Australian Department Of Health Research Articles

EXERCISE PRESCRIPTION TO SUPPORT THE MANAGEMENT OF OSTEOPOROSIS: AN EXPERT STATEMENT FOR EXERCISE PHYSIOLOGISTS

INTRODUCTION & AIMS Low bone density, which includes osteopenia and osteoporosis, leads to roughly 183,000 fractures annually in Australia, with associated direct costs of $2.59B. Osteoporosis is underdiagnosed. Exercise is effective therapy but is underutilised due to a lack of knowledge and unfounded concerns about risk of injury. The aim of the newly developed Exercise Prescription for the Prevention of Osteoporosis Fracture National Statement is to provide clear, actionable, evidence-based exercise advice to improve the bone health of people living with osteopenia and osteoporosis. The project was led and supported by Healthy Bones Australia with funding awarded by the Australian Government Department of Health, Public Health and Chronic Disease Program Osteoporosis – Education and Prevention. METHODS An expert working group (scientists, AEP, physiotherapist, endocrinologist and orthopaedic resident) and advisory committee (practising AEPs and physiotherapists) reviewed current evidence and existing guidelines to formulate recommendations for a national statement in the Australian context. A National Exercise Roundtable was convened, including consumers and stakeholders across multiple disciplines, to adapt the recommendations for clinical practice and consumer acceptability. RESULTS The final statement is presented as an evidence-based document, and a 2-page user summary. The Statement outlines the general principles of osteogenic loading and falls prevention, then presents a comprehensive exercise prescription based on those principles, along with special considerations for comorbid conditions. Level A consensus was achieved on five summary statements. CONCLUSION Bone health is an essential part of general health. While exercise prescription for other chronic diseases, such as, heart health and diabetes, is quite well established, there is a care gap for bone which we have addressed. Our National Statement, informed by high level evidence and expert insight, delivers best practice for prescribing exercise for osteoporosis to achieve best patient outcomes. We will present the document to the intended end users – exercise physiologists.

Viral clearance as a surrogate of clinical efficacy for COVID-19 therapies in outpatients: a systematic review and meta-analysis

Surrogates of antiviral efficacy are needed for COVID-19. We aimed to investigate the relationship between the virological effect of treatment and clinical efficacy as measured by progression to severe disease in outpatients treated for mild-to-moderate COVID-19. In this systematic review and meta-analysis, we searched PubMed, Scopus, and medRxiv from database inception to Aug 16, 2023, for randomised placebo-controlled trials that tested virus-directed treatments (ie, any monoclonal antibodies, convalescent plasma, or antivirals) in non-hospitalised individuals with COVID-19. We only included studies that reported both clinical outcomes (ie, rate of disease progression to hospitalisation or death) and virological outcomes (ie, viral load within the first 7 days of treatment). We extracted summary data from eligible reports, with discrepancies resolved through discussion. We used an established meta-regression model with random effects to assess the association between clinical efficacy and virological treatment effect, and calculated I2 to quantify residual study heterogeneity. We identified 1718 unique studies, of which 22 (with a total of 16 684 participants) met the inclusion criteria, and were in primarily unvaccinated individuals. Risk of bias was assessed as low in 19 of 22 studies for clinical outcomes, whereas for virological outcomes, a high risk of bias was assessed in 11 studies, some risk in ten studies, and a low risk in one study. The unadjusted relative risk of disease progression for each extra log10 copies per mL reduction in viral load in treated compared with placebo groups was 0·12 (95% CI 0·04-0·34; p<0·0001) on day 3, 0·20(0·08-0·50; p=0·0006) on day 5, and 0·53 (0·30-0·94; p=0·030) on day 7. The residual heterogeneity in our meta-regression was estimated as low (I2=0% [0-53] on day 3, 0% [0-71] on day 5, and 0% [0-43] on day 7). Despite the aggregation of studies with differing designs, and evidence of risk of bias in some virological outcomes, this review provides evidence that treatment-induced acceleration of viral clearance within the first 5days after treatment is a potential surrogate of clinical efficacy to prevent hospitalisation with COVID-19. This work supports the use of viral clearance as an early phase clinical trial endpoint of therapeutic efficacy. Australian Government Department of Health, Medical Research Future Fund, and Australian National Health and Medical Research Council.

Clinical research imperatives: principles and priorities from the perspective of Allied Health executives and managers.

