Australian National Research Articles

The Debt Trap, by JoshMitchell (Simon & Schuster, New York, NY, 2021), 272 pages*

Economic RecordEarly View Review The Debt Trap, by Josh Mitchell (Simon & Schuster, New York, NY, 2021), 272 pages * Bruce Chapman, Corresponding Author Bruce Chapman [email protected] College of Business and Economics, Australian National UniversitySearch for more papers by this author Bruce Chapman, Corresponding Author Bruce Chapman [email protected] College of Business and Economics, Australian National UniversitySearch for more papers by this author First published: 29 May 2023 https://doi.org/10.1111/1475-4932.12738 With thanks to Robert Shireman. The author alone is responsible for errors and omissions. Read 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 References Barr, N., Dearden, L. and Dynarski, S. (2019), ‘The US College Loans System: Reform Lessons from Australia and England’, Economics of Education Review, 71, 32– 49. Chapman, B. (2018), ‘Book Review of the Student Loans Mess (by Joel Best and Eric Best)’, Economic Record, 94, 204– 6. Chapman, B. and Doan, D. (2019), ‘Introduction to the Special Issue: Higher Education Financing: Student Loans’, Economics of Education Review, 71, 1– 7. Shireman, R. (2017), ‘Learn Now, Pay Later: A History of Income-Contingent Student Loans in the United States’, Annals of the American Academy of Political and Social Sciences, 671, 184– 201. Stiglitz, J.E. (2014), ‘ Remarks on Income Contingent Loans: How Effective Can they be at Mitigating Risk?’ in B. Chapman, T. Higgins and J.E. Stiglitz (eds), Income Contingent Loans: Theory, Practice and Prospects, IEA Conference Volume No. 153, Barcelona, Spain. New York, NY: Palgrave Macmillan; 31– 8. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Experience with the US health care system for Black and White patients with advanced prostate cancer.

The purpose of this study was to assess differences in reported information about treatment, integration into care, and respect by self-identified Black and White individuals with advanced prostate cancer in the United States. This is a prospective cohort study of 701 participants (20% identifying as Black) enrolled in the International Registry for Men with Advanced Prostate Cancer at 37 US sites from 2017 to 2022. Participants were asked six questions from the Cancer Australia National Cancer Control Indicators about their experience with care at study enrollment. Prevalence differences by self-reported race were estimated using marginal standardization of logistic-normal mixed effects models (adjusted for age at enrollment and disease state at enrollment), and 95% CIs were estimated using parametric bootstrapping. Most participants reported a high quality of care for each question. Black participants generally reported higher care quality compared with White participants. Black participants reported more frequently that they were offered a written assessment and care plan (71%) compared with White participants (58%; adjusted difference, 13 percentage points; 95% CI, 4-23). Black participants also reported more frequently being given the name of nonphysician personnel who would support them (64%) than White participants (52%; adjusted difference, 10; 95% CI, 1-20). Prevalence differences did not differ by disease state at enrollment. Black participants generally reported a higher quality of care compared with White participants. This study calls attention to the need to study potential mediating factors and interpersonal aspects of care in this population to improve survivorship.

Listening to First Nations women’s voices, hearing requests for continuity of carer, trusted knowledge and family involvement: A qualitative study in urban Darwin

ProblemAustralian First Nations women are more likely to commence care later in pregnancy and underutilise maternal health services than non-First Nations women. BackgroundDisrespectful maternity care is a major barrier to care-seeking in pregnancy, often resulting in later commencement and underutilisation of care. AimWe aimed to identify barriers and enablers to pregnancy-related care-seeking for Australian First Nations women living in the Darwin region through yarning about their experiences of pregnancy care. MethodsTen Australian First Nations women shared stories about their pregnancy care journeys. Yarns took place at a time and location determined by the women, with recruitment continuing until saturation was reached. FindingsEmerging themes included a desire for continuity of carer, particularly with midwives; access to trustworthy information, enabling informed decision-making; and a need to have family involved in all aspects of care. No specific barriers were identified within this cohort DiscussionUniversal access to continuity of carer models would provide women with the relational care they are asking for as well as address other identified needs, such as a desire for information relevant to their pregnancy; and space for partners/family members to be involved. The themes that emerged provide a picture of what a positive, respectful pregnancy care experience could be for First Nations women within the Darwin Region, thus enabling care-seeking in pregnancy. ConclusionAlthough the public sector and Aboriginal Controlled Community Health Organisations currently provide continuity of carer models, robust systems ensuring these models are made available to all women are lacking.

