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This paper proposes a system, the Smart Learning Design Framework, designed to support the development of pedagogically sound learning material within an integrated, platform-independent data structure. The system supports sharing, reuse and adaptation of learning material via a metadata-driven philosophy that enables the technicalities of the system to be imperceptible to the author and consumer. The system proposes the use of pedagogically focused metadata to support and guide the author and to adapt and deliver the content to the targeted consumer. A prototype of the proposed system, which provides proof of concept for the novel processes involved, has been developed. The paper describes the Smart Learning Design Framework and places it within the context of alternative learning object models and frameworks to highlight similarities, differences and advantages of the proposed system. (Contains 5 notes, 1 table, and 7 figures.)

Summary: Despite ongoing public health messages about the risks associated with bat contact, the number of potential exposures to Australian bat lyssavirus (ABLV) due to intentional handling by members of the general public in Queensland has remained high. We sought to better understand the reasons for intentional handling among these members of the public who reported their potential exposure to inform future public health messages. We interviewed adults who resided in a defined geographic area in South East Queensland and notified potential exposure to ABLV due to intentional handling of bats by telephone between 1 January 2012 and 31 December 2013. The participation rate was 54%. Adults who reported they had intentionally handled bats in South East Queensland indicated high levels of knowledge and perception of a moderately high risk associated with bats with overall low intentions to handle bats in the future. However, substantial proportions of people would attempt to handle bats again in some circumstances, particularly to protect their children or pets. Fifty‐two percent indicated that they would handle a bat if a child was about to pick up or touch a live bat, and 49% would intervene if a pet was interacting with a bat. Future public health communications should recognize the situations in which even people with highrisk perceptions of bats will attempt to handle them. Public health messages currently focus on avoidance of bats in all circumstances and recommend calling in a trained vaccinated handler, but messaging directed at adults for circumstances where children or pets may be potentially exposed should provide safe immediate management options. [ABSTRACT FROM AUTHOR]

The article presents a study which found that waist hip ratio (WHR) independently predicted death from cardiovascular and coronary heart disease (CHD) in Australian men and women. Of the 473 participants who died from all causes, 137 died from cardiovascular disease (CVD), and 91 died from CHD. WHR was a strong and independent predictor of CVD or CHD death in both men and women. Previous CHD in men and women, current smoking in women, and diastolic BP and triglycerides in men were also risk factors for CVD or CHD death. Such traditional risk factors as low density lipoprotein, high density lipoprotein, and presence of diabetes were not found to be independent predictors.

Monitoring progress towards improvement in HIV care for those newly diagnosed in Queensland, Australia Viral suppression was more common among older age-groups and individuals with lower CD4 counts (<350cell/ L) at diagnosis, and lower among those with another BBV or STI pre/at diagnosis, and injecting drug users (IDUs). B Background: b Shortening the time to viral suppression after HIV diagnosis reduces morbidity and transmission. [Extracted from the article]

Purpose: There is limited evidence to guide therapists in home modification outcome evaluation. Involving consumers in evaluating home modifications is critical to progressing practice. This study investigated the home modification experience and outcomes most valued by older adults and individuals with a disability in Australia., Materials and Methods: An interpretive description approach was used. Twenty participants aged 24-93 who had received major home modifications were interviewed and transcripts were analysed thematically., Results: Two major themes emerged: life before and during modifications - "it was all hard," and life after modifications - "to have a life." People's prior experience of home, the circumstance of and time to plan modifications, the perceived value of the modifications, and the home modification process and funding influenced perceptions of outcomes. Valued home modification outcomes included those that enable people to experience emotional and physical health, and safety; do what they want; maintain the image of the home; and plan for the future. Experiences and perceptions of modifications ranged from supportive to disruptive., Conclusions: These findings point to the need for therapists to deeply understand and evaluate their clients' experiences of home and life as an initial and critical step in the home modification process.Implications for rehabilitationMajor home modifications result in broad and meaningful outcomes of importance to clients.Occupational therapists need to partner with clients to understand their life before and during modifications to achieve positive outcomes.Evaluation of major home modifications needs to be integrated and prioritised in daily practice.

Background/aim: Although sensory approaches are recommended to relieve distress and agitation and reduce the use of seclusion and restraint, many Australian psychiatric units have struggled to sustain their practice. The aim of this study was to investigate the barriers and enablers influencing the use of different sensory approaches across one health region in Australia and to obtain recommendations for strategies to improve their use., Method: This cross-sectional survey was informed by the Theoretical Domain Framework. Likert scale questions considered barriers and enablers to the use of non-weighted sensory interventions, weighted modalities, sensory rooms, and sensory assessments/plans. Open-ended questions explored participant concerns and recommendations to improve the use of sensory approaches., Results: Participants (n = 211) were from nursing, allied health, medical, and peer support staff across inpatient psychiatric units. Factors most frequently identified as enablers for using sensory approaches were beliefs of positive benefits to consumers (e.g. decreasing distress and agitation); belief it was within the staff's role; and knowledge of the approaches. Limited time was the most common identified barrier. Factors statistically associated with more frequent use were knowledge, skills, confidence, availability, and easy access to sensory tools/equipment. Only 30% of participants were concerned about potential risks of sensory approaches, with this risk mitigated through adequate supervision and thorough risk assessment. Recommendations to improve practice included improved access to, and maintenance of, equipment, more training, and increased staffing., Conclusion: This study revealed how barriers and enablers vary for different sensory approaches and how these factors impact their frequency of use in psychiatric units. It provides insights into staff recommendations to improve the use of sensory approaches in one health region in Australia. This knowledge will lead to the development of implementation strategies to address identified barriers and improve the use of sensory approaches in psychiatric units., (© 2023 The Authors. Australian Occupational Therapy Journal published by John Wiley & Sons Australia, Ltd on behalf of Occupational Therapy Australia.)