Objective It is widely understood that a key means of improving health systems and patient outcomes is through research - accessing, understanding, generating and applying research evidence-based practice. To promote more targeted and strategic research in Allied Health practice, this study sought to establish the principles, areas and priorities for clinical research as perceived by Allied Health leaders in the South Australian public health system. Methods The study used a mixed-methods design (full, sequential and equal model). Participants were recruited from theSouth Australian Department of Health and Wellbeing employment lists for Allied Health senior leaders. Consenting participants attended face-to-face focus groups; after an overview presentation, they discussed the principles for Allied Health research, followed by areas and priorities for research. Summaries of the responses were themed descriptively and circulated electronically so participants could confirm the research areas and ascribe priority ratings, clinical populations and services. Results A total of 28 people attended the stakeholder forum (5 online); 20 responded to the second-round electronic summary. Nine principles of research action were agreed. Fourteen research areas were identified and prioritised. There was a relatively consistent prioritisation of measuring Allied Health value, Allied Health workforce, hospital avoidance and closing the gap for Aboriginal health outcomes - whether the individuals were thinking about their own service or the state as a whole. Conclusions Allied Health leadership identified key principles and priorities for research to improve service delivery and patient outcomes. These priorities should generate further discussion and interest for novice and experienced researchers and leaders and can be used to inform granting and project plans.

Simulating the healthcare workforce impact and capacity for pancreatic cancer care in Victoria: a model-based analysis

BackgroundThe incidence of pancreatic cancer is rising. With improvements in knowledge for screening and early detection, earlier detection of pancreatic cancer will continue to be more common. To support workforce planning, our aim is to perform a model-based analysis that simulates the potential impact on the healthcare workforce, assuming an earlier diagnosis of pancreatic cancer.MethodsWe developed a simulation model to estimate the demand (i.e. new cases of pancreatic cancer) and supply (i.e. the healthcare workforce including general surgeons, medical oncologists, radiation oncologists, pain medicine physicians, and palliative care physicians) between 2023 and 2027 in Victoria, Australia. The model compares the current scenario to one in which pancreatic cancer is diagnosed at an earlier stage. The incidence of pancreatic cancer in Victoria, five-year survival rates, and Victoria’s population size were obtained from Victorian Cancer Registry, Cancer Council NSW, and Australian Bureau of Statistics respectively. The healthcare workforce data were sourced from the Australian Government Department of Health and Aged Care’s Health Workforce Data. The model was constructed at the remoteness level. We analysed the new cases and the number of healthcare workforce by profession together to assess the impact on the healthcare workforce.ResultsIn the status quo, over the next five years, there will be 198 to 220 stages I-II, 297 to 330 stage III, and 495 to 550 stage IV pancreatic cancer cases diagnosed annually, respectively. Assuming 20–70% of the shift towards pancreatic cancer’s earlier diagnosis (shifting from stage IV to stages I-II pancreatic cancer within one year), the stages I-II cases could increase to 351 to 390 or 598 to 665 per year. The shift to early diagnosis led to substantial survival gains, translating into an additional 284 or 795 out of 5246 patients with pancreatic cancer remaining alive up to year 5 post-diagnosis. Workforce supply decreases significantly by the remoteness levels, and remote areas face a shortage of key medical professionals registered in delivering pancreatic cancer care, suggesting travel necessities by patients or clinicians.ConclusionImproving the early detection and diagnosis of pancreatic cancer is expected to bring significant survival benefits, although there are workforce distribution imbalances in Victoria that may affect the ability to achieve the anticipated survival gain.

Food, nutrition and the dining experience in aged care settings: Findings of a nationwide survey.

Previous research on food, nutrition and dining practices in Australian residential aged care (RAC) homes has been based on a limited sample of single-home or multiple-home providers, but a nationwide study has not been conducted. The aim of this study was to provide a preliminary overview of current food, nutrition and dining practices across Australian RAC facilities using a nationwide survey. A survey was distributed to Australian RAC homes in August-September 2020, as part of the National Congress on Food, Nutrition and the Dining Experience in Aged Care (February 2021). The survey, administered via an online portal, consisted of 38 semistructured questions including yes/no or multiple-choice responses, free text, frequency scales and number entry. Six key topics were explored, including 'food service system and environment', 'catering style', 'menu planning and evaluation', 'nutrition planning and requirements', 'nutrition-related screening and assessment' and 'training and additional information', which were informed by the Australian Government Department of Health and reflected the interests of the Congress. The final sample included 292 respondents (204 individual homes and 88 multiple-home proprietors) representing 1152 homes and 125,393 residents, encompassing approximately 43% of RAC homes (of a possible 2671) and 57% of residents (of a possible 219,965) in Australia. Survey respondents representing RAC homes included service managers, catering managers, Chief Executive Officers, cooks, chefs, dietitians or staff from other roles within homes. A number of potential areas of need were identified, included increasing the autonomy of residents to select the foods they desire, increasing the variety and choice (including timing) of meals, enhancing the dining environments in homes to stimulate food intake and increasing staff training and the number of trained chefs in homes, so that meals are prepared which address diverse nutritional needs of residents. This study provides insight into the food service and mealtime practices of over a third of Australian RAC homes. The findings of this survey may help to identify key targets for intervention to improve the food, nutrition and quality of life of aged care residents.

