Australian National Research Articles

Australian National Clinical Evidence Taskforce COVID-19 drug treatment guidelines: challenges of producing a living guideline.

Australian National Clinical Evidence Taskforce COVID-19 drug treatment guidelines: challenges of producing a living guideline.

The influence of students’ prior numeracy achievement on later numeracy achievement as a function of gender and year levels

AbstractStudents’ prior achievements in school have significant correlations with their later achievements. Specifically, students’ prior numeracy achievement is the most important predictor of later numeracy success. However, the assessment of this predictor across gender and its trend across students’ year levels is often overlooked or not adequately investigated. This study examined the relationships between prior numeracy achievement and its influence on students’ later numeracy achievement across gender. A focus on students’ year level also supported this examination. The data source was the Australian National Assessment Program—Literacy and Numeracy (NAPLAN) numeracy results of Years 5, 7 and 9 students (ages 9 to 14) from the 2017 to 2021 test years. The NAPLAN numeracy scores were analysed using regression analysis. The author examined prior numeracy achievement to determine the predictive value for students’ numeracy performance in NAPLAN across students’ year levels and gender. Findings from this study indicate that prior NAPLAN numeracy results for students were found to be very large in its predictive value (between R2 = .591 and .747) across the year levels. Notably, the predictive value showed an increasing pattern as students progressed through their academic years. Additionally, the study observed a discernible influence of gender on the predictive value of prior numeracy results. Potential initiatives to assist the educational outcomes of students across gender are discussed. Awareness of the influence of numeracy performance across gender might help teachers and educators create better and more efficient mathematics programs and targeted interventions. Such a decision requires identifying the relevant factors and measuring their degree of influence across students’ year levels and gender.

An analysis of Australia’s national action plan on antimicrobial resistance using a governance framework

Abstract Aim Antimicrobial resistance is a global health crisis which undermines the effectiveness of current modern therapeutics against microbial infections and demands effective governance at all levels to effectively address the challenge. The aim of the study was to analyse Australia’s National Action Plan on antimicrobial resistance using a governance framework to facilitate discussion on the state of implementation. Methods A governance framework was used to facilitate the systematic analysis of Australia’s National Action Plan on antimicrobial resistance through iterative coding of activities listed within the working documents. Results From the analysis, 1435 codes were created in congruence with the governance framework. The Australian National Action Plan was aligned with the Global Action Plan on antimicrobial resistance in scope of objectives. The most frequent code was research and innovation (n = 180, 12.5%). The least frequent theme discussed was equity. No strategic vision or objectives were outlined within any of the documents to measure implementation progress. Conclusions Overall, Australia’s governance on AMR has demonstrated siloed implementation with an absence of strategic objectives to measure progress. Governance structure, surveillance and mechanisms for stakeholder participation have been identified as potential actionable points for AMR strategy refinement that can improve overall accountability towards progress.

“I Guess You Could Call It Plant Racism”: Making Kin in Australian Environmental Workfare

ABSTRACT Some scholars have drawn associations between Australian environmentalism and racism. Others have argued that natural resource management policies go beyond the science in justifying policies that have their real foundation in Australian nationalism. Yet applying semiotic analyses to focus upon such associations can risk obscuring efforts to actively loosen the nature–culture binary. Australia has a unique history of three decades of national environmental youth training programs such as Green Corps and Green Army. This environmental workfare engages a diverse range of actors: from university-qualified scientists to unemployed urban and rural youth. If any workplace culture is likely to generate a naïve environmentalist eco-nationalism, then the pseudo-military setting of national environmental workfare programs would be worthy of close examination. Based upon data collected from participants in Australian environmental workfare programs, this article explores how young workers display critical reflexivity, engaging creatively and ironically, embracing the more obscure Others. While attempting to generate cultural capital, particularly in the field of environmental science, they actively spurn naïve environmentalism. From the midst of the Australian bush, young people are answering Haraway’s call to “make kin in the Chthulucene”.