Tumor Cell EnVoys Advance the Education of Platelets

HomeCirculation ResearchVol. 132, No. 11Tumor Cell EnVoys Advance the Education of Platelets No AccessEditorialRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessEditorialRequest AccessFull TextTumor Cell EnVoys Advance the Education of Platelets James I. Hearn and Elizabeth E. Gardiner James I. HearnJames I. Hearn https://orcid.org/0000-0002-3988-2659 Division of Genome Sciences and Cancer, the John Curtin School of Medical Research, The Australian National University, Canberra, Australia (J.I.H., E.E.G.). Search for more papers by this author and Elizabeth E. GardinerElizabeth E. Gardiner Correspondence to: Elizabeth Gardiner, PhD, ACRF, John Curtin School of Medical Research, Australian National University, 131 Garran Rd, Canberra, ACT 2601 Australia. Email E-mail Address: [email protected] https://orcid.org/0000-0001-9453-9688 Division of Genome Sciences and Cancer, the John Curtin School of Medical Research, The Australian National University, Canberra, Australia (J.I.H., E.E.G.). The National Platelet Research and Referral Centre (NPRC), Canberra, Australia (E.E.G.). Search for more papers by this author Originally published25 May 2023https://doi.org/10.1161/CIRCRESAHA.123.322781Circulation Research. 2023;132:1462–1464This article is a commentary on the followingMechanism of Tumor-Platelet Communications in CancerFootnotesFor Disclosures, see page 1464The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Correspondence to: Elizabeth Gardiner, PhD, ACRF, John Curtin School of Medical Research, Australian National University, 131 Garran Rd, Canberra, ACT 2601 Australia. Email elizabeth.[email protected]edu.au

Establishing the Australian National Endometriosis Clinical and Scientific Trials (NECST) Registry: A protocol paper.

Endometriosis is a common yet under-recognised chronic inflammatory disease, affecting 176 million women, trans and gender diverse people globally. The National Endometriosis Clinical and Scientific Trials (NECST) Registry is a new clinical registry, collecting and tracking diagnostic and treatment data, and patient-reported outcomes on people with endometriosis. The registry is a research priority action item from the 2018 National Action Plan for Endometriosis and aims to provide, large-scale, national and longitudinal population-based data on endometriosis. Working groups (consisting of patients with endometriosis, clinicians and researchers) developing the NECST Registry data dictionary and data collection platform started in 2019. Our data dictionary was developed based on existing and validated questionnaires, tools, meta-data and data cubes - World Endometriosis Research Foundation (WERF) Endometriosis Phenome and Biobanking Harmonisation Project (EPHect), endometriosis CORE outcomes set, patient-reported outcome measures, the International Statistical Classification of Diseases-10th Revision Australian Modification diagnosis codes, and Australian Government datasets: Australian Institute for Health and Welfare (for sociodemographic data), Medicare Benefits Schedule (MBS; for medical procedures) and the Pharmaceutical Benefits Scheme (PBS; for medical therapies). The resulting NECST Registry is an online, secure cloud-based database; prospectively collecting minimum core clinical and health data across eight patient and clinician modules and longitudinal data tracking disease life course. The NECST Registry has ethics approval (HREC/62508/MonH-2020) and is registered on the Australian New Zealand Clinical Trials Registry (ACTRN12622000987763).

Unpacking assertions made by the alcohol industry and how they make them: An analysis of submissions into Australia's National Alcohol Strategy.

Alcohol is a leading cause of morbidity and mortality globally. One significant barrier to the implementation of evidence-based alcohol policy is alcohol industry opposition. Making submissions to national policy processes is one way in which the industry exert influence. The aim of this study was to analyse alcohol industry submissions into Australia's National Alcohol Strategy to determine key assertions made by the alcohol industry and the ways in which they use evidence and refute the effectiveness of public health policies to make their claims. Submissions made by alcohol industry actors (n = 12) were analysed using content analysis to determine key industry assertions. A pre-existing framework on alcohol industry use of evidence was then applied to analyse the evidentiary practices used to make these assertions. Five common industry assertions were identified: 'Drinking alcohol in moderation has health benefits'; 'Alcohol isn't the cause of violence'; 'Targeted initiatives, not population level alcohol policies, are needed'; 'Strong alcohol advertising regulations are not necessary'; and 'Minimum unit price and pricing and taxation policies more broadly are not needed'. The industry systematically manipulated, misused and ignored evidence throughout their submissions. The alcohol industry is misusing evidence in their submissions to government consultations to make their assertions about alcohol policy. It is therefore essential that industry submissions are scrutinised and not accepted on face value. Additionally, it is suggested that the alcohol industry requires a distinct model of governance similarly to that which regulates the tobacco industry to prevent their attempts to undermine evidence-based public health policy.