Determinants of passive antibody efficacy in SARS-CoV-2 infection: a systematic review and meta-analysis

Randomised controlled trials of passive antibodies as treatment and prophylaxis for COVID-19 have reported variable efficacy. However, the determinants of efficacy have not been identified. We aimed to assess how the dose and timing of administration affect treatment outcome. In this systematic review and meta-analysis, we extracted data from published studies of passive antibody treatment from Jan 1, 2019, to Jan 31, 2023, that were identified by searching multiple databases, including MEDLINE, PubMed, and ClinicalTrials.gov. We included only randomised controlled trials of passive antibody administration for the prevention or treatment of COVID-19. To compare administered antibody dose between different treatments, we used data on in-vitro neutralisation titres to normalise dose by antibody potency. We used mixed-effects regression and model fitting to analyse the relationship between timing, dose and efficacy. We found 58 randomised controlled trials that investigated passive antibody therapies for the treatment or prevention of COVID-19. Earlier clinical stage at treatment initiation was highly predictive of the efficacy of both monoclonal antibodies (p<0·0001) and convalescent plasma therapy (p=0·030) in preventing progression to subsequent stages, with either prophylaxis or treatment in outpatients showing the greatest effects. For the treatment of outpatients with COVID-19, we found a significant association between the dose administered and efficacy in preventing hospitalisation (relative risk 0·77; p<0·0001). Using this relationship, we predicted that no approved monoclonal antibody was expected to provide more than 30% efficacy against some omicron (B.1.1.529) subvariants, such as BQ.1.1. Early administration before hospitalisation and sufficient doses of passive antibody therapy are crucial to achieving high efficacy in preventing clinical progression. The relationship between dose and efficacy provides a framework for the rational assessment of future passive antibody prophylaxis and treatment strategies for COVID-19. The Australian Government Department of Health, Medical Research Future Fund, National Health and Medical Research Council, the University of New South Wales, Monash University, Haematology Society of Australia and New Zealand, Leukaemia Foundation, and the Victorian Government.

Effectiveness of COVID-19 vaccination against COVID-19 specific and all-cause mortality in older Australians: a population based study

Few studies have examined effectiveness of COVID-19 vaccines against COVID-19 and all-cause mortality across different pandemic periods in2022. We used linked whole-of-population data from the 2021 Australian Census, Australian Immunisation Register, death registrations and other national datasets including migration data. Among 3.8 million adults aged 65+ years and >170,000 aged care residents, we used survival analysis to estimate vaccine effectiveness (VE) against COVID-19 specific mortality and all-cause mortality, by vaccine dose and time since receipt, adjusted for age, sex and other factors. We also estimated absolute COVID-19 mortality rates. From January-May 2022 (Omicron BA.1/2), 3250 COVID-19 deaths occurred; from June-November (Omicron BA.4/5) 3185 COVID-19 deaths occurred. During January-May, VE of a 3rd COVID-19 vaccine dose within 3 months was 93% (95% CI 93-94%) whilst VE of a 2nd dose >6 months since receipt was 34% (26-42%). During June-November, VE of a 4th COVID-19 vaccine dose within 3 months was 84% (82-86%) whilst VE of a 3rd dose >6 months since receipt was 56% (50-62%). VE estimates for aged care residents were similar, but absolute risk reductions were substantially greater. During June-November 2022, for all-cause mortality, VE of a 4th dose within 3 months was 58% (56-59%) whilst VE of a 3rd dose >6 months since receipt was 19% (16-22%). COVID-19 vaccination is highly effective against COVID-19 mortality among older adults although effectiveness wanes with time since the last dose. Our findings emphasise the importance of continuing to administer booster doses, particularly to those at highest risk. This study was funded by the Health Economics Research Division in the Australian Government Department of Health and Aged Care.

