Genomic sequencing has transformed the diagnostic approach for mitochondrial disease, yet integration into standard clinical practice is limited by access and funding. We conducted a post-implementation evaluation of genome sequencing (GS) for mitochondrial disease in Australia, which became publicly funded through the Medicare Benefits Scheme (MBS) in November 2023, to allow for broader access to testing. Test request data, including demographics, phenotypic information, and the diagnostic outcomes, were collected from November 2023 to May 2025 from the Victorian Clinical Genetics Services, the current laboratory provider of the MBS-funded service. Test uptake was 26% of predicted, with lower test rates in regional and remote areas. Over the first 19 months, 300 individuals suspected of mitochondrial disease underwent GS with a median turnaround time of 84 days (8 days-218 days). The diagnostic yield was 20%, with 56% of diagnoses in known mitochondrial disease genes. Of these, 70% (24 of 34) were in mitochondrial DNA. Seventeen diagnoses were in individuals who had prior non-diagnostic testing (exome sequencing or gene panel). We demonstrate that publicly-funded GS can deliver meaningful diagnostic outcomes for mitochondrial disease on a national scale. To maximise its impact, attention must now shift towards ensuring equitable access, particularly for regional and remote areas, and embedding sustainable mainstreaming models that support both genetic and non-genetic clinicians.

An exploration of the factors influencing the uptake of non-invasive ventilation by people with motor neurone disease in Australia: a qualitative study of patient and health professional perspectives

Hellebores (Helleborus spp.) are herbaceous perennial plants that are widely grown for their winter and early spring flowers (Eastwell et al. 2009; Liefting et al. 2010). In 2022, hellebores (Helleborus orientalis) exhibiting severe virus-like symptoms characterised by dark brown to black streaking on sepals, bracts, and stems, as well as irregularly shaped dark lesions on foliar tissues (Figure 1), were collected from a private garden located in the Blue Mountains region of New South Wales (NSW), Australia. It was noted that approximately 10% of the hellebore population in the garden exhibited symptoms. The collected symptomatic tissues were subjected to diagnostic screening at the NSW Department of Primary Industries and Regional Development Plant Health Diagnostic Service laboratory. The symptoms observed appeared consistent with those of hellebore black death, which is associated with Helleborus net necrosis virus (HeNNV, Carlavirus necroretis), a member of the Carlavirus genus (Eastwell et al. 2009; Liefting et al., 2010; Rubino 2024). A composite from multiple samples consisting of symptomatic sepal, bract, and leaf tissues was subjected to transmission electron microscopy following a negative-stain preparation. The electron microscopy analysis revealed filamentous virus-like particles measuring 650-700 nm length, with slightly flexuous and curved properties (Figure 2), which were consistent with those belonging to the Carlavirus genus. In addition, total RNA was extracted from a composite of multiple samples comprised of symptomatic sepal, bract, and leaf tissues using the Bioline ISOLATE II RNA Plant Kit (Meridian Bioscience), following the manufacturer’s instructions. The total RNA integrity was verified via High Sensitivity RNA ScreenTape Analysis (Agilent Technologies) and used to prepare an RNA-Seq library followed by sequencing as described in Maina et al. (2021), using the MiSeq cycle 2 x 251 v3 kit (Illumina). The obtained raw reads were trimmed and de novo assembled as described in Maina et al. (2021). Assembled contigs were subjected to BLASTn analysis, and a single contig of 8,534 nucleotides (nt) sharing 99.3% sequence identity with a HeNNV genome (GenBank accession NC_012038.1) was obtained. The contig of interest was represented by 2.6% of the total reads (79,136 reads out of 3,006,106 total reads), giving an average genome coverage of 1336x. The genome sequence was deposited in GenBank under accession PV165322 (isolate M22-15435). To confirm the presence of HeNNV in the original hellebore sample, specific primers targeting the HeNNV coat protein gene were designed (Sol_F-CCACTCAGCTCTCCAATTGTTA and Sol_R-CCTTCCTGTGCCTGGTTAAA) and used to conduct RT-PCR (at 57°C annealing temperature) using the original RNA sample followed by Sanger sequencing, yielding an amplicon of the expected size (604 bp) that shared 100% identity with the HTS contig. To our knowledge, this is the first detection and report of HeNNV infecting hellebores in Australia. The introduction of HeNNV to Australia may have inadvertently occurred through the importation of infected hellebore propagules. This HeNNV detection reinforces the importance of stringent biosecurity screening of imported plant propagules entering Australia. In addition, the identification of this virus contributes to the knowledge of hellebore black death aetiology. Furthermore, this report will enhance HeNNV awareness, assisting hellebore growers to adopt management strategies aimed at reducing the potential spread and impact of HeNNV disease in Australia.

