The New England Framework, based on 50 years combined clinical practice, has been recently consolidated as an adaptation of the United Kingdom's 'Improving Access to Psychological Therapies' to include physical conditions. Founded on a collaborative approach in helping, health workers assist individuals to select and use self-administered cognitive and behaviourally based (CB) interventions specific to health problems. Heart disease and depression are the leading causes of disability worldwide. Obesity, diabetes, renal disease, respiratory conditions, chronic pain and addictions constitute another large percentage of suffering. Cognitive behavioural therapy (CBT) is the most effective non-pharmacological evidence-based treatment for most of all mental disorders and a wide range of physical health conditions. While CBT was originally developed as a self management tool to help reduce the negative impact that particular thinking and behaving patterns have on health, it evolved into a specific domain practice of professionals. Because of this, access to CBT has been impeded because of lack of available help, cost of treatment and time required - issues compounded for rural populations. With the rapid expansion of freely available online, virtual and print-based CBT, the value of self-directed minimal-assisted first-line treatments has been established.

Gambling has become a popular activity in both urban and rural settings. Although the prevalence and participation of gambling is well known, little has been reported regarding the impacts of gambling on rural communities. Therefore, a narrative literature review approach was adopted to examine what is known regarding gambling in rural communities. This article describes the prevalence and types of gambling that are popular in rural communities around the world. It identifies the benefits and highlights the potential harm caused by a person's gambling and the impact this has on families and the wider rural community. There are both benefits and risks associated with increased availability of gambling opportunities. Specific vulnerable groups within rural populations are identified within this context and how different countries respond to rural gambling is explored. A number of strategies based on a public health approach are recommended to ensure that gambling remains as harmless an activity as possible in rural communities.

Increased access to gambling is proving to be a great burden on the individuals who partake, their families and society in general. Despite growing evidence for the use of Cognitive-Behaviour Therapy (CBT) with problem gamblers, important questions remain unanswered regarding those individuals who do not respond to CBT. This paper compares gamblers who are considered 1) treatment completers, 2) drop-out following an initial assessment and, 3) drop-out after commencing treatment from a specialized CBT service. The results indicate a number of differences between the groups in regard to gambling severity and behaviour, demographic profile and variations in overall psychopathology.

Modified national versions of the WHO’s International Statistical Classification of Diseases, current version ICD-10 with ICD-11 coming into effect in January 2022, have become the standard in many countries for diagnosis and procedure coding to facilitate the submission of medical billing and reimbursement by health insurers. The WHO ICD-10 exists purely as a coded classification of disease. It has no related classification of procedures and lacks the clinical level of diagnostic specificity necessary for the documentation of individual clinical cases and the associated prescribed therapies and interventions, particularly surgical cases. Historically, the US clinical modification of ICD-9, known as ICD-9-CM, established the trend. Australia adopted ICD-9-CM, later adapted it to Australian clinical specifications, and after the launch of the WHO ICD-10 produced the current Australian modification ICD-10-AM, used under license by many other countries. This paper examines a work in progress, rather than offering an academic critique, to illustrate the evolution of national clinical modications with particular reference to those of the United States, Australia and Thailand. The selection is based on the historical ICD-9-CM connection of the US and Australia, and the fact that Thailand is a more advanced developing nation like Saudi Arabia. The study parameters include the Saudi national healthcare system which has not previously employed a classification clinical coding, despite the wealthy developing healthcare system. Nations using their own modification face the burden of upgrading. Saudi Arabia plans to implement the national Australian modification, rather than creating a Saudi national modification.

South East Essex PCT has commissioned an integrated COPD service. At the core is the philosophy of patient centered care to achieve high quality care, equality of care for all patients with COPD, ease of access so patients receive the appropriate care, producing an educational programme which ensures a sustainable service, improved patient information and patient involvement. The aims are also to reduce hospital follow up attendances and hospital admissions. This service has been planned through the local COPD network group where all stakeholders are involved. It was agreed that the Respiratory Consultants would provide clinical leadership for the whole COPD service across boundaries. The network has developed guidelines for managing COPD, a self-management plan and patient pathway. The agreed patient pathway is particularly important in developing the philosophy of the service. A manager has taken on the role of Project manager. The job plans of the Respiratory Consultants have changed and they have started doing clinics in the community. Two thirds of the clinics are conventional and the other thirds are multidisciplinary clinics where staff (usually Community Matrons) bring cases to be discussed without the patients having to attend. This arrangement is outside of tariff and operates through a contract variation. Both these initiatives have moved care closer to home. Community Matrons see many of the patients with severe COPD at home, protocols have been agreed as to whether patients remain on the active case load. Integrated services include the hospital at home service. This is both a prevention of admission and early discharge scheme service.