Rapid detection of monkeypox virus using a CRISPR-Cas12a mediated assay: a laboratory validation and evaluation study

The 2022 outbreak of mpox (formerly known as monkeypox) led to the spread of monkeypox virus (MPXV) in over 110 countries, demanding effective disease management and surveillance. As current diagnostics rely largely on centralised laboratory testing, our objective was to develop a simple rapid point-of-care assay to detect MPXV in clinical samples using isothermal amplification coupled with CRISPR and CRISPR-associated protein (Cas) technology. In this proof-of-concept study, we developed a portable isothermal amplification CRISPR-Cas12a-based assay for the detection of MPXV. We designed a panel of 22 primer-guide RNA sets using pangenome and gene-agnostic approaches, and subsequently shortlisted the three sets producing the strongest signals for evaluation of analytical sensitivity and specificity using a fluorescence-based readout. The set displaying 100% specificity and the lowest limit of detection (LOD) was selected for further assay validation using both a fluorescence-based and lateral-flow readout. Assay specificity was confirmed using a panel of viral and bacterial pathogens. Finally, we did a blind concordance study on genomic DNA extracted from 185 clinical samples, comparing assay results with a gold-standard quantitative PCR (qPCR) assay. We identified the optimal time to detection and analysed the performance of the assay relative to qPCR using receiver operating characteristic (ROC) curves. We also assessed the compatibility with lateral-flow strips, both visually and computationally, where strips were interpreted blinded to the fluorescence results on the basis of the presence or absence of test bands. With an optimal run duration of approximately 45 min from isothermal amplification to CRISPR-assay readout, the MPXV recombinase polymerase amplification CRISPR-Cas12a-based assay with the selected primer-guide set had an LOD of 1 copy per μL and 100% specificity against tested viral pathogens. Blinded concordance testing of 185 clinical samples resulted in 100% sensitivity (95% CI 89·3-100) and 99·3% specificity (95% CI 95·7-100) using the fluorescence readout. For optimal time to detection by fluorescence readout, we estimated the areas under the ROC curve to be 0·98 at 2 min and 0·99 at 4 min. Lateral-flow strips had 100% sensitivity (89·3-100) and 98·6% specificity (94·7-100) with both visual and computational assessment. Overall, lateral-flow results were highly concordant with fluorescence-based readouts (179 of 185 tests, 96·8% concordant), with discrepancies associated with low viral load samples. Our assay for the diagnosis of mpox displayed good performance characteristics compared with qPCR. Although optimisation of the assay will be required before deployment, its usability and versatility present a potential solution to MPXV detection in low-resource and remote settings, as well as a means of community-based, on-site testing. Victorian Medical Research Accelerator Fund and the Australian Government Department of Health.

Stop being a wuss: People's perceptions of men experiencing grief in Australia.

Three years have passed since the Australian Government's Department of Health released its National Men's Health Strategy 2020-2030. Presently, little evidence is available to show whether the strategy has achieved success in rectifying men's mental-ill health, particularly the experience of stigma when expressing vulnerable emotions such as grief. Concurrently, research within the field of psychology continues to show that men experience significant pressure to conform faithfully to their socialised gender role. Given the focus to better men's mental health in Australia, this study ascertained people's perceptions of men experiencing grief. The study adopted social constructionism to explore how participants perceived a fictious character living with grief using a hypothetical vignette by way of convenience sampling. Nine males and seven females who resided in Australia participated in answering seven questions concerning the character's experience of grief. Inductive thematic analysis yielded three themes which collectively represented perceptions of masculinised grief. Notably, avoid stigma by fixing grief, avoid stigma by quickly getting over grief, and avoid stigma by suppressing the expression of grief. SO WHAT?: The study suggests that a stronger research focus should be targeted towards rectifying stigma resulting from men's expression of vulnerable emotions by incorporating in depth interviews in order to create worthwhile public awareness initiatives. Such initiatives should seek to minimise societal pressures that are placed upon men to ensure conformity to dominant masculine ideologies and their socialised gendered role when experiencing and expressing vulnerable emotions such as grief.

Graphical User Interface Development for a Hospital-Based Predictive Risk Tool: Protocol for a Co-Design Study.

This co-design research method details the iterative process developed to identify health professional recommendations for the graphical user interface (GUI) of an artificial intelligence (AI)-enabled risk prediction tool. Driving the decision to include a co-design process is the belief that choices regarding the aesthetic and functionality of an intervention are best made by its intended users and that engaging these users in its design will promote the tool's adoption and use. The aim of this research is to identify health professional design and uptake recommendations for the GUI of an AI-enabled predictive risk tool. We will hold 3 research phases, each consisting of 2 workshops with health professionals, between mid-2023 and mid-2024. A total of 6 health professionals will be sought per workshop, resulting in a total enrollment of 36 health professionals at the conclusion of the research. A total of 7 workshop activities have been scheduled across the 3 workshops; these include context of use, notifiers, format, AI survey-Likert, prototype, AI survey-written, and testing. The first 6 of these activities will be repeated in each workshop to enable the iterative development and refinement of GUI. The last activity (testing) will be performed in the final workshop to examine health professionals' thoughts on the final GUI iteration. Qualitative and quantitative results data will be produced from tasks in each research activity. Qualitative data will be examined through inductive thematic analysis or deductive thematic analysis in accordance with the Nonadoption, Abandonment, and Challenges to the Scale-up, Spread, and Sustainability (NASSS) framework; visual data will be examined in accordance with "framework of interactivity;" and quantitative data will be examined using descriptive statistics. Project registration with the Australia and New Zealand Clinical Trial Registry has been requested (#384098). Finalized design recommendations are expected in early to mid-2024, with a results manuscript to be submitted in mid-2024. This research method has human research ethics approval from the South Australian Department of Health and Wellbeing (#2022/HRE00131) as well as from the Human Research Ethics Committee of the University of South Australia (application ID#204143). Understanding whether an intervention is needed in a particular situation is just the start; designing an intervention so that it is used within that situation is paramount. This co-design process engages end users to create a GUI that includes the aesthetic and functional details they need in a manner that aligns with their existing work practices. Indeed, interventions that fail to do this may be disliked, and at worst, they may be dangerous. PRR1-10.2196/47717.

