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Background: Parental reflective function (PRF) is a candidate mechanism in the transmission of intergenerational trauma. This systematic review examined (1) the association between parental history of childhood maltreatment and PRF, (2) how PRF relates to attachment in children of parent survivors, and (3) whether PRF moderates the association between parental maltreatment history and child attachment. Methods: Ten databases were searched (from inception to 10th November 2021). Inclusion criteria were primary study, quantitative, parent participants, measures of childhood maltreatment, and postnatal PRF. Exclusion criteria were qualitative, intervention follow-up, gray literature, or a review study. Risk of bias was assessed using recommended tools. Data were narratively synthesized. Results: One-thousand-and-two articles were retrieved, of which eleven met inclusion criteria (N = 974 participants). Four studies found a significant association between parental childhood maltreatment and disrupted PRF, six did not, one found mixed results. One study reported the association between childhood maltreatment and attachment (nonsignificant results). Discussion: There is no clear evidence PRF is routinely disrupted in parent survivors, though there is high heterogeneity in studies. Future research should standardize design to better understand whether PRF is a candidate mechanism in intergenerational trauma. Other: PROSPERO CRD42020223594

Introduction: Evidence-based teaching and learning strategies should underpin any educational activity. This is particularly important for interprofessional education (IPE) activities, where there is an expectation that healthcare professions are taught using best available evidence. There is a research–practice gap that this review aims to address by using the current evidence to develop recommendations regarding optimal design components to better inform faculty who design IPE. Methods: A five-stage scoping review was conducted. Methodological characteristics and IPE design components of primary and review studies were extracted. Three important components of design—participants (level and stage of progression, discipline type and number, group size and ratios), learning constructs (theories, frameworks, learning objectives) and learning approaches (exchange, observation, action, simulation and practice)—were reviewed to develop recommendations regarding effective design. Results: A total of 41 papers were eligible for inclusion, 24 primary and 17 review studies. The primary studies were predominantly descriptive case studies with 31 disciplines involved in IPE activities across the studies. There was inconsistent reporting of learning constructs utilised in design, and the most reported learning approach was exchange. There was significant variability in the aims and design of the 17 review studies, ranging from systematic reviews to realist reviews, with the number of included studies ranging from six to 104. Conclusions: There was a lack of detailed reporting regarding design components, which limits the evidence base to inform IPE design. Reported components from the primary studies were augmented by findings from the review studies and the wider literature, which enabled the development of recommendations to assist faculty in the design of IPE programs and activities.

Background: There is a risk of malnutrition when older people are diagnosed with cancer, highlighting the need for nutritional assessments and appropriate management to be undertaken by healthcare professionals including nurses. The absence of a standardised assessment method and management of nutrition in older people creates a gap in clinical practice and warrants further research. Aim: The aim of this review was to explore the current nutritional assessment methods and evidencebased interventions for improving nutritional outcomes in older people with cancer. Methods: An integrative literature review was conducted using electronic databases. Papers were limited to those published in English between 2009 and 2021. Search terms included older adult, elder, geriatric, senior, cancer, nutrition, malnutrition, hospital, and inpatient across four databases: Embase, CINAHL, MEDLINE, and Scopus. Using the inclusion and exclusion criteria, 303 articles were screened. A Mixed Methods Appraisal Tool (MMAT) (2018) was used for quality appraisal. Concept analysis explored themes across the included articles. Findings: The themes from the analysis of 10 primary research articles, which included 5,327 participants, were (i) types of nutritional assessment and (ii) management of older people with cancer. The main nutritional assessment scales used were the Mini Nutrition Assessment and Patient-Generated Subjective Global Assessment. Conclusion: The completion of a comprehensive nutritional assessment by health professionals, including nurses, could facilitate early dietary intervention in older persons with cancer. This would enable supportive dietary advice and supplementation to improve health outcomes.