Abstract Background Digital health offers transformative potential in facilitating healthcare delivery amid the compounding burden of IBD. The 2025 Australian ‘State of the Nation’ report highlights widespread healthcare navigation challenges for people with IBD1. These include fragmented care coordination and high reliance on emergency services, contributing to poor consumer experiences and rising healthcare expenditure. The methodology for developing a consumer/clinician co-created IBD app is described. Methods A core working group comprised of three gastroenterologists and a GI-specialised psychologist as clinical leads, and a six-person software team (software engineers, AI developer, project coordinator, and a user experience/design expert) was established. Additional input was sought from key stakeholders, including IBD nurse specialists and a paediatric gastroenterologist. Horizon scanning to systematically evaluate the mobile app landscape in IBD was performed to contextualise consumer needs. Two independent surveys by Crohn’s Colitis Cure and the software team identified consumer needs and preferences. Focus groups were held iteratively until data saturation, enabling the co-creation of job stories that reflected real-world needs. Job stories were translated into app features and scored out of 5 by importance as a feature, and the commonality/frequency amongst responders. Regular meetings of the core group were held to refine job stories and guide feature set design and development. Results 364 participants/consumers (median age: 40, 61% female) responded to surveys. 76% of respondents were from Australian/New Zealand and 24% from the UK/USA. Crohn’s Disease and ulcerative colitis comprised 59.1%/39.8% of the cohort respectively. The final features identified for development include symptom tracking, healthcare team communication, mental health screening, personal clinical data integration, care organisation, and an interactive large language model built on trusted information. The design allows for both independent function and bi-directional integration with Crohn’s Colitis Care (CCCare) electronic medical records. Conclusion Through consumer/clinician co-creation, we identified key app features to address healthcare navigation challenges, improve clinical care quality and efficiency. The resulting feature set of the patient-facing mobile app has been designed for bi-directional integration with the CCCare and clinical practice integration. Reference: 1. Crohn’s Colitis Australia. State of the Nation in Inflammatory Bowel Disease in Australia: Final Report. February, 2025. Accessed May 1, 2025. https://crohnsandcolitis.org.au/wp-content/uploads/2025/05/CCA_State-of-the-Nation-in-IBD-1.pdf Conflict of interest: Dr. Chan, Patrick: No conflicts of interest. Connor, Susan Jane: Research Support: Abbvie, Agency for Clinical Innovation, Amgen, BMS, Chiesi, Celltrion, DrFalk, Ferring, Janssen, Medical Research Future Fund, Pfizer, South Western Sydney Local Health District, Sydney Partnership for Health, Research and Enterprise, Takeda and The Leona M and Harry B Helmsley Charitable Trust Ad Boards: Abbvie, Amgen, BMS, Celltrion, Eli Lilly, Ferring, GSK, Janssen, Organon, Pfizer, Takeda Speaker Fees: Abbvie, Cornerstones Health, Dr Falk, Ferring, Janssen, Pfizer, Sandoz, Sydney IBD School, Takeda Educational Support: DrFalk, Sandoz, Takeda Knowles, Simon Robert: No conflicts of interest. Andrews, Jane Mary: Grant: This project is supported from a grant by The Leona M. and Harry B. Helmsley Charitable Trust. The work I will present was funded via CCCure. CCCure’s funding sources include grants for research and payments for data reports from Pharma including AbbVie, J&J, Takeda, Celltrion, Falk, Ferring, BMS, Janssen, Pfizer, Sandoz

