will include service usage data, community consultations, interviews, and workshops; analysed using mixed methods and guided by EPIS and other implementation frameworks. Pre-post effectiveness and cost-consequence study components are embedded in the implementation and sustainment phases, with comparison to pre-implementation data and value assessed for each EPIS phase using hospital, service, and resource allocation data. A scaling up strategy will be co-developed using a national roundtable forum in the final year of the study. Qualitative exploration of other aspects of the study (e.g., mechanisms of action and stakeholder engagement) will be conducted. Discussion: Our study will use tailoring to local sites and a community-engaged approach to drive implementation of a mental health care navigation service in rural and remote Australia, with expected benefits to mental healthcare access. This approach is consistent with policy recommendations nationally and internationally as building blocks for rural health including the World Health Organization Framework for Action on Strengthening Health Systems to Improve Health Outcomes. Trial registration: Prospectively registered on April 2, 2024, on the Australian New Zealand Clinical Trials Registry, no. ACTRN12624000382572. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386665&isReview=true. [ABSTRACT FROM AUTHOR]

The need to grapple with hepatitis C‐related stigma and discrimination in Australian health‐care settings has been recognised in public policy, and work is underway to address it. But how likely are people to raise a complaint when they experience stigma or discrimination? And how effective and accessible are complaints mechanisms? Given complaint procedures are considered important parts of the delivery of safe and ethical health care, these are important questions that have yet to be substantially explored. Drawing on interviews with people with lived experience of hepatitis C (n = 30), this article considers how affected people feel about complaints processes and the act of complaining. Alongside these perspectives, we discuss complaint mechanisms, and the views of stakeholders who work with hepatitis C‐affected communities in policy, health, legal and advocacy roles (n = 30) on the institutional and cultural dynamics of complaint. We draw on Sara Ahmed's Complaint! and Fraser et al.'s work on drug‐related stigma to analyse these concerns that have yet to be researched, and argue that the (unlikely) prospect of successful complaint is a key part of the network of forces that perpetuate stigma, discrimination and disadvantage among people who have (lived with) hepatitis C. Although people with lived experience are often powerful advocates and acutely aware of the deficiencies in the quality of their treatment, our interviews suggest that the obstacles they face to accessing health care are seen as commonplace, intractable and insurmountable; and, that mechanisms for addressing them—where they exist at all—treat complaints in narrowly individualising terms and expose complainants to dismissal. Following Ahmed, we call for a 'troubling' of complaints—responding to them not as individual problems but rather as collective, structural concerns, necessitating new approaches. [ABSTRACT FROM AUTHOR]

Background: Growing global demand for palliative care services has prompted generalist clinicians to provide adjunct support to specialist teams. Paramedics are uniquely placed to respond to these patients in the community. However, embedding palliative care principles into their core business will require multifactorial interventions at structural, healthcare service and individual clinician and consumer levels. Aim: To develop a palliative paramedicine framework suitable for national implementation, to standardise best practice in Australia. Design: Delphi study utilising questionnaire completion; each round informed the need for, and content of, the next round. Free text comments were also sought in Round 1. Two rounds of Delphi were undertaken. Setting/participants: Sixty-eight participants took part in Round 1, representing six countries, and 66 in Round 2. Participants included paramedics, palliative care doctors and nurses, general practitioners, researchers and carers with lived experience and expertise in palliative paramedicine. Results: Seventeen of the original 24 components gained consensus; 6 components were modified; and 9 new components arose from Round 1. All modified and new components gained consensus in Round 2. Only one original component did not gain consensus across both rounds and was excluded from the final 32-component framework. Conclusion: This study has developed a comprehensive national framework addressing the macro-, meso- and micro-level interventions required to standardise palliative paramedicine across Australia. Future research ought to engage a multidisciplinary team to create an implementation strategy, addressing any perceived barriers, facilitators and challenges for applying the framework into policy and practice. [ABSTRACT FROM AUTHOR]

Young people in rural, regional, and remote communities experience high levels of mental distress. Health services in rural and remote communities are also poorer in quality. Hence, it is critical to understand how social work can help young people in these areas access mental health supports. This scoping review identifies what enables and hinders access to mental health services for young people in rural, regional, and remote areas of Australia and Canada. Twenty-two studies published between 2018 and 2022 were included and analyzed. Findings highlight the need for social workers to reduce peer-stigmatization of mental illness and foster community collaboration. [ABSTRACT FROM AUTHOR]

