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A large stretch of the east coast of Australia experienced unprecedented rainfall and flooding over a two‐week period in early 2022. It is difficult to reliably estimate the likelihood of such a rare event from the relatively short observational record, so an alternative is to use data from an ensemble prediction system (e.g., a seasonal or decadal forecast system) to obtain a much larger sample of simulated weather events. This so‐called 'UNSEEN' method has been successfully applied in several scientific studies, but those studies typically rely on a single prediction system. In this study, we use data from the Decadal Climate Prediction Project to explore the model uncertainty associated with the UNSEEN method by assessing 10 different hindcast ensembles. Using the 15‐day rainfall total averaged over the river catchments impacted by the 2022 east coast event, we find that the models produce a wide range of likelihood estimates. Even after excluding a number of models that fail basic fidelity tests, estimates of the event return period ranged from 320 to 1814 years. The vast majority of models suggested the event is rarer than a standard extreme value assessment of the observational record (297 years). Such large model uncertainty suggests that multi‐model analysis should become part of the standard UNSEEN procedure. [ABSTRACT FROM AUTHOR]

Heatwaves are an accustomed extreme event of the Australian climate, which can cause catastrophic impacts on human health, agriculture, and urban and natural systems. We have analyzed the trends in Australia‐wide heatwave metrics (frequency, duration, intensity, number, cumulative magnitude, timing, and season duration) across 69 extended summer seasons (i.e., from November‐1951 to March‐2020). Our findings not only emphasize that heatwaves are becoming hotter, longer, and more frequent, but also signify that they are occurring with excess heat, commencing much earlier, and expanding their season over many parts of Australia in recent decades. The Australian heatwave trends have strengthened since last observed Australian study was conducted. We also investigated the heatwave and severe heatwave trends at a local city‐scale using three different observational products (AWAP and SILO gridded datasets and ACORN_SATV2 station data) over selected time periods (1911–2019, 1911–1964, and 1965–2019). Results suggest that heatwave trends are noticeably different amongst the three datasets. However, the results highlight that the severe heatwave cumulative magnitude and their season duration have been increasing significantly in recent decades over Australia's southern coastal cities (like Melbourne and Adelaide). The climatological mean of the most heatwave and severe heatwave metrics is substantially higher in recent decades compared to earlier periods across all the cities considered. The findings of our study have significant implications for the development of advanced heatwave planning and adaptation strategies. Key Points: Australian heatwaves are becoming hotter, longer, frequent, occurring with excess heat, starting earlier, and extending their season durationAustralian heatwave trends are noticeably different amongst gridded and in‐situ station datasetsHeatwaves and severe heatwaves have increased rapidly in the recent decade compared to previous periods in the considered Australian cities [ABSTRACT FROM AUTHOR]

This systematic review sought to identify whether health care reforms led to improvement in the emergency department (ED) length of stay (LOS) and elective surgery (ES) access in Australia, Canada, New Zealand, and the United Kingdom. The review was registered in the PROSPERO database (CRD42015016343), and nine databases were searched for peer-reviewed, English-language reports published between 1994 and 2014. We also searched relevant ''grey'' literature and websites. Included studies were checked for cited and citing papers. Primary studies corresponding to national and provincial ED and ES reforms in the four countries were considered. Only studies from Australia and the United Kingdom were eventually included, as no studies from the other two countries met the inclusion criteria. The reviewers involved in the study extracted the data independently using standardized forms. Studies were assessed for quality, and a narrative synthesis approach was taken to analyze the extracted data. The introduction of health care reforms in the form of time-based ED and ES targets led to improvement in ED LOS and ES access. However, the introduction of targets resulted in unintended consequences, such as increased pressure on clinicians and, in certain instances, manipulation of performance data. [ABSTRACT FROM AUTHOR]