Background: The COVID-19 pandemic triggered a rapid scale-up of telehealth services in Australia as a means to provide continued care through periods of physical restrictions. The factors that influence engagement in telehealth remain unclear., Objective: The purpose of this study is to understand the experience of Australian people who engaged in a telehealth consultation during the pandemic period (2020-2021) and the demographic factors that influence engagement., Methods: A web-based survey was distributed to Australians aged over 18 years that included 4 questions on frequency and type of clinical consultation, including with a general practitioner (GP), specialist, allied health, or nurse; 1 question on the experience of telehealth; and 2 questions on the quality of and satisfaction with telehealth. Statistical analysis included proportion of responses (of positive responses where a Likert scale was used) and regression analyses to determine the effect of demographic variables., Results: Of the 1820 participants who completed the survey, 88.3% (1607/1820) had engaged in a health care consultation of some type in the previous 12 months, and 69.3% (1114/1607) of those had used telehealth. The most common type of consultation was with a GP (959/1114, 86.1%). Older people were more likely to have had a health care consultation but less likely to have had a telehealth consultation. There was no difference in use of telehealth between metropolitan and nonmetropolitan regions; however, people with a bachelor's degree or above were more likely to have used telehealth and to report a positive experience. A total of 87% (977/1114) of participants agreed or strongly agreed that they had received the information they required from their consultation, 71% (797/1114) agreed or strongly agreed that the outcome of their consultation was the same as it would have been face-to-face, 84% (931/1114) agreed or strongly agreed that the doctor or health care provider made them feel comfortable, 83% (924/1114) agreed or strongly agreed that the doctor or health care provider was equally as knowledgeable as providers they have seen in person; 57% (629/1114) of respondents reported that they would not have been able to access their health consultation if it were not for telehealth; 69% (765/1114) of respondents reported that they were satisfied with their telehealth consultation, and 60% (671/1114) reported that they would choose to continue to use telehealth in the future., Conclusions: There was a relatively high level of engagement with telehealth over the 12 months leading up to the study period, and the majority of participants reported a positive experience and satisfaction with their telehealth consultation. While there was no indication that remoteness influenced telehealth usage, there remains work to be done to improve access to older people and those with less than a bachelor's degree., (©Elizabeth Thomas, Crystal Man Ying Lee, Richard Norman, Leanne Wells, Tim Shaw, Julia Nesbitt, Isobel Frean, Luke Baxby, Sabine Bennett, Suzanne Robinson. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.08.2023.)

Background: Prior to implementing new programmes or practices, it is essential to understand the context, barriers and enablers to support successful use. The tailored activity programme (TAP) is an evidence-based intervention provided by occupational therapists to support community-dwelling people living with dementia and their carers. The programme was developed in the United States, and although it is not currently available for routine use in Australia, its implementation would address the needs of many Australians with dementia and their carers., Aim: The aim of the study is to understand the perspectives of occupational therapists and their managers regarding barriers and enablers to the delivery and implementation of the TAP in Queensland, Australia., Methods: A qualitative descriptive methodology was employed. Semistructured interviews were undertaken with occupational therapists (n = 18) who work with community-dwelling people with dementia and their carers, and their managers (n = 10). Participants were recruited from a range of organisations across Queensland, and they were asked about potential barriers and enablers to implementing TAP. Interviews were recorded and transcribed verbatim. Data were mapped using framework analysis whilst remaining open to other themes., Findings: Themes were identified, and facilitating factors included the close alignment of TAP with occupational therapists' scope of practice; their acceptance of, and optimism about the programme and its perceived benefits including improved client outcomes; and an opportunity for occupational therapists to further develop their skills. Managerial support and carers' readiness and willingness to participate were also identified as important factors for success, whereas barriers were cost to clients and the capacity of the occupational therapy workforce to provide TAP., Conclusion: Occupational therapists and their managers expressed enthusiasm for TAP and awareness of its likely benefits, while also identifying barriers that will need to be addressed if implementation of the programme is to be successful in Australia., (© 2022 The Authors. Australian Occupational Therapy Journal published by John Wiley & Sons Australia, Ltd on behalf of Occupational Therapy Australia.)

Aboriginal and Torres Strait Islander LGBTIQ+ peoples face an elevated risk for poor health and social-emotional wellbeing, suggesting that this patient group are likely to attend health and community services. However, the current practices of those who deliver care to Aboriginal and Torres Strait Islander LGBTIQ+ peoples are unknown. Utilising mixed methods (survey; n = 197; focus groups and interviews; n = 56), we explored the current practices, confidence, knowledge, and training needs for working with Aboriginal LGBTIQ+ clients among Western Australian health and community service workers. Participants were predominately from the mental health and social-emotional wellbeing care sector. One-third of survey participants indicated that it was likely Aboriginal LGBTIQ+ peoples accessed their service. On average, participants reported high confidence and knowledge in working with Aboriginal LGBTIQ+ clients. Qualitative data indicated that staff struggled to accommodate what they understood to be the needs of clients who were both Aboriginal and/or Torres Strait Islander and LGBTIQ+, despite a willingness to 'get it right'. Findings provide the first-ever snapshot of inclusive practices among health and social support workers in Western Australia.

