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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.

To evaluate the secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the Townsville region, Australia.Adherence to benzathine benzylpenicillin G (BPG) was determined for 196 children and young adults aged under 22 years between January 2009 and December 2019, and factors associated with BPG adherence were analysed. Secondary outcomes included attendance at specialist reviews and echocardiograms.Adequate adherence (80%) to regular BPG injections was met by 51.1% of the cohort. Adequate BPG adherence more likely occurred for those that attended the Paediatric Outreach Clinic (OR4.15, 95%CI:2.13-8.05) or a school delivery program (OR1.87, 95%CI:1.11-3.45). People with moderate/severe RHD had greater BPG adherence (OR1.76,95%CI:1.00-3.10). People in rural/remote areas were less likely to have adequate BPG adherence compared to urban counterparts (OR0.31, 95%CI:0.15-0.65). Adherence to echocardiography was 66% and specialist review attendance was 12.5-50%.Half of the cohort in the Townsville region received adequate BPG prophylaxis to prevent ARF/RHD. Although rates were relatively higher than those reported in other Australian regions, health delivery goals should be close to 100%. Low attendance at specialist services was reported. Implication for public health: Delivery models with dedicated services, case management and family support could improve BPG adherence in individuals with ARF/RHD. Further resources in rural and remote areas are needed.

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.

Rheumatic heart disease, as a result of a single or recurrent episode of acute rheumatic fever (ARF), remains a significant cause of morbidity and mortality in northern and remote Australia; ARF has a peak incidence among 5-14-year-old Aboriginal and Torres Strait Islander children. Long-term regular benzathine penicillin G injections are the only currently successful secondary prevention strategy; however, rates of adherence remain critically low. In contrast, rates of adherence to immunisations on the National Immunisation Program (NIP) Schedule are high, even among this target population. This article compares strategies used to implement and improve ARF secondary prophylaxis with those used in the NIP. Some successful NIP strategies, such as Service Incentive Payment for health providers, home-visiting delivery models and integration into the National Immunisation Register, if applied to ARF secondary prophylaxis have the potential to improve benzathine penicillin G adherence.

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.

Objectives: To determine the knowledge of vacant country specialist positions, the main barriers to filling country specialist positions, the acceptance of hypothetical creative employment models and to gain understanding of what would it take for respondents to accept a country position. Methodology: Mailed self-report questionnaires to all 103 Queensland paediatricians and finishing paediatric trainees (response rate 93.1%) to explore reasons for the long-term vacancy of the Staff Paediatrician position at the Mount Isa Base Hospital, North-west Queensland, Australia. Results: Of the respondents, 87.4% were aware of the vacant position. The lack of adequate locum cover for leave (97.8%), on-call load (92.2%), professional isolation (91.4%), and family commitments (91.4%) were identified as the four most frequently recognized recruitment barriers. Of the respondents, 30.2% said they could be attracted to such a position if they were guaranteed the ability to return to their present post in 2 years, 30.7% said they could be attracted to a rural exchange, and 73.1% suggested the position would be more attractive to new Fellows if at the end of a 2-year period they were guaranteed some Visiting Medical Officer sessions or a temporary Staff Paediatrician position at a tertiary centre. Significantly, fewer of the 30–39-years age group said available job opportunities for their spouse made it impossible for them to consider the advertised position, compared to older age groups (P = 0.003). In response to the question 'What would it take for you to consider such a position?', 22.6% answered a change in employment package, 22.6% a change in family commitments, 16.6% too subspecialized, and 7.1% could possibly consider a locum or exchange in the future. Conclusions: Specialist positions, such as the advertised position, are well known, but remain unfilled because they are considered unsustainable. However, the response to hypothetical creative employment models suggests this could be changed, provided specialist training (e.g. paediatric training) is kept general and the younger consultant is given consideration.

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.

[Extract] I applaud Leach and colleagues for their recent article examining lost opportunities with Australia’s health workforce. There are many lost opportunities in the area of rural health. National and international studies have documented that a health professional with rural origins is more likely to return to a rural area to work than a colleague who grew up in the city. My research over the past 4 years looks predominantly at primary school students and their parents, teachers and governesses who reside over 800 000 km2 of outback Australia and study by distance education. My research is mainly into primary school-aged students because it is generally agreed among career development theorists that students start to shape ideas about occupations long before they reach high school.

[Extract] A female practitioner with young children working part-time in the country faces many challenges. One particular morning I was looking forward to a 7 am paediatric journal club meeting to be held by teleconference. There are only six a year, and they are sponsored by the Royal Australasian College of Physicians and chaired by Michael Williams from Mackay in Queensland. They are well organised, well presented and packed with information.

Diaphragmatic pacing is a method of long-term artificial ventilation that is preferable to other forms of ventilation in suitable patients. Its use is described in a 14 year old quadriplegic boy who was previously hospital dependent and required continuous positive pressure ventilation.

Introduction: Rural and remote Australia has a severe shortage of health professionals and the health of its people is relatively poor. For decades, national and international studies have demonstrated that health professionals who grow up in rural areas are more likely to practise in rural areas when compared with health professionals raised in the city. However, an often unrecognised consequence of the severe shortage of health professionals is the severe shortage of role models to inspire rural and remote school students to go on to become health professionals. So how do these school students paint a picture for themselves of what it would be like to be a health professional? Do they acquire images from school? Career development theorists suggest that children start to shape ideas about careers before preschool and then continue to shape these ideas throughout their school years. They also agree that, to aspire to a career, a student must first know about that career. At the time of writing, no review of primary school curricular materials in rural and remote Australia related to information inspiring students to health professions was available in the literature. Methods: This article reports on an analysis of all the Department of Education set curricular materials studied by rural and remote distance-education school students in years 3–7 in one Australian state. The aim was to look for content relevant to careers in the health professions. Results: Students are provided with very little information to help them build an image of these careers. Some of the information, provided in the students’ curricular materials, painted negative images of health professionals, especially doctors. Conclusions: These findings contribute to an understanding of why relatively few students from rural and remote Australia go on to become health professionals. It is exhilarating to realise these findings are modifiable, with the potential to improve future rural health workforce recruitment and retention.