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.

ObjectivesTo investigate differences in the prevalence of specific chronic diseases in Australia by selected measures of socio‐economic position, and by age group and sex, using representative national census population data.Study designCross‐sectional, whole of population study; analysis of 2021 Australian census data.Participants, settingPeople aged 40 years or older for whom 2021 Australian census health status and socio‐economic position‐related data were available.Main outcome measuresAge‐standardised prevalence of ten chronic diseases (arthritis, asthma, cancer, dementia, diabetes, heart disease, kidney disease, lung disease, mental health conditions, and stroke), by socio‐economic position (Index of Relative Socio‐economic Disadvantage [IRSD], income category, educational level, occupational grade), age group, and sex; mean change in prevalence across socio‐economic position categories.ResultsHealth status responses and data that allowed IRSD categorisation were available for 11.3 million people aged 40 years or older (92% of all adults aged 40 years or older). The proportions of people who reported nine chronic diseases (exception: cancer) increased with increasing socio‐economic disadvantage as measured by IRSD decile and income. The increases were less marked for people aged 80 years or older than for those aged 40–79 years, and more marked for women than men. For people aged 40–59 or 60–79 years, the increase in age‐standardised chronic disease prevalence per one decile decrease in IRSD was greatest for lung disease in both women (40–59 years, 18.4% per decile; 60–79 years, 10.6% per decile) and men (40–59 years, 16.9% per decile; 60–79 years, 11.0% per decile). In people aged 80 years or older, the increase in prevalence per one decile decrease in IRSD was greatest for kidney disease in women (6.0% per decile) and for mental health conditions in men (7.1% per decile). The age‐standardised prevalence of cancer decreased by 0.4–1.1% per one decile decrease in IRSD for all age groups and both sexes, except for men aged 40−59 years (increased by 0.1% per IRSD decile). Consistent relationships with educational level or occupational grade were not found.ConclusionsThe prevalence of chronic disease differs by socio‐economic position, but the direction, magnitude, and consistency of the effect differs by disease, socio‐economic position measure, age, and sex. Understanding the relationship between different socio‐economic position measures and chronic diseases facilitates the formulation of directed interventions.

SummaryBackgroundNon-communicable chronic diseases (NCDs), including cardiovascular diseases, cancer, chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM), pose a significant burden on Australia's healthcare system. Despite advancements in disease prevention and management, NCDs remain the leading cause of morbidity and mortality. This study aimed to assess trends in the burden of NCDs and the impact of dietary risks in Australia from 2003 to 2024 using data from the Australian Institute of Health and Welfare (AIHW).MethodsData were from the AIHW 2024 burden of disease dataset, which provided estimates for mortality, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs). Since the 2024 death counts were missing, total mortality attributable to dietary risks was expressed as the percentage change from 2003 to 2018. Joinpoint Regression was performed to assess DALYs, YLLs, and YLDs of NCDs from 2003 to 2024, analyze the contribution of various dietary risk factors to the disease burden and conduct subgroup comparisons based on sex.FindingsFrom 2003 to 2018, mortality attributed to dietary risks declined by 15.29%. From 2003 to 2024, dietary risks attributable to DALYs decreased by 16.93%. Atrial fibrillation showed the most significant decline in both mortality (−10.0%) and DALYs (−7.81%), driven by a reduction in high-sodium diets. In contrast, inflammatory heart disease experienced the highest increases in DALYs, rising by 18.18% percentage change, which is associated with diet high in sodium. Breast cancer showed the most significant growth driven by diet high in red meat in dietary attributable DALYs, with a percentage change of 6.45%; and in deaths, with a percentage change of 6.67%. T2DM also illustrated a slight increase in dietary attributable DALYs driven by a diet high in red meat, with a percentage change of 2.36%, and in deaths driven by a diet high in processed meat, with a percentage change of 4.10%. In contrast, CKD decreased due to reduction of high sodium in dietary attributable DALYs, with a percentage change of 1.49%, and deaths, with a percentage change of 3.13%. Males showed an increase in risks related to high sodium consumption, with inflammatory heart disease DALYs rising by 15.38%, and a rise in oesophageal cancer deaths linked to low vegetable intake, with a percentage change of 14.49%. Females experienced an increase in T2DM DALYs attributable to high red meat consumption, with a percentage change of 10.26%, and a significant rise in coronary heart disease deaths associated with high sodium intake, with a percentage change of 18.97%.InterpretationThese findings emphasize the ongoing impact of dietary risks on NCDs burden in Australia and underscore the need for sex-specific and targeted dietary interventions to reduce preventable NCDs. Strengthening public health policies, dietary guidelines, and awareness campaigns is crucial for mitigating the impact of poor diet on long-term health outcomes.Funding10.13039/501100005104AIHW is primarily funded by the 10.13039/100015539Australian Government, with additional funding from state and territory governments.