Green hydrogen is a necessary component of a grid with an increasing non-dispatchable renewable energy supply

It is very well-known that wind and solar energy are supplied when there are resources, which are continuously changing, and not when demanded by the grid. Thus, in a grid without the supply of dispatchable electricity burning carbon and hydrocarbon combustion fuels, it is indispensable to include very large energy storage and given the variability not only short term within the day but from day to day following seasonality additional to weather, the large energy storage has to be mostly hydrogen. Extremely misleading are the cost assessment of prices of electricity to consumers through a Levelized Cost of Energy (LCOE) without factoring in dispatchability, as dispatchable and non-dispatchable electricity has a different value. Without energy storage, the production by wind and solar in the defect of the grid demand has to be supplied by other energy sources. Similarly, the production in excess would be wasted. This inconvenient truth has already produced increasing prices of electricity for customers. The Australian National Electricity Market data shows as phased with the uptake of wind and solar, in the absence of adequate energy storage, the price of energy supply has grown enormously. Without addressing the energy storage issue, mission net zero is incompatible with having cheap and abundant electricity.

Area-level associations of travel behaviour metrics with waist circumference: findings from linkage of travel and health surveys

Individual-level analyses have consistently shown associations of travel behaviours with obesity-related measures. However, transport planning policies often target areas rather than individuals. To better inform transport-related policies and initiatives for obesity prevention, area-level relationships need to be investigated. This study linked data from two travel surveys with data from the Australian National Health Survey at the level of Population Health Areas (PHAs) and examined to what extent area-level travel behaviours metrics (prevalence of active travel, mixed travel and sedentary travel, diversity of travel modes) were associated with the rate of high waist circumference. Data from 51,987 travel survey participants were aggregated into 327 PHAs. Bayesian conditional autoregressive models were used to account for spatial autocorrelation. It was found that statistically replacing participants who relied on cars for travel (without walking/cycling) with those engaging in 30+ min/d of walking/cycling (without car use) was associated with a lower rate of high waist circumference. Areas with greater diversity of travel modes (mix of walking/cycling, car use, public transport use) also had lower prevalence of high waist circumference. This data-linkage study suggests that area-level transport planning strategies addressing car dependency, shifting car use to walking/cycling over 30 min/d, may help to reduce obesity.

Evaluating the role of asymptomatic throat carriage of Streptococcus pyogenes in impetigo transmission in remote Aboriginal communities in Northern Territory, Australia: a retrospective genomic analysis

Streptococcus pyogenes, or group A Streptococcus (GAS), infections contribute to a high burden of disease in Aboriginal Australians, causing skin infections and immune sequelae such as rheumatic heart disease. Controlling skin infections in these populations has proven difficult, with transmission dynamics being poorly understood. We aimed to identify the relative contributions of impetigo and asymptomatic throat carriage to GAS transmission. In this genomic analysis, we retrospectively applied whole genome sequencing to GAS isolates that were collected as part of an impetigo surveillance longitudinal household survey conducted in three remote Aboriginal communities in the Northern Territory of Australia between Aug 6, 2003, and June 22, 2005. We included GAS isolates from all throats and impetigo lesions of people living in two of the previously studied communities. We classified isolates into genomic lineages based on pairwise shared core genomes of more than 99% with five or fewer single nucleotide polymorphisms. We used a household network analysis of epidemiologically and genomically linked lineages to quantify the transmission of GAS within and between households. We included 320 GAS isolates in our analysis: 203 (63%) from asymptomatic throat swabs and 117 (37%) from impetigo lesions. Among 64 genomic lineages (encompassing 39 emm types) we identified 264 transmission links (involving 93% of isolates), for which the probable source was asymptomatic throat carriage in 166 (63%) and impetigo lesions in 98 (37%). Links originating from impetigo cases were more frequent between households than within households. Households were infected with GAS for a mean of 57 days (SD 39 days), and once cleared, reinfected 62 days (SD 40 days) later. Increased household size and community presence of GAS and scabies were associated with slower clearance of GAS. In communities with high prevalence of endemic GAS-associated skin infection, asymptomatic throat carriage is a GAS reservoir. Public health interventions such as vaccination or community infection control programmes aimed at interrupting transmission of GAS might need to include consideration of asymptomatic throat carriage. Australian National Health and Medical Research Council.

