A rapid review of leading indicators to measure Australian farm safety culture.

Agriculture accounts for over half of Australia's land use therefore the farmers managing this land need to be safe at work. This paper offers measuring farm safety culture as a way to overcome the stagnation in the trend of fatal farm injury burden. To work towards achieving a way to measure farm safety culture, this research reviewed the leading indicators of safety. Following PRISMA guidelines, we screened for globally significant literature in the field of methodologies to measure safety climate and safety culture. We performed a rapid review of literature resulting in nineteen articles that add to our understanding of how to create and re-adapt existing questionnaires and produce validated metrics. The leading indicators were grouped into 8 dimensions where we found a translational disconnect between safety for organisational structures and safety for family farm businesses. This paper provides recommendations for government, safety regulators, policymakers, and industry of the leading indicators that may be applicable for measuring farm safety culture for Australian farmers.

How healthy are the healthcare staff in a rural health service? A cross-sectional study.

Background: The COVID-19 pandemic has amplified the need to understand the health and wellbeing of healthcare workers in hospital settings. Crises like the COVID-19 pandemic create poor health outcomes for healthcare workers, yet little is understood about underlying patterns of modifiable health determinants. Objective: The aim of the study was to examine the health and wellbeing data of healthcare workers before and during the COVID-19 pandemic and inform future healthy intervention activities within the workplace. Design: Repeat cross-sectional study pre-2018 and mid-COVID-19 2020. Settings: Rural health service in Victoria, Australia. Participants: All 800 healthcare workers within the health service were invited; of these, 184 (23%) participated at Time 1 and 87 (11%) at Time 2. Methods: Diet, physical activity, sleep behaviours, and psychological distress were collected via online survey in Qualtrics. Pre-COVID-19 pandemic, anthropometry (height, weight, waist circumference, blood pressure), and type 2 diabetes risk were collected by a trained practitioner. However, to reduce burden on healthcare workers mid-COVID-19 pandemic, only self-reported anthropometry was collected. Results: The majority of participants were Australian-born females (84% at both timepoints) with half over the age of 45 (63% Time 1, 53% Time 2). Around half worked part-time (49% Time 1, 54% Time 2), over a third full-time (39% Time 1, 36% Time 2), and the majority reported working regular day shifts in the past 3 months (70% Time 1, 65% Time 2). Among this sample, there were few smokers (9% Time 1, 7% Time 2), and two thirds of participants were living with overweight or obesity (64% Time 1, 67% Time 2). Across both time points, compliance with health guidelines was low; 41% (Time 1) and 42% (Time 2) met fruit, 17% (Time 1) and 12% (Time 2) met vegetable, and just under 50% met physical activity guidelines at both time points. Those reporting moderate to very high levels of psychological stress increased from 42% (Time 1) to 59% (Time 2) (p< 0.05). At Time 1, >80% were at intermediate (39%) or high (33%) risk of developing type 2 diabetes within the next 5 years; and a third (32%) were hypertensive. Reasons for physical inactivity at work included already exercising out-of-work hours (28%), living too far from work (18%), available time (9%), and inflexible work hours (8%). Conclusions: Several high-risk health areas along with opportunities for supporting improved wellbeing were identified in this group of healthcare workers. Psychological distress of healthcare workers urgently needs to be addressed, and this is reinforced by the need to understand the longitudinal impact of COVID-19 on the health and wellbeing of healthcare workers. Workplace settings, such as a health service, is an ideal setting to invest in healthcare workers with individual, organisational, and broader community benefits.

Emergency presentations for farm-related injuries in older adults residing in south-western Victoria, Australia.

INTRODUCTION: Farm workers are at high risk for injuries, and epidemiological data are needed to plan resource allocation. OBJECTIVE: This study identified regions with high farm-related injury rates in the Barwon South West region of Victoria, Australia, for residents aged ≥50 yr. DESIGN: Retrospective synthesis using electronic medical records of emergency presentations occurring during 2017-2019 inclusive for Local Government Areas (LGA) in the study region. For each LGA, age-standardised incidence rates (per 1000 population/year) were calculated. FINDINGS: For men and women combined, there were 31 218 emergency presentations for any injury, and 1150 (3.68%) of these were farm-related. The overall age-standardised rate for farm-related injury presentations was 2.6 (95% CI 2.4-2.7); men had a higher rate than women (4.1, 95% CI 3.9-4.4 versus 1.2, 95% CI 1.0-1.3, respectively). For individual LGAs, the highest rates of farm-related emergency presentations occurred in Moyne and Southern Grampians, both rural LGAs. Approximately two-thirds of farm-related injuries occurred during work activities (65.0%), and most individuals arrived at the hospital by transport classified as "other" (including private car, 83.3%). There were also several common injury causes identified: "other animal related injury" (20.2%), "cutting, piercing object" (19.5%), "fall ⟨1 m" (13.1%), and "struck by or collision with object" (12.5%). Few injuries were caused by machinery (1.7%) and these occurred mainly in the LGA of Moyne (65%). DISCUSSION AND CONCLUSION: This study provides data to inform future research and resource allocation for the prevention of farm-related injuries.

