Australian Community Research Articles

Rheumatic heart disease: an ongoing public health concern in vulnerable communities

Abstract Background Acute rheumatic fever (ARF) results from an autoimmune response triggered by group A streptococcus (GAS) infection (1). Severe or recurrent ARF episodes can cause permanent heart valve damage, leading to complications including heart failure, stroke, arrhythmias, carditis, and decompensation during pregnancy (2). Purpose Rheumatic fever (RF) remains a public health concern in Australia, particularly among Indigenous, migrant populations and socioeconomically disadvantaged communities. Europe and various regions worldwide have experienced significant migration from areas with a high prevalence of RHD (3). Amongst the more than 1 million asylum seekers who arrived in Europe in 2015, an estimated 1% could potentially be affected by RHD (3). This migration influx underscores the pressing need for the implementation of strategies in health policy and practice. We aimed to outline the attributes of our RF-RHD cohort to aid in the formulation of a Model of Care (MoC). Methods Cases were identified on a quarterly basis either through the NSW Public Health Rapid, Emergency, Disease, and Syndromic Surveillance (PHREDSS) system or via clinical diagnoses reported to the Public Health Unit (PHU) from January 2015 to June 2023. Demographic profiles, clinical particulars, and patient outcomes were collected from patients in the South Western Sydney Local Health District (SWSLHD), NSW, Australia. Results A total of 45 cases were reported (Table 1). This consisted predominantly of females with an average age at diagnosis of 14 years. A majority were obese (69%). Most were in the Maori and Pacific Islander populations (62%), while a smaller portion of patients were of Aboriginal or Torres Strait Islander descent (9%) (Australian Indigenous community). Notably, 84% of patients diagnosed with ARF subsequently progressed to RHD. Among the reported cases, 16 patients underwent valvular surgery, 2 patients progressed to end-stage heart failure, and there was 1 mortality. 39% (11) of female patients were pregnant during the study period, with 6 (55%) of these patients decompensating during their pregnancy (Table 2). Conclusion Rheumatic fever persists as a public health concern on a global scale. Our findings emphasize the need for a high index of clinical awareness in considering RF/RHD in socioeconomically disadvantaged communities. In our setting, there is a disproportionate burden of disease among the Pacific Islander population. The high occurrence of cardiac decompensation during pregnancy, underscores the need for close monitoring in this demographic. Despite the prevalence of rheumatic fever predominantly affecting young patients in vulnerable groups, we found a significant proportion of individuals lost to follow-up or not connected with Cardiology services. Addressing rheumatic fever requires a comprehensive approach that encompasses improved healthcare accessibility, targeted health education initiatives, and socioeconomic interventions.

Sporting clubs’ perceptions about harmful industry sponsorship: Lessons from gambling research

Abstract Background Unlike tobacco, there are no restrictions relating to gambling sponsorship in Australian sports. While some sporting teams have voluntarily refused sponsorship deals with gambling companies and other harmful industries, many are still actively entering into or renewing such deals. There is limited understanding of why, despite widespread public concern, sporting organisations continue to engage in commercial partnerships with gambling companies and venues. This study aimed to qualitatively explore the ethical and related practical issues associated with gambling sponsorship. Methods In-depth interviews were held with 24 key decision makers in Australian community sporting organisations. Participants were asked questions relating to attitudes towards gambling, decisions about gambling sponsorship within their clubs, and issues relating to alternative sponsors and sponsorship disparities. Data was analysed using reflexive thematic analysis. Results Interviews revealed the difficulty for sporting organisations to avoid harmful industry sponsorship. When deciding to align with gambling companies, sporting organisations had to consider their own values and the reputational impact of such deals, and balance this with the financial viability of the sporting organisation. Despite sporting organisations relying heavily on sponsorship deals, some stated they would refuse gambling sponsorship for ethical reasons but recognised that sporting clubs in poorer financial positions may be more vulnerable to taking up gambling sponsorship. Conclusions As elite sporting organisations begin to move away from gambling sponsorship, gambling companies may target community sport. The authors consider practical strategies to protect communities from sponsorship from harmful industries. Key messages • Sporting organisations navigate ethical dilemmas when considering gambling sponsorships, weighing values, reputation, and financial viability. Policy action is needed to protect local communities. • Community sporting organisations face increased risk of gambling sponsorship as elite sporting clubs move away, prompting the need for protective strategies.

