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Introduction In Australia, suicide is the leading cause of death for people aged 15–44 years. Health professionals deliver most of our key suicide prevention strategies via health services, but other efficacious population-level strategies include means restriction and public awareness campaigns. Currently, we have no population-level data allowing us to determine which individuals, in what parts of Australia, are likely to use our most promising interventions delivered by health services. The aims of this study are to describe: (1) health service utilisation rates in the year prior to death by suicide, and how this varies by individual case characteristics; (2) prescribed medicines use in the year prior to death by suicide, medicines used in suicide by poisoning and how this varies by individual case characteristics.Methods and analysis This is a population-based case series study of all suicide cases in Australia identified through the National Coronial Information System (NCIS) from 2013 to 2019. Cases will be linked to administrative claims data detailing health service use and medicines dispensed in the year before death. We will also obtain findings from the coronial enquiry, including toxicology. Descriptive statistics will be produced to characterise health service and prescribed medicine use and how utilisation varies by age, sex, method of death and socioeconomic status. We will explore the geographical variability of health service and medicine use, highlighting regions in Australia associated with more limited access.Ethics and dissemination This project involves the use of sensitive and confidential data. Data will be linked using a third-party privacy-preserving protocol meaning that investigators will not have access to identifiable information once the data have been linked. Statistical analyses will be carried out in a secure environment. This study has been approved by the following ethics committees: (1) the Justice Department Human Research Ethics Committee (REF: CF/17/23250), (2) the Western Australian Coroners Court (REF: EC 14/18 M0400), (3) the Australian Institute of Health and Welfare (REF: EO2017/4/366) and (4) NSW Population & Health Services Research Ethics Committee (REF: 2017/HRE1204). Findings will be published in peer-reviewed journals, presented at conferences and communicated to regulatory authorities, clinicians and policy-makers.

Summary: Background: Suicide prevention requires a shift from relying on an at-risk individual to engage with the healthcare system. Understanding patterns of healthcare engagement by people who have died by suicide may provide alternative directions for suicide prevention. Methods: This is a population-based case-series study of all suicide decedents (n = 3895) in New South Wales (NSW), Australia (2013–2019), with linked coronial, health services and medicine dispensing data. Healthcare trajectories were identified using a k-means longitudinal 3d analysis, based on the number and type of healthcare contacts in the year before death. Characteristics of each trajectory were described. Findings: Five trajectories of healthcare utilisation were identified: (A) none or low (n = 2598, 66.7%), (B) moderate, predominantly for physical health (n = 601, 15.4%), (C) moderate, with high mental health medicine use (n = 397, 10.2%), (D) high, predominantly for physical health (n = 206, 5.3%) and E) high, predominantly for mental health (n = 93, 2.4%). Given that most decedents belonged to Trajectory A this suggests a great need for suicide preventive interventions delivered in the community, workplace, schools or online. Trajectories B and D might benefit from opioid dispensing limits and access to psychological pain management. Trajectory C had high mental health medicine use, indicating that the time that medicines are prescribed or dispensed are important touchpoints. Trajectory E had high mental health service predominantly delivered by psychiatrists and community mental health, but limited psychologist use. Interpretation: Although most suicide decedents made at least one healthcare contact in the year before death, contact frequency was overall very low. Given the characteristics of this group, useful access points for such intervention could be delivered through schools and workplaces, with a focus on alcohol and drug intervention alongide suicide awareness. Funding: Australia’s National Health and Medical Research Council.

Background: Texting has become central to social life, with adverse effects on physiological functioning. Research into the impact of texting on cortisol secretion is limited. Aim: Thus study aimed to determine how receiving mobile text messages affected salivary cortisol concentrations and investigate the moderating effects of stress, anxiety and depression on cortisol secretion. Setting: Undergraduate physiology students attending physiology lectures at the Faculty of Health Sciences, University of the Free State, 2016. Methods: An experimental, crossover, quantitative design was used. Participants were involved over two consecutive days, receiving mobile text messages (intervention) on one day and acting as their own control on the other. Self-reported data on stress, anxiety, depression and subjective experience of the study, and saliva samples were collected. Text frequency and wording (neutral, positive, negative) were varied among participants. Results: Forty-eight students participated in the study. Salivary cortisol concentrations did not differ significantly between the intervention and control days. High anxiety levels were associated with increased cortisol concentrations. No associations with cortisol concentrations were documented in low to moderate anxiety, stress, depression or how participants experienced the intervention. There were no significant differences between text frequency, text emotion and change in cortisol concentrations on the intervention day. Conclusion: Receiving mobile text messages did not elicit a significant cortisol response in participants. Contribution: Findings added to the body of knowledge about the effect of texting on student learning by measuring salivary cortisol concentrations in a lecture setting, with investigation into the moderating effects of stress, anxiety, depression and participants’ subjective experience.