An important service system for rural parents experiencing complex trauma is primary health care.To investigate workforce knowledge, attitudes and practices, and barriers and enablers to trauma-informed care in rural primary health care.This study used a descriptive, cross-sectional design. It involved an on-line survey conducted in 2021 in rural Victoria, Australia. Participants were the primary health care workforce. The main outcome measures were study-developed and included, a 21-item Knowledge, Attitudes and Practices tool, a 16-item Barriers and Enablers to Trauma-Informed Care Implementation tool, and three open-ended questions.The 63 respondents were from community health (n = 40, 63%) and child and family services (n = 23, 37%). Many (n = 43, 78%) reported undertaking trauma-informed care training at some point in their career; with 32% (n = 20) during higher education. Respondents self-rated their knowledge, attitudes and practices positively. Perceived enablers were mainly positioned within the service (e.g. workforce motivation and organisational supports) and perceived barriers were largely external structural factors (e.g. availability of universal referral pathways, therapeutic-specific services). Open-ended comments were grouped into four themes: (1) Recognition and understanding; (2) Access factors; (3) Multidisciplinary and collaborative approaches; and (4) Strengths-based and outcome-focused approaches.Primary health care is an important driver of population health and well-being and critical in rural contexts. Our findings suggest this sector needs a rural trauma-informed care implementation strategy to address structural barriers. This also requires policy and system development. Long-term investment in the rural workforce and primary care service settings is essential to integrate trauma-informed care.

Refereed/Peer-reviewed Background: Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. Objectives: To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. Search methods: In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. Selection criteria: All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio‐emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. Data collection and analysis: Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre‐designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta‐analyses using random‐effects models. Main results: We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions: Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma‐related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent‐child relationships slightly compared to usual service provision (SMD 0.45, 95% CI ‐0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low‐certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI ‐0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low‐certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self‐harm. Psychological interventions: Psychological interventions may result in little or no difference in trauma‐related symptoms compared to usual care (SMD ‐0.05, 95% CI ‐0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low‐certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low‐certainty evidence, SMD ‐0.34, 95% CI ‐0.66 to ‐0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low‐certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low‐certainty evidence). Benefits for parent‐child relationships were very uncertain (26 participants, very low‐certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low‐certainty evidence). No studies assessed the effects of psychological interventions on parents' self‐harm. Service system approaches: One service system approach assessed the effect of a financial empowerment education programme, with and without trauma‐informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low‐certainty evidence). No studies assessed the effects of service system interventions on parents' trauma‐related symptoms, substance use, relationship quality, self‐harm, parent‐child relationships or parenting skills. Authors' conclusions: There is currently a lack of high‐quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio‐emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent‐child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high‐quality research into effective strategies for this population.

This study investigates the effect of Developmentally Moderated Focus on Form (DMFonF) focusing on plural marking in English L2 in Indonesian kindergarten children. Before the study, these children learned English through a communicative programme. The study, designed within the Processability Theory framework, included a pre-test, DMFonF intervention, and post-test. Two kindergarten classes, K1 (first-year, n = 10) and K2 (second-year, n = 10), participated in the study. At pre-test, all children were at the single-word stage. That was after K1 children learned English for one semester and K2 for three semesters. After the one semester-DMFonF intervention, all children acquired lexical plural marking, and most of them also acquired phrasal plural agreement. This finding suggests that DMFonF is effective in promoting early L2 grammatical development.

Monitoring is largely ignored in its capacity to provide a distinct contribution to evaluation. It is often thought of as a process of collecting data to feed into an evaluation, rather than for its own powerful transformative potential. Evaluation is considered a mechanism for producing findings that enable learning, improvement and decision-making; but what if monitoring could produce these same outcomes with, in some cases, greater alignment to quality characteristics of utility, timeliness, feasibility, propriety, accuracy, completeness and monitoring accountability? This article examines the utilisation and value of monitoring through a case study of a government funded 12-month rural health project in Victoria, Australia. The project initially commissioned a baseline to assess against post-project outcomes. However, adopting a utilisation-focused perspective to prepare for use and support stakeholder engagement enabled implementation of a multipurpose monitoring framework. The case study provides examples of monitoring in action with timely learning, decision-making and improvements resulting in incremental system and behaviour changes, rather than relying on periodic outcome recommendations at evaluation completion. This article adds to evaluation theory and practice through highlighting monitoring as a significant mechanism for enabling learning, decision-making, and improvement.