Ruby Princess case study: a systems thinking analysis of COVID-19, cruise ships and Australia’s response

PurposeThe COVID-19 pandemic tested leadership in chaos and complexity and resulted in many lessons learnt in the process. One such opportunity was the cruise ship Ruby Princess “mishap” in Australia which resulted in the failure to quarantine the virus onboard the cruise ship thus allowing transmission into the Australian community. The purpose of this paper is to use the Ruby Princess as a case study and apply a systems thinking analysis to it.Design/methodology/approachWhilst many inquiries and commissions have documented the failings of the agencies or “systems” involved in the Ruby Princess, the Ruby Princess case study provides a suitable example for the application of systems thinking analysis. The paper proceeds by identifying the various agencies either directly or indirectly involved in the Ruby Princess disaster and groups them based on the system they represented (state; federal; international or cruise-based system). These systems were mapped providing a visual representation of the complexity of the landscape in which police and public safety agencies had to operate in to respond to the Ruby Princess.FindingsOver 30 agencies were found to be either directly or indirectly involved in the Ruby Princess. Following the application of systems thinking analysis, it was clear that the various systems were operating in silos, thus failing to fully exploit the interconnections between and within all the systems which ultimately resulted in the Ruby Princess.Practical implicationsThe results of this analysis have informed a series of recommendations for leadership development within similar contexts, including embracing a systems thinking approach.Originality/valueUsing the Ruby Princess as a case study, this article presents a novel approach through the application of systems thinking and how it can enhance a leader’s ability to navigate the current “new normal” operating environment. It highlights the importance of public safety leadership moving away from an insular systems focus towards more of a public sector partnership which is an imperative for police and other public safety agencies to navigate through times of complexity and chaos.

The anomalous Mr Hubert H.D. Griffith (1877–1958), Australian field naturalist, collector and benefactor

ABSTRACT Hubert H.D. Griffith was a significant but neglected contributor in the scientific discovery of Australia’s natural heritage. Although his interests were forged in his youth in Tasmania, his return to Adelaide as a young man heralded an energetic engagement with leading scientific societies and figures over nearly two decades at the beginning of the twentieth century. His interests were wide, spanning insects, birds, plants and photography. In particular, he supported J.M. Black in his preparation of the Flora of South Australia. Griffith’s impressive collections of beetles and plants have been consulted by taxonomists for more than a century and are now preserved in various state and national museums and herbaria in Australia. One genus (Griffithia) and 14 species of beetles and an important southern Australian seagrass, Amphibolis griffithii, are named after him in recognition of his contributions to science. A longtime and respected citizen of Adelaide, another enduring legacy of Hubert and his wife May (née Scott) is the Griffith Hospital, a private rehabilitation hospital they endowed in the 1950s, which continues to provide valued services to the South Australian community.

Cat Caring Behaviors and Ownership Status of Residents Enrolling a Cat in a Free Sterilization Program.

Most cats entering animal shelters in Australia are less than 12 months old and emanate from low socioeconomic areas. Many are unidentified and may be either owned or semi-owned cats (cats cared for by someone who does not consider themselves the owner). In Australia, approximately 33% of cats entering shelters and pounds are euthanized annually, adversely affecting the mental health of staff involved. Our study investigated cat ownership and caregiving behaviors of cats enrolled in the Australian Pet Welfare Foundation's Community Cat Program, which included free sterilization, microchipping, and preventive healthcare. The suburbs targeted in Ipswich, Australia had a high per capita cat intake into animal shelters. We surveyed 1094 cat owners and semi-owners. Most cats were under 12 months old (79%), primarily domestic short-haired (69%), and acquired through informal channels such as friends, family, or as strays. Veterinary care was limited, with only 15% of cats having visited a veterinarian and 28% being vaccinated. Prior to hearing about the free sterilization program, 88.5% of participants identified as owners, while 11.5% were semi-owners. Before completing the survey, these semi-owners transitioned from an informal caregiving relationship to becoming owner of the cat/s. Of the semi-owners, 93% indicated that their transition to ownership was driven by feelings of responsibility, emotional attachment, and access to free sterilization services. These findings suggest that targeted interventions, such as accessible veterinary care and sterilization programs, are crucial in encouraging semi-owners to take full ownership of cats, improving cat welfare, and reducing unplanned breeding. Supporting this transition helps curb overpopulation and fosters improved caregiving, benefiting both cats and communities.