The role of syphilis self-testing as an additional syphilis testing approach in key populations: a systematic review and meta-analysis

Syphilis is causing epidemics in many countries. Syphilis self-testing (SST) has potential to increase testing and treatment coverage in the same manner as documented for self-testing of, for example, HIV, hepatitis C virus, and COVID-19. We aimed to synthesise current evidence on the utility of SST. We conducted a systematic review and, where possible, meta-analysis. We searched MEDLINE, Embase, CINAHL, Scopus, and Web of Science for publications published from Jan 1, 2000, to Oct 13, 2022. We included publications with original data on any syphilis rapid tests, including dual HIV-syphilis tests. Study populations were not restricted. We used random-effects meta-analysis to calculate the pooled proportion of people offered SST who undertook the test. The systematic review was registered in PROSPERO (CRD42022302129). In total, 40 499 citations were identified. 11 publications from seven studies from the USA, Zimbabwe, and China met eligibility criteria. Of those, four studies reported data from men who have sex with men and five studies used dual HIV-SST. Using data from one randomised controlled trial and three observational studies, the pooled proportion of people who received SST kits who undertook the test was 88% (95% CI 85-91). No studies provided data on the sensitivity or specificity of SST. Overall, user and provider preference for SST was high, with participants reporting convenience, privacy, rapid results, autonomy, trust in blood-based tests, decreased facility contact, and time savings, with individuals being able to correctly self-test. Publications from China reported that SST had lower costs per person tested than existing facility-based testing options. Our review builds on the literature for self-testing across different disease areas and demonstrates that SST has the potential to reach underserved populations. As this review found that SST use was acceptable and feasible to implement, SST can be used as an additional syphilis testing approach. Since no data on the sensitivity and specificity of SST were found, further implementation research will be required to guide the best strategies for SST service delivery and future scale-up. WHO, Australian National Health and Medical Research Council, and Unitaid.

Is the association between psychological distress and risky alcohol consumption shifting over time? An age-period-cohort analysis of the Australian population

This study explored age, period, and cohort effects associated with trends in psychological distress and risky alcohol consumption. Data came from 108,536 Australians aged 14-79 years old from birth cohorts between 1925-2005, endorsing past year alcohol use in the 2004-2019 Australian National Drug Strategy Household Surveys. Risky alcohol consumption was split into exceeding weekly national drinking limits (>10 drinks per week) or daily limits (>4 drinks per day). An extended hierarchical age-period-cohort model was used to investigate differential effects on trends in psychological distress. Psychological distress showed an inverse U-shape throughout the lifespan with a peak in distress at age 60. Exceeding weekly alcohol limits was positively related to psychological distress prior to age 40 while exceeding daily alcohol limits remained positively related across the lifespan. There were relatively flat period effects, with no alcohol-related changes in psychological distress across years. Lastly, psychological distress gradually increased across birth cohorts until a notable spike among Australians born from 1980-2005 alongside weakening alcohol-related cohort effects. Overall, the recent increases in psychological distress did not appear to be meaningfully explained by risky alcohol consumption though risky alcohol consumption remained an important factor to consider alongside psychological distress.

Who cares for the carers? carerhelp: development and evaluation of an online resource to support the wellbeing of those caring for family members at the end of their life

BackgroundMost people living with a terminal illness and approaching death will need the assistance of a non-professional carer such as a family member, friend, or neighbour to provide physical, emotional, and practical caring supports. A significant portion of these carers can feel overwhelmed, isolated and experience psychological and/or financial distress. Carers can have unmet information needs and information needs can change across the caring period.MethodsGuided by an Australian National Reference Group, this project undertook a multiphase set of activities to enable the development of an online carer resource. These activities included a literature review of key issues and considerations for family carers supporting someone with a terminal illness, a scoping scan of existing online resources, and interviews and focus groups with eighteen carers to understand their needs and context of caring. This information formed the basis for potential digital content. A web project team was established to create the information architecture and content pathways. User testing survey and usability assessment of the CarerHelp Website was undertaken to assess/optimise functionality prior to release. An evaluation process was also devised.ResultsThe literature review identified carer needs for practical and psychological support along with better education and strategies to improve communication. The scoping scan of available online resources suggested that while information available to carers is plentiful, much of that which is provided is general, disparately located, inadequately detailed, and disease specific. The eighteen carers who were interviewed highlighted the need for helpful information on: services, symptom management, relationships, preparation for death, managing the emotional and psychological burden that often accompanies caring, and support during bereavement. User testing and usability assessment of the prototype resource led to changes to enhance the user experience and effectiveness of navigation. It also highlighted a lack of awareness of existing resources and the needs of marketing and communication to address this problem.ConclusionsThe project led to the development of an open access online resource, CarerHelp (www.carerhelp.com.au), for use by carers and families caring for a person who has palliative care needs. The web metrics demonstrate substantial use of the resources.