In 2018, state and territory health departments in Australia received 51,174 notifications of enteric diseases potentially related to food. This was 28% higher than the five-year average number of notifications for enteric diseases in Australia. Consistent with previous years, most notified infections were either campylobacteriosis (n = 33,143; 65%) or salmonellosis (n = 14,144; 28%). In total, 137 gastrointestinal outbreaks, including 127 foodborne outbreaks, were reported in 2018. The remaining ten outbreaks were due to environmental or probable environmental transmission (nine outbreaks) and waterborne or probable waterborne transmission (one outbreak). Foodborne outbreaks affected 1,644 people, resulting in at least 283 hospital admissions and thirteen deaths. Eggs continue to be a source of Salmonella Typhimurium infection across the country, with 26 egg-related outbreaks, affecting at least 535 people, reported across five jurisdictions in 2018.

As a native Australian citrus, finger lime (Citrus australasica) is gaining importance as First Nations foods are being utilized in high-end cuisine. In February 2018, finger lime in Rosebank, New South Wales, Australia (28°39′43.10″S, 153°23′22.58″E) exhibited fruit rot. The disease was initially noticed by brown lesions on the rind, which gradually increased in size followed by white to pale grey mycelia growing in the center. Small 4 mm2 pieces of tissue from margin of the lesions were immersed in sodium hypochlorite (1.0% active ingredient) for 2 minutes, washed by sterile water for five times, and cultured on potato dextrose agar (PDA) at 25°C for 7 days. Pure cultures were established by single spore isolations, and one isolate (BRIP 66844) exhbiting distinct morphology retained. Colonies on PDA were flat with entire margin, of white to pale grey aerial mycelium, and contained orange acervuli in the center; reaching 47.5 – 50 mm diam in 7 days. Sexual morph not observed. Conidia hyaline, smooth-walled, aseptate, cylindrical, two ends slightly acute or one end round and another end slightly acute, 15.8 ± 1.3 × 5.2 ± 0.3 μm (n = 30). Appressoria pale to medium brown, smooth-walled, elliptical or irregular, 8.7 ± 0.8 × 6.5 ± 0.7 μm (n = 30). To further characterize the pathogen, the internal transcribed spacer and intervening 5.8S nrDNA (ITS), glyceraldehyde-3-phosphate dehydrogenase (gapdh), β-tubulin (tub2), actin (act) and histone (his3) gene sequences of isolate BRIP 66844 were amplified with primers ITS-1F (Gardes and Bruns, 1993) and ITS4 (White et al., 1990), GDF1 and GDR1 (Guerber et al., 2003), Btub2Fd and Btub4Rd (Woudenberg et al., 2009), ACT-512F and ACT-783R (Carbone and Kohn, 1999) and CYLH3F and CYLH3R (Crous et al., 2004), respectively. The Basic Local Alignment Search Tool showed that the obtained sequences (ITS: PV562989, gapdh: PV568327, tub2: PV568328, act: PV568326 and his3: PV568329) of isolate BRIP 66844 shared a 99.60 to 100.00% similarity with Colletotrichum johnstonii sequences (ITS: JQ948443, gapdh: JQ948774, tub2: JQ950094, act: JQ949764 and his3: JQ949434) in GenBank. Phylogenetic trees based on maximum-likelihood (ML) analysis and Bayesian inference (BI) analysis of combined ITS, gapdh, tub2, act and his3 sequences confirmed that isolate BRIP 66844 was C. johnstonii. The pathogenicity was confirmed by inoculating 6 μL spore suspension (1.0 × 106 conidia/mL) onto finger lime fruits wounded using a sterilized needle or nonwounded. Three fruits were used per treatment and the experiment was repeated once. Sterile water was used in the control group. The inoculated fruits were placed inside a plastic box and incubated at 25°C with 100% humidity in the dark. Brown lesions were observed on the wound-inoculated fruits 7 days after inoculation, while the non-wound inoculated fruits and the fruits in the control group did not develop any symptoms. Colletotrichum johnstonii was reisolated from the inoculated fruits including asymptomatic non-wound inoculated fruits to satisfy Koch's postulates. Colletotrichum johnstonii was previously reported to cause fruit rot of Citrus spp. in New Zealand (Damm et al., 2012; Talhinhas and Baroncelli 2023). Colletotrichum johnstonii has been isolated from stem blight / dieback of Grevillea crithmifolia in Australia (unpublished data). To our knowledge, this is the first report of C. johnstonii associated with citrus disease outside of New Zealand, and the first time it is associated with citrus disease in Australia.