A review of emergency laparoscopic cholecystectomies in Far North Queensland.

Access to laparoscopic cholecystectomy is more limited for remote communities and Indigenous patients internationally. To date, studies exploring the incidence of gallstone disease and access to laparoscopic cholecystectomy in Australian regional communities are limited. This study examined the rates and outcomes of emergency laparoscopic cholecystectomy (EMLC) in Far North Queensland, specifically in Indigenous and remote populations. We retrospectively examined all patients who underwent an EMLC at Cairns Hospital between 2016 and 2021. Over the study period, 634 EMLCs were undertaken. The average annual rate of 56 cases per 100 000 was considerably lower than national estimates. However, rates of EMLC were significantly higher in remote communities and Indigenous patients compared with the remaining cohort. Patients from remote communities were more likely to have pre-existing gallstone disease but were less likely to have been seen in a surgical outpatient clinic prior to admission. Despite this, surgical outcomes for EMLC were comparable to national and international standards. This study highlights the challenges in surgical healthcare provision for gallstone disease in a regional centre. The requirement for EMLC disproportionately effects geographically isolated communities and Australian Indigenous people. Addressing the healthcare barriers to management of GD in regional Australia should be a priority.

A Stroll Along Australian Ecosystems: Using Bioclimatic Transects to Examine Environmental Drivers of Community Assembly in Birds

ABSTRACTAimVariation in community composition along environmental gradients provides crucial information for identifying zones where species turnover is rapid and to ascertain whether compositional changes occur gradually or rather abruptly. We examined changes in bird community composition along three bioclimatic transects in Australia to test whether drivers of species turnover are consistent, rather than spatially contingent, across biologically contrasting ecosystems. We also detected potential transition zones associated with environmental thresholds and determined whether certain abiotic conditions promote a higher rate of community compositional turnover.LocationMainland Australia.TaxonTerrestrial birds.MethodsWe applied multivariate community analysis, generalised dissimilarity modelling (GDM) and threshold indicator taxa analysis (TITAN).ResultsWe observed that environmental variables are better predictors of community composition than spatial distance, which indicates that species sorting, rather than dispersal, plays a key role in structuring Australian avian communities. Annual precipitation constitutes a key driver of species turnover regardless of the analysed transect. The most humid landscapes and those with a higher tree canopy show lower spatial heterogeneity in community composition compared to those with less benign environmental conditions (e.g., dryer environments). TITAN detected significant transition points and supported the results obtained using GDM, which suggests that bird composition change along the gradients is not monotonic.Main ConclusionsOur results suggest that avian beta diversity increases with increasing environmental harshness, presumably through changes in the relative importance of stochastic versus deterministic processes. The obtained findings show that open forests and woodlands are extremely important ecosystems on this continent and deserve special attention in terms of conservation due to their vulnerability to global change. Lastly, this study exemplifies the value of combining community‐ and taxon‐based analyses to identify and interpret community thresholds, which can serve to pinpoint targets for preserving biodiversity.

Language and terminology to describe transgender communities; Perspectives from people with lived experience

Background There is no consensus over the meaning of “transgender,” “trans and gender diverse,” and other terminology used to describe people with a gender different from the gender presumed or recorded for them at birth. We aimed to survey transgender (trans) individuals to understand lived experience perspectives on terminology. Methods An online cross-sectional survey of trans people currently living in Australia and aged ≥16 was conducted from June 2021 to April 2022. Demographic data and terminology preferences were ascertained through fixed-option and free-text questions. Results Of 1023 respondents with a median age of 30 years (IQR 24, 41), 37.1% were trans women, 34.9% were trans men, 27.6% were non-binary, and 0.4% had a culturally specific identity. There was no consensus regarding community-level terminology, with “trans/transgender and gender diverse” the most preferred term (21.9%), followed by “trans/transgender” (19.3%), and “gender diverse” (15.1%). The term “trans/transgender” was more preferred by trans women (27.9%), trans men (19.0%), respondents who had a history of or wanted gender-affirming hormone therapy (GAHT; 20.7%), and gender-affirming surgery (GAS; 20.9%), compared to non-binary respondents (8.2%), and respondents who did not want GAHT (4.9%) or GAS (13.9%). Three themes emerged from free-text responses regarding term preference: (1) Inclusivity, (2) Trans as a binary and medicalized experience, and (3) Societal understanding, accessibility, and destigmatization. Conclusion From Australian trans communities’ perspectives, the term “trans/transgender and gender diverse” was the most preferred community-level terminology to collectively describe people with a gender different from the gender presumed or recorded for them at birth. Further perspectives are needed from other cohorts internationally.