The Weight Stigma Heat Map: A tool to identify weight stigma in public health and health promotion materials.

Public health campaigns and health promotion endeavours have been criticised for perpetuating weight stigma by reinforcing misinformation and using deficits-based narratives about larger-bodied people. The aim of this project was to develop a 'heat map' tool to appraise existing health policy and resources for elements that promote weight stigma. Ten themes were identified from literature using inductive analytic review methodology including pictorial/photographic representation, weight-health beliefs, body weight modifiability and financial concerns. Each theme was divided into four appraisal categories: the demonstration of weight stigma (via negative stereotyping, prejudice or discrimination that limits access to opportunities or services), weight bias (via presenting smaller bodies as normal/natural/healthy/good/desirable), bias-neutral (via representation of people of all shapes and sizes and accurate and nuanced health information about larger-bodied and smaller-bodied people) and finally an anti-stigma approach (via use of strengths-based narratives and overtly positive representation of and leadership by larger-bodied people). A colour coding schema (the 'heat map') to visualise stigmatising elements across materials and a scoring system was devised for future quantitative evaluation. To demonstrate the use of the Weight Stigma Heat Map (WSHM), the Australian National Obesity Strategy 2022-2032 was appraised. It is likely that weight stigmatisation is an important but under-recognised factor influencing the effectiveness of campaigns and interventions promoting behaviour change. SO WHAT?: Public health and health promotion professionals should consider using the WSHM as a framework for the development of less stigmatising policies, campaigns and resources and to direct reviews of existing materials.

The origins of the Anglosphere idea and the contestation of Australian nationhood, 1991–2007

This article shows how Australian politics played an under-researched part in the development of the Anglosphere idea. By examining the contestation of nationhood in Australia from the republic referendum of the 1990s until the mid-2000s, this article offers a new interpretation of the genesis of the Anglosphere idea. The article suggests that debates about national identity in Australia and the Anglosphere idea are co-constitutive. These co-constitutive relationships are with the United Kingdom (via the republic debate, the process of reconciliation between settlers and Indigenous peoples and civics and citizenship education), New Zealand (via ‘Anzac’ war commemoration) and the United States of America (via defence and security). The Anglosphere idea remains important to debates about national identity and public policy in Australia and provides context for decisions about how Australia positions itself in the world at a time of significant transnational challenges and threats.

Buprenorphine versus methadone for the treatment of opioid dependence: a systematic review and meta-analysis of randomised and observational studies

Opioid dependence is associated with substantial health and social burdens, and opioid agonist treatment (OAT) is highly effective in improving multiple outcomes for people who receive this treatment. Methadone and buprenorphine are common medications provided as OAT. We aimed to examine buprenorphine compared with methadone in the treatment of opioid dependence across a wide range of primary and secondary outcomes. We did a systematic review and meta-analysis in accordance with GATHER and PRISMA guidelines. We searched Embase, MEDLINE, CENTRAL, and PsycINFO from database inception to Aug 1, 2022; clinical trial registries and previous relevant Cochrane reviews were also reviewed. We included all RCTs and observational studies of adults (aged ≥18 years) with opioid dependence comparing treatment with buprenorphine or methadone. Primary outcomes were retention in treatment at 1, 3, 6, 12, and 24 months, treatment adherence (measured through doses taken as prescribed, dosing visits attended, and biological measures), or extra-medical opioid use (measured by urinalysis and self-report). Secondary outcomes were use of benzodiazepines, cannabis, cocaine, amphetamines, and alcohol; withdrawal; craving; criminal activity and engagement with the criminal justice system; overdose; mental and physical health; sleep; pain; global functioning; suicidality and self-harm; and adverse events. Single-arm cohort studies and RCTs that collected data on buprenorphine retention alone were also reviewed. Data on study, participant, and treatment characteristics were extracted. Study authors were contacted to obtain additional data when required. Comparative estimates were pooled with use of random-effects meta-analyses. The proportion of individuals retained in treatment across multiple timepoints was pooled for each drug. This study is registered with PROSPERO (CRD42020205109). We identified 32 eligible RCTs (N=5808 participants) and 69 observational studies (N=323 340) comparing buprenorphine and methadone, in addition to 51 RCTs (N=11 644) and 124 observational studies (N=700 035) that reported on treatment retention with buprenorphine. Overall, 61 studies were done in western Europe, 162 in North America, 14 in north Africa and the Middle East, 20 in Australasia, five in southeast Asia, seven in south Asia, two in eastern Europe, three in central Europe, one in east Asia, and one in central Asia. 1 040 827 participants were included in these primary studies; however, gender was only reported for 572 111 participants, of whom 377 991 (66·1%) were male and 194 120 (33·9%) were female. Mean age was 37·1 years (SD 6·0). At timepoints beyond 1 month, retention was better for methadone than for buprenorphine: for example, at 6 months, the pooled effect favoured methadone in RCTs (risk ratio 0·76 [95% CI 0·67-0·85]; I·=74·2%; 16 studies, N=3151) and in observational studies (0·77 [0·68-0·86]; I·=98·5%; 21 studies, N=155 111). Retention was generally higher in RCTs than observational studies. There was no evidence suggesting that adherence to treatment differed with buprenorphine compared with methadone. There was some evidence that extra-medical opioid use was lower in those receiving buprenorphine in RCTs that measured this outcome by urinalysis and reported proportion of positive urine samples (over various time frames; standardised mean difference -0·20 [-0·29 to -0·11]; I·=0·0%; three studies, N=841), but no differences were found when using other measures. Some statistically significant differences were found between buprenorphine and methadone among secondary outcomes. There was evidence of reduced cocaine use, cravings, anxiety, and cardiac dysfunction, as well as increased treatment satisfaction among people receiving buprenorphine compared with methadone; and evidence of reduced hospitalisation and alcohol use in people receiving methadone. These differences in secondary outcomes were based on small numbers of studies (maximum five), and were often not consistent across study types or different measures of the same constructs (eg, cocaine use). Evidence from trials and observational studies suggest that treatment retention is better for methadone than for sublingual buprenorphine. Comparative evidence on other outcomes examined showed few statistically significant differences and was generally based on small numbers of studies. These findings highlight the imperative for interventions to improve retention, consideration of client-centred factors (such as client preference) when selecting between methadone and buprenorphine, and harmonisation of data collection and reporting to strengthen future syntheses. Australian National Health and Medical Research Council.

Setting parameters for developing undergraduate expertise in transdisciplinary problem solving at a university-wide scale: a case study

As part of a curriculum reform process, The Australian National University (ANU) is introducing a universal undergraduate requirement that responds to decades-long calls for universities to take seriously the development of expertise in the transdisciplinary problem solving required to address the major challenges facing society. Described here are the process and outcomes of the deliberations of the working group tasked with setting parameters for the implementation of this expertise. The working group identified relevant context, including that the requirement has to work for all of the University’s 13,000 undergraduate students, allowing them to tailor coursework in transdisciplinary problem solving according to their disciplinary choices, personal interests and career aspirations. The expertise is to be developed in existing and new courses, featuring small classes with flexible interactive delivery and should build on the University’s comprehensive coverage of academic disciplines and fields, along with the university’s strong track records in transdisciplinary research and education. The working group developed an ANU framework for transdisciplinary problem solving, focused on the following six characteristics: change-oriented, systemic, context-based, pluralistic, interactive and integrative. How these characteristics can be translated into learning outcomes is demonstrated, along with relevant ways of teaching. The working group highlighted two key challenges that those involved in the mechanics of the implementation will have to deal with and proposed a way forward for the first of them. One is for students to be able to readily identify relevant courses. The working group proposed a tag-and-points system, with the ‘tag’ identifying courses relevant to transdisciplinary problem solving and ‘points’ indicating the number of characteristics covered and the depth of that coverage. The second challenge is coordination across courses to minimise duplication and maximise the opportunity to keep building skills. The paper concludes by summarising key areas that may be useful to others deliberating on the expertise required for university graduates to effectively contribute to addressing societal challenges, as well as how universities can best foster the development of that expertise.

Das Florilegium Vindobonense: neue Handschrift, neue Fragen

AbstractThis paper deals with the textual tradition of the Florilegium Vindobonense (14th century). According to the current state of research, only one manuscript of this alphabetical anthology is known, which can be found in Codex Philologicus Graecus 169 (Austrian National Library). In preparing the text for edition, however, I found another manuscript that contains the anthology in its entirety. Codex Vaticanus Graecus 895 also dates from the beginning of the 14th century. This article examines the relationship between the two text variants in light of the provenience of the manuscripts and textual criticism.

Moving beyond our borders to inspire education change

Purpose This paper contextualises a keynote address delivered at the 2022 Speech Pathology Australia National Conference in Melbourne, Australia. The paper aligns with the conference theme of Beyond Borders from the perspective of moving beyond borders of regular practice to develop strong partnerships and networks within our communities to advocate and support necessary change. Method Change or enhancement to current practice is necessary if we are to reduce current inequities in education experienced by many children in our communities, including those with communication challenges. Strengths-based and culturally responsive literacy approaches to supporting children within the context of their family and community are increasingly gaining support as we address this challenge. The Better Start Literacy Approach (Te Ara Reo Matatini), currently being implemented in junior school classrooms across New Zealand is described. It is one example of large-scale implementation of a strengths-based and culturally responsive early literacy approach, based on the science of reading. Result Data support the effectiveness of the Better Start Literacy Approach in significantly enhancing the foundational literacy skills of 5- and 6-year-old children, including those who commence school with lower levels of oral language ability. Conclusion Through establishing strong partnerships within communities, speech pathologists have much to offer in motivating systems level change to enhance early literacy success for all learners.

The human-initiated model of wolf domestication - An expansion based on human-dingo relations in Aboriginal Australia.

The historically known relationship of interspecies companionship between Aboriginal foraging communities in Australia and free-ranging dingoes provides a model for understanding the human-canid relations that gave rise to the first domesticated dogs. Here, we propose that a broadly similar relationship might have developed early in time between wild-living wolves and mobile groups of foragers in Late Pleistocene Eurasia, with hunter-gatherers routinely raiding wild wolf dens for pre-weaned pups, which were socialized to humans and kept in camp as tamed companions ("pets"). We outline a model in which captive wolf pups that reverted to the wild to breed when they were sexually mature established their territories in the vicinity of foraging communities - in a "liminal" ecological zone between humans and truly wild-living wolves. Many (or most) of the wolf pups humans took from the wilderness to rear in camp may have derived from these liminal dens where the breeding pairs had been under indirect human selection for tameness over many generations. This highlights the importance of the large seasonal hunting/aggregation camps associated with mammoth kill-sites in Gravettian/Epigravettian central Europe. Large numbers of foragers gathered regularly at these locations during the wild wolf birthing season. We infer that if a pattern of this kind occurred over long periods of time then there might have been a pronounced effect on genetic variation in free-ranging wolves that denned and whelped in the liminal zones in the vicinity of these human seasonal aggregation sites. The argument is not that wolves were domesticated in central Europe. Rather, it is this pattern of hunter-gatherers who caught and reared wild wolf pups gathering seasonally in large numbers that might have been the catalyst for the early changes leading to the first domesticated dogs - whether in western Eurasia or further afield.

Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial

Low back pain is the leading cause of years lived with disability globally, but most interventions have only short-lasting, small to moderate effects. Cognitive functional therapy (CFT) is an individualised approach that targets unhelpful pain-related cognitions, emotions, and behaviours that contribute to pain and disability. Movement sensor biofeedback might enhance treatment effects. We aimed to compare the effectiveness and economic efficiency of CFT, delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling low back pain. RESTORE was a randomised, controlled, three-arm, parallel group, phase 3 trial, done in 20 primary care physiotherapy clinics in Australia. We recruited adults (aged ≥18 years) with low back pain lasting more than 3 months with at least moderate pain-related physical activity limitation. Exclusion criteria were serious spinal pathology (eg, fracture, infection, or cancer), any medical condition that prevented being physically active, being pregnant or having given birth within the previous 3 months, inadequate English literacy for the study's questionnaires and instructions, a skin allergy to hypoallergenic tape adhesives, surgery scheduled within 3 months, or an unwillingness to travel to trial sites. Participants were randomly assigned (1:1:1) via a centralised adaptive schedule to usual care, CFT only, or CFT plus biofeedback. The primary clinical outcome was activity limitation at 13 weeks, self-reported by participants using the 24-point Roland Morris Disability Questionnaire. The primary economic outcome was quality-adjusted life-years (QALYs). Participants in both interventions received up to seven treatment sessions over 12 weeks plus a booster session at 26 weeks. Physiotherapists and patients were not masked. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001396213. Between Oct 23, 2018 and Aug 3, 2020, we assessed 1011 patients for eligibility. After excluding 519 (51·3%) ineligible patients, we randomly assigned 492 (48·7%) participants; 164 (33%) to CFT only, 163 (33%) to CFT plus biofeedback, and 165 (34%) to usual care. Both interventions were more effective than usual care (CFT only mean difference -4·6 [95% CI -5·9 to -3·4] and CFT plus biofeedback mean difference -4·6 [-5·8 to -3·3]) for activity limitation at 13 weeks (primary endpoint). Effect sizes were similar at 52 weeks. Both interventions were also more effective than usual care for QALYs, and much less costly in terms of societal costs (direct and indirect costs and productivity losses; -AU$5276 [-10 529 to -24) and -8211 (-12 923 to -3500). CFT can produce large and sustained improvements for people with chronic disabling low back pain at considerably lower societal cost than that of usual care. Australian National Health and Medical Research Council and Curtin University.

Circumstances of suicide after registration with a national digital mental health service: an analysis of coroners' reports.

Little is known about the safety of mental healthcare provided remotely by digital mental health services (DMHS), which do not offer face-to-face contact. To examine the circumstances of suicide by patients registered with a national DMHS. Data from 59 033 consenting patients registered with a national DMHS, the MindSpot Clinic, between 1 January 2013 and 31 December 2016 were linked with the Australian National Death Index and documents held by the National Coronial Information System (NCIS). Data extracted included demographic information, the nature of contact, duration between last contact and death, symptom scores and information in police, autopsy, toxicology and coroners' reports. Of the 59 033 patients, 90 (0.15%) died by suicide in a follow-up period of up to 5 years. The mean time between last contact and death was 560 days. Coroners' reports were located for 81/90 patients. Most (87.0%) were receiving face-to-face care around the time of death, 60.9% had a documented previous suicide attempt, 52.2% had been in hospital in the previous 6 months and 22.2% had severe mental illness, mainly schizophrenia or bipolar disorder. Other common findings were current treatment with psychotropic medication (79.2%) and the presence of alcohol (41.6%), benzodiazepines (31.2%), and illegal drugs and non-prescribed opioids (20.8%) at time of death. Those who died by suicide after contact with the DMHS had more severe illness, were mostly engaged with face-to-face services and often had disinhibiting substances, especially benzodiazepines, present at the time of death.

Interview: Andrew Blakers, Professor of Engineering, Australian National University

Interview: Andrew Blakers, Professor of Engineering, Australian National University

Changing the Scene: Lessons Learned and Actioned into General Practice from Australian Flood Fire Drought & Heat through Primary Health Networks

Introduction:General Practitioners (GPs) manage the majority of usual healthcare needs in a community. These healthcare needs do not cease in disasters; they increase and expand. However, inclusion of GPs in disaster healthcare systems is only just beginning. Systematic review of the health effects of disasters over days, months, and years, shows the major burden of healthcare needs associated with disasters is within the realm of usual general practice. In Australia, Primary Health Networks (PHNs) represent local GPs in each region. They offer the best option for systematic linkage of GPs to the broader DHM system.Method:A systematic review of the literature on the health effects of disasters and three qualitative studies reviewing the current experiences, barriers and facilitators to GP involvement in DHM systems were undertaken through a PhD at the Australian National University in 2022. A knowledge to action framework was developed and utilized to provide a systematic strategy to guide efforts to diffuse, disseminate, and implement the research as it emerged, with a focus on sustaining those changes through integration of PHNs into Australian DHM systems.Results:Integration of GPs, through PHNs, is evolving, through systematic inclusion in planning and policy in local health districts. Over time, evidence-based knowledge of disaster healthcare needs has been incorporated into GP disaster planning and preparedness, and resource development, and utilized by GPs during the recent 2019 Black Summer Bushfires, and East coast Floods.Conclusion:As our knowledge of the healthcare needs of disasters continues to reflect our increasingly challenging and complex world, the proven benefit of active involvement in holistic, comprehensive continuity of healthcare through General Practice in DHM systems through PHN linkage becomes more urgent.