International audience; In a previous Phase 2 study, olesoxime had a favorable safety profile. Although the primary endpoint was not met, analyses suggested that olesoxime might help in the maintenance of motor function in patients with Types 2/3 SMA. This open-label extension study (OLEOS) further characterizes the safety, tolerability and efficacy of olesoxime over longer therapy durations. In OLEOS, no new safety risks were identified. Compared to matched natural history data, patients treated with olesoxime demonstrated small, non-significant changes in motor function over 52 weeks. Motor function scores were stable for 52 weeks but declined over the remainder of the study. The greatest decline in motor function was seen in patients ≤15 years old, and those with Type 2 SMA had faster motor function decline versus those with Type 3 SMA. Previous treatment with olesoxime in the Phase 2 study was not protective of motor function in OLEOS. Respiratory outcomes were stable in patients with Type 3 SMA >15 years old but declined in patients with Type 2 SMA and in patients with Type 3 SMA ≤15 years old. Overall, with no stabilization of functional measures observed over 130 weeks, OLEOS did not support significant benefit of olesoxime in patients with SMA.

Background Smoking is a grossly overlooked risk factor for people with chronic hepatitis C with regard to disease progression. It is unclear whether current smoking cessation interventions are effective for this population. Purpose The purpose was to evaluate the effectiveness of a telephone counseling and nicotine replacement therapy (NRT) intervention for smokers with chronic hepatitis C to quit or reduce rates of smoking. Methods A randomized controlled trial was conducted with participants randomized and stratified according to heaviness of smoking. Ninety-two eligible adults who smoked cigarettes and attended hepatology outpatient clinics were recruited. The intervention included NRT and telephone counseling compared with telephone counseling alone. Data collection occurred from December 2010 to November 2011. Data were collected at baseline, 6, and 12 weeks to assess smoking cessation. Change scores were analyzed using analysis of variance to examine the differences between smoking interventions. Results At 6 weeks, both control and intervention groups had quit or reduced the number of cigarettes smoked daily. However, over 12 weeks, the intervention group showed sustained quitting or reduced smoking, with 5.8 (confidence interval [CI]: 2.4, 9.3) fewer cigarettes smoked per day from baseline. The control group maintained an average reduction of 1.6 (CI: -1.9, 5.2) fewer cigarettes per day. Implications for practice Nicotine replacement therapy and individualized telephone counseling interventions increase the prospects of smoking cessation. Interventions such as these, introduced at routine clinic appointments in the outpatients' setting, by a nurse practitioner (hepatology) showed clinically important results for smoking cessation in this population.

This short report summarises a current quasi-experimental investigation into the effect of developmentally moderated focus on form instruction (DMFonF; Di Biase 2002, 2008) in an EFL classroom in an Indonesian kindergarten. DMFonF is an instructional approach which combines Pienemann's (1984) teachability hypothesis within Processability Theory (Pienemann 1998, 2011) with Long's (1991) focus on form (FonF) feedback. Specifically, the current study focuses on the acquisition of English plural marking on nouns. One first-year Indonesian kindergarten class (K1) and one second-year kindergarten class (K2) participated in the study. Children in both K1 and K2 were assessed at the beginning of the study and all of them, bar one exception, were found to be at the lexical stage; that is, they produced only single words and formulaic expressions in English without any grammatical markings. Analyses for K1 after one semester of instruction with DMFonF indicated that all the children acquired lexical plural marking and nine out of ten children also acquired phrasal agreement between quantifiers and nouns. A comparison of these results with K2 children (who were one year ahead in their meaning-based instruction) suggests that DMFonF instruction is effective in promoting grammatical development in the second language acquisition of kindergarten children.