Co-designing a peer-led model of delivering behavioural activation for people living with depression or low mood in Australian farming communities.

INTRODUCTION: Farmers face a range of factors that negatively influence their mental health and suicide risk, yet have limited access to appropriate support. Behavioural activation (BA) is an evidence-based therapy that can be effectively delivered by nonclinical workers. Working with members of farming communities to deliver BA to their peers has the potential to overcome many well-established barriers to mental health help-seeking and improve outcomes for this at-risk group. OBJECTIVE: This paper describes the findings of a co-design phase informing the development of a peer (farmer)-led approach for delivering BA for farmers living with depression or low mood. DESIGN: This qualitative study used a co-design approach involving members of the target community. Focus groups were transcribed and analysed using Thematic Analysis and the Framework approach. FINDINGS: Ten online focus groups with 22 participants were held over 3 months. Four overarching, interlinked themes were identified: (i) filling the gap in rural mental health support; (ii) alignment with the farming context-tailoring how, where and when we engage about mental health; (iii) the 'messenger' is as important as the message; and (iv) sustainability, governance and support. DISCUSSION: Findings suggest BA could be a contextually appropriate model of support for the farming community-given its practical and solution-focused approach-and could help improve access to support. Having peer workers deliver the intervention was viewed as appropriate. Ensuring governance structures are developed to support peers to deliver the intervention will be essential to facilitate effectiveness, safety and sustainability. CONCLUSION: Insights gained through co-design have been critical to the success of developing this new model of support for members of farming communities experiencing depression or low mood.

Benefits and risks of ventilator hyperinflation in mechanically ventilated intensive care patients: A systematic review and meta-analysis.

OBJECTIVES: Patients requiring mechanical ventilation in the intensive care unit (ICU) have diminished respiratory defences and are at high risk of respiratory compromise, leading to an increased risk of pulmonary infection and prolonged ventilation. Ventilator hyperinflation (VHI) is an airway clearance technique used by physiotherapists and is suggested to improve respiratory mechanics. The objective of this study was to review the evidence for the benefits and risks of VHI in intubated and mechanically ventilated patients in the ICU. REVIEW METHOD USED: We conducted a systematic review. DATA SOURCES: We searched PubMed, Embase, CINAHL, CENTRAL, and Scopus from inception to 31st May 2022 for all randomised control trials evaluating VHI in intubated and mechanically ventilated adults in the ICU. REVIEW METHODS: Two authors independently performed study selection and data extraction. Individual study risk of bias was assessed using the Physiotherapy Evidence Database scale, and certainty in outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluations framework. RESULTS: We included 10 studies enrolling 394 patients. Compared to standard care, VHI had significant effects on sputum clearance (Standardise mean difference: 0.36, 95% confidence interval [CI]: 0.12 to 0.61; very low certainty), static pulmonary compliance (mean difference [MD]: 4.77, 95% CI: 2.40 to 7.14; low certainty), dynamic pulmonary compliance (MD: 1.59, 95% CI: 0.82 to 2.36; low certainty) and oxygenation (MD: 0.28, 95% CI: 0.01 to 0.55; low certainty). No significant adverse events or immediate side effects relating to VHI were reported. There is a paucity of data available on the effects of VHI on clinical outcomes including mechanical ventilation duration, ICU length of stay, and mortality. CONCLUSIONS: Our findings suggest VHI has potential short-term respiratory benefits including increased secretion clearance, pulmonary compliance, and oxygenation, with no immediate adverse effects in intubated and mechanically ventilated ICU patients. However, there remains limited data on the longer term influence of VHI on clinical outcomes, and further research to inform clinical practice is needed. REGISTRATION: This study is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022341421).