Resistance of Australian fish communities to drought and flood: implications for climate change and adaptations

Climate change‐induced extreme weather and related drought and flood conditions are heterogeneous across space and time. The variability in location, timing, and magnitude of rainfall can alter how species respond to the drought and flood disturbances. To further complicate this matter, when droughts end they are often followed by extreme flooding, which are rarely considered as a disturbance (Humphries et al. 2024), let alone assessed with its own heterogeneity. Consequently, it is difficult to quantify impacts on ecological communities across large spatiotemporal scales without considering flood‐drought disturbance characteristics in sequence (Burton et al. 2020). We hypothesized that native organisms have evolved resistance to withstand repeated cycles of drought‐flood disturbances, and that established non‐native species have adapted to persist in novel conditions. To test this, we fit spatiotemporal models of species occurrence with local rainfall patterns as covariates in the drought and flood impacted Murray‐Darling basin in Australia during the decade long Millenium Drought, and its recovery period. During these drought conditions, river‐floodplain organisms in the Murray‐Darling became localized in refugia that limited longitudinal and lateral connectivity (Bond et al. 2008), and following flooding the same organisms were exposed to dispersal and recruitment opportunities (Humphries et al. 2020), as well as to hypoxic blackwater events that lead to the mortality of aquatic organisms (Small et al. 2014). At the basin‐scale we found that the range size of most native and non‐native fishes were highly resistant to the extreme drought and post‐flood conditions. At local scales, species richness, or detection, actually increased under drought conditions. Both findings highlight the resistance of species to climate change driven extreme weather, which opens new questions on community adaptations.

Place attachment and lived values in Western Australian communities

Substantial research exists on attachments people have to places and the phenomena and objects they value. However, insights on how values vary between different locations and across demographics and how place attachment differs between rural and urban areas are more limited. These understandings are needed to design meaningful adaptation strategies for people and communities at risk from climate change. This study examines attachment to place and things people value in eight communities in Western Australia, using a survey with 403 participants. Results showed that residents across the rural communities shared similar values, but that the values of urban communities were differentiated socioeconomically. Contrary to our hypothesis, place attachment was not stronger among the rural compared to the urban sites. The findings point to the importance of incorporating place-based, lived values and needs, particularly from less affluent residents, into inclusive adaptation planning.

Health professionals’ and caregivers’ perspectives on improving paramedics’ provision of palliative care in Australian communities: a qualitative study

ObjectivesParamedics have the potential to make a substantial contribution to community-based palliative care provision. However, they are hindered by a lack of policy and institutional support, as well as targeted...

An inpatient mental health placement for paramedic undergraduate students: a pilot study

BackgroundThe prevalence of mental and behavioural illnesses in the Australian community is increasing. Paramedics are frequently the first health responders to a mental health crisis, and their workload associated with mental health presentations is also increasing. The present study explored the experience and perspectives of undergraduate paramedic students who participated in a pilot mental health placement.MethodsA pilot workplace learning opportunity was established in which students completed a portion of their community service hours in an inpatient mental health setting at Port Macquarie Base Hospital. Eight students attended and completed the placement and were administered the Clinical Placement Evaluation Questionnaire.ResultsStudent responses to this placement experience were overwhelmingly positive. The data showed that all the students responded “Strongly Agree” or “Agree” to each of the survey items. Thematic analysis of the qualitative data yielded four central themes related to benefits, additional training and education, nursing staff, and improvements.ConclusionsThis pilot study suggests that mental health placements for paramedics have meaningful educational value and can impact student learning. Since this pilot study, mental health placements have been permanently included as part of the undergraduate curriculum in our institution.