Introduction Implementation of interprofessional education (IPE) is recognised as challenging, and well-designed programs can have differing levels of success depending on implementation quality. The aim of this review was to summarise the evidence for implementation of IPE, and identify challenges and key lessons to guide faculty in IPE implementation. Methods Five stage scoping review of methodological characteristics, implementation components, challenges and key lessons in primary studies in IPE. Thematic analysis using a framework of micro (teaching), meso (institutional), and macro (systemic) level education factors was used to synthesise challenges and key lessons. Results Twenty-seven primary studies were included in this review. Studies were predominantly descriptive in design and implementation components inconsistently reported. IPE was mostly integrated into curricula, optional, involved group learning, and used combinations of interactive and didactic approaches. Micro level implementation factors (socialisation issues, learning context, and faculty development), meso level implementation factors (leadership and resources, administrative processes), and macro level implementation factors (education system, government policies, social and cultural values) were extrapolated. Sustainability was identified as an additional factor in IPE implementation. Conclusion Lack of complete detailed reporting limits evidence of IPE implementation, however, this review highlighted challenges and yielded key lessons to guide faculty in the implementation of IPE.

Problem & background: Support is important for all parents but critical for those experiencing complex trauma. The The Healing the Past by Nurturing the Future project uses participatory action research to co-design effective perinatal support for Aboriginal and Torres Strait Islander parents. Aim: This research aims to identify and refine culturally appropriate support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma. Design: We presented our synthesised eight parent support goals and 60 strategies, collated from Elder and parent focus groups, previous participatory workshops, and evidence reviews, for discussion at a stakeholder workshop. Stakeholder perspectives were captured using a three-point agreement activity and, self- and scribe-recorded comments. Aboriginal and non-Aboriginal researchers analysised the qualitative data, to identify core factors which might facilitate or help enact the parenting related goals. Findings: Overall, stakeholders (n = 37) strongly endorsed all eight goals. Workshop attendees (57% Aboriginal) represented multiple stakeholder roles including Elder, parent and service provider. Four core factors were identified as crucial for supporting parents to heal from complex trauma: Culture (cultural traditions, practices and strengths), Relationality (family, individual, community and services), Safety (frameworks, choice and control) and Timing (the right time socio-emotionally and stage of parenting). Discussion: Context-specific support tailored to the Culture, Relationality, Safety, and Timing needs of parents is essential. These four factors are important elements to help enact or facilitate parenting support strategies. Conclusion: Further work is now required to develop practical resources for parents, and to implement and evaluate these strategies in perinatal care to address cumulative and compounding cycles of intergenerational trauma. Refereed/Peer-reviewed

To understand primary health care practice, student nurse education requires opportunities to engage in authentic, person-in-environment interaction. This paper reviews an innovative student nurse placement model developed in rural Australia through a multidisciplinary partnership between a rural health service, a university, and the state governmental Department of Education and Training. Semi-structured interviews were conducted with a purposive sample of 12 student nurses at placement completion. Themes drawn out of the data collected were grounded in the participants’ opinions and experiences. The interview findings were grouped into six themes surrounding: (1) placement model, (2) identity, (3) autonomy, (4) interpersonal skills, (5) primary care, and (6) young people. Overall, student nurses gave positive feedback about the placement model and felt the experience contributed to their professional identity and autonomy as they transition to graduate roles. They self-reported strong indications that learning about the nuances and complexity of primary health care contributed to their practice skills. Investing in placement models such as the one presented in this paper is important to build capacity in the nursing workforce. Enabling an adaptable, responsive nursing profession is a critical area for further nurse education research and evaluation.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of interventions provided to support parents experiencing complex trauma or who have experienced childhood maltreatment (or both) on parenting capacity and parental psychological or socio‐emotional well‐being.