Translation of evidence into practice in healthcare is challenging, particularly with new innovations. Indocyanine Green (ICG) lymphography is a novel innovation where the superficial lymphatics are imaged to provide information about lymphoedema diagnosis and to guide individualised therapy for a person's long-term chronic management of lymphoedema, supporting care across the continuum to the community setting. Despite the unique information ICG lymphography provides, the technology itself is complex and highly specialised and currently has limited adoption in clinical practice. This paper sought to determine the barriers and enablers to establishing an ICG lymphography clinic within an outpatient lymphoedema service by exploring staff perceptions and experiences. An interpretive descriptive design was used with semi-structured interviews of key staff participants from a quaternary public hospital six months after ICG lymphography clinic establishment. An interview guide was developed, underpinned by the Consolidated Framework for Implementation Research (CFIR), to guide the inquiry. Interview data were transcribed, inductively coded and analysed to identify themes. All eligible management, clinical and ancillary staff were included (N = 8). Four key themes were identified from the data as essential to implementation success. These were support is critical for implementation; beliefs about the technology; practicalities are achievable; and sustainability for ongoing success. Themes were found to be interrelated and centred around support from staff and the organisation as a critical process facilitator. The study demonstrated an ICG lymphography clinic can be successfully established as part of an outpatient lymphoedema service. Key enablers related to positive staff attitudes and beliefs about ICG lymphography and its application. Future implementation sites may consider that although the complexity of this innovation creates process challenges, the use of an implementation framework can assist in identifying determinants of success for effective implementation to practice., (© 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.)

Background/aim: Australian guidelines and policies recommend the use of sensory approaches in mental health care. Nevertheless, many Australian psychiatric units report difficulty sustaining these approaches. To inform efforts to close the gap between recommendations and practice, the aim of this study was to understand the patterns of use of sensory approaches and what demographic and clinical factors influence their use, across one health region in Queensland, Australia., Methods: Using a cross-sectional survey design, a custom-designed questionnaire was distributed via email and in paper form to health professionals and peer support workers working in acute, secure, and community care psychiatric units across one health region. Information on demographics and the use of various sensory interventions was gathered utilising both open-ended and Likert scale questions., Results: Useable questionnaires were collected from 183 participants from various disciplines (77% nursing). The majority reported using sensory approaches with a limited number of consumers, and almost 9% never used the approach. Activity-based sensory interventions and sensory equipment were most often used, whereas sensory assessments, sensory plans, and sensory groups were least used. Sensory interventions were mainly used to reduce consumer anxiety and agitation and to assist with emotional regulation. Factors positively correlated with frequency of use for all interventions were discipline (occupational therapy); working in an acute inpatient unit; and training in sensory approaches. Age was negatively correlated with frequency of use only for weighted modalities., Conclusions: This study revealed that sensory approaches were used by most staff though with a limited proportion of consumers in psychiatric units in one large metropolitan health service. It provides insights into the factors influencing frequency of use, highlighting the importance of training in sensory approaches and access to occupational therapists. With this knowledge, we can work towards closing the gap between recommendations and the practice of sensory approaches., (© 2022 The Authors. Australian Occupational Therapy Journal published by John Wiley & Sons Australia, Ltd on behalf of Occupational Therapy Australia.)

Purpose: To explore the decision-making processes and experiences of acute and rehabilitation clinicians, regarding referral and acceptance of patients to rehabilitation after stroke., Materials and Methods: Multi-site rapid ethnography, involving observation of multidisciplinary case conferences, interviews with acute stroke and rehabilitation clinicians, and review of key documents within five (5) acute stroke units (ASUs) in Queensland, Australia. A cyclical, inductive content analysis was performed., Results: Seven key themes were identified, revealing the complex nature of post-stroke rehabilitation referral and acceptance decision making. Although the majority of clinicians felt that all patients could benefit from rehabilitation, they acknowledged this could not always be the case. Rehabilitation potential and goals were considered by clinicians, but decision making was impacted by ASU context and team processes, rehabilitation service availability and access procedures, and the relationships between the acute and rehabilitation clinicians. Patients and families were not actively involved in the decision-making processes., Conclusions: Post-stroke rehabilitation decision making in Queensland, Australia involves complex processes and compromise. Decisions are not based solely on patients' rehabilitation needs, and patients and families are not actively involved in the decision-making process. Mechanisms are required to streamline access procedures, and improve shared decision making with patients.IMPLICATIONS FOR REHABILITATIONReferral decision making for post-stroke rehabilitation is complex and not always based solely on patients' needs.Clear and straightforward access procedures and positive relationships between acute and rehabilitation clinicians have a positive impact on referral decision making.Stroke services should review their processes to ensure shared decision making is facilitated when patients require access to rehabilitation.