The prevalence of psychological distress in adults newly diagnosed with type 2 diabetes: Data from the Australian 3D case-series study.

This cross-sectional analysis of the Australian 3D study aimed to determine the prevalence of psychological distress and describe its associated characteristics in adults recently diagnosed with type 2 diabetes. Adults (aged 18 years and over) who were recently diagnosed with type 2 diabetes (<6 months prior) were recruited through the Australian National Diabetes Services Scheme in 2018-2019. Demographic and health data were collected via interview-administered telephone surveys. Hierarchical regression was used to analyse whether demographic, self-care and clinical characteristics were associated with psychological distress, as measured by the K10 questionnaire. Of the participants (n = 223), 26.3% presented with psychological distress, with 8.4% reporting mild, 8.4% reporting moderate and 9.5% reporting severe psychological distress. Neither age, sex, body mass index or taking anti-depressant medications were associated with the presence of psychological distress (p > .05). Being a smoker, living situation, less physical activity and poorer healthy eating beliefs and intentions were significantly associated with psychological distress in those not taking anti-depressant medications (p < .05). Being female was significantly associated with psychological distress in those taking anti-depressant medications (p < .05). The study found that psychological distress is highly prevalent in adults recently diagnosed with type 2 diabetes. Behavioural factors such as smoking and low physical activity, as well as psycho-social factors such as living situation, poor healthy eating beliefs and intentions were significantly associated with psychological distress. This has implications for the management of people with newly diagnosed type 2 diabetes. SO WHAT?: Psychological distress is highly prevalent in Australian adults newly diagnosed with type 2 diabetes, emphasising the urgent need for enhanced psychological care to support this group.

Promoting early childhood development in Viet Nam: cost-effectiveness analysis alongside a cluster-randomised trial

Economic evaluations are critical to ensure effective resource use to implement and scale up child development interventions. This study aimed to estimate the cost-effectiveness of a multicomponent early childhood development intervention in rural Viet Nam. We did a cost-effectiveness study alongside a cluster-randomised trial with a 30-month time horizon. The study included 669 mothers from 42 communes in the intervention group, and 576 mothers from 42 communes in the control group. Mothers in the intervention group attended Learning Clubs sessions from mid-pregnancy to 12 months after delivery. The primary outcomes were child cognitive, language, motor, and social-emotional development at age 2 years. In this analysis, we estimated the incremental cost-effectiveness ratios (ICERs) of the intervention compared with the usual standard of care from the service provider and household perspectives. We used non-parametric bootstrapping to examine uncertainty, and applied a 3% discount rate. The total intervention cost was US$169 898 (start-up cost $133 692 and recurrent cost $36 206). The recurrent cost per child was $58 (1 341 741 Vietnamese dong). Considering the recurrent cost alone, the base-case ICER was $14 and mean ICER of 1000 bootstrap samples was $14 (95% CI -0·48 to 30) per cognitive development score gained with a 3% discount rate to costs. The ICER per language and motor development score gained was $22 and $20, respectively, with a 3% discount rate to costs. The intervention was cost-effective: the ICER per child cognitive development score gained was 0·5% of Viet Nam's gross domestic product per capita, alongside other benefits in language and motor development. This finding supports the scaling up of this intervention in similar socioeconomic settings. Australian National Health and Medical Research Council and Grand Challenges Canada. For the Vietnamese translation of the abstract see Supplementary Materials section.

Navigating the barriers to supporting neurodevelopmental disorders in children in out-of-home care

Children with neurodevelopmental disorders are currently overrepresented in the out-of-home-care (OOHC) system. This overrepresentation has created an increasing need for staff and carers to be equipped to handle the complexities these conditions entail. The aim of the present study was to gather information to understand the current service needs, practices, and knowledge within a private provider of OOHC services in Queensland. This included identifying barriers to the implementation of the Australian National Clinical Assessment Framework, which aims to facilitate appropriate screening, assessment and intervention provision for children and young people in OOHC. Twenty-five staff and 15 caregivers participated in an online survey. Results demonstrated that both staff and carers felt they needed additional training in understanding and supporting children with neurodevelopmental disorders and identified a number of barriers to accessing services. Barriers included: insufficient access to information (e.g., lack of training, health records missing or incomplete and lack of appropriate pre-placement consultation) and lack of available resources (e.g., extensive wait times for services due to reliance on public health system and ‘red tape’ systemic issues). The results also highlighted the level of unmet physical, developmental and psychological needs for children and young people in care, with a third of carers reporting concerns. Overall, the current study provides critical recommendations for future implementation strategies and interventions to better meet the needs of children and young people in the Queensland OOHC system.

