Marjan Kljakovic

Our research has shown that health professionals place chronic illness somewhere in the borderlands between health and illness. They think of chronic illness as a natural kind made up of a cluster of multiple features that include causes, symptoms, consequences, concerns, and the emotional response to chronic illness.

Background Since 2009, when the revised Pharmaceutical Affairs Act was enacted in Japan, selfmedication practices have increased. Because the concept of self-medication was recently introduced in Japan, few studies exist on this topic. Therefore, it is necessary to explore how self-medication is practiced. This study examined Japanese consumers' self-medication practices and attitudes toward over-the-counter (OTC) medicines based on their sex, age, and socioeconomic status (SES).

Background Climate change is a global public health problem that will require complex thinking if meaningful and effective solutions are to be achieved. In this conceptual paper we argue that GPs have much to bring to the issue of climate change from their wide-ranging clinical experience and from the principles underpinning their clinical methods. This experience and thinking calls forth particular contributions GPs can and should make to debate and action.

Objectives: To assess the characteristics of people with common mental health problems who are recognised by their general practitioner, and those who are not. Design: Two different case-finding techniques (brief self-report and structured diagnostic interview) were compared with GPs' independent assessments of patients' presentations as psychological and/or medical.

BACKGROUND: With the influx of Australian medical graduates into the workforce, new clinical prevocational training rotations within general practice need to be developed. This study describes the relationship between general practitioner teachers' interest in hosting junior doctor rotations, and general practice characteristics including rural location, size and infrastructure. METHOD: All GP teachers of registrars and medical students in the Australian Capital Territory and southeast New South Wales were sent a survey.

Objective: To evaluate the impact of an educational intervention on general practitioners' skills in cognitive behavioural strategies (CBS). Design: Randomised controlled trial, with baseline and post-training measurement of GP competency in CBS using standardised simulated patient consultations, conducted between January 2005 and December 2006.

Results: The proportion of individuals making claims for MBS CD items was 18.5% for asthma, 22.3% for heart disease, and 44.9% for diabetes. Associations between participant characteristics and a claim for a CD item showed similar patterns across the three diseases. For heart disease and asthma, people most likely to claim a CD item were women, older, of low income and education levels, with multiple chronic conditions, fair or poor self-rated health, obesity and low physical activity levels.

Aim. To measure the association between infant feeding practices and parent-reported nut allergy in school entrant children. Method. The Kindergarten Health Check Questionnaire was delivered to all 110 Australian Capital Territory (ACT) primary schools between 2006 and 2009. Retrospective analyses were undertaken of the data collected from the kindergarten population. Results. Of 15142 children a strong allergic reaction to peanuts and other nuts was reported in 487 (3.2%) and 307 (3.9%), children, respectively.

Data sources: 25 electronic databases, scanning reference lists of articles and consultation with experts in the field. We searched publications in English after 1999, but a search of the German language literature for a specific model type was also undertaken. The grey literature was explored through a hand search of the medical trade press and websites of relevant national and international clearing houses and professional or industry bodies.

A functional patient-doctor dialogue is at the core of diagnostic decision making in general practice.1 Patients are active in this dialogue by expecting their general practitioner to explain the purpose of diagnostic tests.2 Studies show that such explanations satisfy patients' expectations of what doctors should do in relation to diagnostic tests and perceived omissions can lead to decreased patient satisfaction.2–5 Patient beliefs and attitudes toward diagnostic tests are important in all aspects of general practice.

Background Picky eating is relatively common among infants and children, often causing anxiety for parents and caregivers. The purpose of this study was to determine the key aspects of picky eating and feeding difficulties among children aged 1 to 10 years in Singapore and the impact on their parents or caregivers.

Abstract Introduction. Five years ago Australia, and the world, placed itself on heightened alert for pandemic influenza, based on concerns about the potential spread of the avian influenza virus. This prompted a flurry of preparation activity involving general practice, with information from various sources; government, colleges and divisions of general practice. Method.

Its author, Christchurch General Practitioner Lynda Exton, needed a more than usual amount of courage and determination to surmount this task. All participants in the tortuous saga of New Zealand's maternity services over the last 18 years should be interested, if not required, to read this detailed and extensively referenced account of events.

Background: The clinical audit of vitamin D health promotion in one Australian general practice was undertaken by measuring health service use and serum 25-hydroxyvitamin D levels in 995 patients aged 45 to 49 years. Findings: Over 3 years, 486 (51%) patients had a Medicare funded Health Assessment. More women (54%) were assessed than men (46%) p = 0.010. Mean 25-OHD was higher for men (70.0 nmol/l) than women (60.3 nmol/l) p < 0.001. More patients had their weight measured (50%) than 25-OHD tested (28%).