Background: Australia has seen a rapid uptake of virtual care since the start of the COVID-19 pandemic. We aimed to describe the willingness of consumers to use digital technology for health and to share their health information; and explore differences by educational attainment and area of remoteness., Methods: We conducted an online survey on consumer preferences for virtual modes of healthcare delivery between June and September 2021. Participants were recruited through the study's partner organisations and an online market research company. Australian residents aged ≥18 years who provided study consent and completed the survey were included in the analysis. We reported the weighted percentages of participants who selected negative response to the questions to understand the size of the population that were unlikely to adopt virtual care. Age-adjusted Poisson regression models were used to estimate the prevalence ratios for selecting negative response associated with education and remoteness., Results: Of the 1778 participants included, 29% were not aware of digital technologies for monitoring/supporting health, 22% did not have access to technologies to support their health, and 19% were not willing to use technologies for health. Over a fifth of participants (range: 21-34%) were not at all willing to use seven of the 15 proposed alternative methods of care. Between 21% and 36% of participants were not at all willing to share de-identified health information tracked in apps/devices with various not-for-profit organisations compared to 47% with private/for-profit health businesses. Higher proportions of participants selected negative response to the questions in the lower educational attainment groups than those with bachelor's degree or above. No difference was observed between area of remoteness., Conclusions: Improving the digital health literacy of people, especially those with lower educational attainment, will be required for virtual care to become an equitable part of normal healthcare delivery in Australia., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

There is currently limited evidence on parents' and early childhood educators' perspectives on implementing programs that combine cognitive and motor tasks in early childhood. An online survey was distributed across Australia through social network platforms and emails at preschool centres, asking 65 parents of preschool children and early childhood educators about their preferences on program delivery, duration, and mode. Responses from the survey were evaluated in order to develop and pilot a 4 week home-based ( n = 5 parents) and a 6 week school-based program ( n = 5 educators) including cognitively engaging physical activity, requesting parents' and educators' perspectives, respectively, about the program components. Results from the online survey showed a preference for programs with online (e.g., video-based) compared to traditional delivery (e.g., books), emphasising the potential benefits on children's physical activity levels, sleep, and cognitive function. However, after piloting the program, educators preferred to use the book version instead of the video. This program has the potential to become part of daily regular practice. Barriers reported include logistics issues (i.e., book size), connectivity issues with internet, and the need for varying activities.

Clinical guidelines and policies worldwide call for sensory modulation approaches to be incorporated into inpatient mental health care to assist in eliminating the use of restrictive practices. Although increasing evidence shows that these approaches reduce patient distress and the need for seclusion and restraint, sensory modulation approaches have been challenging to implement in many psychiatric units. Implementation strategies can effectively support inclusion of new approaches by addressing potential barriers to change and supporting likely enabling factors. This study aimed to gain a better understanding of the barriers and enablers influencing implementation of sensory modulation approaches in psychiatric inpatient units in one health region in Australia. A qualitative descriptive study design was used, with three focus groups and a total of 15 participants from nursing and allied health disciplines answering questions about the use of sensory modulation approaches. Framework analysis using the Theoretical Domains Framework and thematic analysis was used to analyse data. Overall, participants were positive about the use of sensory modulation approaches, particularly for reducing distress. Four domains (Social Influences; Belief about Consequences; Professional Role and Identify; and Environmental Context and Resources) were identified as the most salient. The key influencing factors were support from peers; beliefs about risks; belief it was part of their role; and availability of resources and materials. Numerous challenges and opportunities related to implementing sensory modulation approaches in mental health inpatient units, identified in this study, provide insights to support effective implementation of these approaches, underpinning more person-centred, trauma-informed, and recovery-orientated care., (© 2020 Australian College of Mental Health Nurses Inc.)

This scoping review provides a summary of research findings on social support dynamics in the wake of disasters that occurred on the continent of Australia and Oceania between 1983 and 2013. Forty-one studies, quantitative and qualitative, were summarised, investigating different facets of post-disaster supportive interactions. All inquiries assessed disasters resulting from natural hazards, with the majority of them conducted following events in Australia and New Zealand. The review revealed similar patterns of post-disaster social support dynamics that routinely unfold after disastrous incidents all over the world. Consistent with the disaster mental health literature, the documentation of social support mobilisation and social support deterioration processes was common. Salutary direct effects of supportive behaviours on post-disaster psychological distress were also highly evident. Most studies, however, posed research questions or hypotheses that lacked empirical or theoretical grounding. In conclusion, the review offers several recommendations on how to advance research on post-disaster social support., (© 2019 The Authors Disasters © 2019 Overseas Development Institute.)

Vertical transmission from mother-to-child is an important mode of hepatitis B virus (HBV) infection, accounting for up to half of all incident cases globally. We evaluated the uptake of HBV neonatal vaccination and immunoglobulin delivery in Queensland, Australia, between 2001 and 2013. We identified HBV-positive mothers using linked notifiable conditions, hospitalisation, and perinatal administrative data. Perinatal receipt of monovalent HBV vaccine and hepatitis B immunoglobulin were examined. Of 710,859 live births, with 5753 infants (0.81%) born to identified HBV-positive mothers; 91.7% received HBV neonatal vaccine. Immunoglobulin uptake was 20.0% in 2012 and 36.6% in 2013. Uptake was higher when the mother's HBV-positive status was recorded in perinatal records (69.6% if maternal HBV status recorded on perinatal data collection vs 9.5% otherwise). Delivery of neonatal HBV vaccination in Queensland was high. Improved identification and documentation of HBV-positive mothers' status during the antenatal period was associated with increased immunoglobulin administration., (Copyright © 2019. Published by Elsevier Ltd.)