Background There are staff shortages nation-wide in residential aged care, which is only predicted to grow as the population ages in Australia. The aged care staff shortage is compounded in rural and remote areas where the health service workforce overall experiences difficulties in recruitment and retention. There is evidence that nurse practitioners fill important service gaps in aged care and rural health care but also evidence that barriers exist in introducing this extended practice role. Methods In 2018, 58 medical and direct care staff participated in interviews and focus groups about the implementation of an older person’s nurse practitioner (OPNP) in aged care. All 58 interviewees had previously or currently worked in an aged care setting where the OPNP delivered services. The interviews were analysed using May’s implementation theory framework to better understand staff perceptions of barriers and enablers when an OPNP was introduced to the workplace. Results The major perceived barrier to capacity of implementing the OPNP was a lack of material resources, namely funding of the role given the OPNP’s limited ability to self-fund through access to the Medicare Benefits Schedule (MBS). Staff perceived that benefits included timely access to care for residents, hospital avoidance and improved resident health outcomes. Conclusion Despite staff perceptions of more timely access to care for residents and improved outcomes, widespread implementation of the OPNP role may be hampered by a poor understanding of the role of an OPNP and the legislative requirement for a collaborative arrangement with a medical practitioner as well as limited access to the MBS. This study was not a registered trial.

Background In Australia, alcohol use is accountable for 5.1% of the total burden of disease and injury along with being responsible for 24% of the burden as a result of chronic liver disease. There is a paucity of quality evidence-based programmes for alcohol use management and the chronic viral hepatitis population. Aims To evaluate the effectiveness of an alcohol brief intervention for ambulatory patients with chronic viral hepatitis C attending a hepatology clinic. Methods A randomised controlled trial determined the effectiveness of: a brief intervention and routine care (Group 1) compared to routine care only (no formalised intervention) (Group 2). Alcohol reduction is the primary outcome measure. Reduction in risky drinking and quality of life were also measured. Data was collected at three-time points, baseline prior to randomisation, four weeks and eight weeks. Findings Alcohol intake reduced in both groups at 4 weeks, with 57% (intervention) and 41% (control) having a 50% reduction in alcohol (p = 0.295). This reduction was maintained by both groups at 8 weeks with 53% (intervention) and 43% (control) (p = 0.536). The intervention group showed a greater reduction over time, but this was not statistically significant. Discussion Increasing nurse led models of care, such as nurse practitioners specialising in hepatology, could provide an effective response for managing people with chronic viral hepatitis C and alcohol misuse. Conclusion Assessing for alcohol use using the AUDIT C and TLFB_A and providing a brief intervention with routine care by the Nurse Practitioner, Hepatology is an acceptable and useful intervention to reduce alcohol consumption in this population.

The global educational landscape is now focused on educational provision for all. Many countries in the Asia Pacific, including Indonesia, have moved outside the “box” of traditional schooling. In Indonesia, equivalency programs have been set up to accommodate children and youth who have previously been pushed out by the traditional system. The Indonesian Equivalency Program gives young people, especially those who are from disadvantaged backgrounds, the opportunity to reengage with schooling through an alternative pathway. Attending alternative schooling provides a “second chance” at education for these young people and flexible learning strategies. The Indonesia’s Equivalency Program includes Package A (primary school equivalent), Package B (junior secondary school equivalent), and Package C (senior secondary school equivalent). Flexible learning strategies are the foundation of the equivalency program to bring education to excluded children and youth. Many disadvantaged Indonesian youth discover their own authentic learning in this program. This educational program has made a difference by empowering young people and creating the opportunity for them to graduate from high school and achieve long-term economic benefits.

Background World-wide antimicrobial resistance is increasing, and antimicrobial stewardship (AMS) interventions aimed at increasing compliance with optimal antimicrobial prescribing are essential in tackling this issue. Local level research about antimicrobial use is important to tailor interventions in a place-based approach to solve local level problems. Methods As part of a broader mixed methods study, Medical Practitioners and Senior Nurses at three rural health services were invited by email to participate in interviews to explore opinions and practices of antimicrobial prescribing. Results Seven Medical Practitioners and thirteen Senior Nurses from three small rural health services participated in the study. The major findings were that nurses were perceived as the ‘gatekeepers' to antimicrobial initiatives by all participants. Senior Nurses perceived AMS activities as being a link in a world-wide program to eradicate antimicrobial resistance, while Medical Practitioners perceived it as a local level program, aimed at educating individual prescribers. There was consensus that an intervention aimed at improved documentation at the point of prescribing and increased accessibility to antimicrobial prescribing guidelines had a high potential for increased compliance with optimal prescribing of antimicrobials. Conclusion The research enabled identification of interventions aimed at increasing optimal compliance with antimicrobial prescribing that are acceptable to and appropriate for Medical Practitioners and nursing staff at three rural health services.