Background Farmers in Australia, in general, have poorer health outcomes, including higher rates of suicide. Aims To investigate risk and protective factors and attitudes towards suicide and help-seeking among farmers living and working in New South Wales and Queensland in Australia. Methods A qualitative study in which three farming sites were selected in each state to represent an area with a suicide rate equal to, below and above the state average. Focus groups were conducted with men and women separately. Results Focus groups involved 30 men and 33 women. Inductive thematic analysis showed three broad themes characterized responses: environment and society; community and relationships; and individual factors. There was considerable overlap and dynamic interaction between themes. A combination of individual factors, as well as social and environmental stressors, was described as most likely to increase risk of suicide death and reduce help-seeking. The vast majority of known farmer suicides described involved men and many of the issues discussed pertained specifically to male farmers. Participants found suicide as an act complex, intertwined with many factors, and hard to fathom. A common belief was that an individual must feel a complete lack of hope and perceive their situation vastly differently from others to contemplate suicide. Conclusions Future suicide prevention efforts for farmers should take a biopsycho-ecological approach. Physical, psychological and cultural isolation could be addressed with education and training programmes and public campaigns. These could also improve people's ability to recognize possible suicidality. [ABSTRACT FROM AUTHOR]

Aims To examine the prevalence and correlates of suicidal ideation (SI) in a community-based sample of adults with Type 1 or Type 2 diabetes. Methods Participants were 3338 adults aged 18-70 years with Type 1 diabetes ( n = 1376) or Type 2 diabetes (non-insulin: n = 1238; insulin: n = 724) from a national survey administered to a random sample registered with the National Diabetes Services Scheme. Depression and SI were assessed using the Patient Health Questionnaire, and diabetes-specific distress with the Problem Areas In Diabetes scale. Separate logistic regression analyses by diabetes type/treatment were used to determine relative contribution to SI. Results Overall, we observed a SI rate of 14% in our sample. Participants with Type 2 diabetes using insulin reported more frequent depressive symptoms, and were more likely to report recent SI (19%) compared with those with either Type 1 diabetes or Type 2 diabetes not using insulin (14 and 12%, respectively). After controlling for depression, there was little difference in the prevalence of SI between diabetes types/treatments, but higher diabetes-specific distress significantly increased the odds of SI. Conclusions As SI is a significant risk factor for a suicide attempt, the findings have implications for healthcare professionals, pointing to the importance of adequate screening and action plans for appropriate follow-up of those reporting depression. Our findings are also indicative of the psychological toll of diabetes more generally, and the need to integrate physical and mental healthcare for people with diabetes. [ABSTRACT FROM AUTHOR]

Research on farmer suicide is limited in explaining the variations in farmers' demographic characteristics. This study examines farmer suicides in two Australian states: Queensland (QLD) and New South Wales (NSW). Standardized suicide rates over 2000-2009 showed a 2 times higher prevalence of suicide in QLD than NSW (147 vs. 92 cases, respectively). Differences in age and suicide method were observed between states, although they do not appear to account for the sizeable intra- and interstate variations. Suicide prevention initiatives for farmers should account for different age groups and also specific place-based risk factors that may vary between and within jurisdictions. [ABSTRACT FROM AUTHOR]