Background General practitioners (GPs) are involved in the management of most melanocytic skin lesions in Australia. A high quality biopsy technique is a crucial first step in management, as it is recognized that poor techniques can mislead, delay, or miss a diagnosis of melanoma. There has been little published on the biopsy decisions and techniques of GPs.

BACKGROUND: The characteristics of practising general practitioners who teach evidence based medicine (EBM) during their clinical work–and their attitudes toward it–are poorly known. METHODS: One hundred and twenty-two Canberra GPs who previously had medical students attend their practice were sent a questionnaire on their education, experience, knowledge, confidence, and attitudes toward teaching EBM.

Support for general practice nursing in Australia is also widespread and growing with the Royal College of Nursing (Australia), the Royal Australian College of General Practitionersii and the Australian Medical Association (AMA) iii all endorsing the role of nurses in general practice. Studies of consumer perceptions of practice nurses found acceptance by consumers of defined practice nurses roles, especially where these facilitate access to services and patient choice of providersiv, v.

Sir, I was somewhat disheartened to see that the Journal has added to the confusion surrounding the term'audit. The paper by Gillam and colleagues (June Journal, p. 236) demonstrates the misuse of the term today. Audit is a cyclical process.'Present practice is identified and compared with a standard which can beeither implicit or explicit. Action is then taken to alter prac-ticeto approach the desired standard.

BACKGROUND: The clinical audit of vitamin D health promotion in one Australian general practice was undertaken by measuring health service use and serum 25-hydroxyvitamin D levels in 995 patients aged 45 to 49 years. FINDINGS: Over 3 years, 486 (51%) patients had a Medicare funded Health Assessment. More women (54%) were assessed than men (46%) p= 0.010. Mean 25-OHD was higher for men (70.0 nmol/l) than women (60.3 nmol/l) p< 0.001. More patients had their weight measured (50%) than 25-OHD tested (28%).

Aim. To measure the association between infant feeding practices and parent-reported nut allergy in school entrant children. Method. The Kindergarten Health Check Questionnaire was delivered to all 110 Australian Capital Territory (ACT) primary schools between 2006 and 2009. Retrospective analyses were undertaken of the data collected from the kindergarten population. Results. Of 15142 children a strong allergic reaction to peanuts and other nuts was reported in 487 (3.2%) and 307 (3.9%), children, respectively.

Abstract Background: In response to the escalating burden of chronic illness in Australia, recent health policies have emphasised the promotion of patient self-management and better preventive care. A notable omission from these policies is the acknowledgment that patients with chronic illness tend to have co-morbid conditions.

" I have concerns about the article by Arroll et al (NZ Med J 2002; 115: 176-9). The title of this article is misleading. It suggests the study had the goal of looking at the prevalence of depression in an Auckland general practice. It turned out the article had different goals. The authors' prime goal was to study the abilities of general practitioners (GPs) to diagnose depression as compared to the gold standard of the Beck's Diagnostic Inventory scale.

OBJECTIVE: To ascertain the issues all general practice educators need to understand when educating GP registrars to learn about research. STUDY DESIGN: A review of MEDLINE [1996–2007], six websites and key informants produced 302 publications, which reduced to 35 articles, 7 books, and 9 policy documents.

Aim: To carry out a pilot study in two regions in order to investigate prevalence of psychological problems in primary care in New Zealand. Method: General Practitioners (GPs) within two geographic regions were randomly selected. All adult attenders at their practice on selected days were administered a short questionnaire, the GHQ-12, which assesses the presence of psychological symptoms.

The assessment of patient encounters with general practitioners (GPs) at both rural and urban settings is a remarkably under-researched area in New Zealand. Despite the importance of this information for the planning, funding and delivery of local health services and both undergraduate and postgraduate medical education, only a handful of studies have attempted to describe the nature and frequency of visits to general practices based in either urban or country areas.

VOLUME 4• NUMBER 3• SEPTEMBER 2012 J OURNAL OF PRIMARY HEALTH CARE 239 The anatomical placement of body organs by Australian and New Zealand patients and health professionals in general practice Academic Unit of General Practice and Community Health, School of General Practice, Rural and Indigenous Health, Australian National University Medical School, Woden, ACT, Australia.

There is a well-recognised need to carry out randomised trials in the primary care setting where the majority of patient contacts occur, rather than rely on results from secondary and tertiary healthcare settings that may not be applicable. However, trials in primary care are often difficult to conduct and some are unsuccessful. This paper reports successful recruitment in a local trial using a variety of strategies, including early consultation with GPs, effective communication, and good benefits for participating GPs and patients.