Background Self-efficacy in nursing is the nurses' perception of their abilities to show caring orientations, attitudes, and behaviours and to develop caring relationships with patients. Self-efficacy is associated with years of experience, higher levels of job satisfaction and changes to nursing practices that conform with best practice. There is currently a paucity of evidence and no Australian studies were found examining the relationships between socio-demographic variables and self-efficacy in Australian nurses. Aim The aim of this study was to examine if relationships existed between the socio-demographic variables, years of experience, age, gender, marital status, level of education, years employed in the same workplace, employment status, geographical location, specialty area, health sector and Australian state and the perceived self-efficacy of Australian registered nurses. Research Design Cross-sectional survey of Australian registered nurses. Methods A stratified random sample of registered nurses was drawn from the database of a national industrial and professional organisation. The Caring Efficacy Scale (CES) was categorised into quartiles, and bivariate and multivariable relationships were examined using ordinal logistic regression. Results The proportion of nurses reporting low caring efficacy scores tended to decrease with years of experience and was lower in nurses who have been married. After adjustment in the final multivariable model, marital status and years of experience remained significantly related to caring efficacy ( p Conclusion A relationship exists between years of nursing experience, marital status and perceived self-efficacy among Australian registered nurses who belonged to an industrial and professional organisation. Targeted professional development programmes that support the improvement of perceived self-efficacy of all levels of nurses, might improve nurses' confidences and abilities to develop caring relationships with patients.

INTRODUCTION: Lifelong health behaviour habits are often consolidated in adolescence, with primary health care an important element of current and future health and wellbeing. Barriers to adolescent primary healthcare access are complex and include social, behavioural and geographical issues as well as organisational and systemic barriers. METHOD: This article describes the first year of implementation of a Doctors in Secondary School program in a rural setting in Victoria, Australia. RESULTS: The program provided 332 primary healthcare appointments over 10 months, equating to 102.33 hours of general practitioner contact with students. The program offered scheduled and unscheduled (drop-in) appointments with above-average consultation times. Cancellations and 'no-shows' were low, at 9% overall. Health promotion resources, material and information, were sourced and provided by the clinic practice nurse. CONCLUSION: The role of the practice nurse has been instrumental in providing a needs-based service for students, connecting to local and regional health and community services. Adolescents in rural areas require holistic primary care including provision of resources, basic wellbeing needs and advocacy. Programs to support rural adolescents should be integrated across the strengths and opportunities that exist in each unique context.

Smoking is a grossly overlooked risk factor for people with chronic hepatitis C with regard to disease progression. It is unclear whether current smoking cessation interventions are effective for this population.The purpose was to evaluate the effectiveness of a telephone counseling and nicotine replacement therapy (NRT) intervention for smokers with chronic hepatitis C to quit or reduce rates of smoking.A randomized controlled trial was conducted with participants randomized and stratified according to heaviness of smoking. Ninety-two eligible adults who smoked cigarettes and attended hepatology outpatient clinics were recruited. The intervention included NRT and telephone counseling compared with telephone counseling alone. Data collection occurred from December 2010 to November 2011. Data were collected at baseline, 6, and 12 weeks to assess smoking cessation. Change scores were analyzed using analysis of variance to examine the differences between smoking interventions.At 6 weeks, both control and intervention groups had quit or reduced the number of cigarettes smoked daily. However, over 12 weeks, the intervention group showed sustained quitting or reduced smoking, with 5.8 (confidence interval [CI]: 2.4, 9.3) fewer cigarettes smoked per day from baseline. The control group maintained an average reduction of 1.6 (CI: -1.9, 5.2) fewer cigarettes per day.Nicotine replacement therapy and individualized telephone counseling interventions increase the prospects of smoking cessation. Interventions such as these, introduced at routine clinic appointments in the outpatients' setting, by a nurse practitioner (hepatology) showed clinically important results for smoking cessation in this population.