A Self-Help Online Intervention Is Associated with Reduced Distress and Improved Mental Wellbeing in Australian Farmers: The Evaluation and Key Mechanisms of www.ifarmwell.com.au.

OBJECTIVES: Farmers are faced with many stressors, along with numerous barriers to accessing traditional forms of mental health support. The ifarmwell online intervention was co-designed with farmers and is informed by Acceptance and Commitment Therapy to equip farmers with transferable coping strategies, particularly to help them cope with circumstances beyond their control. We aimed to evaluate the effect of ifarmwell on farmers' short- and long-term distress and mental wellbeing. METHODS: Australian farmers (21-73 years) who registered on www.ifarmwell.com.au completed measures at the commencement of module 1 (N = 228), the end of the intervention (N = 77) and 6-months post-intervention (N = 61). Primary outcomes included distress (Kessler Psychological Distress Scale) and mental wellbeing (Mental Health Continuum - Short Form). We also examined the relationship between distress, mental wellbeing, neuroticism (Quickscales-R) and ACT-based psychological mechanisms; psychological inflexibility (Acceptance and Action Questionnaire-II), cognitive fusion (Cognitive Fusion Questionnaire), believability of automatic thoughts (Automatic Thoughts Questionnaire-B), coping via acceptance (4 items from the situational COPE) and mindfulness (Five Facet Mindfulness Questionnaire-Short Form). Secondary outcomes of acceptability (Client Satisfaction Questionnaire-8) and usability (System Usability Scale) were also explored. RESULTS: Pre- to post-intervention, farmers' distress decreased and mental wellbeing increased. These effects were maintained at 6-month follow-up. Changes in these outcomes were greatest for participants who entered the intervention with high baseline distress (߈= -0.59, 95%CI =[-0.70, -0.47]) and low mental wellbeing (߈= -0.33, 95%CI = [-0.47, -0.19]). Decreases in distress and increases in mental wellbeing were associated with decreases in psychological inflexibility, cognitive fusion, and believability of thoughts, and increases in coping via acceptance and mindfulness. Levels of satisfaction (M = 26.92/32) and usability (M = 84.70/100) were high, and 94.6% of participants said they would recommend ifarmwell to a friend in need of similar advice and tools. CONCLUSIONS: ifarmwell is an effective and usable intervention that is likely to help farmers reduce their levels of distress and improve their mental wellbeing, by improving their psychological flexibility, ability to focus on the present and accept things beyond their control, as well as by reducing the extent to which they believe unhelpful thoughts.

Utilizing the Delphi method to develop parent and child surveys to understand exposure to farming hazards and attitudes toward farm safety.

Children on farms are at increased risk of injury. In Australia, children under 15 years consistently represent ~15% of all farm-related fatalities. This study aimed to develop parent and child surveys to gain a greater understanding of children's (5-14 years) exposure to occupational risk on farms by exploring their exposure to farm hazards, risk-taking behavior, their use and attitudes toward safety measures, and experience of farm-related injury. As farming communities are heterogeneous, a modified Delphi method was undertaken to ensure input from a diverse group. Seventeen experts participated in a three round process-the first two rounds required rating of proposed survey questions in an online questionnaire and the final round was an online discussion. Consensus was defined as 75% agreement or higher. This process resulted in 155 parent questions and 124 child questions reaching consensus to include. The modified Delphi method developed surveys that provide insight into the behaviors and attitudes of children (individuals) and their parents on farms (family) and will assist in informing how community, organizations and policy frameworks can improve child safety on farms. It will assist in identifying and understanding common farming exposures/behaviors of children and their parents to inform the development of targeted and culturally appropriate injury prevention strategies. As farming groups are heterogeneous, these survey scan be used on varying farming cohorts to identify their unique farming hazards and challenges. Child farm-related injuries are a problem globally and must be addressed; children are dependent on adults and communities to create safe environments for them.

Some differences but all at risk: Improving farm safety for young people-An Australian experience.

