It is well established that bushfires and other natural disasters have long‐term effects on the mental health of affected individuals and communities (Black Dog Institute, 2020). These effects can last for years as demonstrated following the 2009 Black Saturday fires in Victoria, Australia: one fifth (21.9%) of the highest impacted communities reported mental health symptoms at the five‐year follow‐up (Gibbs et al. 2013). The recent 2019–2020 catastrophic bushfires in Australia was nothing like we have experienced before (Morton 2019), resulting in unprecedented devastation across much of the country with current estimates suggesting 14.5 million acres have been affected (White & Gilbert 2020) and numerous lives, houses, and livelihoods impacted. The 2019–2020 bushfires in New South Wales, Victoria, South Australia, Western Australia, and Tasmania caused much loss of life and property, environmental destruction, and community disturbance (Flanagan 2020), leaving an estimated one third of Australians now affected by the bushfires (Morton 2020). The last month of summer in the Northern Hemisphere has resulted in bushfires affecting and almost destroying small towns in the USA (Newburger, 2020). With predictions that globally, temperatures will continue to increase with more frequent heatwaves and less rainfall (CSIRO 2018), bushfires are likely to be a more frequent event, and the consequences of them being more widespread.

Background: Although mental illness among Indigenous Australians is generally accepted to be a major health problem, there is little evidence to show whether a clinical diagnostic tool is culturally appropriate for this population.
Objectives: To determine the cultural appropriateness of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (SCID-I) in the diagnosis of mental illness among Indigenous Australians.
Methods: SCID-I, a semi-structured clinical interview that uses the clinical judgement of the psychologist as well as the information collected by the SCID-I tool itself, was administered by culturally trained psychologists to 544 Indigenous adults living in Southern Queensland and Northern New South Wales.
Findings: The feedback questionnaire was completed by 498 (91.5%) participants. Administrating psychologists provided qualitative feedback for 502 (92.3%) interviews. Most (95.6%) participants were totally comfortable or mostly comfortable during the interview: 96.2% felt that they psychologist understood their responses during the interview; and 83% said that there were no culturally inappropriate questions. For psychologists, 72.5% of interviews did not encounter any cultural challenges to reach a clinical diagnosis; and 40.4% developed an excellent rapport with the participant. Sections of the interview where cultural aspects did need to be considered included those of psychosis (n = 99, 19.7%), anxiety (n = 4, 0.8%) and trauma sections (n = 4, 0.8%).
Conclusions: Cultural nuances need to be considered when SCID-I is used for Indigenous Australians. When administered by a culturally trained psychologist, SCID-I is considered culturally appropriate in this group.

Background: Little is known of the appropriateness of existing gatekeeper suicide prevention programs for Indigenous communities. Despite the high rates of Indigenous suicide in Australia, especially among Indigenous youth, it is unclear how effective existing suicide prevention programs are in providing appropriate management of Indigenous people at risk of suicide.
Methods: In-depth, semi-structured interviews and focus groups were conducted with Indigenous communities in rural and regional areas of Southern Queensland. Thematic analysis was performed on the gathered information.
Results: Existing programs were time-intensive and included content irrelevant to Indigenous people. There was inconsistency in the content and delivery of gatekeeper training. Programs were also not sustainable for rural and regional Indigenous communities.
Conclusions: Appropriate programs should be practical, relevant, and sustainable across all Indigenous communities, with a focus on the social, emotional, cultural and spiritual underpinnings of community wellbeing. Programs need to be developed in thorough consultation with Indigenous communities. Indigenous-led suicide intervention training programs are needed to mitigate the increasing rates of suicide experienced by Indigenous peoples living in rural and remote locations.

Background: Suicide is a leading cause of death among Indigenous youth worldwide. The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community. Method: Using a systematic strategy, relevant databases and targeted resources were searched using the following terms: 'suicide', 'gatekeeper', 'training', 'suicide prevention training', 'suicide intervention training' and 'Indigenous'. Other internationally relevant descriptors for the keyword "Indigenous" (e.g. "Maori", "First Nations", "Native American", "Inuit", "Metis" and "Aboriginal") were also used. Results: Six articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training. Conclusion: Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.

The Report of the NSW Bushfire Inquiry into the 2019-20 bushfires faIled to recognise the mental health impacts on the people in affected communities. The 2019-20 bushfires are considered one of the worst recorded in Australian history. The inquiry rightly identified the significant mental health impact of the bushfires on the firefighters and first responders. These individuals are exposed to significant hazards in their attempts to protect the land and communities. Their health and well-being is of the upmost importance. The disappointment is that the report includes several references to the physical health effects to communities exposed to the smoke from bushfires, with no reference to the mental health impact on those that have lost loved ones, their homes and/or their livelihood.

Background. Australia is one of the highest users of antibiotics in the developed world.
Objective. This study aimed to identify consumer antibiotic information needs to improve targeting of medicines information.
Methods. We conducted a retrospective, mixed-method study of consumers' antibiotic-related calls to Australia's National Prescribing Service (NPS) Medicines Line from September 2002 to June 2010. Demographic and question data were analysed, and the most common enquiry type in each age group was explored for key narrative themes. Relative antibiotic call frequencies were determined by comparing number of calls to antibiotic utilization in Australian Statistics on Medicines (ASM) data.
Results. Between 2002 and 2010, consumers made 8696 antibiotic calls to Medicines Line . The most common reason was questions about the role of their medicine (22.4%). Patient age groups differed in enquiry pattern, with more questions about lactation in the 0- to 4-year age group (33.6%), administration (5–14 years: 32.4%), interactions (15–24 years: 33.4% and 25–54 years: 23.3%) and role of the medicine (55 years and over: 26.6%). Key themes were identified for each age group. Relative to use in the community, antibiotics most likely to attract consumer calls were ciprofloxacin (18.0 calls/100000 ASM prescriptions) and metronidazole (12.9 calls/100000 ASM prescriptions), with higher call rates than the most commonly prescribed antibiotic amoxicillin (3.9 calls/100000 ASM prescriptions).
Conclusions. Consumers' knowledge gaps and concerns about antibiotics vary with age, and certain antibiotics generate greater concern relative to their usage. Clinicians should target medicines information to proactively address consumer concerns.