Investigating the influence of information sources on flood-coping appraisal: Insights into flood mitigation behaviour

Understanding how individuals and communities respond to flood risks is paramount for effective disaster management and community resilience. This study investigates the impact of information sources on the coping appraisal of Australian flood-prone communities (flood-coping appraisal) to gain insight into flood mitigation behaviour. Utilizing the cognitive process of Protection Motivation Theory (PMT) and integrating it with the Health Belief Model (HBM), a comprehensive framework is developed to explore the interplay between sources of information, cognitive appraisals, and coping responses. Using Partial Least Squares Structural Equation Modeling (PLS-SEM), data from a research survey are analysed to examine the relationships between latent variables within the framework. The results reveal two key components significantly affecting flood-coping appraisal: Benefit/barrier Appraisal and Social Environment. Benefit/barrier Appraisal evaluates individuals' perceptions of the cost-effectiveness of mitigation measures, their potential impacts on property appearance, and property resale value, while the Social Environment assesses individuals’ observational learning from social norms and the availability of social support. Additionally, experiences with floods inside buildings emerge as a significant factor influencing the flood-coping appraisal. The findings underscore the importance of understanding the sources of information that drive higher flood-coping appraisal for effective flood risk management and community resilience. These insights contribute to developing targeted flood risk communication strategies to promote adaptive behaviours and enhance community resilience in the face of flood hazards.

Food intake in an Australian Aboriginal rural community facing food and water security challenges: A cross-sectional survey.

Researchers were invited by Aboriginal leaders to collaborate on this study which aimed to assess food intake in the Walgett Aboriginal community to inform long-term community-led efforts to improve food and water security and nutrition. Aboriginal adults living in or near Walgett, a remote community in north-west NSW, Australia, completed an adapted Menzies Remote Short-item Dietary Assessment Tool, which was administered verbally and face-to-face in early 2022. Aboriginal people were involved in the survey design, training and collection, and analysis of data. Descriptive statistics were tabulated, overall and by gender, age, and location. Differences by sex, age group (18-44 years versus ≥45 years), and location (Walgett town or other) were determined using a chi-square test. A total of 242 participants completed the survey; 55% were female. Three-quarters of participants reported meeting the recommendations for discretionary foods (73%); however, more than half (56%) exceeded the recommended maximum serves of sugar-sweetened beverages. The proportion of participants meeting core food group guidelines was 72% for meat, 36% for fruit, 20% for bread and cereals, 6% for dairy, and 3% for vegetables. Overall, none of the participants met the recommended serves of all food groups outlined in the Australian Dietary Guidelines. Findings show that Walgett Aboriginal community members surveyed were consuming a healthier diet than national data reported for Aboriginal and Torres Strait Islander people in Australia. However, none of the participants were meeting all of the national dietary guidelines, placing them at increased risk of diet-related chronic disease. Local Aboriginal community-led efforts to improve food and water security should include specific strategies to improve nutrition.

Experiences of COVID-19 in an Australian community cohort of adults with epilepsy

A number of studies have been conducted on the effects of the COVID-19 pandemic on people with epilepsy (PWE), some showing increased seizures, poorer psychosocial states, and reductions in Quality of Life (QoL). During the latter stages of COVID-19, well before the UN declared an end to the state of emergency, our study was conducted in Australia of a sample of women and men ≥ 18 years. The study was based on Wave 6 of the Australian Epilepsy Longitudinal Study (AELS). It used mixed methods. Two main scales were used in the study, the QOLIE-31 for QoL and the MOS-8 for social support. The quantitative component of the study looked at QoL in relation to COVID-19 and found no QoL differences in those who contracted the virus. However, there was significantly lower QoL in those having difficulties in seeing a GP, for those with limited access to healthcare, and for those who had problems in gaining ASMs (anti-seizure medicines) and/or other medicines and being unvaccinated. Being younger and living in rental accommodation were most likely significant contributing factors. Those not being vaccinated were less than the proportion in the whole national population., The qualitative component focussed on reasons for being vaccinated or not. Overall, the responses to the question “Were you vaccinated?” demonstrated that people made informed decisions on vaccinations, taking into account their own health as well as protecting family and public health considerations.

Factors Associated with Advance Care Planning Engagement Among Community‐Dwelling Older Adults: A Cross‐Sectional Study

ABSTRACTAimTo explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community‐dwelling older adults.DesignA cross‐sectional study was conducted with 262 community‐dwelling older Australians across metropolitan, regional and rural communities between August and October 2022.MethodsValidated self‐reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis.ResultsAnxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement.ConclusionIncreased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community‐dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community‐dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning.ImpactUnderstanding factors associated with advance care planning engagement among community‐dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community‐dwelling older adults in advance care planning.Reporting MethodThe STROBE statement checklist was used as a guide to writing the manuscript.Patient or Public ContributionThe study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.