A significant portion of on-farm deaths and injuries in Australia occur among young people working on the farm. Since most Australian farms are still family owned and operated, young people are an integral part of everyday operations and the farm is a place where these young people live, work and play. This paper describes how the international Gear Up for Ag Health and Safety™ program, originally developed in North America, was further developed for a younger Australian audience (ages 12-19) enrolled in agricultural programs at secondary or vocational schools. In addition, we share insight on demographics, self-reported farm safety behaviours, and the most common farm tasks being performed by program participants utilising a pre-survey originally developed for program customisation. Of particular importance were the most common farming tasks reported by this group. The most common tasks performed on Australian farms included a large variety of vehicle use (farm vehicles, motorbikes, and quadbikes) and handling livestock. Females reported operating vehicles and other farm equipment at the same rates as males. Males were more likely to be working with large heavy machinery and driving trucks, while females were more likely to be working with livestock and using horses for stockwork. Both males and females reported low use of PPE and poor safety habits. In future Australian programs, it will be important to address the conspicuous use of motor vehicles, quadbikes, motor bikes and machinery at early ages, and to target gender-specific tasks to reduce risks on the farm.

High-Heat Days and Presentations to Emergency Departments in Regional Victoria, Australia.

Heat kills more Australians than any other natural disaster. Previous Australian research has identified increases in Emergency Department presentations in capital cities; however, little research has examined the effects of heat in rural/regional locations. This retrospective cohort study aimed to determine if Emergency Department (ED) presentations across the south-west region of Victoria, Australia, increased on high-heat days (1 February 2017 to 31 January 2020) using the Rural Acute Hospital Data Register (RAHDaR). The study also explored differences in presentations between farming towns and non-farming towns. High-heat days were defined as days over the 95th temperature percentile. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes associated with heat-related illness were identified from previous studies. As the region has a large agricultural sector, a framework was developed to identify towns estimated to have 70% or more of the population involved in farming. Overall, there were 61,631 presentations from individuals residing in the nine Local Government Areas. Of these presentations, 3064 (5.0%) were on days of high-heat, and 58,567 (95.0%) were of days of non-high-heat. Unlike previous metropolitan studies, ED presentations in rural south-west Victoria decrease on high-heat days. This decrease was more prominent in the farming cohort; a potential explanation for this may be behavioural adaption.

Combining Farmers' Preferences With Evidence-Based Strategies to Prevent and Lower Farmers' Distress: Co-design and Acceptability Testing of ifarmwell.

BACKGROUND: Farming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services; however, improved internet access now provides promising avenues for offering support. OBJECTIVE: This study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population. METHODS: Research evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9%) female, aged 21-73 years; 95.5% (149/156) residing in inner regional to very remote Australia, and 68.2% (107/157) "sheep, cattle and/or grain farmers." Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively sampled users. Updates were then made according to adaptive trial design methodology. RESULTS: This systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies-ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, examples, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health-related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1% (52/140) of users who started module 1 completed all modules, with too busy or not got to it yet being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion. CONCLUSIONS: Sequential integration of research evidence, expert knowledge, and farmers' preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617000506392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526.

Mental health at the COVID-19 frontline: An assessment of distress, fear, and coping among staff and attendees at screening clinics of rural/regional settings of Victoria, Australia.

PURPOSE: Research examining psychological well-being associated with COVID-19 in rural/regional Australia is limited. This study aimed to assess the extent of psychological distress, fear of COVID-19, and coping strategies among the attendees in COVID-19 screening clinics at 2 rural Victorian settings. METHODS: A cross-sectional study was conducted during July 2020 to February 2021 inclusive. Participants were invited to fill in an online questionnaire. Kessler Psychological Distress Scale (K-10), Fear of COVID-19 Scale, and Brief Resilient Coping Scale were used to assess psychological distress, fear of COVID-19, and coping, respectively. FINDINGS: Among 702 total participants, 69% were females and mean age (±SD) was 49 (±15.8) years. One in 5 participants (156, 22%) experienced high to very high psychological distress, 1 in 10 (72, 10%) experienced high fear, and more than half (397, 57%) had medium to high resilient coping. Participants with mental health issues had higher distress (AOR 10.4, 95% CI: 6.25-17.2) and fear (2.56, 1.41-4.66). Higher distress was also associated with having comorbidities, increased smoking (5.71, 1.04-31.4), and alcohol drinking (2.03, 1.21-3.40). Higher fear was associated with negative financial impact, drinking alcohol (2.15, 1.06-4.37), and increased alcohol drinking. Medium to high resilient coping was associated with being ≥60 years old (1.84, 1.04-3.24) and completing Bachelor and above levels of education. CONCLUSION: People who had pre-existing mental health issues, comorbidities, smoked, and consumed alcohol were identified as high-risk groups for poorer psychological well-being in rural/regional Victoria. Specific interventions to support the mental well-being of these vulnerable populations, along with engaging health care providers, should be considered.