South Australia's tobacco retail landscape and its intersection with socioeconomic factors and smoking prevalence.

Tobacco product availability is higher in socioeconomically disadvantaged areas, which can further widen tobacco-related health and disease burden inequities. This study aimed to describe retail availability of tobacco products in South Australia and examine the association between tobacco vendor location, population's socioeconomic status (SES) and tobacco smoking prevalence. Cross-sectional 2022 tobacco vendor licence data and 2021-2022 state-wide population health survey data from the South Australian Department of Health were used. Tobacco vendors were enumerated by Statistical Area 2 (SA2) using geocoding software, with SA2s assigned health survey derived smoking prevalence, SES, remoteness category, area size, and population size. As of 2022, there were 1723 tobacco vendors in South Australia and the overall tobacco smoking prevalence across the state was 11.8%. Regression analyses indicated that tobacco vendor density increased with socioeconomic disadvantage and geographic remoteness, and that smoking prevalence was higher in low SES areas. Vendor density was not related to smoking prevalence. Findings are consistent with existing research indicating greater tobacco availability in socially disadvantaged areas. This supports that tobacco vendor saturation may be directed to areas in a way that promotes tobacco availability for vulnerable populations. Our finding that smoking prevalence was unrelated to tobacco availability contrasts existing literature and should be carefully interpreted. SO WHAT?: This is the first study to map tobacco retailers across South Australia, contributing needed evidence on the intersection of tobacco vendor density, social disadvantage, and smoking prevalence.

Examining the long-term effects of a safe food-handling media campaign

In Australia, food poisoning affects over 4.1 million people annually, with most cases occurring in domestic (i.e., household) environments. Strategies aimed at improving safe food-handling among the community have begun being implemented across Australia. Recently, the ‘Play it Food Safe’ mass media campaign by the Western Australian Department of Health was piloted and shown to have some effectiveness in improving safe food-handling behaviour among consumers following the campaign. However, little is known about whether these changes in safe food-handling behaviours can be maintained in the long-term. Therefore, the aim of this paper was to determine if the Western Australian ‘Play it Food Safe’ campaign could lead to long-term change of safe food-handling knowledge, behaviour, and related psychological constructs (i.e., habit, perceived risk, self-efficacy, and subjective norms) among consumers. Participants (N = 689) completed measures assessing their safe food-handling knowledge, behaviour, and psychological constructs, derived from psychological theories, following the conclusion of the ‘Play it Food Safe’ campaign that was re-run in Perth, Western Australia. Participants completed these measures again approximately eight-weeks later. Data were analysed to determine if there were any changes in these measures over time, or whether scores on these measures were maintained long-term. Results indicated that some psychological constructs improved over time, and knowledge was higher among participants who saw the campaign, however, behaviour remained the same. These findings show that the ‘Play it Food Safe’ campaign may be effective for increasing knowledge, and effective for improving some psychological constructs long-term, though further development of the campaign is needed for further impact on behaviour.

Current approaches in the recognition and management of eating disorders.

Eating disorders are now well acknowledged mental health problems that are common and present in people from diverse sociodemographic backgrounds. The past decade has seen a rapid expansion in research into eating disorder interventions. In response to the increasing burden of eating disorders, the Australian Government Department of Health and Aged Care has implemented significant policy changes to improve patient access to Medicare and inpatient treatment facilities. There are several international clinical practice guidelines and a robust evidence base particularly for first line care with specific psychological therapies, including guidelines for the management of eating disorders in individuals with a high weight. Medications play an important adjunct role in care, and novel neuromodulating treatments, such as psychostimulants, are under study. There is emerging evidence for increased person-centred care, with more choice in the form of alternatives to hospital inpatient programs and more respectful consideration of care for all who experience an eating disorder, including people with high weight.