Objective: To examine outcomes of public health management of notified enteric fever cases in South-East Queensland over the past five years., Methods: Notification records of typhoid and paratyphoid infection in South-East Queensland 2008-2012 (inclusive) were reviewed to determine likelihood of cases and contacts adhering to present or previous recommendations for faecal clearance/screening, duration of infectiousness of cases and extent of local transmission to contacts., Results: Sixty-nine of 85 cases and 218 of 265 contacts submitted at least one faecal specimen. Cases were 2.7 (95%CI 1.2-6.0) and contacts were 4.4 (95%CI 3.0-6.4) times more likely to complete recommended faecal clearance/screening under previous compared to present guidelines (requiring more specimens). In ten cases with positive post-treatment specimens, last recorded infectiousness was 19 days to six months after notification. The documented rate of local transmission of infection was 18/1,000 contacts submitting at least one faecal specimen (95%CI 6-48/1,000)., Conclusions: Local transmission risk of enteric fever in South-East Queensland is low, although small numbers of cases may have prolonged bacilli excretion post-treatment. More complex clearance/screening regimens are associated with decreased compliance., Implications: Pursuing extensive faecal clearance/screening regimens is unlikely to be effective in terms of public health management of enteric fever in South-East Queensland. We suggest a unified national approach focussing on cases/contacts at high risk of disease transmission., (© 2015 Public Health Association of Australia.)

We introduce a dataset of biological, ecological, conservation and legal information for every species and subspecies of Australian bird, 2056 taxa or populations in total. Version 1 contains 230 fields grouped under the following headings: Taxonomy & nomenclature, Phylogeny, Australian population status, Conservation status, Legal status, Distribution, Morphology, Habitat, Food, Behaviour, Breeding, Mobility and Climate metrics. It is envisaged that the dataset will be updated periodically with new data for existing fields and the addition of new fields. The dataset has already had, and will continue to have applications in Australian and international ornithology, especially those that require standard information for a large number of taxa.

Species interactions are integral drivers of community structure and can change from competitive to facilitative with increasing environmental stress. In subtidal marine ecosystems, however, interactions along physical stress gradients have seldom been tested. We observed seaweed canopy interactions across depth and latitudinal gradients to test whether light and temperature stress structured interaction patterns. We also quantified interspecific and intraspecific interactions among nine subtidal canopy seaweed species across three continents to examine the general nature of interactions in subtidal systems under low consumer pressure. We reveal that positive and neutral interactions are widespread throughout global seaweed communities and the nature of interactions can change from competitive to facilitative with increasing light stress in shallow marine systems. These findings provide support for the stress gradient hypothesis within subtidal seaweed communities and highlight the importance of canopy interactions for the maintenance of subtidal marine habitats experiencing environmental stress., (© 2015 John Wiley & Sons Ltd/CNRS.)

Climate-mediated changes to biotic interactions have the potential to fundamentally alter global ecosystems. However, the capacity for novel interactions to drive or maintain transitions in ecosystem states remains unresolved. We examined temperate reefs that recently underwent complete seaweed canopy loss and tested whether a concurrent increase in tropical herbivores could be maintaining the current canopy-free state. Turf-grazing herbivorous fishes increased in biomass and diversity, and displayed feeding rates comparable to global coral reefs. Canopy-browsing herbivores displayed high (~ 10,000 g 100 m(-2) ) and stable biomass between 2006 and 2013. Tropical browsers had the highest abundance in 2013 and displayed feeding rates approximately three times higher than previously observed on coral reefs. These observations suggest that tropical herbivores are maintaining previously kelp-dominated temperate reefs in an alternate canopy-free state by grazing turfs and preventing kelp reestablishment. This remarkable ecosystem highlights the sensitivity of biotic interactions and ecosystem stability to warming and extreme disturbance events., (© 2015 John Wiley & Sons Ltd/CNRS.)

Background: Shared decision making is a crucial component of evidence-based practice, but a lack of training in the "how to" of it is a major barrier to its uptake., Objective: To evaluate the effectiveness of a brief intervention for facilitating shared decision making skills in clinicians and student clinicians., Design: Multi-centre randomized controlled trial., Participants: One hundred and seven medical students, physiotherapy or occupational therapy students undertaking a compulsory course in evidence-based practice as part of their undergraduate or postgraduate degree from two Australian universities., Intervention: The 1-h small-group intervention consisted of facilitated critique of five-step framework, strategies, and pre-recorded modelled role-play. Both groups were provided with a chapter about shared decision making skills., Main Measures: The primary outcome was skills in shared decision making and communicating evidence [Observing Patient Involvement (OPTION) scale, items from the Assessing Communication about Evidence and Patient Preferences (ACEPP) Tool], rated by a blinded assessor from videorecorded role-plays., Secondary Outcomes: confidence in these skills and attitudes towards patient-centred communication (Patient Practitioner Orientation Scale (PPOS))., Key Results: Of participants, 95 % (102) completed the primary outcome measures. Two weeks post-intervention, intervention group participants scored significantly higher on the OPTION scale (adjusted group difference = 18.9, 95 % CI 12.4 to 25.4), ACEPP items (difference = 0.9, 95 % CI 0.5 to 1.3), confidence measure (difference = 13.1, 95 % CI 8.5 to 17.7), and the PPOS sharing subscale (difference = 0.2, 95 % CI 0.1 to 0.5). There was no significant difference for the PPOS caring subscale., Conclusions: This brief intervention was effective in improving student clinicians' ability, attitude towards, and confidence in shared decision making facilitation. Following further testing of the longer-term effects of this intervention, incorporation of this brief intervention into evidence-based practice courses and workshops should be considered, so that student clinicians graduate with these important skills, which are typically neglected in clinician training.