Background: The quality of support provided by preceptors should be optimal to develop students’ competence. We describe the validation of the measuring instrument to monitor support offered by preceptors during their accompaniment. Method: A quantitative survey design was used to validate the self-administered instrument. A sample of 346 s- and third-year undergraduate nursing students at two higher education nursing institutions provided 930 assessments of preceptor support, 750 which contained no missing data and were used for the analysis. Descriptive data analysis was conducted to determine the reliability and validity. Results: The Cronbach alpha coefficient showed high reliability (0.98) overall and for each subscale (0.95–0.97). The confirmatory factor analysis showed good fit (RMSEA = 0.057) with items measuring various elements of support loading strongly on their respective latent variables. Conclusion: The confirmatory factor analysis confirmed the instrument as fit for purpose to monitor preceptor support, specifically system, cognitive and emotional support.

Google Trends (GT) is a useful real-time surveillance tool for epidemic outbreaks such as monkeypox (Mpox). GT provides hour-by-hour (real-time) data for the last seven days of Google searches. Non-real-time data are a random sample that encompasses search trends from 2004 and up to 72 h. Google Health Trends (GHT) API extracts daily raw search probabilities relative to the time period and size of the underlying population. However, little is known about the utility of GT real-time surveillance and GHT API following the public health announcements. Thus, this study aimed to analyzed Mpox GT real-time, non-real-time, and GHT API data 72 h before and after the WHO declared Mpox a public health emergency of international concern (PHEIC) in the top five Mpox-affected countries. Joinpoint regression was used to measure hourly percentage changes (HPC) in search volume. The WHO PHEIC statement on Mpox generated 18,225.6 per 10 million Google searches in the U.S. and Germany (946.8), and in 0–4 h, the HPC increased by an average of 103% (95% CI: 37.4–200.0). This study showed the benefits of real-time surveillance and the GHT API for monitoring online demand for information on emerging infectious diseases such as Mpox.

Background: Musculoskeletal diseases (MSDs) are a major cause of disability worldwide. It is essential to address effective MSD management, including appropriate referrals to physiotherapists and other healthcare professionals. Limited information is available regarding the referral practices of medical practitioners for patients with MSD. The doctors’ referral practices to physiotherapists can impact the patient population and the South African health system. Objectives: To investigate or understand the referral practices of medical practitioners in Bloemfontein, South Africa, to physiotherapy services, for individuals living with MSD. Method: A quantitative study approach, implementing a semi-structured questionnaire, was used. Forty-nine participants completed the questionnaire. Results: The referral of patients with MSDs by medical practitioners to physiotherapy services varied and multidimensional factors influenced their referral practices. Medical practitioners were unsure of the specific role played by physiotherapists in the management of individuals living with MSD. A need for improved relationships and communication between medical practitioners and physiotherapists was identified. Conclusions: Medical practitioners regularly referred individuals living with MSD to physiotherapists, but referral practices should be optimised in terms of evidence-based practice and the use of specialised physiotherapy services. In an attempt to decrease the burden of MSD, adequate awareness should be created for improved referral practices between medical practitioners and physiotherapists. Clinical implications: Collaborative development of detailed guidelines for apt, evidence-based referrals should be developed, to ensure early detection and management of individuals living with MSD. Health care professionals should be educated and encouraged to refer individuals living with MSD to physiotherapists for appropriate management with clinical benefits including improvement of HRQOL and cost effectiveness of this management not only to the individual but also to the health system in South Africa. Physiotherapists should try to communicate their role in the treatment of individuals living with MSD to medical practitioners for the benefit of the patient.