Introduction: Global workforce shortages in medical specialties strain healthcare systems, jeopardising patient outcomes. Enhancing recruitment strategies by supporting professional identity (PI) development may be one way to address this workforce gap—yet little research has explored this topic. The goal of the current study was to explore specialty‐specific recruitment through considering PI. As proposed causes of workforce shortages in anatomical pathology (AP) bear similarities to many other specialties, this study uses the field of AP as a model for specialist PI development and asks: (1)why, how and when do doctors choose to pursue AP trainingand (2) what can be learned from this for recruitment to AP and other specialties? Methods: A qualitative research approach was undertaken using narrative inquiry. Interviews with junior doctors interested in AP, AP registrars and AP consultants from Australia and New Zealand were interpreted as stories via 're‐storying'. Narrative synthesis of participants' collective stories identified chronological key events (i.e. 'turning points') in choosing AP. Results: Narrative synthesis resulted in identification of three portraits entering medical specialist training: (1) die‐hards, deciding upon initial exposure; (2) negotiators, choosing after comparing specialties; and (3) migrants, seeking to move away from non‐pathology specialties. The negotiators and migrants cemented their decision to pursue AP as a postgraduate doctor, whereas the die‐hards made this decision during medical school. Conclusions: Given the similarities in portrait traits between AP and other specialties across the literature, our results suggest ways to support specialty recruitment using PI development. We propose a medical specialist recruitment framework to support the PI development of doctors with die‐hard, negotiator and migrant traits. Use of this framework could enhance current specialty‐specific recruitment approaches, particularly in fields challenged by workforce shortages. Want to know more about doctors' decision‐making processes when choosing a specialty? Check out this article! [ABSTRACT FROM AUTHOR]

High rates of child removal from parents with learning disabilities persist despite substantial evidence that parents with learning disabilities can provide their children with satisfactory care given appropriate support. Child welfare interventions disproportionality based on disability status presents a compelling social issue deserving urgent attention. Co-operative inquiry was used to analyse attitudinal and structural barriers that perpetuate inequitable treatment of parents with learning disabilities and their children, drawing on policy and practice examples from Australia and the UK. Bacchi's 'What is the problem represented to be?' approach to social policy issues was used to answer the question: if we know what works to support parents with learning disabilities, why aren't we doing it? This commentary contends that the pervasive representation of parents with learning disabilities as inherently deficient in the requisite skills ('parenting capacity') needed for safe caregiving has been difficult to shift due to systematic ableism. Neoliberal policies stigmatise a need for support ('dependence') as an individual failing and recast assessments of long-term support needs as an unsustainable burden on support services/systems. We conclude that for outcomes to change for parents with learning disabilities and their children a social model of child protection that addresses attitudinal and structural barriers and is based on principles of interdependence, relationality, and ethics of care is required. [ABSTRACT FROM AUTHOR]

Objective: Australia has been undergoing a major aged care reform process since 2012 focused on consumer‐oriented home and community‐supported care, but little is known about the impact of these reforms on residential aged care delivery. This study aimed to review research about the quality of residential aged care service delivery during the implementation period of these reforms. Methods: The review followed a five‐stage scoping review framework and searched five databases for articles published between 2012 and February 2022 (the 10‐year implementation period of the reforms). Initial searches identified 495 articles. Articles were imported to Covidence™ for title, abstract and full‐text screening. Results: Twenty‐two articles were included in the review. Articles were framed using the micro (residents and families)/meso (staff)/macro (governance, government) continuum in the operation of residential aged care facilities. Most articles focused on workforce perspectives. Conclusions: Attention was paid to workforce issues and a limited focus was on consumer experience and expectations. There is a need for an evaluation of the reforms as a vehicle for promoting consumer empowerment. Many contributing factors to quality of care were identified, and there were some quality issues that were contrary to the intended objectives of the reforms. These warrant closer attention. [ABSTRACT FROM AUTHOR]

Objective: To assess Chinese‐Australian carers' needs and preferences through co‐design strategies with stakeholders to embed an evidence‐based iSupport for Dementia program into routine community aged care services in Chinese ethno‐specific aged care organisations. Methods: A cross‐sectional survey was conducted from July to August 2022 in three Chinese ethno‐specific aged care organisations in Australia. We applied a univariate analysis to test variables associated with carers' needs and preferences when embedding the iSupport for Dementia program into routine practice among community aged care services. Results: A total of 101 carers completed the survey. Most carers in our study preferred the iSupport program to be provided in their first language, have a program facilitator to lead the program and would like to interact with peers in the program. Most carers indicated that they are willing to pay for the iSupport program using the budget allocated to their home care package. Younger carers (younger than 65 years), and adult children's carers are more likely to use the web‐based iSupport manual and invite their family members to the program compared to those older than 65 years. Other demographic characteristics had no significant association with their needs and preferences. Conclusions: Chinese‐Australian carers' perceived needs and preferences in this study will inform the implementation of a culturally tailored iSupport program to be embedded in community aged care services provided by Chinese ethno‐specific aged care organisations. Findings will also inform culturally and linguistically congruent iSupport programs for carers from other culturally and linguistically diverse communities in Australia. [ABSTRACT FROM AUTHOR]