Responding to rural children and their families seeking paediatric services-Can we do better?

Australian Journal of Rural HealthEarly View PRACTICE INSIGHTS Responding to rural children and their families seeking paediatric services—Can we do better? Anne Somerville GDip, Corresponding Author Anne Somerville GDip [email protected] orcid.org/0000-0002-7867-0886 St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Correspondence Anne Somerville, St Anthony's Family Medical Practice, Bendigo, PO Box 319, Eaglehawk, Victoria 3556, Australia. Email: [email protected] Contribution: Writing - original draftSearch for more papers by this authorKaren Riley GDip, Karen Riley GDip St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Conceptualization, Funding acquisition, Methodology, Writing - original draftSearch for more papers by this authorAshlee Lance BSc Physio, Ashlee Lance BSc Physio St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorStephanie McIntosh MBBS, Stephanie McIntosh MBBS St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorTania Collins, Tania Collins St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Project administrationSearch for more papers by this authorNicole Brereton RN, Nicole Brereton RN St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorKatherine Hyde MBBS, BMedSc, Katherine Hyde MBBS, BMedSc St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this author Anne Somerville GDip, Corresponding Author Anne Somerville GDip [email protected] orcid.org/0000-0002-7867-0886 St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Correspondence Anne Somerville, St Anthony's Family Medical Practice, Bendigo, PO Box 319, Eaglehawk, Victoria 3556, Australia. Email: [email protected] Contribution: Writing - original draftSearch for more papers by this authorKaren Riley GDip, Karen Riley GDip St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Conceptualization, Funding acquisition, Methodology, Writing - original draftSearch for more papers by this authorAshlee Lance BSc Physio, Ashlee Lance BSc Physio St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorStephanie McIntosh MBBS, Stephanie McIntosh MBBS St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorTania Collins, Tania Collins St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Project administrationSearch for more papers by this authorNicole Brereton RN, Nicole Brereton RN St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorKatherine Hyde MBBS, BMedSc, Katherine Hyde MBBS, BMedSc St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this author First published: 16 June 2023 https://doi.org/10.1111/ajr.13006Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES 1 Royal Far West. Stories of the Invisible Children: the state of country children's health and development in their own words [Internet]. 2017 (cited 2023 Feb 15). Available from: Stories-of-The-Invisible-Children.pdf (royalfarwest.org.au). p. 3. 2 Royal Far West. The Invisible Children: the state of country children's health and development in Australia [Internet]. 2017 (cited 2023 Feb 15). Available from: The-Invisible-Children-Report.pdf (royalfarwest.org.au). p. 4. 3 Australian Government Strengthening Medicare Taskforce Report [Internet]. Strengthening Medicare taskforce report. Canberra, Australia: Australian Government Department of Health and Aged Care; 2022 (cited 2023 Feb 15). p. 5– 13. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Keeping kids in school: modelling school-based testing and quarantine strategies during the COVID-19 pandemic in Australia.

In 2021, the Australian Government Department of Health commissioned a consortium of modelling groups to generate evidence assisting the transition from a goal of no community COVID-19 transmission to 'living with COVID-19', with adverse health and social consequences limited by vaccination and other measures. Due to the extended school closures over 2020-21, maximizing face-to-face teaching was a major objective during this transition. The consortium was tasked with informing school surveillance and contact management strategies to minimize infections and support this goal. Outcomes considered were infections and days of face-to-face teaching lost in the 45 days following an outbreak within an otherwise COVID-naïve school setting. A stochastic agent-based model of COVID-19 transmission was used to evaluate a 'test-to-stay' strategy using daily rapid antigen tests (RATs) for close contacts of a case for 7 days compared with home quarantine; and an asymptomatic surveillance strategy involving twice-weekly screening of all students and/or teachers using RATs. Test-to-stay had similar effectiveness for reducing school infections as extended home quarantine, without the associated days of face-to-face teaching lost. Asymptomatic screening was beneficial in reducing both infections and days of face-to-face teaching lost and was most beneficial when community prevalence was high. Use of RATs in school settings for surveillance and contact management can help to maximize face-to-face teaching and minimize outbreaks. This evidence supported the implementation of surveillance testing in schools in several Australian jurisdictions from January 2022.