Background: Training for Australian general practice, or family medicine, can be isolating, with registrars (residents or trainees) moving between rural and urban environments, and between hospital and community clinic posts. Virtual communities of practice (VCoPs), groups of people sharing knowledge about their domain of practice online and face-to-face, may have a role in overcoming the isolation associated with general practice training., Objective: This study explored whether Australian general practice registrars and their supervisors (trainers) would be able to use, and would be interested in using, a VCoP in the form of a private online network for work and training purposes. It also sought to understand the facilitators and barriers to intention to use such a community, and considers whether any of these factors may be modifiable., Methods: A survey was developed assessing computer, Internet, and social media access and usage, confidence, perceived usefulness, and barriers, facilitators, and intentions to use a private online network for training purposes. The survey was sent by email link to all 139 registrars and 224 supervisors in one of Australia's 17 general practice training regions. Complete and usable responses were received from 131 participants (response rate=0.4)., Results: Most respondents had access to broadband at home (125/131, 95.4%) and at work (130/131, 99.2%). Registrars were more likely to spend more than 2 hours on the Internet (P=.03), and to use social media sites for nonwork purposes (P=.01). On a 5-point Likert scale, confidence was high (mean 3.93, SD 0.63) and was negatively associated with higher age (P=.04), but not associated with training stage. Social media confidence was lower, with registrars more confident than supervisors for almost all social media activities. On a 5-point Likert scale, overall usefulness was scored positively (n=123, mean 3.63, SD 0.74), and was not significantly associated with age or training level. The main concerns of respondents were worries about privacy (registrar: 61/81, 75.3%; supervisor: 30/50, 60.0%) and insufficient time (registrar: 41/81, 50.6%; supervisor: 36/50, 72.0%). Using a multivariate generalized linear regression model, training stage and perceived usefulness were positively predictive, and concerns about privacy and time were negatively predictive of intention to use a private online network., Conclusions: General practice registrars and supervisors are interested in using a private online network, or VCoP, for work and training purposes. Important considerations are the extent to which concerns such as privacy and usefulness may be overcome by training and support to offset some other concerns, such as time barriers. Participants at an early stage in their training are more receptive to using an online network. More senior registrars and supervisors may benefit from more training and promotion of the online network to improve their receptiveness.

General practice training is a community of practice in which novices and experts share knowledge. However, there are barriers to knowledge sharing for general practioner (GP) registrars, including geographic and workplace isolation. Virtual communities of practice (VCoP) can be effective in overcoming these barriers using social media tools. The present study examined the perceived usefulness, features and barriers to implementing a VCoP for GP training. Following a survey study of GP registrars and supervisors on VCoP feasibility, a qualitative telephone interview study was undertaken within a regional training provider. Participants with the highest Internet usage in the survey study were selected. Two researchers worked independently conducting thematic analysis using manual coding of transcriptions, later discussing themes until agreement was reached. Seven GP registrars and three GP supervisors participated in the study (average age 38.2 years). Themes emerged regarding professional isolation, potential of social media tools to provide peer support and improve knowledge sharing, and barriers to usage, including time, access and skills. Frequent Internet-using GP registrars and supervisors perceive a VCoP for GP training as a useful tool to overcome professional isolation through improved knowledge sharing. Given that professional isolation can lead to decreased rural work and reduced hours, a successful VCoP may have a positive outcome on the rural medical workforce.

Despite high diversity and abundance of nominally herbivorous fishes on coral reefs, recent studies indicate that only a small subset of taxa are capable of removing dominant macroalgae once these become established. This limited functional redundancy highlights the potential vulnerability of coral reefs to disturbance and stresses the need to assess the functional role of individual species of herbivores. However, our knowledge of species-specific patterns in macroalgal consumption is limited geographically, and there is a need to determine the extent to which patterns observed in specific reefs can be generalised at larger spatial scales. In this study, video cameras were used to quantify rates of macroalgae consumption by fishes in two coral reefs located at a similar latitude in opposite sides of Australia: the Keppel Islands in the Great Barrier Reef (eastern coast) and Ningaloo Reef (western coast). The community of nominally herbivorous fish was also characterised in both systems to determine whether potential differences in the species observed feeding on macroalgae were related to spatial dissimilarities in herbivore community composition. The total number of species observed biting on the dominant brown alga Sargassum myriocystum differed dramatically among the two systems, with 23 species feeding in Ningaloo, compared with just 8 in the Keppel Islands. Strong differences were also found in the species composition and total biomass of nominally herbivorous fish, which was an order of magnitude higher in Ningaloo. However, despite such marked differences in the diversity, biomass, and community composition of resident herbivorous fishes, Sargassum consumption was dominated by only four species in both systems, with Naso unicornis and Kyphosus vaigiensis consistently emerging as dominant feeders of macroalgae.

Background/aim: Dementia significantly impacts on the individual's and caregiver's quality of life. The aim of this study was to describe Australian occupational therapy practice with people with dementia., Methods: A questionnaire was piloted and sent to occupational therapists in Australia working with people with dementia. Participants were recruited in one of three ways: (i) identified by OT AUSTRALIA as working in aged care; (ii) through dementia-specific facilities in Australia; or (iii) through occupational therapy aged care list serves. The questionnaire asked occupational therapists about referrals received, assessments and interventions used, perceived barriers to the delivery of interventions and perceived educational needs. Data were analysed descriptively and presented as frequencies and percentages., Results: One hundred and thirty-four occupational therapists responded to this survey. Referrals were predominantly for environmental modification, home assessment or falls prevention and for assessment of activities of daily living. Therapists spent most of their time on assessment, with brief cognitive and functional assessments used most frequently. The most common interventions were environmental modification advice and prescription of assistive equipment. Lack of time was the most commonly reported barrier to the delivery of interventions with therapists also identifying concerns about staffing and role restrictions imposed by organisations. Therapists also identified that further training in this area would be useful., Conclusions: Therapists working in dementia care indicated that they are constrained in terms of time, staffing and organisational restrictions. Recommendations include enhanced training, further research into the most viable occupational therapy interventions, and advocating for improved funding, staffing and resources., (© 2011 The Authors. Australian Occupational Therapy Journal © 2011 Australian Association of Occupational Therapists.)

