A randomised controlled trial of consumption of dark chocolate in pregnancy to reduce pre-eclampsia: Difficulties in recruitment, allocation and adherence.

In 2013-2014 we undertook a randomised controlled trial (RCT) to determine whether the daily ingestion of dark chocolate during pregnancy could reduce the incidence of pre-eclampsia in primigravidae. However, after two years we had not succeeded in recruiting more than 3.5% of the number of participants required to answer the research question, and the trial was halted. We also reviewed the literature on this topic and found it to be limited. We report here our findings and discuss the difficulties facing researchers in this area.

Increasing access to sexual health care for rural and regional young people: Similarities and differences in the views of young people and service providers.

OBJECTIVE: This study aims to describe the views of sexual health service providers on access issues for young people and consider them together with the views of young people themselves. DESIGN: A cross-sectional mixed-methods study design involving semi-structured interviews with health service providers and an electronic survey with young people. SETTING: Four towns in rural and regional Queensland, Australia. PARTICIPANTS: A total of 32 service providers: 9 sexual health nurses, 8 general practitioners, 6 school-based youth health nurses, 5 sexual health educators, 2 Australian Aboriginal health workers and 2 youth workers. There were 391 young people who participated in the Young People's Survey. MAIN OUTCOME MEASURES: Themes generated from interviews with service providers and quantitative data from young people addressing access to sexual and reproductive health (SRH) services for rural and regional young people. RESULTS: Service providers frequently identified structural barriers, confidentiality and lack of awareness of SRH services as barriers for young people seeking SRH care. Young people also reported that structural factors such as transport, cost and service operating hours were important; however, they placed greater value on personal attributes of service providers, particularly welcoming and non-judgemental attitudes. CONCLUSION: Health service policy and training focused on attitudinal qualities of individual service providers may improve access to SRH services for young people. Selective staff recruitment and professional development are important to increase sensitivity to youth issues. Promotion of non-judgemental and confidential care may also improve access for youth.

Supporting GP advanced rural skills training.

OBJECTIVE: The aim of this study was to: investigate doctors' experiences of support during GP advanced rural skills training, and identify strategies to improve support. DESIGN: The qualitative responses from a cross-sectional, postal survey are reported. SETTING: Rural vocational training sector. PARTICIPANTS: Sixty-one doctors who had completed GP advanced rural skills training (procedural or non-procedural) in Queensland between 1995 and June 2009 participated in the study. MAIN OUTCOME MEASURE: Advanced trained doctors' experiences of support and their strategy recommendations to improve support. RESULTS: Experiences and strategies to improve support were developed into a framework of support, consisting of three theme areas. Strategies included: provision of training and career advice to allow immediate use of advanced skills; introduction of rural attachments and rural case studies during training to ensure rural orientation; development of GP mentor and peer networks for clinical and non-clinical support; advocacy to improve understanding and recognition of advanced rural skills training. CONCLUSIONS: Expanded support is required across the pre-enrolment, training, early practice continuum. A holistic approach to support is required. Training providers, professional bodies, health departments, universities and workforce agencies need to work together to address and resource the support needs of advanced, rural GP trainees before, during and after training.

Young people's perceptions of sexual and reproductive health in regional and rural Queensland: capturing the views of adolescents through reference groups and a user-friendly electronic survey.

UNLABELLED: Background Young people in regional and rural Queensland have difficulty accessing sexual and reproductive health (SRH) services. Young people's views regarding barriers and enablers for accessing SRH services and markers of quality are largely unknown. METHODS: Young people's perceptions regarding SRH services are explored through a cross-sectional study via eight reference group meetings and an electronic survey in four sites: Atherton Tablelands, Rockhampton, Toowoomba and Townsville. The survey, developed in consultation with young people, was administered online and face to face using tablet computers. Data from 391 rural and regional participants was precoded for bivariate comparisons involving χ(2) and confidence interval (CI) tests. RESULTS: The most valued markers of quality in SRH services defined by young people all related to staff characteristics. Young people preferred services where staff were friendly (87.3%; 95% CI: 83.8-90.8%), easy to talk to (91.4%; 95% CI: 88.5-94.3%), good listeners (95.4%; 95% CI: 93.2-97.6%) and did not judge them (90.5%; 95% CI: 87.4-93.6%). A model of SRH service delivery encompassed within general health services was highly valued by 58.9% (95% CI 53.7-64.1%). However, 36.2% (95% CI: 31.4-41.0%) preferred to seek care from SRH specialist services. CONCLUSIONS: Service provision can be improved by training, and retaining friendly, attentive and non-judgemental staff. A model of service provision that includes general health care and provides sexual health services may increase the acceptability and accessibility of SRH services among youth. Additionally, our study highlights the need for choice between general and specialist SRH services.

A tale of three hospitals: solving learning and workforce needs together.

Major developments in medical education in Australia include increasing the numbers of students and educating more students within the community and in regional, rural and remote settings. Rapid growth of student numbers and the rural orientation of the James Cook University medical school course has meant that northern Queensland had to deal with these issues earlier than other regions. One solution has been to transform some rural hospitals into teaching health services. Two hospitals that have successfully made this transformation, and another on its way, suggest that important factors include local commitment to quality clinical services, medical and academic leadership, coordination of local resources, community support, and strategic links between key organisations. Transformation to a teaching health service involves senior doctors functioning as true consultants with cascading supervision as in the traditional consultant-registrar-resident model. As both clinical and teaching capacity develops, the workforce may stabilise, infrastructure and teaching culture are established, and long-term recruitment and retention strategies emerge. Applying these models in other rural and community settings may make it possible to manage the increased training capacity and address workforce needs without compromising the educational experience - indeed, it may be enhanced.