Many children with developmental language disorder (DLD) have emotion recognition and regulation difficulties, but there are currently no known interventions enhancing emotional awareness in this population. This study explores the impact of parents' perspectives regarding children with DLD emotional understanding through a parent-led online emotion recognition (ER) intervention. Ten parents of children with DLD aged 6–11 participated in the study. A nonconcurrent multiple baseline design was employed, allowing for a rigorous analysis of changes in parental beliefs over time. Weekly data were collected through the Parents' Beliefs About Children's Emotions Questionnaire. Interviews were also conducted to gain deeper insights into parents' perceptions regarding the ER skills of their children. Results indicated that parents' beliefs about the need for guiding and supporting their child's ER skills increased over the intervention. Interviews also supported this, and three main themes were generated. The intervention program increased parents' awareness of (a) the importance of ER for children with DLD, (b) emotion-focused communication and engagement with their child, and (c) the integration of emotions into daily life. This study is the first known study that explores parents' beliefs about children with DLD ER skills, highlighting the importance of supporting parents through accessible interventions. [ABSTRACT FROM AUTHOR]

Aims To evaluate a self-administered digital education resource for patients after a heart attack (adapted simplified Chinese version of Cardiac College™) on secondary prevention knowledge and health behaviour change outcomes. Methods and results Chinese immigrants recovering from a heart attack were recruited from cardiac rehabilitation programmes at four metropolitan tertiary hospitals. Participants provided access to Cardiac College™ (adapted simplified Chinese version), a self-learning secondary prevention virtual education resource over 4 weeks. The web-based resources include 9 booklets and 10 pre-recorded video education sessions. Assessments included health literacy, secondary prevention knowledge, self-management behaviours, self-reported physical activity, and a heart-healthy diet. Satisfaction, acceptability, and engagement were also assessed. From 81 patients screened, 67 were recruited, and 64 (95.5%) completed the study. The participants' mean age was 67.2 ± 8.1 years old, 81.2% were males, and the majority had no English proficiency (65.6%). Following the intervention, significant improvements were observed for secondary prevention knowledge overall and in all subdomains, with the most improvement occurring in medical, exercise, and psychological domains (P < 0.001). Dietary and self-management behaviours also improved significantly (P < 0.05). According to participants, the educational materials were engaging (100%), and the content was adequate (68.8%); however, 26.6% found the information overwhelming. Overall, 46.9% were highly satisfied with the resources. Conclusion A self-learning virtual patient-education package improved secondary prevention knowledge and self-care behaviour in Chinese immigrants after a heart attack. The culturally adapted version of Cardiac College™ offers an alternative education model where bilingual staff or translated resources are limited. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and current cost of living crisis have highlighted socioeconomically patterned health disparities, bringing renewed focus on equity in public health. Despite political rhetoric invoking cultural narratives of egalitarianism and opportunities for class mobility, social class remains a significant factor in health outcomes in the Australian context. For social scientists, class (despite robust critiques) is a key analytical concept that has been theoretically broadened to encompass social and cultural practices (habitus). In public health, however, concepts of social disadvantage have expanded toward frames such as health equity and socioeconomic status in ways that can obscure 'class' and habitus. Understandings and operationalization of concepts of class and equity not only impact collaborative and interdisciplinary relationships, but also the framing of public health problems and health promotion interventions and policies. In this article, we draw on our experiences as anthropologists conducting ethnography in and of Australian health promotion programs to map and re-evaluate the intersection of concepts of social class and equity. We trace how representations of class emerged in these programs, and the versions of class and equity that materialized across different public health contexts. We argue for a conceptual repositioning of class that recognizes its shape-shifting qualities and of its materializations in different politics, disciplines and everyday contexts. In doing so, we highlight 'class' as a salient dimension of the design, implementation and evaluation of health promotion programs. [ABSTRACT FROM AUTHOR]

People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic catapulted Telehealth to the forefront of Emergency Medicine (EM) as an alternative way of assessing and managing patients. This challenged the traditional idea that EM can only be practised within brick‐and‐mortar EDs. Many Emergency Physicians may find the idea of practising Telehealth in Emergency Medicine (TEM) confronting, particularly in the absence of training and clear practice guidelines. The purpose of the present paper is to describe the current use of TEM in Australasia, and outline the advantages and barriers in adopting this practice domain. [ABSTRACT FROM AUTHOR]