Background/Objectives: Genetic testing is important for diagnosing inherited retinal diseases (IRDs), but further evidence is needed on the utility of singleton genetic testing in an Australian cohort. Methods: A consecutive series of individuals with clinically diagnosed IRDs without prior genetic testing underwent commercial panel-based sequencing (Invitae or Blueprint Genetics), clinical assessment, and multimodal imaging. Retinal images were graded using the Human Phenotype Ontology terms. Binary logistic regression was used to evaluate clinical predictors of a positive molecular diagnosis. Results: Among 140 participants (mean age 49 ± 19 years), genetic testing was undertaken, on average, 23 ± 17 years after the initial clinical IRD diagnosis. Of the 60% who received a probable molecular diagnosis, 40% require further phase testing, highlighting the limitations of singleton genetic testing. USH2A, ABCA4, and RPGR were the most common encountered genes; 67% of the probably solved participants had causative genes with targeted experimental treatments in ongoing human clinical trials. Symptom onset before the age of 30 (OR = 3.06 [95% CI: 1.34–7.18]) and a positive IRD family history (OR = 2.87 [95% CI: 1.27–6.78]) were each associated with higher odds of receiving a molecular diagnosis. Diagnostic rates were comparable across retinal imaging phenotypes (atrophy and autofluorescence patterns in widespread IRD, and the extent of dystrophy in macular IRDs). Conclusions: In an Australian IRD population without prior genetic testing, commercial panels yielded higher diagnostic rates in individuals with IRD onset before the age of 30 and those with an IRD family history. Further research is needed to understand the genetic basis of IRDs, especially isolated and late-onset cases, to improve diagnosis and access to emerging therapies.

BackgroundCardiovascular disease, the world’s leading cause of death, could be significantly reduced through sodium reduction strategies; however, the implementation of such strategies has had limited impact in Australia and globally. Switching to potassium-enriched salt is a highly promising intervention, but uptake by the food industry and consumers remains limited. This study investigated the barriers and enablers for scaling up potassium-enriched salt use in Australia.MethodsA qualitative, theory-informed study design was used to conduct 24 semi-structured interviews with representatives from civil society, government, and industry. Interviewees discussed scaling up potassium-enriched salt in relation to their interests, ideas, existing policies and guidelines, and perceived challenges and opportunities within the Australian context. Data were analysed using thematic analysis.ResultsMinimal knowledge and awareness of potassium-enriched salt among all stakeholder groups was the most prominent finding. The key perceived barriers were low consumer demand for potassium-enriched salt products and little incentive for industry to invest in supply. Further, government stakeholders expressed hesitancy to implement policies due to perceived health risks such as hyperkalaemia. Interviewees identified increased awareness, support for industry research and development, and leveraging current policies and initiatives (such as the Australian Health Star Rating system) as potential enablers.ConclusionImproving stakeholder understanding of the benefit of switching to potassium-enriched salt in Australia may require a coordinated advocacy strategy that disseminates the evidence and addresses misconceptions. Efforts to drive increased supply and demand could be advanced using a multi-sectoral approach that focuses on supporting industry uptake, encouraging consumer demand, and informing policy implementation.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-23717-w.

Charcoal rot of strawberry caused by the soil-borne pathogen Macrophomina phaseolina has increased in importance in Australia and many other countries since 2005. Several factors might explain the increase in the disease in Australia, including the withdrawal of the soil fumigant methyl bromide in 2005 due to its adverse effect on stratospheric ozone. We conducted a field experiment to test the hypothesis that soil disinfestation with methyl bromide could eliminate charcoal rot in a strawberry field severely affected by the disease. Results showed that a single application of methyl bromide/chloropicrin reduced M. phaseolina in infected strawberry crowns buried in soil by 98%, and DNA concentrations in soil at planting by 100% compared with the untreated control. The use of methyl bromide/chloropicrin also reduced charcoal rot in the strawberry crop by 99.7% and increased marketable fruit yields by 86% and revenue by A$2.81 per plant. In contrast, the adopted substitute fumigant, 1,3-dichloropropene/chloropicrin, controlled M. phaseolina and charcoal rot considerably less effectively than methyl bromide/chloropicrin. The results add weight to the premise that the phase-out of methyl bromide was an important factor that contributed to the increase in charcoal rot in strawberry in Australia, and possibly in other countries. The benefits of methyl bromide withdrawal for the environment are significant and well documented, so the ongoing need to identify suitable alternatives for managing soil-borne diseases like charcoal rot remains vitally important.

