General practitioner participation in the second Australian National Blood Pressure Study (ANBP2).

1. The second Australian National Blood Pressure Study (ANBP2) is an outcome trial of the treatment of hypertension in the elderly conducted entirely in general practices across Australia. Prior to ANBP2, no study of this size and nature had been undertaken in Australian general practice and the response of General Practitioners (GPs) to becoming involved in long-term cardiovascular research was unknown. 2. Academic departments and Divisions of General Practice were approached to support the project. General Practitioners were approached by letter of invitation and contacted by a regional medical coordinator (RMC) either at a face-to-face meeting or by telephone. 3. At the close of recruitment to ANBP2, 1938 GPs from 950 practices had registered as investigators. Sixty-two Divisions of General Practice were approached to support the study in five mainland Australian states with 39 (63%) participating, although participation by state was highly variable (range: 18-100%). Thirty divisional or promotional dinner meetings were held, with 56% (368/658) of those attending registering as investigators. Of the 8098 GPs sent a letter of invitation to participate in the study, 1357 (17%) expressed interest and eventually enrolled as investigators, ranging from 8% in Queensland to 28% in New South Wales. Ninety-six per cent of GPs who had a personal face-to-face contact (696/724) with the RMC registered in the study. 4. The GP recruitment phase of ANBP2 has been successfully completed. Peer-to-peer recruitment was the most successful strategy; however, success varied between states. General Practitioner recruitment to long-term clinical trials appears to be successful with a multifactorial approach focusing on peer-to-peer recruitment.

Youth suicide issues in general practice.

OBJECTIVE: To identify the factors that predispose to suicidal thinking and behaviours in young Australians who visit a general practitioner. METHOD: A clinical audit program that required a pre-entry survey of 50 young people attending a GP. RESULTS: Suicidal thinking and behaviours in young people have been increasing over the past decades. In this survey of over 6000 young Australians, evidence suggests that there are fundamental mental health factors that all GPs should explore with young people to assess the risk of self harm. These include feelings of hopelessness and powerlessness, the pattern and type of drug use, a history of sexual abuse, concerns about sexuality and sexual identity. DISCUSSION: General practitioners should not rely on their previous knowledge of a young person but continue to explore issues of suicide where any combinations of the above factors are present.

Sexual abuse and suicidal issues in Australian young people. An interim report.

BACKGROUND: Youth suicide remains a significant issue in Australian society with suicide rates among young males being of particular concern. While there are many antecedents for suicidal behaviours one that is often overlooked is sexual abuse. In particular, sexual abuse in males has the potential to be an easily overlooked issue and yet may lead to significant emotional distress. OBJECTIVE: The objective of this study was to identify if sexual abuse played a significant role in depression and suicide risk, including suicidal intent. DISCUSSION: This study supports an apparent high prevalence of sexual abuse in young Australians and indicates that such abuse contributes to a number of health risk behaviours including self harm and suicidal intent. General practitioners need to be aware of this as a suicidal risk factor and need to raise it in discussion with any young person who presents with significant health risk behaviours such as drug taking, sexual risk taking and self harm.

Feasibility of conducting cardiovascular outcome research in Australian general practice: results from the ANBP2 pilot study. Australian National Blood Pressure Study.

1. The present study aimed to determine the feasibility of conducting a 5 year cardiovascular outcome trial of the treatment of 6000 elderly hypertensive patients in Australian general practices. 2. General practitioners (GPs) were invited to participate by mail and personal follow-up. Patient records were reviewed to identify subjects for a blood pressure (BP) screening programme. Blood pressure was measured on three occasions and eligible subjects were included if the average BP was > or = 160 mmHg systolic or > or = 90 mmHg diastolic if systolic BP was > or = 140 mmHg. 3. Seven hundred and forty-one GPs were approached and 89 were enrolled in the study (12% of mail invites and 75% of those receiving a personal contact). In 16 practices where screening was completed, 82,000 records were reviewed to identify 4% patients eligible for screening. Twenty-two per cent of eligible subjects attended screening. Of 1938 subjects screened, 180 (9%) had BP > or = 160/90 mmHg. Forty-seven per cent of subjects (n = 916) were receiving antihypertensive therapy and 184 (20%) were withdrawn from therapy. One hundred and sixteen (63%) of these subjects had BP return to study entry levels within 6 weeks. Fifty-seven newly diagnosed and 81 previously treated subjects were randomized (7% of the screened population). 4. Based on the high participation rate of GPs, the response rate of patients to attend a BP screening programme and the 7% randomization to screening ratio for entry into the study, the ANBP2 pilot study has demonstrated that it is feasible to recruit subjects from Australian general practices to a cardiovascular outcome trial.