Background: In routine antenatal care, blood pressure is used as a screening tool for preeclampsia and its associated adverse outcomes. As such women with a blood pressure greater than 140/90 mm Hg undergo further investigation and closer follow-up, whereas those with lower blood pressures receive no additional care. In the nonpregnant setting, the American College of Cardiology now endorses lower hypertensive thresholds and it remains unclear whether these lower thresholds should also be considered in pregnancy.Objective: (1) To examine the association between lower blood pressure thresholds (as per the American College of Cardiology guidelines) and pregnancy outcomes and (2) to determine whether there is a continuous relationship between blood pressure and pregnancy outcomes and identify the point of a change at which blood pressure is associated with an increased risk of such outcomes.Study Design: This was a retrospective study of singleton pregnancies at Monash Health, Australia. Data were obtained with regards to maternal characteristics and blood pressure measurements at varying gestational ages. Blood pressures were then categorized as (1) mean arterial pressure and (2) normal, elevated, stage 1 and stage 2 hypertension, as per the American College of Cardiology guidelines. Multivariable regression analysis was performed to identify associations between blood pressure categories and pregnancy outcomes.Results: This study included 18,243 singleton pregnancies. We demonstrated a positive dose-response relationship between mean arterial pressure and the development of preeclampsia in later pregnancy. Across all gestational ages, the risk of preeclampsia was greater in those with "elevated blood pressure" and "stage 1 hypertension" in comparison with the normotensive group (adjusted risk ratio; 2.45, 95% confidence interval, 1.74-3.44 and adjusted risk ratio, 6.60; 95% confidence interval, 4.98-8.73 respectively, at 34-36 weeks' gestation). There was also an association between stage 1 hypertension, preterm birth, and adverse perinatal outcomes.Conclusion: This study demonstrated that preeclampsia and the associated adverse outcomes are not exclusive to those with blood pressures greater than 140/90 mm Hg. As such, those with prehypertensive blood pressures may also benefit from closer monitoring. Further research is essential to determine whether lowering the blood pressure threshold in pregnancy would improve detection and outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Rural communities in Australia have an elevated risk of suicide. The aim of the current study was to evaluate a well-being and suicide prevention education workshop, SCARF (Suspect, Connect, Ask, Refer, Follow-Up) developed for Australian farming and rural communities., Methods: The SCARF program was delivered to 14 groups, a convenience sample including frontline agricultural workers and farmers from New South Wales. The Literacy of Suicide Scale, Stigma of Suicide Scale, and items assessing confidence to assist others were administered immediately before and after the workshop, and at 3-month follow-up. The Warwick Edinburgh Mental Wellbeing Scale was given immediately before and at 3-month follow-up. In total, 255 agreed to participate in the study, with 127 completing 3-month follow-up. Data were analyzed using linear mixed-effects regression., Findings: There was a significant increase in suicide literacy and confidence to assist others immediately after the workshop, which remained significant at 3-month follow-up. Mental well-being significantly improved at 3-month follow-up., Conclusion: The SCARF program is unique for its brevity, cultural specificity, focus on health, and incorporation of the biopsycho-ecological model and the Interpersonal Theory of Suicide. It represents a useful program for Australian farming and rural communities to improve mental well-being, suicide literacy, and confidence to recognize and respond to suicidality., (© 2019 National Rural Health Association.)

Aims: We examined: (a) the prevalence of comorbid elevated symptoms of anxiety/depression; (b) its demographic/clinical correlates; (c) associations with self-care behaviors, by diabetes type., Methods: Cross-sectional self-report data of 6590 adults with diabetes (42% type 1; 58% type 2) from the Australian and Dutch Diabetes MILES studies were used. Elevated symptoms of anxiety/depression were defined as GAD-7 ≥ 10/PHQ-9 ≥ 10., Results: In both diabetes types, comorbid elevated symptoms of anxiety/depression were present in 9% and symptoms of anxiety alone in 2%; symptoms of depression alone were present in 8% of adults with type 1 diabetes and 11% with type 2 diabetes. Shorter diabetes duration (type 1 only) was the only characteristic that distinguished those with comorbid elevated symptoms of anxiety/depression but not those with symptoms of anxiety/depression alone from the reference group (no/minimal symptoms of anxiety/depression). Those with comorbid elevated symptoms of anxiety/depression had increased odds of sub-optimal diabetes self-care behaviors compared with the reference group, with higher odds than those with symptoms of anxiety or depression alone., Conclusions: Comorbid elevated symptoms of anxiety/depression affected one in ten respondents, who also had increased odds of suboptimal diabetes self-care. Those with shorter type 1 diabetes duration may be at increased risk., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Farmers and farm workers have been recognised as a group at high risk of suicide in Australia; however this risk is not without geographic and demographic variation. This study aims to identify and better understand the complex interplay of risk and protective factors surrounding farmer suicide, with an emphasis on social influences, so as to inform tailored and effective suicide prevention initiatives., Methods: Focus groups were conducted in three diverse sites across two states in Australia with men and women separately to gain perceptions about suicide risk and protective factors and attitudes towards suicide and help seeking. The three communities in each state represented areas with a suicide rate similar to, above, and below the state average. The communities were also diverse in their population, types of farming, geographic location, distance from and access to services. There were a total of 33 female and 30 male participants., Results: Qualitative analysis indicated three major interrelated social factors: (1) changing rural communities, (2) community attitudes and stigma and (3) relationship issues., Conclusions: The biopsycho-ecological model is considered useful to better understand and address social, as well as individual and environmental factors, pertaining to farmer suicide.