In Australia, little research has been undertaken on the development of clinical practice guidelines (CPGs) to assist with the impact of postdeployment ill-health including medically unexplained symptoms (MUS) and it has been unclear whether such a development is desired by Australian primary care practitioners. In response an empirical investigation into the perceptions and experiences of 24 medical officers from the Australian military with regard to postdeployment ill-health, medically unexplained symptoms, and the potential development of CPGs in this area was undertaken. The analysis suggests that although MUS are accepted as common in general practice they are not perceived by practitioners to be as prevalent in the Australian Defense Forces. Although the medical officers do not perceive clinical practice guidelines as the best tool for managing MUS, there was interest in the development of practical tools to assist in the diagnosis of medically unexplained symptoms. The response by practitioners is of critical importance for the potential implementation of clinical practice guidelines in this area.

Background: Online evidence databases can provide access to high quality evidence at the point of care, making evidence-based practice more achievable. A discipline-specific online bibliographic database called OTseeker (www.otseeker.com) was designed for use by occupational therapists. The database is free, and contains citations and abstracts of systematic reviews, and critically appraised randomized controlled trials relevant to occupational therapy., Objectives: The aim of this study was to investigate search practices of database users, their views on its functionality, and the reported impact, if any, on their practice from using OTseeker., Design: An online survey, placed on the database website for 30 days., Sample: Potential participants were users of OTseeker during a 30-day period. A total of 498 people who had used the database more than once from over 40 countries completed the survey., Results: Three hundred and nine (62%) participants believed that OTseeker had improved their ability to locate research about the effectiveness of occupational therapy interventions, and 92 (19%) agreed that the information in the database had contributed to a change in practice. Those reporting no practice changes agreed that use of OTseeker had improved their knowledge generally (n=189; 38%), confirmed their practice (n=75; 15%), or revealed that there was insufficient research relevant to their search topic (n=92; 19%). Features of the database which helped respondents locate research evidence included: having discipline-specific content, providing critical appraisal ratings for randomized controlled trials, and presenting search results ranked for methodological quality., Conclusion: This study confirms the value of a discipline-specific, online database for helping occupational therapists locate high quality research evidence. Information located on databases such as OTseeker can help change or confirm practice, and improve knowledge.

Rationale and Aims: 'OTseeker' is an online database of randomized controlled trials (RCTs) and systematic reviews relevant to occupational therapy. RCTs are critically appraised and rated for quality using the 'PEDro' scale. We aimed to investigate the inter-rater reliability of the PEDro scale before and after revising rating guidelines., Methods: In study 1, five raters scored 100 RCTs using the original PEDro scale guidelines. In study 2, two raters scored 40 different RCTs using revised guidelines. All RCTs were randomly selected from the OTseeker database. Reliability was calculated using Kappa and intraclass correlation coefficients [ICC (model 2,1)]., Results: Inter-rater reliability was 'good to excellent' in the first study (Kappas >or= 0.53; ICCs >or= 0.71). After revising the rating guidelines, the reliability levels were equivalent or higher to those previously obtained (Kappas >or= 0.53; ICCs >or= 0.89), except for the item, 'groups similar at baseline', which still had moderate reliability (Kappa = 0.53). In study 2, two PEDro scale items, which had their definitions revised, 'less than 15% dropout' and 'point measures and variability', showed higher reliability. In both studies, the PEDro items with the lowest reliability were 'groups similar at baseline' (Kappas = 0.53), 'less than 15% dropout' (Kappas

The 1983 National Dietary Survey of Adults and the 1983 Risk Factor Prevalence Survey No. 2, conducted on the same subjects, provided an opportunity to examine the nutrient intakes of smokers (1024 men and 785 women) and nonsmokers (1974 men and 2421 women). The nutrients analysed were energy (kJ); fat (g/day and contribution to energy); starch (contribution to energy); dietary fibre (g/day and g/1000 kJ); alcohol (g/1000 kJ); polyunsaturated/saturated fats ratio; cholesterol, niacin, vitamin C, calcium, iron, zinc and magnesium (mg/1000 kJ); and vitamin A, thiamin and riboflavin (microgram/1000 kJ). For both men and women, nonsmokers have a significantly higher intake of starch, dietary fibre (g/day and g/1000 kJ), thiamin, vitamin C, calcium and magnesium than smokers, who have a significantly higher intake of alcohol. Male smokers also have a higher intake of energy and cholesterol, but a lower intake of riboflavin, than nonsmokers. These differences in nutrient intakes suggest that nonsmokers consume a more nutritious diet than smokers, in regard to having a higher intake of fruit and vegetables, wholegrain cereals and milk and milk products. There is a highly statistically significant association between smoking status and hazardous intake of alcohol. Both men and women who smoke have a significantly lower body mass index (BMI), than nonsmokers or ex-smokers.