Abstract Background Inflammatory Bowel Disease (IBD) is experiencing compounding prevalence with Australian prevalence expected to grow by 258% by 20301. Digital technologies hold promise for improving care quality and accessibility by virtue of scalability. Patient-facing mobile applications can be implemented across different stages including diagnosis, monitoring, facilitation of treatment, and research. These tools can empower patients, enhance engagement, and reduce care navigation stress Despite a number of IBD apps being described in literature or available to consumers, very few are accessible locally, whilst existing solutions offer limited functionality and fall short in supporting meaningful clinical use. Methods Two independent reviewers conducted a systematic search of the Australia/New Zealand Apple App Store and Android Play Store. The following search terms were included “colitis”, “ulcerative colitis”, “IBD”, “inflammatory bowel disease”, and “Crohn’s”. Apps were included if the title/description referenced IBD, excluding those focused on other gastrointestinal conditions. Non-English apps, and those limited or locked to a specific institution were also excluded. Results Within both stores, 49 apps were identified and 16 met the inclusion criteria. Most were free (14/16), though three required paid subscriptions. Only four apps reported medical professional input. Symptom tracking was the most common feature (10/16), followed by dietary logging (9/16). Fewer apps included medication management (5/16), educational content (4/16), or administrative tools (2/16). Symptom-tracking functionality was heteregenous, with only four incorporating validated measures such as SCCAI or HBI. Two apps included AI-based flare prediction. Dietary tools ranged from basic logging to AI-driven analysis. Four apps offered educational content covering topics such as lifestyle and wellbeing, medication, and disease-related information. Sources varied, with two providing expert-curated or medically reviewed material, while others were unsourced or AI-generated content. Additional features includ ed remote calprotectin testing, administrative tools and community support forums. Overall, functionality was fragmented across different apps, with nearly half (43.7%) of apps including one of the above categories, and the majority (62.5%) incorporated two or fewer feature categories. Conclusion The growing burden of IBD and its associated costs remain a challenge within current health system constraints. Digital technology holds promise in augmenting clinical care, yet most existing IBD apps offer narrow feature sets, lack health system integration, and are not personalised to individuals, thus limiting their usefulness in clinical settings. Reference: 1. Crohn’s Colitis Australia. State of the Nation in Inflammatory Bowel Disease in Australia: Final Report. February, 2025. Accessed May 1, 2025. https://crohnsandcolitis.org.au/wp-content/uploads/2025/05/CCA_State-of-the-Nation-in-IBD-1.pdf Conflict of interest: Dr. Chan, Patrick: No conflicts of interest. Wu, Rodger: No conflicts of interest. Andrews, Jane Mary: The work I will present was funded via CCCure. CCCure’s funding sources include grants for research and payments for data reports from Pharma including AbbVie, J&J, Takeda, Celltrion, Falk, Ferring, BMS, Janssen, Pfizer, Sandoz Connor, Susan Jane: Grant: This project is supported by a grant from The Leona M. and Harry B. Helmsley Charitable Trust. Research Support: Abbvie, Agency for Clinical Innovation, Amgen, BMS, Chiesi, Celltrion, DrFalk, Ferring, Janssen, Medical Research Future Fund, Pfizer, South Western Sydney Local Health District, Sydney Partnership for Health, Research and Enterprise, Takeda and The Leona M and Harry B Helmsley Charitable Trust Ad Boards: Abbvie, Amgen, BMS, Celltrion, Eli Lilly, Ferring, GSK, Janssen, Organon, Pfizer, Takeda Speaker Fees: Abbvie, Cornerstones Health, Dr Falk, Ferring, Janssen, Pfizer, Sandoz, Sydney IBD School, Takeda Educational Support: DrFalk, Sandoz, Takeda

Crusted scabies is a rare but severe skin condition that predominantly affects immunocompromised and elderly individuals, with potentially fatal outcomes if untreated. It can also trigger institutional outbreaks, complicating public health responses. Diagnosis can be challenging due to overlapping features with other dermatological conditions. In 2016, crusted scabies was classified as a notifiable disease in Australia’s Northern Territory. This review aims to summarize the pathogenesis, clinical features, diagnostic methods, and treatment options for crusted scabies over a period of 20 years ending in December 2022. A critical literature review was conducted using PubMed, Google Scholar, and Research4life for studies published between January 2003 and December 2022. Relevant articles in English discussing pathogenesis, clinical manifestations, diagnostic approaches, and treatment strategies were reviewed. Crusted scabies is characterized by a Th1-to-Th2 immune shift, leading to hyperkeratosis, extensive scaling, and minimal pruritus. Diagnostic methods include microscopy, dermatoscopy, biopsy, PCR, and serodiagnosis. Treatments involve topical scabicides, keratolytic agents, and oral ivermectin. Standardized protocols for diagnosis and treatment are needed to address variability in current practices. Early diagnosis and timely management are critical to improving patient outcomes and preventing complications, including sepsis and nosocomial outbreaks.