Pathogen genomics is rapidly becoming a cornerstone in the surveillance and response to infectious diseases. However, there is little evidence on how it shapes strategies for effective public health response and decision-making. This paper presents the evaluation protocol for the Australian Pathogen Genomics (AusPathoGen) program, which aims to assess the utility of whole genome sequencing in informing public health responses to infectious diseases in Australia. A mixed methods approach will be adopted to systematically explore the utility of whole genome sequencing in public health action and decision-making through a series of linked projects. Methods include situation assessment surveys of Australian public health laboratories, expert elicitation, and case study analysis. The situation assessment surveys will gather data on public health laboratories' processes, practices, and associated costs for whole genome sequencing. Expert elicitation will seek views on the prioritization of pathogens for whole genome sequencing. Case studies of specific pathogens and outbreaks will serve as the basis for both impact assessment and qualitative comparative analysis. Genomic and epidemiological data will shed light on the influence of whole genome sequencing on outbreak response. This comprehensive evaluation of pathogen whole genome sequencing in Australia will enhance our understanding of how this data can be applied in public health response and decision-making. The methods discussed can be adapted to different public health pathogen genomic surveillance systems globally. Undertaking evaluation of such systems is crucial for identifying areas of improvement and providing recommendations to optimize quality, efficiency and resource allocation of pathogen genomics to improve public health responses.

BackgroundThere is growing appreciation of the role health literacy plays in population health and health care design. Health literacy encompasses an individual’s capacity to manage their health and the responsiveness of the health system. Our aim was to identify the health literacy strengths and challenges in an Australian cohort living with motor neurone disease (MND), including both people living with the disease and their carers.MethodsThis study used the Health Literacy Questionnaire and eHealth Literacy Questionnaire for health literacy assessment. Using a secure online platform, an anonymous survey was disseminated which included demographic data and clinical measurements. Descriptive statistical analysis and cluster analysis were employed to describe the sample and to identify different health literacy patterns in subgroups of people living with MND and their carers.ResultsA total of 227 people participated (171 people living with MND and 56 carers). Cluster analysis generated fifteen cluster profiles for the cohort living with MND and seven cluster profiles for carers. The variability and potential significance of patterns of health literacy strengths and challenges within the MND community are described. There was extensive diversity within the sampled population, with a mix of sociodemographic backgrounds across each cluster profile.ConclusionsThe health literacy cluster profiles created from this study provide insight into the full spectrum of where the challenges and strengths exist for individuals and subgroups of people managing this fatal disease. The results from this study pave the way for generating system wide interventions that address health literacy diversity, to create more enabling health care environments for all those affected by MND.

Powdery mildew of mung bean (Vigna radiata) is caused by two species in Australia: Podosphaera xanthii and Erysiphe vignae. Currently, two fungicides are permitted for managing this disease in Australia: azoxystrobin and tebuconazole. The commercial fungicide products used for mung bean powdery mildew management contain either tebuconazole alone or a mixture of azoxystrobin and tebuconazole. This study detected the G143A mutation in the mitochondrial cytochrome b gene of both P. xanthii and E. vignae. The mutation was detected in two P. xanthii and one E. vignae populations out of a total of 15 populations sampled in south-east Queensland from 2017 to 2024. The G143A mutation is the major DNA marker of resistance to Quinone outside Inhibitor (QoI) fungicides, including azoxystrobin. This study confirmed that both powdery mildew species have developed QoI resistance in Australian mung bean fields.

The prevalence of immune complex-mediated glomerulonephropathy (ICGN) in dogs with proteinuric kidney disease is approximately 50% in the United States and Europe but is unknown in other locations such as Australia and New Zealand. Determine the prevalence of ICGN in dogs biopsied for proteinuric kidney disease in Australia and New Zealand and compare clinicopathologic variables in dogs with specific pathologic lesions. Fifty client-owned dogs. Retrospective case series. Reports from renal biopsy samples submitted to the Texas and International Veterinary Renal Pathology Services from dogs with proteinuric kidney disease (urine protein-to-creatinine ratio ≥ 0.5) between 2007 and 2023 were reviewed. Clinical data were retrieved and compared. Among 50 dogs with proteinuric renal disease, 15 dogs (30%) had ICGN and 35 (70%) had non-ICGN. The most common category of ICGN was membranous glomerulonephropathy (6/15; 40%). Glomerulosclerosis was the most common category of non-ICGN (17/35; 49%). Dogs with glomerulosclerosis (median, 10 years) were older than dogs with other types of lesions (membranoproliferative, mesangioproliferative or mixed pattern; median, 6 years; p = 0.04) and those with membranous glomerulonephropathy (median, 4 years; p = 0.005). Dogs with membranous glomerulonephropathy had lower serum albumin concentrations (median, 2.1 g/dL) than dogs with glomerulosclerosis (median, 3.0 g/dL; p = 0.01) or other nephropathies (median, 3.0 g/dL; p = 0.04). The prevalence of ICGN is lower in dogs in Australia and New Zealand biopsied for proteinuric kidney disease, potentially because of a lower prevalence of infectious disease, particularly vector-borne disease. The lower prevalence of ICGN emphasizes the importance of renal biopsy to optimize treatment.