Background and objective: By adopting a trauma-informed approach to care at the organisational and clinical levels, health care systems and providers can enhance the quality of care that they deliver and improve health outcomes for individuals with a trauma history. This study aimed to explore the trauma-related knowledge, attitudes awareness, practice, competence and confidence of health service staff from three small rural health services in Victoria, Australia, and examine their self-reported capacity to respond to clients with a trauma history.Methods: Staff from each site were invited to complete a paper-based survey. The survey included demographic information and questions related to knowledge and understanding of trauma, experience of trauma-informed care and confidence engaging in, and perceived importance of, trauma-informed practices. Results: The respondents were predominately nurses. Results showed that 16% of respondents had undertaken training in trauma-informed care and 44% disagreed that they had an understanding of trauma-informed practices. There were high levels of agreement for statements related to knowledge and understanding of trauma and low levels of agreement with statements related to experience of trauma-informed care. More than 70% of respondents reported that they had little knowledge of the principals of trauma-informed care, and little experiencing with practicing trauma-informed care.Discussion and conclusions: Overall, the survey results showed that staff were trauma-aware, but supported the need for more education and training in trauma-informed practices and improved organisational approaches to support trauma-informed approaches. It is important for organisations to shift from being trauma aware to being trauma-informed, by building foundational awareness of these practices and reinforcement through continuing education.

This study aimed to determine what carers of people with dementia in rural Australia found stressful in their caring role. It was part of a broader mixed methods study exploring carer depression, anxiety and stress and utilisation of formal community support services. The findings suggest that carer stress varies among individuals, but that a predominant source of stress is the unremitting burden experienced when caring for someone with dementia. Improved utilisation of support services in rural areas and tailoring services to individual carers dependent on the source of stress is recommended.

Summary Background Spinal muscular atrophy (SMA) is a progressive motor neuron disease causing loss of motor function and reduced life expectancy, for which limited treatment is available. We investigated the safety and efficacy of olesoxime in patients with type 2 or non-ambulatory type 3 SMA. Methods This randomised, double-blind, placebo-controlled, phase 2 study was done in 22 neuromuscular care centres in Belgium, France, Germany, Italy, Netherlands, Poland, and the UK. Safety and efficacy of olesoxime were assessed in patients aged 3–25 years with genetically confirmed type 2 or non-ambulatory type 3 SMA. A centralised, computerised randomisation process allocated patients (2:1 with stratification by SMA type and centre) to receive olesoxime (10 mg/kg per day) in an oral liquid suspension or placebo for 24 months. Patients, investigators assessing outcomes, and sponsor study personnel were masked to treatment assignment. The primary outcome measure was change from baseline compared with 24 months between the two treatment groups in functional domains 1 and 2 of the Motor Function Measure (MFM D1 + D2) assessed in the full analysis population. A shorter, 20-item version of the MFM, which was specifically adapted for young children, was used to assess patients younger than 6 years. Safety was assessed in all patients who received one or more doses of the study drug. The trial is registered with ClinicalTrials.gov, number NCT01302600. Findings The trial was done between Nov 18, 2010, and Oct 9, 2013. Of 198 patients screened, 165 were randomly assigned to olesoxime (n=108) or placebo (n=57). Five patients in the olesoxime group were not included in the primary outcome analysis because of an absence of post-baseline assessments. The change from baseline to month 24 on the primary outcome measure was 0·18 for olesoxime and −1·82 for placebo (treatment difference 2·00 points, 96% CI −0·25 to 4·25, p=0·0676). Olesoxime seemed to be safe and generally well tolerated, with an adverse event profile similar to placebo. The most frequent adverse events in the olesoxime group were pyrexia (n=34), cough (n=32), nasopharyngitis (n=25), and vomiting (n=25). There were two patient deaths (one in each group), but these were not deemed to be related to the study treatment. Interpretation Olesoxime was safe at the doses studied, for the duration of the trial. Although the primary endpoint was not met, secondary endpoints and sensitivity analyses suggest that olesoxime might maintain motor function in patients with type 2 or type 3 SMA over a period of 24 months. Based on these results, olesoxime might provide meaningful clinical benefits for patients with SMA and, given its mode of action, might be used in combination with other drugs targeting other mechanisms of disease, although additional evidence is needed. Funding AFM Telethon and Trophos SA.