Are Australian Jewish community organisations meeting child safe standards in their policies? An exploratory desktop audit

Are Australian Jewish community organisations meeting child safe standards in their policies? An exploratory desktop audit

Barriers and Enablers to Data-Based Decision Making in Australian Place-Based Community Initiatives: A Qualitative Study Informed by the COM-B Model and Theoretical Domains Framework

AbstractThis study investigated barriers and enablers to collecting, reporting, and using data and evidence-based lead indicators in decision-making. Four Australian place-based initiatives (PBI) focused on improving child health and reducing inequities participated. Eight interviews with PBI leaders revealed barriers and enablers aligned with all three Capability, Opportunity, and Motivation factors of the COM-B model of behaviour. Difficulties sharing data across services and with the PBI was a main barrier. Enablers were largely related to opportunity factors (e.g., data access) and demonstrating to service providers the benefits to families. Interventions targeting multiple barriers and enablers are needed for consistent, routine use of lead indicators.

Melatonin Use in School-Aged Children and Adolescents: An Exploration of Caregiver and Pharmacist Perspectives

ABSTRACT Objective This study aims to explore the perspectives and experiences of Australian caregivers and community pharmacists about pediatric melatonin use. Methods A convenience sample of caregivers with children (aged 11–16 years) using melatonin as a sleep aid and community pharmacists (including pharmacist interns) were recruited. Participants first completed an online survey followed by an online semi-structured interview. Interviews were guided by a schedule of questions for the respective participant groups, broadly exploring their beliefs about melatonin, experiences in using/supplying melatonin, and perceived facilitators/barriers for melatonin use. Interviews were digitally recorded, transcribed verbatim, and analyzed using the Framework Approach. Results Fourteen caregivers of predominantly neurodiverse adolescents and 24 community pharmacists were interviewed. While melatonin was perceived by caregivers of both typically developing and neurodiverse dependants as safer than pharmacological sleep aids, treatment was only initiated after trialling non-pharmacological strategies first. Pharmacists expressed concerns around the ambiguities in practice and the limited scope of existing resources for guiding pediatric melatonin use. Caregivers frequently deferred to the information available online to procure products or self-adjust doses and dosing schedules. Both pharmacists and caregivers emphasized the need for more affordable and age-appropriate proprietary formulations that are readily accessible. Conclusion Melatonin is administered predominantly by caregivers of neurodiverse adolescents to address their sleep disturbances. The findings underscore the need for reliable, evidence-based information to guide safe and appropriate use of melatonin in pediatric populations. Patient education is also warranted to address maladaptive medication-administration practices. Lastly, there is a need for stronger regulatory oversight of melatonin products to ensure their quality and safety of use.

Consideration of life safety risk equity principles in the assignment of design flood probability

ABSTRACT When designing hazardous infrastructure a life safety assessment process can be applied that considers three tests; 1 an individual risk equity test; 2 a societal intolerance test; and 3 a ‘legal’ test as to whether risks are reduced to be ‘so far as is reasonably practicable’ (SFAIRP) or ‘as low as reasonably practicable’ (ALARP). This approach, which is embedded in many workplace health and safety regulatory jurisdictions and safety standards for infrastructure including dams, nuclear facilities and industrial facilities, has clear justification, can be rigorously tested, and is defensible. While evidence to suggest a strong societal intolerance to floods is limited (i.e. there does not appear to be a disproportionate reaction to life loss from flood events compared to, for example, dam failure) there is a clear connection between flood risk and life safety equity principles. An individual life safety risk equity test, considering a person’s right to certain levels of protection in our society, compares flood risk with that of the background life safety risks from all hazards that exist in the Australian community. Based on age and gender distributed census data and typical annual exceedance probabilities assigned for flood management, there may be circumstances where flooding is the leading fatality risk for particular individuals living on a floodplain. Other considerations include ownership of flood risk (the floodplain manager or the individual), the distinction between voluntary and involuntary risk taking (noting that many road fatalities occur during flood events), the ratio between flood exposure and fatality (including flood hazard) and any legal and ethical obligations relating to public safety and a standard of care.