Rural suicide risk and physical ill health: A qualitative study of the Victorian Suicide Register, 2009-2015.

OBJECTIVE: To gain new insight into contextual factors shaping how physical ill health acts as a stressor in rural suicides-informing the development of appropriate targeted interventions. DESIGN: Retrospective cohort study. SETTING: Non-metropolitan Victoria, Australia. SAMPLE: 802 rural (non-metropolitan) suicide deaths between the years 2009 and 2015. MAIN OUTCOME MEASURE: Qualitative data from the Victorian Suicide Register relating to physical ill health of suicide decedents. RESULTS: Thematic analysis identified 4 themes: (a) 'living with physical ill health in a rural area' highlights both practical and cultural challenges associated with managing physical ill health within the context of life in a rural setting; (b) 'causes and experience of chronic pain' highlights rural risk factors for chronic pain, how pain was experienced and treatment managed; (c) 'when living an independent, contributing life is no longer possible' describes the debilitating physical and mental outcomes of chronic ill health and pain; and (d) 'the cumulative impact of physical ill health and other factors on suicide risk' highlights the complexity of risk factors-in combination with (or as a result of) physical ill health-that contribute to a suicide death. CONCLUSION: Identified themes suggest pathways to improve understanding and support for those experiencing physical ill health and associated suicide risk. These supports include contextually and culturally appropriate rural services to provide effective and necessary treatment, pain relief and mental health support; acknowledgement and response to a culture of alcohol misuse as an (ultimately ineffective) coping strategy; proactive psychosocial support mechanisms; and alternative approaches to support including consideration of innovative peer support models.

Child Farm-Related Injury in Australia: A Review of the Literature.

Children on farms have been identified as a population vulnerable to injury. This review seeks to identify child farm-related injury rates in Australia and to determine the key hazards and contributing risk factors. This critical review utilised the PRISMA guidelines for database searching. Research from the year 2000 onward was included as well as earlier seminal texts. Reference lists were searched, and the relevant research material was explored. Our primary focus was on Australian peer-reviewed literature with international and grey literature examples included. Evidence suggests that there is limited Australian research focusing on child farm-related injuries. Child representation in farm-related injuries in Australia has remained consistent over time, and the key hazards causing these injuries have remained the same for over 20 years. The factors contributing to child rates of farm injury described in the literature include child development and exposure to dangerous environments, the risk-taking culture, multi-generational farming families, lack of supervision, child labour and lack of regulation, limited targeted farm safety programs, underuse of safe play areas, financial priorities and poor understanding and operationalisation of the hierarchy of control. It is well known that children experience injury on farms, and the key hazards that cause this have been clearly identified. However, the level of exposure to hazards and the typical attitudes, behaviours and actions of children and their parents around the farm that contribute to chid injury remain unexplored.

Self-management of diabetes and associated comorbidities in rural and remote communities: a scoping review.

Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to: (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas.

Translating Co-Design from Face-to-Face to Online: An Australian Primary Producer Project Conducted during COVID-19.

Primary producers face considerable risks for poor mental health. While this population can be difficult to engage in programs to prevent poor mental health, approaches tailored to reflect the context of primary producers' life and work have been successful. This paper reports on the co-design phase of a project designed to prevent poor mental health for primary producers-specifically, the advantages, challenges and considerations of translating face-to-face co-design methods to an online environment in response to COVID-19 restrictions. The co-design phase drew upon the existing seven-step co-design framework developed by Trischler and colleagues. Online methods were adopted for all steps of the process. This paper models how this co-design approach can work in an online, primary producer context and details key considerations for future initiatives of this type. The development of online co-design methods is an important additional research method for use not only during a pandemic but also when operating with limited resources or geographic constraints. Results demonstrate the following: (i) co-designing online is possible given adequate preparation, training and resource allocation; (ii) "hard to reach" populations can be engaged using online methods providing there is adequate early-stage relationship building; (iii) co-design quality need not be compromised and may be improved when translating to online; and (iv) saved costs and resources associated with online methods can be realigned towards intervention/service creation, promotion and user engagement. Suggestions for extending Trischler and colleagues' model are incorporated.

Suicide and Accidental Death for Australia's Farming Families: How Context Influences Individual Response.