Background: During the 1970s in Australia, mortality from coronary heart disease (CHD) and stroke was higher among lower socioeconomic groups and inequalities were widening. This analysis examines subsequent trends in socioeconomic inequalities, with reference to socioeconomic patterns in major cardiovascular risk factors., Methods: Socioeconomic status was defined by occupation. Age-standardized mortality rates were calculated for men aged 25-64, using death registration data and labour force estimates for 1979-1993. Risk factor data were taken from three cross-sectional population surveys conducted in 1980, 1983 and 1989., Results: Men in manual occupations were at least 35 percent more likely to die from CHD than men in professional occupations and 60 percent more likely to die from stroke. Their 5-year population risk of a coronary event was 30 percent higher. Since 1979, both groups experienced reductions in coronary risk and mortality., Conclusions: Socioeconomic inequalities in CHD mortality continued to widen during the early 1980s, stabilized thereafter and persisted into the 1990s. Decreases in blood pressure and smoking prevalence contributed most to declines in coronary risk and to socioeconomic differentials.

Study Objective: To examine trends in socioeconomic inequalities in cardiovascular risk factors using educational attainment to indicate socioeconomic status., Design: Behavioural data, physical measurements, blood pressure, and lipid determination collected in three, successive multicentre cross sectional community surveys conducted in 1980, 1983, and 1989., Setting: The six state capital cities of Australia; Sydney, Melbourne, Brisbane, Adelaide, Perth, and Hobart., Participants: A total of 19,315 randomly selected respondents stratified by age (25-44, 45-64) and sex., Results: During the 1980s, average blood pressure declined for each level of educational attainment. Dietary messages to reduce the intake of saturated fat had little effect on the lipid profile of any population group. Height and educational attainment were positively associated. Women increased in weight from between 2 to 4 kg depending on age and educational attainment while older men experienced increases of around 2.5 kg regardless of educational attainment. Advice to avoid salt was adopted across the spectrum of educational attainment but with no suggestion that the socioeconomic gradient, which favoured the more highly educated, was diminishing. Men of all education levels responded positively to the anti-smoking initiatives of the 1980s but the relative disadvantage of those of lower education was maintained. Among women, the decline in smoking was less among those in the low education group. The prevalence of moderate to heavy drinkers was higher in men of lower educational attainment but declined significantly over the period. Walking for recreation or exercise became more popular, especially among older men of low education, while the prevalence of aerobic exercise and vigorous exercise remained largely unchanged. Overall, the clear socioeconomic gradient between leisure time physical activity and education attainment remained., Conclusions: The lower socioeconomic group has improved its risk factor profile but its relative disadvantage compared with the higher socioeconomic group persists. Health promotion activities in Australia seem to have been effective in reaching the lower socioeconomic groups but the challenge to reduce inequalities remains. The steady increase in educational attainment in Australia may have been an important factor in the general improvement in the nation's risk factor profile and in the decrease in mortality from coronary heart disease.

The measurement of blood pressure in epidemiological studies is difficult to standardize between centres in multi-centre studies and between repeat surveys over time. The use of standard mercury sphygmomanometers is common but especially prone to measurement error in terms of departure from the protocol and variation in measurement technique. Data from Australia's cardiovascular risk factor prevalence surveys on 21 independent populations, distributed geographically and temporally, has been examined to assess the effect of these errors on cross-sectional and trend analyses. The examination showed that last digit preference for zero may inflate estimates of proportions having high blood pressure. A tendency to record identical duplicate measurements could contribute 0.85 mmHg to time trends or geographic differences in mean systolic blood pressure (but not diastolic blood pressure). Epidemiological studies for geographic and trend differentials in systolic blood pressure need to be mindful of these effects in their analysis. There was some evidence of deterioration in data quality during data collection but no evidence that observers were influenced in their recording practice by observable respondents' characteristics. Training procedures for blood pressure measurement are of critical importance and adherence to the measurement protocol should be continuously monitored during data collection to ensure comparability of results.

Inequalities in biomedical and life-style risk factors for cardiovascular disease were examined for 6,116 immigrants to Australia and 14,941 people born in Australia, using data collected in the 1980, 1983 and 1989 risk-factor prevalence surveys. After adjusting for age and study design, significant differences were identified between immigrant groups and the Australian-born reference group, particularly for systolic blood pressure, overall obesity and behavioural risk factors. There were few substantial differences in blood lipid concentrations and little evidence to suggest that total plasma cholesterol has played a major role in lower cardiovascular mortality among immigrants. Overall, the results suggested that profiles of risk factors commonly accepted as determinants of cardiovascular disease are an insufficient explanation of the lower standardised mortality ratios from cardiovascular disease which characterise immigrants in Australia. Systolic blood pressure best explained variation in cardiovascular mortality among male immigrants, and smoking prevalence among female immigrants. The acculturation process affected immigrant groups differently. Generally, systolic blood pressure increased with period in Australia. Body mass index increased among Asian immigrants, as did participation in physical activity during leisure time.

A national survey covering all States and Territories was conducted in urban and rural schools to determine the iron status of Australian children and adolescents. This article reports the results of blood analyses for 1696 schoolchildren aged 9, 12 and 15 years. The measures of iron status analysed were plasma levels of iron, transferrin and ferritin. Results for all of these measures were available for 1204 of the schoolchildren for whom iron status was assessed based on the plasma ferritin and transferrin saturation model. Iron status was generally satisfactory in the 9, 12 and 15 year old boys and the 9 and 12 year old girls. There was a marked and statistically significantly higher prevalence of iron deficiency among the 15 year old girls. These results are discussed in relation to the food and nutrient intakes of 12 and 15 year old children who also participated in the 1985 National Dietary Survey of Schoolchildren.