The burden of disease estimates from the Australian Institute of Health and Welfare are influential in driving priorities for actions across research, policy and practice. Following the latest estimates in 2024, much attention focused on top risk factors including obesity, tobacco and diet. Meanwhile, upstream social, economic and political drivers were overlooked. In this perspective, we argue that to effectively move the dial on disease burden, we must shift our focus from downstream action on individual-level risk factors to upstream action on structural causes. Failure to do so represents a missed opportunity to improve population health and tackle health inequity.

BackgroundCutaneous malignant melanoma (CMM) represents a substantial health burden for the elderly; however, data regarding its impact and epidemiology within this demographic remain scarce. This study aims to evaluate the global, regional, and national trends of CMM among individuals aged 60 and elderly from 1990 to 2021.MethodsWe retrieved data on the age-standardized incidence, prevalence, and mortality rates, and disability-adjusted life years (DALYs) of CMM among individuals aged 60 and above across 204 countries and territories from 1990 to 2021, sourced from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study 2021. We calculated the estimated annual percentage changes in age-standardized incidence and DALY rates of CMM, categorized by age, sex, and socio-demographic index (SDI), to quantify temporal trends. Additionally, we employed Spearman correlation analysis to examine the relationship between age-standardized rates and SDI.ResultsThis study analyzed global trends in CMM from 1990 to 2021 using the GBD database. The findings indicate a significant increase in the incidence (EAPC=0.65, 95% CI: 0.33–0.96) and prevalence (EAPC=1.02, 95% CI: 0.64–1.41) of CMM, while a significant decreasing trend was observed for mortality (EAPC=−0.43, 95% CI: −0.57- −0.30) and DALYs (EAPC=−0.67, 95% CI: −0.82- −0.53). In 2021, high-income North America exhibited the highest prevalence of CMM but the lowest growth rate. In contrast, the Middle East and North Africa experienced the fastest growth rate, while Latin America also demonstrated a significant increase in prevalence. The growth rates of incidence and prevalence were notably higher among male patients compared to females, reflecting gender-specific behavioral differences. Furthermore, an analysis of the relationship between the burden of disease and the SDI for CMM across various regions from 1990 to 2021 revealed that the burden of disease in Australia significantly exceeded model predictions. The APC analysis indicated that the prevalence of CMM among elder population (≥60 years old) declined with age, but the overall disease burden continues to rise annually, demonstrating higher prevalence rates in later birth cohorts. Similar trends were observed for incidence, DALYs, and mortality.ConclusionThis study reveals that the burden of CMM disease is rapidly increasing among populations residing at lower latitudes. The findings underscore the necessity for dynamic optimization of global prevention and control strategies, considering regional disparities.

High temperatures increase the burden of cardiovascular disease in Australia.

OP 29: Health Status 4, B302 (FCSH), September 4, 2025, 16:00 - 17:00AimInternational evidence has found that receipt of primary prevention for cardiovascular disease (CVD) can differ by ethnicity. Prior Australian research has demonstrated undertreatment of CVD risk factors in Aboriginal and Torres Strait Islander Australians. However, inequalities in the receipt of preventive therapies have not been examined in Australia’s non-Indigenous population. The aim of this study is to determine the presence of inequalities in primary preventative drug therapy for CVD by ethnicity in Australia.MethodsWe used data from a Census-linked cohort study of the New South Wales population aged 30 years and over. We created a cohort of individuals without prior history of a CVD event, who experienced their first CVD event during the period August 9, 2016 to June 2022. Incident CVD events were identified from hospitalisation or death records using relevant ICD-10-AM codes. We examined use of any preventative drug therapy (blood pressure and lipid lowering medications) in the two years prior to the first CVD event using linked prescription record data.ResultsIn preliminary analyses, we found that the proportion of individuals receiving at least one prescription of preventative drug therapy was overall high in the cohort (0.88, 95%CI [0.87, 0.88]). A higher proportion of females (0.89, 95%CI [0.89, 0.89]) were prescribed preventive therapy compared to males (0.86, 95%CI [0.86, 0.87]). In addition, we found a lower proportion of Asian males (0.81, 95%CI [0.78, 0.84]), Pasifika males (0.72, 95%CI [0.63, 0.82]) and Māori females (0.69, 95%CI [0.52, 0.86]) were prescribed preventive medication before their first CVD event compared to the population average.ConclusionThese fundings suggest that access to preventive medication for CVD in Australia differs by ethnicity and sex. Lower prescriptions in males and in Māori and Pasifika ethnic groups are concerning given their higher incidence of CVD.