Characteristics and risk of coronary-related events following hospitalisation for chronic coronary disease

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Western Australian Department of Health. Background Chronic coronary heart disease (CCD) is associated with a high healthcare burden and expenditure in Western societies, yet population-level data on CCD are limited. Use of hospitalisation data to investigate CCD epidemiology has not been well explored. Our aim was to describe characteristics of patients hospitalised with CCD and to estimate the long-term risk of coronary outcomes in this cohort. Method We used Western Australian state-wide linked hospitalisation/mortality data to identify all hospitalisations for CCD, comprised stable angina (SA, ICD-10-AM I20.1-I20.9) and chronic ischaemic heart disease (IHD, I25) from 2002 – 2017. Index admissions were defined as the first SA or chronic IHD admission in the study period. 14-years of hospitalisation history data were used to identify prior medical history, including admissions for acute coronary syndromes (ACS) +/- angiography, PCI and CABG. Kaplan-Meier survival analyses were used to estimate risk of readmission for coronary outcomes and procedures using up to 15-years of follow-up from linked morbidity/mortality data. Results There were 32,557 index SA and 29,505 index chronic IHD admissions from 2002-2017. SA index case number declined by -3.9%/year while chronic IHD admissions increased steadily (+5.3%/year, age-adjusted). The mean age was 66 years for SA and chronic IHD index admissions, with women on average 3 years younger than men; median length of stay was 3 days. Women comprised a higher proportion of SA admissions (37.8%) than chronic IHD (26.9%, p&amp;lt;0.0001). SA admissions were more likely to be emergency admissions (45.6% vs 13.4%) and have comorbidities including diabetes, hypertension and stroke. Patients with a chronic IHD admission were more likely to undergo angiography only (65.3% vs 46.7%) or revascularisation (20.6% vs 12.9%) during the index admission. Around 1/3 of SA and chronic IHD patients had a prior ACS admission (n=9964 and 8291 respectively); around half of these prior ACS admissions occurred in the 1-year preceding the index SA and chronic IHD admissions (Figure), with the majority occurring in the 90 days immediately prior to the index admission. Following an index SA or chronic IHD admission, the risk of ACS within the initial year of follow-up was 9.4% in men and 8.6% in women with SA, and 5.6% in chronic IHD men and women. This risk increased to &amp;gt;20% in both groups with 15 years of follow-up. The 15-year risk of CVD mortality was 4.3% in men and 4.2% in women following a chronic IHD admission; similar long-term risks were seen following SA admissions. Conclusion The heterogeneity in clinical profile and outcomes between patients admitted for SA versus chronic IHD requires cautious interpretation of hospitalisation data to inform the epidemiology of CCD. However, while mortality risk is low, the risk of ACS readmission is high, indicating significant ongoing morbidity and healthcare burden of CCD.

Mortality and mental health funding—do the dollars add up? Eating disorder research funding in Australia from 2009 to 2021: a portfolio analysis

Eating Disorders (EDs) are among the deadliest of the mental disorders and carry a sizeable public health burden, however their research and treatment is consistently underfunded, contributing to protracted illness and ongoing paucity of treatment innovation. We compare absolute levels and growth rates of Australian mental health research funding by illness group for the years 2009-2021, with a specific focus on eating disorders analysed at the portfolio level. Actual and adjusted data obtained from Australia's three national medical research funding bodies (NHMRC, ARC and MRFF) shows eating disorders receive a disproportionately low allocation of mental health research funding despite having amongst the highest mortality rates. Forty-one category one research grants totalling $AUD28.1 million were funded for eating disorders over the period. When adjusted for inflation, this equates to $2.05 per affected individual, compared with $19.56 for depression, $32.11 for autism, and $176.19 for schizophrenia. Half of all research funded for eating disorders was 'basic' research (e.g., illness underpinning), with little investment in the development of innovative treatment models, novel therapeutics or translation, well reflected by recovery rates of less than 50% in individuals with Anorexia Nervosa. Significant discrepancy remains between research funding dollars and disease burden associated with the mental health disorders. The extent to which eating disorders are underfunded may in part be attributable to inaccuracies in epidemiological and burden of disease data. This work was in-part funded by the Australian Government Department of Health and the National Eating Disorder Research & Translation Strategy. The funder was not directly involved in informing the development of the current study.

Restricting access to antibiotics: The effectiveness of a 'no repeats' government policy intervention.