Antibiotic use and quality indicators of antibiotic prescription in Bhutan: a point prevalence survey using the Australian National Antimicrobial Prescribing Survey tool.

The National Action Plan on Antimicrobial Resistance in Bhutan promotes the rational use of antibiotics. It is important to establish baseline data on the use of antibiotics and the quality indicators of antibiotic prescriptions to identify where improvement efforts may need to be focused. To describe the prevalence and patterns of antibiotic prescription and establish baseline data regarding quality indicators of antibiotic prescriptions in four major hospitals in Bhutan. This was a point prevalence survey of antibiotic use among inpatients in June 2022 conducted using the Australian National Antibiotic Prescribing Survey (NAPS). There were 314 patients (41.5%) receiving at least one antibiotic on the audit day. Among prescriptions reviewed, 278 (88.5%) had indications for use documented, 102 (32.5%) had a review or stop date documented and 120 (38.2%) had microbiology samples collected prior to antibiotics. Ceftriaxone (68; 21.7%), cefazolin (41; 13.1%) and metronidazole (32; 10.2%), were the common antibiotics prescribed. The most common indications for use were surgical prophylaxis (42; 13.4%), community-acquired pneumonia (39; 12.4%) and sepsis (26; 8.3%). There were 125 prescriptions (39.8%) that were compliant with national/therapeutic antibiotic guidelines and 169 (53.8%) where antibiotic prescriptions were appropriate. This study identified key areas for targeted interventions in antimicrobial stewardship programmes in Bhutan. The prevalence of antibiotic use, indications for use, and drug choices were similar to data from other countries. Documentation plans for durations of use, prolonged surgical prophylaxis and concordance of choices with guideline recommendations present opportunities for improvement.

Phenotypic Features of Pediatric Bronchiectasis Exacerbations Associated With Symptom Resolution After 14 Days of Oral Antibiotic Treatment

Respiratory exacerbations in children and adolescents with bronchiectasis are treated with antibiotics. However, antibiotics can have variable interindividual effects when treating exacerbations. Can phenotypic features associated with symptom resolution after a 14-day course of oral antibiotics for a nonsevere exacerbation of bronchiectasis be identified? Combining data from two multicenter randomized controlled trials, we identified 217 children with bronchiectasis assigned to at least 14days of oral antibiotics to treat nonsevere (nonhospitalized) exacerbations. Univariable and then multivariable logistic regression were used to identify factors associated with symptom resolution within 14days of commencing antibiotics. Identified associations were re-evaluated by mediation analysis. Of the 217 study participants (52%male patients), 41%were Indigenous (Australian First Nations, New Zealand Māori, or Pacific Islander). The median age was 6.6 years (interquartile range, 4.0-10.1 years). By day 14, symptoms had resolved in 130 children (responders), but persisted in the remaining 87 children (nonresponders). Multivariable analysis found those who were Indigenous (adjusted OR [AOR], 3.59; 95%CI, 1.35-9.54) or showed new abnormal auscultatory findings (AOR, 3.85; 95%CI, 1.56-9.52) were more likely to be responders, whereas those with multiple bronchiectatic lobes at diagnosis (AOR, 0.66; 95%CI, 0.46-0.95) or higher cough scores when starting exacerbation treatment (AOR, 0.55; 95%CI, 0.34-0.90) were more likely to be nonresponders. Detecting a respiratory virus at the beginning of an exacerbation was not associated with antibiotic failure at 14days. Children with Indigenous ethnicity, milder bronchiectasis, mild exacerbations (low reported cough scores), or new abnormal auscultatory signs are more likely to respond to appropriate oral antibiotics than those without these features. These patient and exacerbation phenotypes may assist clinical management and development of biomarkers to identify those whose symptoms are more likely to resolve after 14days of oral antibiotics. Australian New Zealand Clinical Trials Registry; Nos.: ACTRN12612000011886 and ACTRN12612000010897; URL: https://www.anzctr.org.au.