The prevalence of immune-mediated inflammatory diseases (IMIDs) is rising, associated with increasing disease burden and healthcare expenditure. Medical therapy is the major driver of healthcare costs associated with IMIDs, owing to the need for lifelong therapy. However, many patients exhaust medical options, highlighting the need for new therapies with novel mechanisms of action. Recently, a highly effective class of medical therapy gained registration for use in Australia for IMIDs but was unsuccessful in attaining Pharmaceutical Benefits Scheme reimbursement. There is a growing need to reevaluate the reimbursement process for medicines in Australia, aiming to balance access to new therapies with prudent health-economic policy.

BackgroundExisting literature has identified inequalities in incidence and health outcomes between urban and rural populations with Alzheimer's disease (AD), however, potential disparities in the diagnostic process are poorly understood. We aimed to investigate differences in the diagnostic pathway – including the completion of key diagnostic investigations and diagnostic wait times – among individuals with all‐cause mild cognitive impairment (MCI) or dementia due to AD residing in rural and urban Australia.MethodWe conducted a cross‐sectional study using data from the Australia Dementia Network (ADNeT) Registry. Patients diagnosed with all‐cause MCI or AD dementia between registry commencement (March 2020) and December 2023 were included. Participants were categorised into three geographic groups – Major Cities (urban), Inner Regional, Outer Regional (both rural) – based on patient postcode (or clinic postcode if unavailable). Logistic and quantile regression models were used to investigate associations between rural/urban residence and the clinical diagnostic pathway.ResultWe identified 3,648 patients, 1,455(39.88%) with all‐cause MCI and 2,193(60.12%) with dementia due to AD. Participants in inner regional areas were more likely (odds ratio [OR]=1.55; 95% confidence interval [CI]=1.14,2.13; p = 0.006) to have had more basic diagnostic investigations completed (including core blood tests, cognitive assessments, functional assessments, structural neuroimaging) compared to those in major cities. However, participants in both inner regional (OR=0.37; 95% CI=0.28,0.48; p <0.001) and outer regional (OR=0.32; 95% CI=0.21,0.48; p <0.001) areas were less likely to have functional neuroimaging completed. Median wait times for an initial appointment following referral to a memory clinic were up to 28 days longer for rural compared to urban participants (Inner regional: Beta (median)=12.92; 95% CI=5.15,20.69; p = 0.001; Outer regional: Beta (median)=27.50; 95% CI=18.80,36.20; p <0.001). However, median wait times from initial appointment to diagnosis were up to 47 days shorter in rural compared to urban residents (Inner regional: Beta (median)=‐46.83; 95% CI=‐52.35,‐41.32; p <0.001; Outer regional: Beta (median)=‐44.42; 95% CI=‐50.35,‐38.49; p <0.001).ConclusionFindings suggest disparities in access to advanced diagnostic investigations and timely initial appointments across rural Australia. These inequalities may preclude access to timely post‐diagnostic services and exacerbate existing barriers to access novel disease modifying therapies which often require advanced diagnostic investigations such as functional neuroimaging.