Australia has a high rate of antibiotic use. Government policy interventions are one strategy to optimise the use of antibiotics. On 1 April 2020, the Australian Government Department of Health introduced a policy intervention to increase the quality use of four antibiotics. To assess if the government policy intervention improved the appropriate supply of the four antibiotics amoxicillin, amoxicillin-clavulanic acid, cefalexin and roxithromycin. This study employed a retrospective cohort study design comparing a 10% sample (n=345,018) of four antibiotics prescribed and dispensed in Australia during a three-month period (May, June, July) in 2019, and again in 2020 (after the policy intervention). The 10% sample of PBS data was obtained from the Australian Government Department of Health. Descriptive statistics, bivariate and multivariable logistic regression analysis were carried out. The results suggest the policy change improved the appropriate supply of original prescriptions in 2020 compared to 2019 OR=1.75 (95% CI=1.68-1.82, p<0.001), and appropriate supply of repeat prescriptions OR=1.56 (95% CI=1.25-1.96, p<0.001). In 2020, the proportion of appropriate supply of original prescriptions increased by an absolute difference of 1.8% (95% CI=1.6-1.9%; P<0.001), and appropriate supply of repeat prescriptions increased by 3.9% (95% CI=2.2-5.5%; P<0.001). The total number of antibiotic prescriptions prescribed and dispensed in 2019 (N=219,960) reduced in 2020 (N=125,058) after the policy intervention. The study provides evidence for the impact of a government policy intervention to improve the appropriate supply of antibiotics, although some of the reduction in antibiotic use was likely due to the concomitant COVID-19 pandemic. Further research is required to assess the impact of the intervention outside a pandemic.

Health4Life eHealth intervention to modify multiple lifestyle risk behaviours among adolescent students in Australia: a cluster-randomised controlled trial

Lifestyle risk behaviours are prevalent among adolescents and commonly co-occur, but current intervention approaches tend to focus on single risk behaviours. This study aimed to evaluate the efficacy of the eHealth intervention Health4Life in modifying six key lifestyle risk behaviours (ie, alcohol use, tobacco smoking, recreational screen time, physical inactivity, poor diet, and poor sleep, known as the Big 6) among adolescents. We conducted a cluster-randomised controlled trial in secondary schools that had a minimum of 30 year 7 students, in three Australian states. A biostatistician randomly allocated schools (1:1) to Health4Life (a six-module, web-based programme and accompanying smartphone app) or an active control group (usual health education) with the Blockrand function in R, stratified by site and school gender composition. All students aged 11-13 years who were fluent in English and attended participating schools were eligible. Teachers, students, and researchers were not masked to allocation. Primary outcomes were alcohol use, tobacco use, recreational screen time, moderate to vigorous physical activity (MVPA), sugar-sweetened beverage intake, and sleep duration at 24 months, measured by self-report surveys, and analysed in all students who were eligible at baseline. Latent growth models estimated between-group change over time. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000431123). Between April 1, 2019, and Sept 27, 2019, we recruited 85 schools (9280 students), of which 71 schools with 6640 eligible students (36 schools [3610 students] assigned to the intervention and 35 [3030 students] to the control) completed the baseline survey. 14 schools were excluded from the final analysis or withdrew, mostly due to a lack of time. We found no between-group differences for alcohol use (odds ratio 1·24, 95% CI 0·58-2·64), smoking (1·68, 0·76-3·72), screen time (0·79, 0·59-1·06), MVPA (0·82, 0·62-1·09), sugar-sweetened beverage intake (1·02, 0·82-1·26), or sleep (0·91, 0·72-1·14) at 24 months. No adverse events were reported during this trial. Health4Life was not effective in modifying risk behaviours. Our results provide new knowledge about eHealth multiple health behaviour change interventions. However, further research is needed to improve efficacy. Paul Ramsay Foundation, the Australian National Health and Medical Research Council, the Australian Government Department of Health and Aged Care, and the US National Institutes of Health.

A modelled evaluation of the impact of COVID-19 on breast, bowel, and cervical cancer screening programmes in Australia.

Australia introduced COVID-19 infection prevention and control measures in early 2020. To help prepare health services, the Australian Government Department of Health commissioned a modelled evaluation of the impact of disruptions to population breast, bowel, and cervical cancer screening programmes on cancer outcomes and cancer services. We used the Policy1 modelling platforms to predict outcomes for potential disruptions to cancer screening participation, covering periods of 3, 6, 9, and 12 mo. We estimated missed screens, clinical outcomes (cancer incidence, tumour staging), and various diagnostic service impacts. We found that a 12-mo screening disruption would reduce breast cancer diagnoses (9.3% population-level reduction over 2020-2021) and colorectal cancer (up to 12.1% reduction over 2020-21), and increase cervical cancer diagnoses (up to 3.6% over 2020-2022), with upstaging expected for these cancer types (2, 1.4, and 6.8% for breast, cervical, and colorectal cancers, respectively). Findings for 6-12-mo disruption scenarios illustrate that maintaining screening participation is critical to preventing an increase in the burden of cancer at a population level. We provide programme-specific insights into which outcomes are expected to change, when changes are likely to become apparent, and likely downstream impacts. This evaluation provided evidence to guide decision-making for screening programmes and emphasises the ongoing benefits of maintaining screening in the face of potential future disruptions.