Purpose: Although patients demonstrate a range of problematic health-related lifestyle behaviours preceding suicidal behaviour, there is little research that routinely measure these behaviours. This paper seeks to establish the utility of health-related lifestyle measure (Fantastic Lifestyle Checklist) in people presenting to a major inner city Emergency Department with a range of suicidal behaviours., Methods: From 2007-2014, data from the 366 patients who had completed the Fantastic Lifestyle Checklist, after referral by the Emergency Department to a service for people with deliberate self-harm or suicidal ideation, were included in the analysis study. A Maximum Likelihood factor analysis was performed to assess the factor structure of the Fantastic Lifestyle Checklist and the resultant factors were explored in relation to measures of health; namely the Depression, Anxiety and Stress Scale and the 12-item Short-Form Health Survey., Results: A three-component factor structure emerged comprising Component 1 'positive life investments', Component 2 'poor emotional regulation' and Component 3 'poor health behaviours'. There was a significant negative correlation between 'positive life investments' and each of the Depression, Anxiety and Stress scales subscales and significant positive associations with 'poor emotional regulation' and Short Form Health Survey-12 mental health scores. Only the Short Form Health Survey-12 physical health subscale was weakly correlated with 'poor health behaviours', in females., Conclusion: Our findings support the construct and concurrent validity of the Fantastic Lifestyle Checklist measure. The three factors obtained for the Fantastic Lifestyle Checklist were coherent and seem useful for research and clinical practice., (© The Royal Australian and New Zealand College of Psychiatrists 2015.)

Background: Clinical guidelines advise screening for depression in patients with diabetes. The Patient Health Questionnaire (PHQ-9) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) are commonly used in primary care., Aim: To compare the efficacy of HADS-D and PHQ-9 in identifying moderate to severe depression among primary care patients with type 2 diabetes., Design of Study: Self-report postal survey, clinical records assessed by GPs., Setting: Seven metropolitan and rural general practices in Victoria, Australia., Method: Postal questionnaires were sent to all patients with diabetes on the registers of seven practices in Victoria. A total of 561 completed postal questionnaires were returned, giving a response rate 47%. Surveys included demographic information, and history of diabetes and depression. Participants completed both the PHQ-9 and HADS-D. Clinical data from patient records included glycosylated hemoglobin (HbA1c) levels and medications., Results: The proportion of the total sample completing HADS-D was 96.8% compared with 82.4% for PHQ-9. Level of education was unrelated to responses on the HADS-D but was related to completion of the PHQ-9. Using complete data (n = 456) from both measures, 40 responders showed HADS-D scores in the moderate to severe range, compared with 103 cases identified by PHQ-9. Only 35 cases were classified in the moderate to severe category by both the PHQ-9 and HADS-D. Items with the highest proportions of positive responses on the PHQ-9 were related to tiredness and sleeping problems and, on the HADS-D, feeling slowed down., Conclusion: It may be that the items contributing to the higher prevalence of moderate to severe depression using the PHQ-9 are due to diabetes-related symptoms or sleep disorders.