This study aimed to identify practitioner awareness of and adherence to clinical practice guidelines for Indigenous peoples with otitis media in Australia. Database searches were conducted in Medline, Embase, APA PsychInfo, Scopus, Web of Science Core Collection, Academic Search Premier, and CINAHL. Studies were eligible for inclusion if they reported on practitioner awareness of or adherence to clinical practice guidelines for otitis media management for Indigenous peoples in Australia. Search terms included 'Indigenous peoples', 'otitis media', and 'guidelines'. Four peer-reviewed studies published between 2007 and 2020 met eligibility for inclusion. This review identified three key concepts: (1) practitioner awareness rates for the Therapeutic Guidelines were significantly higher than for the 2001 OM Guidelines, (2) practitioners self-reported higher adherence to the Therapeutic Guidelines compared with the 2001 OM Guidelines, and (3) antibiotic prescriptions for Indigenous children varied, possibly due to use of different guidelines and adherence criteria, as well as variations in geographical areas and settings. Practitioner adherence to clinical practice guidelines specific for Indigenous peoples with otitis media is critical to ensuring a consistent impact and, by extension, closing the gap in related life outcomes for Indigenous peoples in Australia. It is important to evaluate guideline impact through establishing current practitioner adherence rates. Furthermore, increasing awareness of culturally appropriate research approaches and availability of evaluation tools, such as the Aboriginal and Torres Strait Islander Quality Appraisal Tool, should improve the conduct of future Indigenous research.

Epidemiology, Surgical Management and Mortality of Thoracic Aortic Disease in Australia: A 10-Year Population-Based Study.

Crohn's disease and ulcerative colitis affect 180 000 people in Australia, have no cure, have variable responses to treatment and cause a large burden of disease. Using methods developed by the James Lind Alliance, the top 10 research priorities were identified by consumers and clinicians to facilitate the planning and funding of future research.

In Australia, there were 1,552 cases (6.7 per 100,000 population per year) of invasive pneumococcal disease (IPD) notified to the National Notifiable Diseases Surveillance System (NNDSS) in 2013, and 1,564 cases (6.7 per 100,000 population per year) in 2014. The non-age standardised rate of IPD in Indigenous Australians was six times the rate of IPD in non-Indigenous Australians in both 2013 and 2014. Following the July 2011 introduction of the 13-valent pneumococcal conjugate vaccine (13vPCV) to the National Immunisation Program (NIP), the overall rate of IPD in children aged less than 5 years decreased from 19.8 per 100,000 population per year in 2011 to 12.5 per 100,000 population per year in 2013. In 2014 there was a slight increase in the overall rate of IPD in children aged less than 5 years to 14.1 per 100,000 population per year in 2014. In both 2013 and 2014, the rate of IPD caused by serotypes included 23-valent pneumococcal polysaccharide vaccine (23vPPV) declined in Indigenous adults aged 50 years or older (40.5 per 100,000 population per year and 35.2 per 100,000 population per year, respectively) after displaying a gradual increase between 2002 and 2012. Rates of IPD in non-Indigenous adults aged 65 years or older caused by serotypes included in the 23vPPV also declined in both 2013 and 2014 (9.5 per 100,000 population per year and 8.3 per 100,000 population per year, respectively) compared to 2011 (11.8 per 100,000 population per year). There were 134 deaths attributable to IPD in 2013 (a case fatality rate of 8.6%) and 118 in 2014 (a case fatality rate of 7.5%).

Low back pain (LBP) has the second highest burden of disease in Australia and is the 5th most common reason for attending an Emergency Department (ED). Variation in clinical care is linked to poorer outcomes and higher health care costs. In 2022, the Australian Commission for Safety and Quality in Healthcare (ACSQHC) released the LBP Clinical Care Standard (LBP CCS). An audit was completed at a tertiary metropolitan hospital ED to benchmark the care of patients attending with LBP against the LBP CCS. The medical notes of all adult patients with a diagnosis of LBP, attending Royal Perth Hospital (RPH) ED between 1 January and 31 March 2023 were reviewed. A total of 170 records met the inclusion criteria and were audited against the LBP CCS. A groupwise threshold of 80% was set a priori to confirm acceptable adherence of recorded practice with each item of the LBP CCS. Screening for serious spinal pathologies and appropriate patient review demonstrated the highest adherence, with imaging rates close to meeting the pre-determined threshold. No patients were screened for psychosocial factors and compliance with the remaining LBP CCS items was low. This audit demonstrated that care for people with LBP in a tertiary ED did not meet the recommendations set out by the LBP CCS. A multifaceted approach incorporating a pathway within ED, with ongoing clinician education to implement contemporary LBP management, is warranted to reduce this variation and facilitate higher value care for patients with LBP.