Background
Rural medical workforce shortage contributes to health disadvantage experienced by rural communities worldwide. This study aimed to determine the regional results of an Australian Government sponsored national program to enhance the Australian rural medical workforce by recruiting rural background students and establishing rural clinical schools (RCS). In particular, we wished to determine predictors of graduates’ longer-term rural practice and whether the predictors differ between general practitioners (GPs) and specialists.
Methods
A cross-sectional cohort study, conducted in 2012, of 729 medical graduates of The University of Queensland 2002–2011. The outcome of interest was primary place of graduates’ practice categorised as rural for at least 50% of time since graduation (‘Longer-term Rural Practice’, LTRP) among GPs and medical specialists. The main exposures were rural background (RB) or metropolitan background (MB), and attendance at a metropolitan clinical school (MCS) or the Rural Clinical School for one year (RCS-1) or two years (RCS-2).
Results
Independent predictors of LTRP (odds ratio [95% confidence interval]) were RB (2.10 [1.37–3.20]), RCS-1 (2.85 [1.77–4.58]), RCS-2 (5.38 [3.15–9.20]), GP (3.40 [2.13–5.43]), and bonded scholarship (2.11 [1.19–3.76]). Compared to being single, having a metropolitan background partner was a negative predictor (0.34 [0.21–0.57]). The effects of RB and RCS were additive—compared to MB and MCS (Reference group): RB and RCS-1 (6.58[3.32–13.04]), RB and RCS-2 (10.36[4.89–21.93]). Although specialists were less likely than GPs to be in LTRP, the pattern of the effects of rural exposures was similar, although some significant differences in the effects of the duration of RCS attendance, bonded scholarships and partner’s background were apparent.
Conclusions
Among both specialists and GPs, rural background and rural clinical school attendance are independent, duration-dependent, and additive, predictors of longer-term rural practice. Metropolitan-based medical schools can enhance both specialist and GP rural medical workforce by enrolling rural background medical students and providing them with long-term rural undergraduate clinical training. Policy settings to achieve optimum rural workforce outcomes may differ between specialists and GPs.

Networks are everywhere. Health systems and public health settings are experimenting with multifarious forms. Governments and providers are heavily investing in networks with an expectation that they will facilitate the delivery of better services and improve health outcomes. Yet, we lack a suitable conceptual framework to evaluate the effectiveness and sustainability of clinical and health networks. This paper aims to present such a framework to assist with rigorous research and policy analysis. The framework was designed as part of a project to evaluate the effectiveness and sustainability of health networks. We drew on systematic reviews of the literature on networks and communities of practice in health care, and on theoretical and evidence-based studies of the evaluation of health and non-health networks. Using brainstorming and mind-mapping techniques in expert advisory group sessions, we assessed existing network evaluation frameworks and considered their application to extant health networks. Feedback from stakeholders in network studies that we conducted was incorporated. The framework encompasses network goals, characteristics and relationships at member, network and community levels, and then looks at network outcomes, taking into account intervening variables. Finally, the short-term, medium-term and long-term effectiveness of the network needs to be assessed. The framework provides an overarching contribution to network evaluation. It is sufficiently comprehensive to account for many theoretical and evidence-based contributions to the literature on how networks operate and is sufficiently flexible to assess different kinds of health networks across their life-cycle at community, network and member levels. We outline the merits and limitations of the framework and discuss how it might be further tested.

The findings reported by McGrail and colleagues in this issue of the MJA support the effectiveness of Australian government incentives for recruiting and training general practitioners in rural areas as a strategy for reducing rural medical workforce shortages. The study found that rural origin of trainees and rural vocational training of GPs were each strongly associated with their practising in rural areas in the early years after completing vocational training. However, their findings also suggest that these effects had started to diminish by 4 years post-training. This finding is consistent with another recent Australian study, which found that the effects of rural recruiting and training diminished over time.

Objective: To investigate the level of Q fever awareness in Australia.

Methods: A scoping review was conducted by searching the electronic databases Medline, PubMed and Web of Science using keywords for Q fever, awareness, knowledge, and Australian locations. The search was initially limited to articles published in the 10 years prior to June 2022 and then extended up to and including August 2023" yielding 387 records.

Results: Fifteen articles were assessed as being eligible. These articles reported on surveys and interviews conducted with farmers, veterinary practitioners and nurses, medical practitioners, policy makers, researchers, industry representatives, animal science students, cat breeders, wildlife rehabilitators, and agriculture show attendees. Farmers were the largest group represented. Level of Q fever awareness amongst these communities, including those at high-risk, was generally low. The need for increased awareness was recognised. General practitioner awareness levels were low and recognised to be so by high-risk groups. Awareness of preventive measures including vaccination was greater among those with greater awareness and risk.

Conclusion: With the availability of a highly effective vaccine in Australia, there is a need to increase Q fever knowledge and awareness among high-risk groups and primary health care practitioners.

Implications for public health: Strategies to increase awareness and knowledge of Q fever risks and prevention strategies may assist with reducing Q fever burden in Australia.