The professional identities of Aboriginal teachers in Australia are shaped by ongoing processes of racialization. This chapter seeks to reject more recent manifestations of this process in the form of cultural essentialism. It discusses how Australian Aboriginal groups have been continuously transformed through long-established practices of trade, intermarriage, and, more recently, colonization. The argument is that cosmopolitan theory is able to capture this dynamism and provide a language of transformation that moves beyond the us/them discourse that contributes to cultural essentialism. A cosmopolitan analysis is then used to argue that Aboriginal teachers can be seen as cosmopolitan workers, who engage with multiple epistemologies. This leads to the need to reassess binary logics in the development of Aboriginal professional identities.

Southern Theory provides the framing theory for this edited collection, and in this chapter Reid and Major outline their engagement with its key concepts and constructs in relation to cultural and linguistic diversity in education contexts in the global North and South. Intercultural education and culturally relevant/responsive teaching are discussed as common responses to diversity, and are problematized using Southern Theory. The aim is to prompt dialogue about equity and social justice from “below” in education, and the tensions, contradictions and complexities that lie at the heart of achieving this.

Aim To explore the use of community and dementia-specific services by informal carers caring for someone with dementia in a rural setting. Methods Carers of people with dementia were recruited through a variety of rural community services and invited to complete a survey related to the utilisation of community services. Results A total of 39 carers completed surveys. Despite 84% reporting use of the Aged Care Assessment Service and 61% reporting provision of printed information on the services available, less than half of the carers utilised commonly available support services. Only 46% receive financial compensation for their carer role. Conclusions Rural carers of care recipients with behavioural and psychological symptoms of dementia underutilise community services. Services that may assist with carer stress and depression and services that provide advice on the management of distressing behavioural and psychological symptoms of dementia were utilised by less than half of the carers surveyed.

AIM: The aim of this study was to explore the levels of stress, anxiety and depression of informal carers caring for someone with dementia in a rural setting. METHODS: Carers of people with dementia were recruited to complete a survey that incorporated the Depression Anxiety Stress Scales (DASS) to measure carer emotional well-being. The survey also included the Neuropsychiatric Inventory Questionnaire (NPI-Q), which assesses the presence and severity of behavioural and psychological symptoms of dementia (BPSD) of care recipients and their effects on the carer. RESULTS: A total of 39 carers completed surveys. Almost half of the respondents reported levels of stress and depression in the moderate to severe range as measured on the DASS. BPSD exhibited by care recipients, such as agitation, anxiety, aggression and nocturnal disturbance, were associated with the level of stress reported by the carer as measured with the NPI-Q. CONCLUSION: Caring for care recipients who exhibit BPSD predisposes carers in rural areas to high levels of stress and depression. Regular, periodic screening of carers is required to detect abnormal levels of stress, depression and anxiety in order to enable timely introduction of interventions. Language: en

In this paper, recent research into the global movement of teachers [C. Reid, J. Collins, and M. Singh. 2014. Global Teachers, Australian Perspectives: Goodbye Mr Chips, Hello Ms Banerjee. Singapore: Springer] and their experiences in rural areas of Australia are discussed in order to make the case for a cosmopolitan education theory and practice. The paper is divided into four sections. First, is an overview of cosmopolitanism and the rural drawing on Appadurai's [1996. Modernity At Large: Cultural Dimensions of Globalization. Minneapolis: University of Minnesota Press.] conceptualisation of scapes (1996) and Vertovec's [2007. “Super-Diversity and its Implications.” Ethnic and Racial Studies 30 (6): 1024–1054] notion of super-diversity. Second, a brief comparison of the key elements of multiculturalism and cosmopolitanism are outlined in order to reveal the ways in which they differ, and why cosmopolitanism might be useful in understanding rural education. Third, a slice of data from the study of the glo...