Abstract Background Smoking and vaping are major contributors to chronic disease in Australia. While national regulation has reduced smoking rates, vaping has increased, particularly among youth. Gippsland experiences persistently high smoking rates, requiring place-based action to improve health outcomes. The Gippsland Region Public Health Unit (GRPHU) explored local community attitudes toward expanding smoke and vape-free zones through Breathe Easy Gippsland. Methods A cross-sectional online survey was conducted with Gippsland residents aged 12 and older (n = 662) between July and November 2023. Descriptive statistics assessed demographic characteristics and survey items. Logistic regression examined associations between support for interventions and relevant covariates. Open-ended responses were analysed using thematic content analysis. Results Most respondents (91%) supported local action to reduce smoking and vaping harm, including expanding smoke and vape-free zones. Occasional users (OR 4.75, 95% CI 1.45-18.93) and non-users (OR 22.45, 95% CI 10.22-50.26) were more likely to support expansion than regular smokers or vapers. Youth aged 16-18 were less likely to support expansion than those aged 60 and over (OR 0.32, 95% CI 0.11-0.92). Among business owners and managers, 48% anticipated no negative impact and 29% expected positive effects. Thematic analysis revealed strong support for protecting at-risk groups, reducing exposure to secondhand smoke and aerosols, and de-normalising smoking and vaping. Conclusions There is strong public support in Gippsland for expanding smoke and vape-free zones. These findings offer valuable insights into rural and regional attitudes and demonstrate the potential for community-driven action to shape local tobacco and vaping control policies. Key messages • Gippslanders support the expansion of smoke and vape-free zones. • Community-informed policies can shift social norms and reduce exposure to smoking and vaping harms.

ABSTRACTBackgroundParkinson's disease (PD) is a common neurodegenerative condition with no known cure. The prevalence of PD and barriers to accessing clinical care increase with distance from major cities. Understanding factors associated with health‐related quality of life (HRQoL) in PD has important clinical and public health implications.MethodIn a national survey of Australian adults diagnosed with PD, we examined the influence of location on HRQoL and demographics, symptom course and diagnosis, treatment utilisation and preferences, and satisfaction with current services. Final data included 87 respondents from six states in Australia, with 55 identified as living in regional areas and 32 in major cities. Measures also included the Parkinson's Disease Questionnaire (PDQ‐39) and self‐reported Hoehn and Yahr scale for disease severity.ResultsTime to obtain a diagnosis was significantly longer for regional respondents than major city counterparts. There were also significant differences in prioritising 10 statements relating to PD. In an overall analysis examining the impact of all the above variables on HRQoL as determined by the PDQ‐39, only the Hoehn and Yahr scores explained significant variance; there was no significant difference between regional and metropolitan respondents after accounting for the other variables.ConclusionIndividuals living in regional areas experienced longer delays in obtaining a diagnosis of PD. Both groups highly rated better access to neurologists and the need for better diagnosis as priorities. Location, disease duration and satisfaction with services were not significantly associated with HRQoL.

Background Improving engagement and utilisation of Primary Health Care Services (PHCS) by Aboriginal and Torres Strait Islander males is critical to advancing current physical and mental health outcomes among the subgroup with the highest burden of disease in Australia. PHCS are a first point of contact, coordinating services essential in preventing and managing these conditions. A Men's Group was established within a South Australian Aboriginal PHCS as a strategy to address documented barriers of access to health care. This study aimed to explore participant experiences and perspectives of the Men's Group initiative to inform the program. Methods This Aboriginal and Torres Strait Islander led qualitative study used an Aboriginal Participatory Action Research (APAR) framework and a Continuous Quality Improvement approach to gather and transfer Indigenous Knowledges. Semi-structured interviews were conducted by and with Aboriginal and Torres Strait Islander men attending the Men's Group. Data were analysed using thematic network analysis. Results Thirty two participants were interviewed in total. Five global themes were identified: (1) Facilitates and strengthens social and emotional wellbeing (SEWB), (2) Acquiring health knowledge and care is valued, (3) Provide greater opportunities to strengthen connection to culture, (4) Foster individual and collective self-determination, and (5) Improve access and enhance program delivery. Conclusions This study demonstrates the effectiveness of APAR to enhance Aboriginal and Torres Strait Islander male engagement with PHCS through prioritising their voices to co-design a culturally responsive male health program. The findings illustrate profound SEWB, empowerment and health awareness outcomes, resulting from engaging in the newly established, localised Men's Group.