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AIM To summarise existing evidence about barriers and enablers to breastfeeding babies with Down syndrome (DS) in peer-reviewed literature. METHODS Ovid Medline, CINAHL, Scopus and Ovid Emcare were searched. Inclusion and exclusion criteria were used to screen yielded articles and those meeting the criteria were included for data extraction. Two authors extracted data including outcomes, design, definition of DS, barriers and enablers to breastfeeding babies with DS. RESULTS Sixteen studies met the inclusion and exclusion criteria. Barriers and enablers were categorised into maternal, child and health professional factors. CONCLUSIONS This review identified a significant literature gap related to breastfeeding babies with DS and more definitive research under current standards is needed. Mothers reported the need for high-quality health professional breastfeeding support and evidence-based effective breastfeeding techniques. A collaborated and concerted approach from both mothers and health professionals is important to optimise breastfeeding for babies with DS.

Background: Diabetic ketoacidosis (DKA) is an acute life threatening, resource intensive pre-ventable complication of type 1 diabetes which has major biopsychosocial effects on patientsand families. Incidence of pediatric DKA has been studied nationally and internationally in met-ropolitan centers. This study analyzed the DKA incidence at first presentation of type 1 diabe-tes at Townsville Hospital, before and after an educational intervention. This is the first studyof its kind in a regional center in Queensland, Australia. Method: The inclusion criteria consisted of children (0-18 years) diagnosed with type 1 diabetesfrom January, 2006 to December, 2016. Medical and laboratory patient data was retrospec-tively collected. Quantitative analysis was conducted using SPSS. Education sessions weredelivered to health professionals by a pediatric endocrinologist during 2015 and 2016. DKAand its severity were defined by the International Society of Pediatric Diabetes 2014Guidelines.Results: In total, 106 patients met inclusion criteria. Average incidence of DKA at first presen-tation of type 1 diabetes was 48.10%. Pre- and post-intervention incidences were 54.90% and25%, respectively (P = 0.01). DKA severity pre- and post-intervention were severe (48.88%,33.33%), moderate (26.67%, 16.67%), and mild (24.44%, 50%), respectively (P = 0.53).Conclusions: DKA incidence at first presentation of type 1 diabetes prior to intervention, ishigher than that reported by other studies in Australia: Brisbane (31.8%) and Sydney (37.7%).DKA incidence at first presentation of type 1 diabetes decreased significantly during the periodof health professional education. KEYWORDS

The James Cook University (JCU) medical school has a mission to produce doctors who are willing to work across northern Australia and may choose generalist rather than specialist careers. In addition to real-life placements in primary healthcare settings, the medical school has developed simulated General Practice (GP) clinics (simGPclinic) for Year 5 (Y5) students. This study compares the simGPclinic with actual GP placements for authenticity, teaching clinical skills, and preparation for real-life primary healthcare settings. Y5 students were administered a survey following their simGPclinic (n = 65; response rate = 97%). Students rated the simGPclinic's authenticity as 77 out of 100, and were more likely to rate the simGPclinic as being 'better' than their real-life GP placement in teaching them to: 'formulate a medical management plan and order correct pathology tests'; 'rule out the "red flags" for the key clinical problem'; 'undertake a patient-centred history and examination'; 'make a differential diagnosis for the key clinical problem'; and, 'develop communications skills'. The simGPclinic provided medical students with authentic and positive learning experiences in primary healthcare that were at least as beneficial as those provided in real-life settings, as well as being more reliable and better structured.

International and national studies have reported that health professionals who grew up in a rural area are more likely to return to work in a rural area than their urban raised counterparts. The chronic severe shortage of health professionals in rural and remote Australia has meant inequitable health care for rural and remote communities and a shortage of health professional role models for rural children. Career development theories and related research indicate that children start to develop ideas about careers from early childhood but, before they can aspire to a career, they must have knowledge of that career. This article explores the knowledge that primary school students who live in rural and remote areas and study by distance education have of the health professions. This article draws from part of a project that uses qualitative interviews and elements of action research to understand career opportunities for rural and remote students in the health professions and to contribute to building sustainable solutions to the shortage of health professionals in these areas.

Australia has a rural health professional crisis and a dependency on overseas trained health professionals. In 2002, the World Rural Health Conference proposed a code of practice to encourage countries to meet their own workforce needs and discourage recruitment activities that could harm another’s health-care system. Rural upbringing has been associated with rural medical practice, but only small numbers of rural students become health professionals. Parents views were sought as they influence their children’s education. We aimed to identify barriers rural parents saw for their children to study the health professions, determine their views on how to get rural or remote students to become rural health professionals and how the crisis could be resolved.