This study was funded by the Victorian Responsible Gambling Foundation to extend the analyses conducted for A Study of Gambling in Victoria (Hare, 2009) to provide detailed analyses of similarities and differences between male and female gamblers in Victoria Australia. The research objectives were to: 1. Analyse the similarities and differences between male and female gamblers in Victoria in terms of gambling preferences, activities and styles of play; gambling motivations and attitudes; physical and mental health; family and early gambling influences; and help-seeking behaviour; and 2. Analyse the similarities and differences between male and female gamblers in Victoria in terms of risk factors associated with problem/moderate risk gambling and protective factors associated with low risk/non-problem gambling.

The University of New England (UNE), Australia decided to develop innovative placement opportunities for its increasing numbers of nursing students. Extensive community and stakeholder consultation determined that a community centre in rural New South Wales was the welcomed site of the student-led clinic because it fit the goals of the project-to increase access to health care services in an underserved area while providing service learning for students. 'Methods': Supported by a grant from Health Workforce Australia and in partnership with several community organisations, UNE established a student-led clinic in a disadvantaged community using an engaged scholarship approach which joins academic service learning with community based action research. The clinic was managed and run by the students, who were supervised by university staff and worked in collaboration with residents and local health and community services. 'Results': Local families, many of whom were Indigenous Australians, received increased access to culturally appropriate health services. In the first year, the clinic increased from a one day per week to a three day per week service and offered over 1000 occasions of care and involved 1500 additional community members in health promotion activities. This has led to improved health outcomes for the community and cost savings to the health service estimated to be $430,000. The students learned from members of the community and community members learned from the students, in a collaborative process. Community members benefited from access to drop in help that was self-determined. 'Conclusions': The model of developing student-led community health and wellbeing clinics in underserved communities not only fulfils the local, State Government, Federal Government and international health reform agenda but it also represents good value for money. It offers free health services in a disadvantaged community, thereby improving overall health and wellbeing. The student-led clinic is an invaluable and sustainable link between students, health care professionals, community based organisations, the university, and the community. The community benefits from the clinic by learning to self-manage health and wellbeing issues. The benefits for students are that they gain practical experience in an interdisciplinary setting and through exposure to a community with unique and severe needs.

Research has not fully explored factors that influence types of help used from the suite of available options once problem gamblers reach an action stage of change. This study aimed to explore critical factors influencing choice of help (or interventions) once people have decided to address their gambling problem. Particular emphasis was on counselling and self-exclusion, given their demonstrable effectiveness for most users. Interviews were conducted with 103 problem gamblers taking action to address their gambling problem. Inductive analysis revealed nine critical influences on type(s) of help chosen, presented as a grounded theory model. Independent variables were goals of taking up the intervention, problem gambling severity, and level of independence/pride. Six mediating variables helped to explain relationships between the independent variables and choice of intervention. Understanding key influences on choice of gambling help can illuminate how to encourage further uptake and better align interventions with gamblers' preferences, to reduce barriers to help-seeking.

Background: The introduction of a mandatory health insurance system contributing towards the funding of national healthcare in Saudi Arabia necessitates the implementation of clinical coding and a unified health classification system, which has previously not been a feature of Saudi healthcare. As the Ministry of Health (MOH) moves to introduce ICD-10-AM, the Australian modification of the WHO ICD-10, in the Kingdom’s public hospitals, it is important to understand the factors that will influence its successful implementation. Objective: The purpose of this article is to develop and evaluate the internal consistency reliability and validity of a questionnaire establishing the factors influencing the the implementation ICD-10-AM and clinical coding in Saudi public hospitals. Method: The content validity method was initiated by sending the whole draft questionnaire to a panel of experts to indicate values for each item based on a scale of content validity created by the researchers and, subsequently, using the internal consistency reliability and factorial validity methods to estimate the internal reliability of clusters of items, which were assumed to measure the same factors, grouped in this study into three factorial categories, health information (clinical documentation, classification, and coding requirements), organization (the implementation preparation in individual organizations), and national (institutional support through the national hierarchical structure). Results: The content validity identified all items of the proposed questionnaire to be valid. Based on the content validity test, several items were removed as they did not meet the proposed model and the final questionnaire was created in accord with the pilot study result. The pilot study utilized Cronbach's α and factor analysis to examine the reliability and validity of Part 2 of the questionnaire and the findings indicated high internal consistency reliability and factorial validity.

CBT is recognised at the most successful non-pharmacological treatment for problem gamblers. However, debate surrounds the true efficacy of the approach especially in light of the inconsistency in which CBT is applied and reported. All too often research purporting to offer CBT frequently use a mixed models or integrative approaches. This leads to it being unclear which components are responsible for the therapeutic change. This paper will examine the evidence supporting Cognitive-Behavior Therapy (CBT) with problem gamblers. The core components of CBT, as used with problem gamblers, will be further highlighted and a comparison across published studies made. Data will be presented from the authors' own practice and compared against published data where CBT is the main treatment approach. A Cognitive-Behavioral model of problem gambling will be formulated. This model will be used to inform a unified CBT approach that will assist therapists when choosing to treat gamblers using CBT. It will be argued that this approach will offer a common person-centred formulation driven model of treatment that sticks to the fundamental principles of CBT.