Electricity price spike clustering: A zero-inflated GARX approach

Sudden dramatic rises in electricity prices, known as electricity “price spikes”, are ubiquitous in electricity spot markets worldwide. These price spikes often cluster. Energy retailers in many countries, including Australia, purchase electricity in an unregulated spot market and sell it to consumers at a heavily regulated price. As a result, the occurrence and clustering of spikes in the spot electricity price is particularly hazardous for retailers, and effective modelling and forecasting of these spikes is of foremost importance for effective risk management. This paper uses a data-dependent two-regime threshold autoregression to determine the electricity price spikes and proposes a zero-inflated generalized autoregression with exogenous covariates (ZIGARX) for modelling the time series count of price spikes. This model is shown to well capture the salient features of electricity price spikes, and can provide effective rolling probability forecasts of price spike occurrence. We apply the proposed approach to analyze the spot prices in four major regions in the Australian National Electricity Market (NEM) over the period April 2016 to February 2022. Results show that price spike clustering is captured very well using our model, and the persistence in price spike occurrence remains even after controlling for the relevant exogenous covariates. We also find that, in most of our sample period, the increasing use of renewable generation has mixed effects on the occurrence of price spikes.

Дервиш Мехмед бин Мубарек Герай Дженгизи. Хроника «Тарих-и Мехмед Герай» («История Мехмед Герая»). Часть 3

The Chronicle “Tarikh-i Mehmed Geray” (1682–1703) by the Crimean Tatar historiographer Dervish Mehmed bin Mubarek Geray Genghisi is the narrative source reflecting the history of the Crimean Khanate and the Ottoman state in 1682–1703. The date of the work is 1703 (completed in the month of Rejeb 1115). A copy of the chronicle has been preserved in the funds of the Austrian National Library (Österreichische Nationalbibliothek) under the cipher (inventory number) No. 1080, Cod. H.O.86 HAN MAG. Volume (folio) – 125 sheets in taalik script, sheets are small. There are verses on 125 sheets. The manuscript is not marked with the title, but has an appraisal prescript: “Tarih-i Mehmed Geray Qara Mustafa Paşa cenklerin söyler üçünci Sultan Mehmed Han vaqtlarından Sultan Ahmed Han biñ yüz on beş tarihınacek söyler bir maqbul tarihdır” / “Mehmed Tarikh-i Mehmed Giray narrating about the wars of Kara Mustafa Pasha, the acceptable story telling from the time of Sultan Mehmed Khan III to the period of Sultan Ahmed Khan, up to the year one thousand one hundred and fifteen”. The Chronicle’s translation into Russian (the author of the translation is R.R. Abduzhemilev) was made from the text’s transliteration of the manuscript into Latin, presented in the Turkish edition of Ugur Demir’s master thesis “Tarikh-i Mehmed Giray” (assessment – text’s transcription)” (consultant: Prof. Dr. Nejdet Öztürk, Istanbul, 2006, 163 pages).

A study protocol for community implementation of a new mental health monitoring system spanning early childhood to young adulthood

Findings from longitudinal research, globally, repeatedly emphasise the importance of taking an early life course approach to mental health promotion; one that invests in the formative years of development, from early childhood to young adulthood, just prior to the transition to parenthood for most. While population monitoring systems have been developed for this period, they are typically designed for use within discrete stages (i.e., childhood or adolescent or young adulthood). No system has yet captured development across all ages and stages (i.e., from infancy through to young adulthood). Here we describe the development, and pilot implementation, of a new Australian Comprehensive Monitoring System (CMS) designed to address this gap by measuring social and emotional development (strengths and difficulties) across eight census surveys, separated by three yearly intervals (infancy, 3-, 6-, 9- 12-, 15-, 18 and 21 years). The system also measures the family, school, peer, digital and community social climates in which children and young people live and grow. Data collection is community-led and built into existing, government funded, universal services (Maternal Child Health, Schools and Local Learning and Employment Networks) to maximise response rates and ensure sustainability. The first system test will be completed and evaluated in rural Victoria, Australia, in 2022. CMS will then be adapted for larger, more socio-economically diverse regional and metropolitan communities, including Australian First Nations communities. The aim of CMS is to guide community-led investments in mental health promotion from early childhood to young adulthood, setting secure foundations for the next generation.

Forecasting seizure likelihood from cycles of self-reported events and heart rate: a prospective pilot study.

