Objective: To examine the quality of diabetes care and prevention of cardiovascular disease (CVD) in Australian general practice patients with type 2 diabetes and to investigate its relationship with coronary heart disease absolute risk (CHDAR). Methods: A total of 3286 patient records were extracted from registers of patients with type 2 diabetes held by 16 divisions of general practice (250 practices) across Australia for the year 2002. CHDAR was estimated using the United Kingdom Prospective Diabetes Study algorithm with higher CHDAR set at a 10 year risk of .15%. Multivariate multilevel logistic regression investigated the association between CHDAR and diabetes care. Results: 47.9% of diabetic patient records had glycosylated haemoglobin (HbA1c) .7%, 87.6% had total cholesterol >4.0 mmol/l, and 73.8% had blood pressure (BP) >130/85 mm Hg. 57.6% of patients were at a higher CHDAR, 76.8% of whom were not on lipid modifying medication and 66.2% were not on antihypertensive medication. After adjusting for clustering at the general practice level and age, lipid modifying medication was negatively related to CHDAR (odds ratio (OR) 0.84) and total cholesterol. Antihypertensive medication was positively related to systolic BP but negatively related to CHDAR (OR 0.88). Referral to ophthalmologists/optometrists and attendance at other health professionals were not related to CHDAR. Conclusions: At the time of the study the diabetes and CVD preventive care in Australian general practice was suboptimal, even after a number of national initiatives. The Australian Pharmaceutical Benefits Scheme (PBS) guidelines need to be modified to improve CVD preventive care in patients with type 2 diabetes.

High-profile events where in response to the experience of breast cancer women take on adventure activities to raise awareness and/or funds for breast cancer are increasing. These activities offer physical and psychological challenges within a peer support group setting. We investigated the experiences of 21 breast cancer survivors who participated in a 7-day breast cancer awareness motorcycle ride. Assessments included a qualitative pre/postinterview, solicited diary, pre-6-month follow-up survey. Measures included satisfaction with life, distress, happiness, global well being, meaning in life. Motivators were a desire for peer support, to promote breast cancer awareness, enjoyment, and personal growth. The ride incorporated physical and emotional challenge. A positive peer support experience led to feelings of inner peace, accomplishment, self-learning, a positive perspective, and improved social support. For a minority of women peer support or recreational expectations were not met resulting in negative feelings. No significant changes were observed over time in adjustment measures. Adventure events where women undertake emotional and physical challenge in an environment of group peer support provide opportunity for personal growth. In this context, peer support may provide the catalyst for the experience to become transformational and so is critical to generating positive outcomes. Realistic expectations of the ride are also influential.

Communication and information technologies can reduce the barriers of distance and space that disadvantage communities in Australia's underserved rural areas, where the health status of residents is often worse than that of their urban counterparts. ACROSSnet (Australians Creating Rural Online Support Systems) is a 3 year collaborative action research project that aims to design and develop an online support system that will assist rural communities in accessing information, education and support regarding suicide and its prevention, whilst considering the challenges of Internet speed, cost and availability that can impede the delivery of online services. The site provides three distinct levels of access: one level for community members, and two further levels for appropriately credentialled mental health workers. In creating this environment, the ACROSSnet team hopes that online communities of practice will develop, engaging participants of different ages, income and education levels, location, and socioeconomic backgrounds.

Despite a number of national initiatives to improve general practice care and specifically support better care in rural areas, cardiovascular risk management and its impact in Australian general practice patients with type 2 diabetes was still suboptimal during the study period especially among patients from rural areas. Greater effort will be required to reduce the disparity in risk factor prevention for CVD between urban and rural people with type 2 diabetes in Australia.

Some key individual risk factors and CHDAR did not improve in rural patients with type 2 diabetes despite a number of programs designed to provide comprehensive care to rural patients with diabetes. More emphasis is needed on supporting access to lifestyle changes (such as smoking, diet and physical activity) in rural primary health care.