Background: Comorbid depression can occur with diabetes and heart disease. This article reports on a feasibility study focusing on additional roles for practice nurses in detecting and monitoring depression with other chronic diseases., Method: A convenience sample of six practices in southeast Australia was identified. Practice nurses received training via a workshop, which included training in the use of the Patient Health Questionnaire, to detect depression., Results: The 332 patients who participated in the project each received a comprehensive health summary to assist with self management. Depression was identified in 34% of patients in this convenience sample. After 18 months implementation, practice nurses were strongly in favour of continuing the model of care. General practitioners gave highly favourable ratings for effectiveness and willingness to continue this model of care., Discussion: Practice nurses can include depression monitoring alongside systematic care of diabetes and heart disease. A randomised trial is currently underway to compare the clinical outcomes of this model with usual care.

The health care systems in Australia are under pressure from workforce shortages, increasing costs and an ageing population with a high prevalence of chronic disease. There is a well-established description of inequity in health outcomes among rural and remote populations. Most of the inequity appears to be due to poorer access to services than higher levels of health risk factors, such as cholesterol, blood pressure or obesity. Over the last 15 years, the science of improvement has led to quality improvement techniques, such as collaboratives, managed clinical networks and collaborative care, all of which have been tried successfully in Australia. Each of these offers ways to reduce the inequity in health outcomes attributed to rurality or remoteness.

Chemical investigation of the southern Australian marine brown alga Sargassum fallax resulted in the isolation of three meroditerpenoids fallahydroquinone, fallaquinone and fallachromenoic acid together with the previously reported compounds sargaquinone [isolated and identified in a mixture with sargaquinoic acid], sargahydroquinoic acid, sargaquinoic acid and sargachromenol. As a result of this study the complete 2D NMR characterisation for sargaquinoic acid and sargahydroquinoic acid can now be reported for the first time. All structures were elucidated by detailed spectrometric analysis. Sargaquinoic acid and sargahydroquinoic acid displayed moderate antitumour activity.

Background: Randomised controlled trials demonstrate a 60% reduction in type 2 diabetes incidence through lifestyle modification programmes. The aim of this study is to determine whether such programmes are feasible in primary health care., Methods: An intervention study including 237 individuals 40-75 years of age with moderate or high risk of developing type 2 diabetes. A structured group programme with six 90 minute sessions delivered during an eight month period by trained nurses in Australian primary health care in 2004-2006. Main outcome measures taken at baseline, three, and 12 months included weight, height, waist circumference, fasting plasma glucose and lipids, plasma glucose two hours after oral glucose challenge, blood pressure, measures of psychological distress and general health outcomes. To test differences between baseline and follow-up, paired t-tests and Wilcoxon rank sum tests were performed., Results: At twelve months participants' mean weight reduced by 2.52 kg (95% confidence interval 1.85 to 3.19) and waist circumference by 4.17 cm (3.48 to 4.87). Mean fasting glucose reduced by 0.14 mmol/l (0.07 to 0.20), plasma glucose two hours after oral glucose challenge by 0.58 mmol/l (0.36 to 0.79), total cholesterol by 0.29 mmol/l (0.18 to 0.40), low density lipoprotein cholesterol by 0.25 mmol/l (0.16 to 0.34), triglycerides by 0.15 mmol/l (0.05 to 0.24) and diastolic blood pressure by 2.14 mmHg (0.94 to 3.33). Significant improvements were also found in most psychological measures., Conclusion: This study provides evidence that a type 2 diabetes prevention programme using lifestyle intervention is feasible in primary health care settings, with reductions in risk factors approaching those observed in clinical trials.

Mishandled concerns about clinical standards resulted in whistleblowing in four Australian hospitals. Official inquiries followed with recommendations to improve patient safety. In the aftermath of the inquiries, common themes included loss of trust in management and among clinical colleagues, and loss of trust from patients and the community. Without first rebuilding trust, staff will not report mistakes or other concerns about safety. Successful implementation of patient safety procedures requires policies to stress the professional duty of staff to report concerns about colleagues when they believe there is a risk to patients.