Background: Evidence remains unclear as to whether folic acid (FA) and vitamin B-12 supplementation is effective in reducing depressive symptoms. Objectives: The objective was to determine whether oral FA+ vitamin B-12 supplementation prevented cognitive decline in a cohort of community-dwelling older adults with elevated psychological distress.

Background
There is little published on provider continuity in Australian general practice and none on its effect on inequality of care for children.
Method
Questionnaire administered to parents of the ACT Kindergarten Health Screen asking the name of their child’s usual GP and practice address between 2001 and 2008.
Results
Parents of 30,789 children named 433 GPs and 141 practices. In each year, an average of 77% of parents could name both the GP and the practice, an average of 11% of parents could name only the practice, and an average of 12% of parents could name neither. In each year, 25% of parents could not name a usual GP for children of Aboriginal or Torres Straight Islander descent, or children born outside of Australia, compared to 10% of all other children (p=<0.0001). The frequency of GPs displaying continuity of care varied over time with 19% of GPs being present in the ACT in only one year and 39% of GPs being present in every year over the eight years of study. GPs displayed two different forms of transience either by working in more than one practice in each year (5% of GPs), or by not being present in the ACT region from one year to the next (15% of GPs). Fewer parents nominated transient GPs as their child’s GP compared to choosing GPs who displayed continuity (p<0.001).
Conclusions
Many GPs (39%) were reported to provide continuity of care for in the ACT region and some GPs (20%) displayed transient care. Indigenous children or children born outside of Australia had less equity of access to a nominated GP than all other children. Such inequity might disappear if voluntary registration of children was adopted in Australian general practice.

OBJECTIVE To measure the frequency of nonconsent encountered by medical students and describe the influence of gender. METHOD An observational study of general practice teaching consultations. RESULTS Subjects: 63 students (40% female), 67 general practitioners (30% female), and 2572 patients (56% female). Outcome: 3.4% of all patients (79% female) did not give consent (4.6% for male students; 1.6% for female; OR=3.0, 95% CI 1.7-5.3). The rates of nonconsent did not vary between age groups for men but occurred mainly in the 15-44 years age group for women. Male students encountered more nonconsenting female patients than female students, particularly in consultations with female GPs. CONCLUSION Consent to allow medical students to be present in general practice consultations is usually provided. It is typically declined for male students by young women attending women doctors.

To determine the magnitude of morbidity from asthma within the New Zealand population, the degree of satisfaction of patients with their asthma control, and the level of asthma control achieved in relation to treatment. Participants were randomly selected from 29 randomly chosen general practices throughout New Zealand. Information was collected from demographic and clinical questionnaires and from lung function tests. Criteria based on GINA guidelines were developed to define the level of asthma control for each participant, their opinion of their level of control, and to define which participants were under-treated. A total of 445 patients (327 adults, age 16-68; 118 children, age 7-15) took part in the study. Ninety three per cent of adults had asthma that was sub-optimally controlled, 71% had asthma that was not well controlled, and 19% had asthma that was markedly out of control. For children, these figures were 90%, 42% and 4% respectively. These results were consistent regardless of asthma severity. In adults and children whose asthma was not well controlled, 49% and 71% respectively were under-treated. For those whose asthma was markedly out of control, 89% and 75% of adults and children respectively were under-treated. A significant proportion of patients have asthma that is not well controlled or that is markedly out of control, and the majority are under-treated.

Previous studies report GPs under-treat mental health disorders, particularly depression, and treatments are non-specific and lack an evidence base. They conclude further training and education of GP&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s is required. To describe the treatment of common mental health disorders in relation to the level and severity of psychological problems as defined by the GP and external assessment. Cross sectional survey of General Practice attenders in New Zealand. Fifty consecutive adult patients were recruited from each practice of 70 randomly selected GP&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s. The psychological status of 773 respondents selected via the General Health Questionnaire (GHQ) was assessed, and details of management provided. Management options were compared with the level of psychological problem identified by the GP. Treatment varied depending on the level of problem identification, and frequency of consultation, from 93% given treatment when an explicit diagnosis was made to 22.3% in patients with subclinical symptoms. The most commonly given treatment with an explicit diagnosis was psychotropic medication [73% (95% CI 63.6-82.9)] while for those patients with subclinical symptoms the most common form of treatment was discussion and counselling [15.7% (7.1-24.2)]. Only 1.7% (0.3-3.0) of patients with subclinical symptoms received psychotropics. There is a clear association between the level of psychological problem identified and treatment. In contrast to previous views that treatment often appears to be given regardless of diagnosis, these results provide a picture of general practice management of common mental disorders more in line with evidence-based practice than previously described.