Seizure risk forecasting could reduce injuries and even deaths in people with epilepsy. There is great interest in using non-invasive wearable devices to generate forecasts of seizure risk. Forecasts based on cycles of epileptic activity, seizure times or heart rate have provided promising forecasting results. This study validates a forecasting method using multimodal cycles recorded from wearable devices. Seizure and heart rate cycles were extracted from 13 participants. The mean period of heart rate data from a smartwatch was 562 days, with a mean of 125 self-reported seizures from a smartphone app. The relationship between seizure onset time and phases of seizure and heart rate cycles was investigated. An additive regression model was used to project heart rate cycles. The results of forecasts using seizure cycles, heart rate cycles, and a combination of both were compared. Forecasting performance was evaluated in 6 of 13 participants in a prospective setting, using long-term data collected after algorithms were developed. The results showed that the best forecasts achieved a mean area under the receiver-operating characteristic curve (AUC) of 0.73 for 9/13 participants showing performance above chance during retrospective validation. Subject-specific forecasts evaluated with prospective data showed a mean AUC of 0.77 with 4/6 participants showing performance above chance. The results of this study demonstrate that cycles detected from multimodal data can be combined within a single, scalable seizure risk forecasting algorithm to provide robust performance. The presented forecasting method enabled seizure risk to be estimated for an arbitrary future period and could be generalised across a range of data types. In contrast to earlier work, the current study evaluated forecasts prospectively, in subjects blinded to their seizure risk outputs, representing a critical step towards clinical applications. This study was funded by an Australian Government National Health & Medical Research Council and BioMedTech Horizons grant. The study also received support from the Epilepsy Foundation of America's 'My Seizure Gauge' grant.

Editorial introductions.

Editorial introductions.

Development and validation of a dementia risk score in the UK Biobank and Whitehall II cohorts

BackgroundCurrent dementia risk scores have had limited success in consistently identifying at-risk individuals across different ages and geographical locations.ObjectiveWe aimed to develop and validate a novel dementia risk score for...

Trends in the Incidence of End-Stage Kidney Disease in Type 1 and Type 2 Diabetes in Australia, 2010-2019

Trends in end-stage kidney disease (ESKD) among people with diabetes may inform clinical management and public health strategies. We estimated trends inthe incidence of ESKD among people with type 1 and type 2 diabetes in Australia from 2010-2019 and evaluated their associated factors. Cohort study. 71,700 people with type 1 and 1,112,690 people with type 2 diabetes registered on the Australian National Diabetes Services Scheme (NDSS). We estimated the incidence of kidney replacement therapy (KRT) via linkage to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and the incidence of KRT or death from ESKD by linking the NDSS to the ANZDATA and the National Death Index for Australia. Calendar time, sex, age, and duration of diabetes. Incidence of KRT and KRT or death from ESKD. Incidence of ESKD, trendsover time, and associations with factors related to these trends were modeled using Poisson regression stratified by diabetes type and sex. The median duration of diabetes increased from 15.3 to 16.8 years in type 1 diabetes, and from 7.6 to 10.2 years in type 2 diabetes between 2010 and 2019. The incidence of KRT and KRT or death from ESKD did not significantly change over this time interval among people with type 1 diabetes. Conversely, the age-adjusted incidence of KRT and KRT or death from ESKD increased among males with type 2 diabetes (annual percent changes [APCs]: 2.52% [95% CI, 1.54 to -3.52] and 1.27% [95% CI, 0.53 2.03], respectively), with no significant change among females (0.67% [95% CI,-0.68 to 2.04] and 0.07% [95% CI,-0.81 to 0.96], respectively). After further adjustment for duration of diabetes, the incidence of ESKD fell between 2010 and 2019, with APCs of-0.09% (95% CI,-1.06 to 0.89) and-2.63% (95% CI,-3.96 to-1.27) for KRT and-0.97% (95% CI,-1.71 to-0.23) and-2.75% (95% CI,-3.62 to-1.87) for KRT or death from ESKD among males and females, respectively. NDSS only captures 80%-90% of people with diabetes; lack of clinical covariates limits understanding of trends. While the age-adjusted incidence of ESKD increased for males and was stable for females over the last decade, after adjusting for increases in duration of diabetes the risk of developing ESKD has decreased for both males and females. Previous studies showed an increase in new cases of kidney failure among people with type 2 diabetes, but more recent data have not been available. Here, we report trends in the rate of kidney failure for people with type 2 diabetes from 2010 to 2019 and showed that while more people with type 2 diabetes are developing kidney failure, accounting for the fact that they are also surviving longer (and therefore have a higher chance of kidney failure) the growth in this population is not caused by a higher risk of kidney failure. Nevertheless, more people are getting kidney failure than before, which will impact health care systems for years to come.

The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990–2019: a systematic analysis of the Global Burden of Disease Study 2019

Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation.