Australian Population Research Articles

Estimates of Seasonal Influenza Burden That Could Be Averted by Improved Influenza Vaccines in the Australian Population Aged Under 65 Years, 2015-2019.

The interpretation of relative vaccine effectiveness (rVE) of improved influenza vaccines is complex. Estimation of burden averted is useful to contextualise their potential impact across different seasons. For the population aged under 65 years in Australia, this study estimated the additional morbidity and mortality that could be averted using improved influenza vaccines. We used observed, season-specific (2015-2019) influenza notification and influenza-coded hospitalisation frequencies and published modelled estimates of influenza-associated hospitalisations and deaths that occurred under the prevailing influenza vaccination coverage scenario. After back-calculating to the estimated burden in the population without vaccination, we applied published standard influenza vaccine effectiveness and coverage estimates to calculate the burden potentially averted by standard and improved influenza vaccines. A plausible range of rVE values were used, assuming 50% coverage. The percentage point difference in absolute vaccine effectiveness (VE) of an improved vaccine compared to a standard vaccine is directly proportional to its rVE and inversely proportional to the effectiveness of the standard vaccine. The incremental burden averted by an improved vaccine is a function of both its difference in absolute VE and the severity of the influenza season. Assuming an rVE of 15% with 50% coverage, the improved vaccine was estimated to additionally avert 1517 to 12,641 influenza notifications, 287 to 1311 influenza-coded hospitalisations and 9 to 33 modelled all-cause influenza deaths per year compared to the standard vaccine. Improved vaccines can have substantial clinical and population impact, particularly when the effectiveness of standard vaccines is low, and burden is high.

Metabolisable energy from nuts and patterns of nut consumption in Australia: secondary analysis of the 2011-12 National Nutrition and Physical Activity Survey

Nut consumption in Australia does not meet recommended levels, and concern regarding the impact of nuts on body weight is a reported barrier to regular intake, due to their high energy content(1). Nut intake is not associated with higher body weight(2), which may be explained by their lower metabolisable energy(3). Hence, total energy intake may be overestimated among nut consumers. Nut consumption patterns in Australia are also unknown. This study aimed to describe the metabolisable energy from nuts, and nut consumption patterns of the Australian population. A previously developed nut-specific database was expanded to include the metabolisable energy of nuts based on nut type and form, and applied to the 2011-12 National Nutrition and Physical Activity Survey (NNPAS). Mean metabolisable energy was compared to mean energy intake determined using Atwater factors for nut consumers. Additionally, nut consumption patterns were also explored, including the proportion of nuts consumed at meals and snacks, proportion of nuts consumed alone or combined with other foods, and timing of nut intake. Among nut consumers, the mean metabolisable energy from nuts, based only on nut type, was 241.24 (95% CI: 232.00, 250.49) kJ/day. The mean metabolisable energy when considering both nut type and form was 260.69 (95% CI: 250.18, 271.21) kJ/day, while energy from nuts using Atwater factors was 317.60 (95% CI: 304.85, 330.35) kJ/day. Nuts were more likely to be consumed as snacks, with approximately 63% of all nut intake (in grams) occurring as a snack. Nuts were frequently consumed with other foods and beverages, with only 27% of nuts consumed alone or with plain water. Furthermore, nuts were most often consumed after midday (68% of intake) rather than in the morning (32% of intake). Application of metabolisable energy data to the 2011-12 NNPAS has a significant impact on the calculation of energy intake from nuts. Nut consumption patterns identify most nut consumption occurring as snacks and two-thirds of nut intake occurring in the afternoon and evening. These findings may inform strategies to promote nut consumption in Australia.

Current and Future Cost Burden of Ischemic Stroke in Australia: Dynamic Model

Background: Stroke remains one of the leading causes of morbidity and mortality in Australia. The objective of this study was to estimate the current and future cost burden of ischemic stroke (IS) in Australia. Method: First, the annual chronic management cost per person following IS were derived for all people aged ≥30 years discharged from a public or private hospital in Victoria, Australia between July 2012 and June 2017 (with follow-up data until June 2018 [n = 34,471]). Then extrapolated the data from from Victoria to the whole Australian population aged between 30 years and 99 years to project the total healthcare costs following IS (combination of acute event and chronic management cost) over a 20-year period (2019–2038) using a dynamic multistate life table model. Data for the dynamic model were sourced from the Victorian Admitted Episodes Dataset (VAED) and supplemented with other published data. Result: The estimated annual total chronic management cost following IS was 13,525 Australian dollars (AUD) per person (95% CI: AUD 13,380, AUD 13,670) for cohorts in the VAED between July 2012 and June 2017. The annual chronic management cost was estimated to decline following IS. The highest cost was incurred in the first year of follow-up post-IS (AUD 14,309 per person) and declined to AUD 9,776 in the sixth year of follow-up post-IS. The total healthcare cost for people aged 30–99 years was projected to be AUD 47.7 billion (95% UI: AUD 44.6 billion, AUD 51.0 billion) over the 20-year period (2019–2038) Australia-wide, of which 91.3% (AUD 43.6 billion) was attributed to chronic management costs and the remaining 8.7% (AUD 4.2 billion) were due to acute IS events. Conclusion: IS has and will continue to have a considerable financial impact in the next 2 decades on the Australian healthcare system. Our estimated and projected cost burden following IS provides important information for decision making in relation to IS.

Excess Mortality in an Inception Cohort of Childhood Diabetes Diagnosed 1990–2010

Objective. Evaluate the mortality risk of childhood-onset type 1 diabetes compared to the general population. Research Design and Methods. The study population, identified from the Australasian Paediatric Endocrinology Group diabetes register, was diagnosed with type 1 diabetes at age < 16 in New South Wales (NSW), Australia, from 1990 to 2010. The register was linked to National Death Index registrations to ascertain timing and cause of death up to 31/12/2022. Risk factors for mortality were assessed using multivariable Cox regression models and observed mortality rate compared to “expected” rates in the Australian general population using indirect-standardized mortality ratios (SMR), overall and by sex and age at diagnosis. Diabetes-related cause of death categories were identified. Results. Of 5,417 children diagnosed with type 1 diabetes, 157 subsequently died, with all-cause mortality of 1.37/1,000 person years. Increased mortality risk was associated with living in most disadvantaged areas (aHR 1.81 (1.05, 3.11)) but not living in a rural area. Overall SMR was 2.83 (95% CI 2.40, 3.33) with females having higher SMR than males (4.18 vs. 2.19). Most common causes of death recorded were acute diabetes complications (26%), including diabetes ketoacidosis, accident/misadventure (21%), and chronic diabetes complications (15%). Alcohol and/or drug use contributed to 17% of deaths. Conclusion. Compared to the general population, higher risk of mortality in people with type 1 diabetes was associated with female sex and living in area of socioeconomic disadvantage. Education about minimizing risk-taking behaviors should be communicated to young adults with type 1 diabetes.

Proteus species bloodstream infections: Comparative epidemiology of three species

BackgroundAlthough Proteus species are occasional causes of serious infections, their epidemiology has not been well defined. The objective was to describe the overall and species-specific occurrence and determinants of Proteus species bloodstream infection (BSI) in a large Australian population. MethodsAll Queensland residents with Proteus species BSI identified within the publicly funded healthcare system between 2000 and 2019 were included. ResultsA total of 2,143 incident episodes of Proteus species BSI were identified among 2,079 Queensland residents. The prevalence of comorbid illness differed with higher Charlson comorbidity scores observed with P. penneri and P. vulgaris, and higher prevalence of liver disease with P. penneri, higher comorbid cancer with P. vulgaris, and lower diabetes and renal disease prevalence with P. mirabilis BSIs. ConclusionThis study provides novel information on the epidemiology of Proteus species BSI.

Vulnerability to fluctuations in prey and predation landscape in a central place foraging marine predator

IntroductionHuman-induced environmental change is driving a global redistribution of biodiversity, resulting in shifting prey and predation landscapes. These shifting landscapes can lead to changes in behavior, health, and vital rates, with potential implications for population dynamics.MethodsIn the present study, a state-dependent life-history theory model was developed to investigate the individual- and population-level responses of Australian fur seals (Arctocephalus pusillus doriferus) to changes in prey availability and at-sea mortality risk.ResultsRates of pregnancy, pup nursing, and abortion were unaffected by prey availability in the simulated population. Likewise, on-land and at-sea durations were largely unaffected by prey availability, with more pronounced affects for nonreproductive and pregnant females than for lactating females. There was a strong influence of prey availability on the proportion of females that were concurrently pregnant and lactating, largely due to an increase in pup abandonments under low prey availability scenarios. This effect on pup abandonments also had flow on effects for pup recruitment. Increasing at-sea mortality risk resulted in greater offspring losses due to maternal death. The combined impact of prey availability and at-sea mortality risk on the number of simulated female offspring reaching sexual maturity was substantial.DiscussionConsequently, our results suggest high vulnerability of the Australian fur seal population to shifting prey and predation landscapes. These results indicate a need for continued monitoring of Australian fur seal pup production and population dynamics in the face of rapid environmental change.

The Hidden Toll of Psychological Distress in Australian Adults and Its Impact on Health-Related Quality of Life Measured as Health State Utilities.

Psychological distress (PD) is a major health problem that affects all aspects of health-related quality of life including physical, mental and social health, leading to a substantial human and economic burden. Studies have revealed a concerning rise in the prevalence of PD and various mental health conditions among Australians, particularly in female individuals. There is a scarcity of studies that estimate health state utilities (HSUs), which reflect the overall health-related quality of life in individuals with PD. No such studies have been conducted in Australia thus far. We aimed to evaluate the age-specific, sex-specific and PD category-specific HSUs (disutilities) in Australian adults with PD to inform healthcare decision making in the management of PD. Data on age, sex, SF-36/SF6D responses, Kessler psychological distress (K10) scale scores and other characteristics of N = 15,139 participants (n = 8149 female individuals) aged >15 years were derived from the latest wave (21) of the nationally representative Household, Income and Labor Dynamics in Australia survey. Participants were grouped into the severity categories of no (K10 score: 10-19), mild (K10: 20-24), moderate (K10: 25-29) and severe PD (K10: 30-50). Both crude and adjusted HSUs were calculated from participants' SF-36 profiles, considering potential confounders such as smoking, marital status, remoteness, education and income levels. The calculations were based on the SF-6D algorithm and aligned with Australian population norms. Additionally, the HSUs were stratified by age, sex and PD categories. Disutilities of PD, representing the mean difference between HSUs of people with PD and those without, were also calculated for each group. The average age of individuals was 46.130 years (46% male), and 31% experienced PD in the last 4 weeks. Overall, individuals with PD had significantly lower mean HSUs than those likely to be no PD, 0.637 (95% confidence interval [CI] 0.636, 0.640) vs 0.776 (95% CI 0.775, 0.777) i.e. disutility: -0.139 [95% CI -0.139, -0.138]). Mean disutilities of -0.108 (95% CI -0.110, -0.104), -0.140 (95% CI -0.142, -0.138), and -0.188 (95% CI -0.190, -0.187) were observed for mild PD, moderate PD and severe PD, respectively. Disutilities of PD also differed by age and sex groups. For instance, female individuals had up to 0.049 points lower mean HSUs than male individuals across the three classifications of PD. There was a clear decline in health-related quality of life with increasing age, demonstrated by lower mean HSUs in older population age groups, that ranged from 0.818 (95% CI 0.817, 0.818) for the 15-24 years age group with no PD to 0.496 (95% CI 0.491, 0.500) for the 65+ years age group with severe PD). Across all ages and genders, respondents were more likely to report issues in certain dimensions, notably vitality, and these responses did not uniformly align with ageing. The burden of PD in Australia is substantial, with a significant impact on female individuals and older individuals. Implementing age-specific and sex-specific healthcare interventions to address PD among Australian adults may greatly alleviate this burden. The PD state-specific HSUs calculated in our study can serve as valuable inputs for future health economic evaluations of PD in Australia and similar populations.

High COVID-19 vaccine uptake following initial hesitancy among people in Australia who inject drugs

BackgroundPrevious studies have reported high COVID-19 vaccine hesitancy among people who inject drugs. We aimed to examine COVID-19 vaccine coverage, motivations and barriers to vaccination, and factors associated with uptake among this population in Australia, 1.5 years after vaccine rollout commenced. MethodsIn June-July 2022, 868 people (66.0 % male, mean age 45.6 years) who regularly inject drugs and reside in an Australian capital city reported the number of COVID-19 vaccine doses they had received and their primary motivation (if vaccinated) or barrier (if unvaccinated) to receive the vaccine. We compared vaccine uptake to Australian population estimates and used logistic regression to identify factors associated with ≥ 2 dose and ≥ 3 dose uptake. ResultsOverall, 84.1 % (n = 730) had received at least one COVID-19 vaccine dose, 79.6 % (n = 691) had received ≥ 2 doses, and 46.1 % (n = 400) had received ≥ 3 doses. Participants were less likely to be vaccinated than the Australian general population (prevalence ratio: 0.82, 95 % confidence interval [CI]: 0.76–0.88). Key motivations to receive the vaccine were to protect oneself or others from COVID-19, while barriers pertained to vaccine or government distrust. Opioid agonist treatment (adjusted odds ratio [aOR]: 2.49, 95 % CI: 1.44–4.42), current seasonal influenza vaccine uptake (aOR: 6.76, 95 % CI: 3.18–16.75), and stable housing (aOR: 1.58, 95 % CI: 1.02–2.80) were associated with receipt of at least two vaccine doses. Participants aged ≥ 40 years (versus < 40 years; aOR: 1.66, 95 % CI: 1.10–2.53) or who reported a chronic health condition (aOR: 1.71, 95 % CI: 1.18–2.47) had higher odds of receiving at least three vaccine doses. ConclusionWe observed higher COVID-19 vaccine uptake than expected given previous studies of vaccine acceptability among people who inject drugs. However, it was lower than the general population. People who inject drugs and reside in unstable housing are a subpopulation that require support to increase vaccine uptake.

Sex estimation of frontal sinus volume from computed tomography scans in a Western Australian adult population.

With the increasing use of radiological three-dimensional imaging, different metric and morphological aspects of the frontal sinuses (FS) have been examined relative to their potential to aid human identification, including sex estimation. The aim of this study is to assess the validity of the metric analysis of the FS volume for estimating sex in a Western Australian (WA) adult population, following the Michel et al. (2015) method. The right, left and total frontal sinus volume (TFSV) from 99 computed tomography scans (47 males and 52 females) of WA individuals aged 18-40 years were three-dimensionally reconstructed using OsiriX® and their volumes acquired in mm3. Sexual dimorphism in the TFSV was tested, and the accuracy of the Michel et al. (2015) formulae was calculated. Population-specific regression equations were also produced. There was a significant difference between the mean TFSV in males and females. The classification accuracy derived from the Michel et al. (2015) formulae was 59.6%. The WA-specific logistic regression analysis yielded an accuracy of 57.2%. The low accuracy rates preclude the use of the sex estimation method in the WA population, but the volume analysis confirmed the individual variability of the frontal sinuses, which may be useful for personal identification.

Long COVID in a highly vaccinated but largely unexposed Australian population following the 2022 SARS-CoV-2 Omicron wave: a cross-sectional survey.

To estimate the prevalence of long COVID among Western Australian adults, a highly vaccinated population whose first major exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was during the 2022 Omicron wave, and to assess its impact on health service use and return to work or study. Follow-up survey (completed online or by telephone). Adult Western Australians surveyed 90 days after positive SARS-CoV-2 test results (polymerase chain reaction or rapid antigen testing) during 16 July - 3 August 2022 who had consented to follow-up contact for research purposes. Proportion of respondents with long COVID (ie, reporting new or ongoing symptoms or health problems, 90 days after positive SARS-CoV-2 test result); proportion with long COVID who sought health care for long COVID-related symptoms two to three months after infection; proportion who reported not fully returning to previous work or study because of long COVID-related symptoms. Of the 70 876 adults with reported SARS-CoV-2 infections, 24 024 consented to contact (33.9%); after exclusions, 22 744 people were invited to complete the survey, of whom 11 697 (51.4%) provided complete responses. Our case definition for long COVID was satisfied by 2130 respondents (18.2%). The risk of long COVID was greater for women (v men: adjusted risk ratio [aRR], 1.5; 95% confidence interval [CI], 1.4-1.6) and for people aged 50-69 years (v 18-29 years: aRR, 1.6; 95% CI, 1.4-1.9) or with pre-existing health conditions (aRR, 1.5; 95% CI, 1.4-1.7), as well as for people who had received two or fewer COVID-19 vaccine doses (v four or more: aRR, 1.4; 95% CI, 1.2-1.8) or three doses (aRR, 1.3; 95% CI, 1.1-1.5). The symptoms most frequently reported by people with long COVID were fatigue (1504, 70.6%) and concentration difficulties (1267, 59.5%). In the month preceding the survey, 814 people had consulted general practitioners (38.2%) and 34 reported being hospitalised (1.6%) with long COVID. Of 1779 respondents with long COVID who had worked or studied before the infection, 318 reported reducing or discontinuing this activity (17.8%). Ninety days after infection with the Omicron SARS-CoV-2 variant, 18.2% of survey respondents reported symptoms consistent with long COVID, of whom 38.7% (7.1% of all survey respondents) sought health care for related health concerns two to three months after the acute infection.

Trends in the use of ankle arthrodesis and total ankle replacements in Australia over the past 20years.

End stage ankle osteoarthritis (OA) is debilitating. Surgical management consists of either ankle arthrodesis (AA) or a total ankle replacement (TAR). The purpose of this study is to assess the trends in operative intervention for end stage ankle OA in an Australian population. This is a retrospective epidemiological study of 15,046 surgeries. Data were collected from publicly available national registries including the Australian Medicare Database and Australian Orthopaedic Association National Joint Replacement Registrar from 2001 to 2020. There was a significant increase in all ankle surgeries performed across the period of interest. AA remained the more commonly performed procedure throughout the course of the study (11,946 cases, 79.4%) and was never surpassed by TAR (3100, 20.6%). The overall proportions demonstrated no significant changes from 2001 to 2020. The incidence of ankle surgeries continues to increase with the ageing and increasingly comorbid population of Australia. Despite demonstrating no significant overall change in the ratio of TAR and AA in our study population and period, there are noticeable trends within the timeframe, with a recent surge favouring TAR in the last 5years.

‘There seems to be some disparity then between our Syrian and Iraqi refugee children who seemed to have everything’: Constructing ‘good refugees’ and the ensuing equity issues in Australian schools

Abstract Australia took double the normal intake of refugees over 2015–17. On top of the usual humanitarian intake were refugees specifically from Syria and Iraq who were mostly Christian and were settled in metropolitan and regional NSW, Queensland, and Victoria. This article explores the responses of teachers in some of the schools where this cohort was settled. Using Critical Discourse Analysis, it argues that for the Australian population to accept this doubling of humanitarian migration it was important to ensure they were perceived as ‘good refugees’ in a discursive climate shaped by anti-Muslim, anti-refugee and anti-asylum seeker rhetoric. The insights provided in this article aim to support the educational needs and well-being of all refugee students by revealing how discursive positioning can lead to practices and processes of inclusion while simultaneously being exclusionary.

Abstract P285: Relationship Between Body Mass Index, Waist Measurement, Six-Minute Walk Performance and Whole-Body Strength in Adults With Cardiovascular Disease: Findings From the Lifestyle Heart Health Study

Introduction: Cardiovascular disease (CVD) is the leading cause of death, killing 17.9 million people annually worldwide. Key risk factors include physical inactivity, overweight/obesity, high blood pressure, high cholesterol which worsen with age, and smoking and excessive alcohol intake. Six-minute walk (6MW) performance and whole-body muscle strength are both related to cardiovascular mortality and also worsen with age, particularly in the absence of physical activity. The aims of this study were to understand levels of cardiovascular risk and compliance to usual medical treatment (medication, lifestyle modifications) in a high socioeconomic Australian population, and to identify relationships between key risk factors, 6MW and muscle strength. A secondary aim was to help inform development of the Lifestyle Heart Health Education Program. Methods: This was a cross-sectional study of 473 people with CVD in Sydney. Class was classified based on the Australian socioeconomic index for areas. Conditions were defined according to Australian national guidelines. Medical history, body mass index (BMI), waist measurement, whole-body muscle strength and 6MW measurements were assessed. Simple linear and stepwise regressions were used to assess potential relationships. Results: Mean age of the cohort was 66.8±11.6; range 21-94 yrs; 68.5% female; socioeconomic index was deemed high. All participants had CVD, of which 25% were on aspirin. Hypertension was prevalent in 65% (38% on anti-hypertensives); 65% had dyslipidaemia (40% on a statin); 91% had a BMI over 26.0; and 85% of males and 80% of females had a waist measurement over gender-specific heart health recommendations. Less than 3% of the cohort smoked, and less than 10% consumed alcohol at a level deemed high-risk. Almost 20% of the cohort were at risk of CV mortality according to 6MW performance with scores less than 350 metres. Waist measurement, BMI, and blood pressure were the greatest risk factors across the cohort. Muscle strength (r=-0.34; r 2 =0.17; p&lt;0.001) and 6MW performance (r=-0.37; r 2 =0.17; p&lt;0.001) both decreased with age. BMI and age were the most significant predictors of 6MW (r=-0.45; r 2 =0.20; p=0.004) and whole-body strength (r=0.49; r 2 =0.24; p&lt;0.001) in females; waist and age were the most significant predictors of 6MW (r=-0.38; r 2 =0.14; p=0.11) and whole-body strength (r=0.41; r 2 =0.17; p=0.04) in males. Conclusion: Whilst alcohol and smoking campaigns are working to reduce consumption of these harmful substances, low cardiorespiratory and muscular fitness and overweight/obesity remain highly prevalent. Population-level interventions such as the Lifestyle Heart Health Program that aim to reduce weight and waist and improve physical activity, walking ability and muscle strength are urgently needed to reduce cardiovascular risk and mortality.

The congenital hearing phenotype in GJB2 in Queensland, Australia: V37I and mild hearing loss predominates.

GJB2 was originally identified in severe, non-syndromic sensorineural hearing loss (SNHL), but was subsequently associated with mild and moderate SNHL. Given the increasing utilisation of genetic testing pre-conceptually, prenatally, and neonatally, it is crucial to understand genotype-phenotype correlations. This study evaluated the nature and frequency of GJB2 variants in an Australian paediatric population with varying degrees of SNHL ascertained through newborn hearing screening. Audiograms from individuals with GJB2 variants and/or a GJB6 deletion (GJB6-D13S11830) were retrospectively reviewed (n = 127). Two-thirds were biallelic (homozygous/compound heterozygous) for pathogenic/likely pathogenic variants of GJB2 and/or GJB6 (n = 80). The most frequent variant was c.109 G > A, followed by c.35delG and c.101 T > C. Compared to biallelic carriage of other GJB2 variants, c.109 G > A positive individuals (homozygous/compound heterozygous) were more likely to have mild HL at their initial and latest audiograms (p = 0.0004). Biallelic carriage of c.35delG was associated with moderately-severe or greater SNHL at both initial and latest audiograms (p = 0.007). The c.101 T > C variant presented with milder SNHL and U-shaped audiograms (p = 0.02). In this agnostically identified cohort, mild SNHL predominated in GJB2/GJB6 carriers in contrast to previous studies targeting individuals with significant loss. Consequently, c.109 G > A, associated with milder phenotypes, was the most frequent. This study provides valuable data to support prognostic confidence in genetic counselling.

Community Cultural Wealth among a South Australian Muslim Population: A Reflective Evaluation of Strengthening Family Health and Wellbeing

Muslims living in non-Muslim countries may experience marginality, which has associations with exclusion, poor socio-emotional health, higher rates of family violence, and poor quality of life. Faith-based strategies have the potential to bridge the gaps and improve the outcomes for these communities. We undertook a reflective evaluation of the individual and group interventions of a Muslim start-up NGO, Community Development, Education and Social Support Inc. (CDESSA) (Adelaide, SA, Australia). Qualitative data were generated via dialogue, storytelling, and making connections with meaning based on observations of the lived experiences of the narrators. The analysis involved revisiting, reordering, refining, and redefining the dialogue, and conscious framing around a theoretical model of community cultural wealth. The results showed the growth of family and community engagement in CDESSA’s support and intervention activities, commencing with a small religious following in 2021 and growing to more than 300 Muslims regularly joining together for faith, health, welfare, and social wellbeing activities. Reflections on the dimensions of aspirational, navigational, social, familial, ethnoreligious, and resilient forms of community cultural wealth showed that the range of individual and group interventions, involving religious leaders, contributed to improving health and wellbeing, thereby growing community capital as a mechanism for strengthening families in this community.

Temperature-bounded development of Dirofilaria immitis larvae restricts the geographical distribution and seasonality of its transmission: case study and decision support system for canine heartworm management in Australia

Dirofilaria immitis is the causative agent of canine heartworm disease. We used the established heartworm development unit (HDU) principle to map the extrinsic incubation period (EIP) of D. immitis in Australia using historical weather data from 2013–2022. We found weather conditions suitable for EIP completion showed substantial seasonality and geographical variability. Whilst a considerable percentage of the Australian territory showed suitable weather conditions to always support EIP completion (17%), only 2.7% of the 2021 Australian human population lived in this region. Therefore, 97% of the population lived in an area that changed its EIP suitability within the study period. EIP completion is required prior to D. immitis transmission, meaning that infection risk of D. immitis is seasonal and location-dependent, being disrupted each year for most of the human population’s dogs. We developed an online, open access tool allowing us to visualise EIP completion across Australia historically and in near real-time. We aim to support veterinarians to make risk-based recommendations for dirofilariosis prevention by using the tool, available at https://heartworm-mapping.adelaide.edu.au/shiny/.

Educators’ hands are tied: The impact of heteronormative and cisnormative discourses on students in faith-based schools in Australia

Australian religious conservatives continue to argue that religiously affiliated schools should be able to discriminate based on the sexuality and/or gender identity of students. We argue that this discussion fails to adequately consider the serious harms that discrimination against LGBTQ+ educators has on LGBTQ+ and questioning students. The article uses data from an Australian qualitative study examining the experience of LGBTQ+ educators in religiously affiliated organisations. We describe how heteronormative/cisnormative discourses and discriminatory practices toward LGBTQ+ educators have a direct negative impact on LGBTQ+ students. Even in relatively inclusive schools, the heteronormative and cisnormative climate of the schools is damaging, not only for educators but also for LGBTQ+ students. These serious harms need to be given greater consideration in evaluating the arguments for discriminatory practices in religiously affiliated schools funded by the government to provide education to the general Australian population.

Comparing a fecal immunochemical test and circulating tumor DNA blood test for colorectal cancer screening adherence.

Colorectal cancer (CRC) screening programs are most effective at reducing disease incidence and mortality through sustained screening participation. A novel blood test modality is being explored for CRC screening, but it is unclear whether it will provide sustained screening participation. This study aimed to investigate whether a circulating tumor DNA (ctDNA) blood test improved CRC screening re-participation when compared with a fecal immunochemical test (FIT) and to define the predictors of sustained CRC screening in an Australian population. South Australians who initially participated in CRC screening using a ctDNA blood test (n=36) or FIT (n=547) were offered the same CRC screening test approximately 2years later through an extended phase of a randomized controlled trial. Surveys collected demographic, psychosocial, and clinical information. Predictors of CRC screening re-participation were explored using chi-square, Wilcoxon tests, and logistic regression. Participants offered a second ctDNA blood test were equally likely to re-participate in CRC screening as those who completed a FIT in the first round and who were offered the same test (61% vs 66% re-participation respectively, P=0.6). CRC fatalism, health activation, and self-efficacy were associated with repeated screening participation. Test awareness was predictive of repeated FIT-based CRC screening. Targeted interventions to improve CRC screening awareness and increase patient health activation may improve CRC screening adherence. A ctDNA blood test may be a suitable CRC screening option to maintain CRC screening adherence in people who do not participate in screening with FIT.

UrethroNAV: the aetiology and extent of idiopathic urethral stricture in an Australian population.

Lichen sclerosus (LS) is considered a causative factor in 10% of cases of idiopathic urethral stricture disease (IUSD), which is important for determining management strategies due to the underlying pathophysiology. Traditional excision urethroplasty may not be effective as inflammation often extends beyond the macroscopic stricture. This pilot study aims to answer two research questions: is LS an underlying cause of some idiopathic cause of strictures, and, if there is histological evidence suggesting predisposition of the surrounding tissue to strictures. Biopsies were taken from the stricture site as well as 1 and 2 cm proximal and distal in patients with IUSD. Histological features, including macroscopic and microscopic findings, were reported, including the presence of LS, hyperkeratosis, epidermal changes, lichenoid infiltrates, ulceration, scarring, and inflammation. Methylene blue was used to aid in locating damaged urothelium. Patients were prospectively followed up after urethroplasty. From 109 urethroplasties performed between 2019 to 2022, 15 male patients were enrolled after meeting specific inclusion criteria. These criteria included a diagnosis of IUSD and the absence of any evidence of trauma, macroscopic inflammatory disease, or previous endoscopic instrumentation of the urethra. Patients had to be at least 16 years old and medically suitable for undergoing urethroplasty. The study was approved by the hospitals ethics committees. None had macroscopic evidence of LS. One patient had microscopic evidence of LS at the 2 cm proximal biopsy only. A total of 93% of patients had scarring proximal and distal to the stricture, while 20-40% had inflammatory change. The patient with microscopic LS and two inflammatory change patients had stricture recurrence after urethroplasty. Additionally, one patient with inflammatory changes was diagnosed with penile intraepithelial neoplasia (PeIN) and underwent partial penectomy. Findings suggest that an underlying cause of IUSD could be LS. Additionally, the pathophysiology may involve scarring and inflammation beyond the limits of the stricture with extension distal from the stricture site. Careful evaluation for concomitant urethral pathology should be considered in cases of inflammatory changes. These findings should be considered in the surgical management of IUSD and warrant further research into the role of routine biopsy and drug targets in USD.

Getting into a good headspace: a study protocol of a pragmatic trial for an eating disorder prevention program in an Australian youth mental health service

Eating disorders (EDs) are serious, deadly disorders that emerge in adolescence and early adulthood. Further, reported incidences of EDs are increasing worldwide. As such, accessible, affordable, and effective early intervention and prevention efforts are critical. The Body Project is a well-established ED prevention program with demonstrated success at reducing ED symptom severity and the risk of onset of EDs in young females. However, it has not yet been formally evaluated in an Australian population, nor have the benefits of the treatment for young people of all genders been thoroughly investigated. This protocol paper outlines the design for a study which aims to investigate the outcomes and feasibility of the Body Project as a brief ED prevention program within an Australian youth mental health service: headspace Camperdown. This pragmatic trial will compare outcomes between a Body Project treatment group and a Treatment-as-usual control group. Primary outcomes include body image concerns, ED symptomatology and general psychological distress, measured pre- and post-treatment, and at one-month follow-up. All young people attending headspace Camperdown for care are eligible for participation in the trial. The Body Project program is comprised of four group-based 1.5 h sessions run over 4 consecutive weeks. Overall, a trial of the Body Project as an ED prevention program is warranted to investigate the outcomes of the intervention in this sample and will provide valuable information about the feasibility for widespread implementation of the treatment as part of a stepped-care approach to intervention for EDs at youth mental health service locations across Australia. ANZCTR Trial Registration Number: ACTRN12623000695606 (registered 29 June 2023).