This article presents qualitative data to explore the experience of farming family members faced with accidental or suicide death and understand how this is experienced within the farming context. Individual semistructured interviews were conducted with 25 members of Australian farming families bereaved by suicide or accidental death. Qualitative data was thematically analyzed. Three interconnected themes were identified: acceptance of risk, normalization of death, pragmatic behavior patterns and connection to place. Bereavement and reconstruction of meaning following suicide or accidental death for farming families is influenced by the cultural, social, geographical, and psychological contexts of farming families. This article challenges traditional conceptions of suicide and accidental death as necessarily experienced as "violent" or "traumatic," bereavement as experienced similarly across western cultures, and the reaction to suicide or accidental death as one that challenges people's understanding of their world and leaves them struggling to find a reason why the death occurred.

WITHDRAWN: The epidemiology of emergency presentations for falls across Western Victoria, Australia.

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.auec.2019.08.003. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Agricultural health and medicine education-Engaging rural professionals to make a difference to farmers' lives.

OBJECTIVE: Despite continued higher rates of workplace injuries, earlier morbidity and mortality and challenging climatic environments, few formal programs focus on the health, well-being and safety of farmers. The agricultural health and medicine unit, developed in 2010, was designed to increase cultural competence and empower rural professionals to improve the health, well-being and safety outcomes of farming populations in Australia. This study aimed to understand the extent to which graduates (2010-2018) use the knowledge and skills gained in their current occupations and identify barriers and enablers faced in implementing them. DESIGN: Mixed-methods descriptive study. SETTING: Graduates were invited to complete an online survey. Following the survey, graduates participated in a phone interview until saturation was reached. PARTICIPANTS: Forty-one graduates completed the survey (31% response rate), and eleven interviews were conducted. INTERVENTIONS: Education in agricultural health and medicine. MAIN OUTCOME MEASURES: Graduates use of knowledge and skills gained from the course and the barriers and enablers they experienced in implementation. RESULTS: The most represented occupations were nursing, medicine and agriculture (farming). Of respondents, 76% agreed their ability to diagnose, treat or prevent agricultural occupational illness or injury had improved. Positively, 42% use course content professionally at least weekly. Fifty-one per cent experienced barriers in implementing their new knowledge, and little evidence of career advancement was observed. CONCLUSION: This study informs the continuous development of the agricultural health and medicine curriculum and highlights the importance of a collaborative and multidisciplinary approach to improving the health, well-being and safety of farming populations. Despite engaged graduates, the continued high workplace mortality, preventable non-communicable disease and challenging climatic conditions highlight the need for strategic prioritisation of farmers' health across health, agriculture and policy settings.

The ripple effect: a digital intervention to reduce suicide stigma among farming men.

BACKGROUND: Compared with the general population, Australian farmers-particularly men-have been identified as at greater risk of suicide. A complex range of factors are thought to contribute to this risk, including the experience of Stigma. stigma also impacts those who have attempted suicide, their carers, and those bereaved by suicide-manifesting as shame, guilt, social isolation, concealment of death, reduced help seeking and ongoing risk of suicide. This paper evaluates the effectiveness of an intervention, tailored for the farming context, designed to reduce stigma among farming men with a lived experience of suicide. METHODS: The digital intervention used an adult learning model providing opportunity to share insights, reflect, learn and apply new knowledge among people with shared farming interests, suicide experience and cultural context. A range of content-tailored to the gender, farming type and suicide experience of participants-included video stories, postcard messages, education and personal goal setting. Pre- and post- assessment of suicide stigma and literacy was complemented by qualitative data collection during the intervention and participant feedback surveys. RESULTS: The intervention was successful in reaching members of the target group from across Australia's rural communities-with diverse geographic locations and farming industries represented. One hundred and sixty-nine participants from the target group (farming males aged 30-64 years) were recruited. While the Stigma of Suicide Scale failed to identify a reduction in self- or perceived-stigma, qualitative data and participant feedback identified behavioural indicators of stigma reduction. Four subthemes-'growth', 'new realisations', 'hope' and 'encouragement'-highlighted attitudinal and behaviour change indicative of reduced stigma associated with mental health and suicide. Participants' baseline suicide literacy (Literacy of Suicide Scale) was high when compared with previous community samples and total literacy scores did not demonstrate significant improvement over time, although literacy about the link between suicide and alcoholism did significantly improve. CONCLUSIONS: These results highlight opportunities in groups with high suicide literacy for targeted stigma reduction and suicide prevention efforts for both the target group and other populations within Australia and internationally. Results also highlight the need to reassess how stigma change is understood and evaluated across a wider range of population groups. TRIAL REGISTRATION: This research project was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12616000289415) on 7th March, 2016.