Background. Current pandemic influenza plans to place GPs at the front line of a pandemic influenza response. However, little is known about GPs' perceptions of their role and preparedness in the event of a pandemic occurring. Objective. Our aim was to assess general practice preparedness to respond to pandemic influenza and to identify issues that need to be addressed to enhance preparedness for the next pandemic. Methods. We conducted a series of semi-structured interviews to explore GPs' views regarding their role in responding to pandemic influenza, practice preparedness and planning issues, and the expectations and requirements of GPs for provision of professional services during a pandemic. The subjects were 60 Australian GPs, purposively selected to maximize diversity within the sample. Results. GPs in this study expressed a willingness to provide professional services in a pandemic. The motivation for this was largely altruistic and was in the context of high personal risk of becoming infected. Participants did not have stockpiles of antivirals or personal protective equipment within their practices and felt that government had a duty of care to stockpile on behalf of the general practice workforce. Participants were enthusiastic about receiving further information and training in pandemic preparedness. The most appropriate setting for this was within practices. Conclusions. GPs were willing to provide clinical services in a pandemic. However, appropriate education, training and supply of equipment were necessary to support them in this role. This information will inform further planning for the public health response to pandemic influenza.

Background: To increase recognition of airflow obstruction in primary care, we compared two models of spirometry delivery in a target group at risk of chronic obstructive pulmonary disease (COPD). Methods: A 6 month qualitative/quantitative cluster randomised study in eight practices compared opportunistic spirometry by “visiting trained nurses” (TN) with optimised “usual care” (UC) from general practitioners (GPs) for smokers and ex-smokers, aged over 35 years. Outcomes were: spirometry uptake and quality, new diagnoses of COPD and GPs’ experiences of spirometry. Results: In the eligible target population, 531/904 (59%) patients underwent spirometry in the TN model and 87/1130 (8%) patients in the UC model (p<0.0001). ATS spirometry standards for acceptability and reproducibility were met by 76% and 44% of tests in the TN and UC models, respectively (p<0.0001). 125 (24%) patients tested with the TN model and 38 (44%) with the UC model reported a pre-existing respiratory diagnosis (p<0.0001). Three months after spirometry, when the ratio of forced expiratory volume in 1 s/forced vital capacity (FEV₁/FVC) was <0.7 and no prior COPD diagnosis was reported, nine (8%) participants had a new doctor recorded COPD diagnosis in practices with the TN model and two (8%) participants in practices with the UC model. Mislabelling of participants with a diagnosis of COPD when FEV₁/FVC was ⩾0.7 was present in both models prior to and after spirometry. GPs valued high quality spirometry and increased testing of patients at risk of COPD in the TN model. They identified limitations, including the need for better systematic follow-up of abnormal spirometry and support with interpretation, which may explain persisting underdiagnosis of COPD in practice records. Conclusions: Although opportunistic testing by visiting trained nurses substantially increased and improved spirometry performance compared with usual care, translating increased detection of airflow obstruction into diagnosis of COPD requires further development of the model. Trial registration number: Australian Clinical Trials Registry: registration No 12605000019606.

To investigate and examine the factors associated with initiation of, and exclusive breastfeeding at hospital discharge of, late preterm (34 0/7 - 36 6/7 weeks) compared to 37 week gestation (37 0/7 - 37 6/7 week) mother and baby pairs.

Fathers’ attitudes and actions can positively or negatively affect mothers’ intentions to breastfeed, breastfeeding duration and exclusivity. In-depth information about fathers’ perspectives on breastfeeding are largely absent in the literature about infant feeding. The objective of this research was to investigate how fathers view breastfeeding. This mixed method study recruited Tasmanian fathers with children < 24 months of age. Fathers completed a questionnaire and participated in either semi structured one-on-one or group interviews. Transcripts were analysed using a process of iterative thematic analysis. Twenty-six fathers participated in the study. They had a mean age of 34 years and just over half were first time fathers. A total of 13 fathers lived in areas classified by SEIFA as disadvantaged. Twenty-one reported they had decided as a couple to breastfeed their current child. Fathers’ views on breastfeeding are complex, multi-layered and change over time: as babies get older, as fathers get more familiar with feeding babies, when feeding practices change and when family circumstances change. Four thematic categories related to how fathers view breastfeeding were identified; Breastfeeding as healthy and natural, the value of breast feeding and breastmilk, a pragmatic approach to breastfeeding and Breastfeeding as something achieved or imposed. Fathers in our study valued breastfeeding and saw it as healthy and natural for babies. However, many of the fathers in our study had seen their partners struggle with breastfeeding. As a result some also viewed breastfeeding as a potentially harmful practice for mothers. Their accounts demonstrated that breastfeeding problems affect families, not just mothers and infants. There is scope for improvement in the care of women during and after birth to reduce breastfeeding problems and for fathers to learn more about breastfeeding prior to the birth of their child.