Disease In Australia Research Articles

P8 New Onset Cardiovascular Disease in Australia by Socioeconomic Groups: A Modelling Study

P8 New Onset Cardiovascular Disease in Australia by Socioeconomic Groups: A Modelling Study

The Increasing Recognition of Transthyretin Cardiac Amyloidosis (ATTR-CA): Patient Characteristics and Survival in the Australian Context

Despite increasing awareness and treatments for ATTR-CA, true incidence and patient outcomes of the disease in Australia remain unclear. We wished to evaluate the epidemiology, characteristics and survival of ATTR-CA at an Australian state amyloidosis service.

Spatio-temporal distribution of vector borne diseases in Australia and Papua New Guinea vis-à-vis climatic factors.

Weather and climate are directly linked to human health including the distribution and occurrence of vector-borne diseases which are of significant concern for public health. In this review, studies on spatiotemporal distribution of dengue, Barmah Forest Virus (BFV) and Ross River Virus (RRV) in Australia and malaria in Papua New Guinea (PNG) under the influence of climate change and/ or human society conducted in the past two decades were analysed and summarised. Environmental factors such as temperature, rainfall, relative humidity and tides were the main contributors from climate. The Socio-Economic Indexes for Areas (SEIFA) index (a product from the Australian Bureau of Statistics that ranks areas in Australia according to relative socio-economic advantage and disadvantage) was important in evaluating contribution from human society. For future studies, more emphasis on evaluation of impact of the El Niño-Southern Oscillation (ENSO) and human society on spatio-temporal distribution of vector borne diseases is recommended to highlight importance of the environmental factors in spreading mosquito-borne diseases in Australia and PNG.

Poor Heart Disease and Health Services Knowledge in Chinese Immigrants With Limited English Language

In immigrant populations already experiencing health disadvantages, lack of heart-disease related knowledge is an additional barrier to symptom recognition, treatment adherence and secondary prevention uptake. However, little is known of the health information and education needs of Chinese immigrants who have heart disease in Australia, therefore we investigated heart disease-related health information and service needs in this population.

Healthcare Needs and Perceptions of People Living With Inflammatory Bowel Disease in Australia: A Mixed-Methods Study.

Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis are inflammatory bowel diseases (IBDs) that adversely affect the healthcare needs and quality of life (QoL) of people with IBD. The aim of this study was to explore the needs and perceptions of people with IBD in a primary care setting. This sequential explanatory mixed-methods study consisted of a cross-sectional survey (included validated tools), followed by semistructured interviews on participants' perceptions: IBD management, healthcare professionals, IBD care, flare management, and pharmacist's IBD roles. Sixty-seven participants completed the survey, and 8 completed interviews. Quantitative findings: Age at diagnosis had significant association with medication nonadherence (P = .04), QoL (P = .04), and disease control (P = .01) among the respondents. The odds of medication nonadherence were 8 times (adjusted odds ratio [AOR] = 8.04, 95% confidence interval [CI] = 1.08, 60.10) higher among younger participants aged <30 years. Those diagnosed with CD (P = .02) reported more likely to have unfavorable perceptions of pharmacists' role in managing their IBD (AOR = 9.45, 95% CI = 1.57, 56.62) than those with UC and indeterminate colitis. Qualitative findings: General practitioners were considered the most important care provider and the first point of contact for patients in managing all aspects of IBD. Participants identified their key need to be timely access to specialized IBD care and found that other primary healthcare professionals lacked disease-specific knowledge for managing IBD. Primary healthcare professionals are well positioned but need targeted training to influence the needs of IBD patients. The specialty role of an IBD educator could complement existing services to deliver and address patient-specific care.

Echocardiographic Detection of Heart Valve Disease in a Community Cohort Study of Asymptomatic Australians &gt;65 years With Cardiovascular Risk Factors

Valvular heart disease is becoming an increasingly prevalent with population ageing. We sought to define the current prevalence of valvular heart disease in Australia. The TasELF and VicELF studies prospectively recruited 942 asymptomatic participants ≥65 years, with at least one cardiovascular risk factor, from the Tasmanian and Victorian communities. People were excluded if they had a previous diagnosis of heart failure, known significant valve disease, or a life expectancy <1 year. All underwent baseline echocardiography. Those with moderate or severe valvular disease were identified. The current prevalence of clinically significant valve disease was applied to the Australian Bureau of Statistics population projections. Echocardiograms were interpretable in 928 participants (99%). Clinically significant valve disease was present in 5% of the population, and mitral regurgitation was the most common overall valvular lesion, present in 36% of the population. The projected numbers of people with clinically significant valvular disease is expected to increase significantly across all age groups by the year 2060. Clinically significant yet asymptomatic valvular disease was prevalent in a large community cohort of participants with at least one risk factor. The total burden of valvular heart disease is expected to increase dramatically over the coming decades.

Evolution of non-fatal burden estimates for cardiovascular disease in Australia: a comparison of national and state-wide methodology of burden of disease.

Objective Burden of disease studies measure the impact of disease at the population level;however, methods and data sources for estimates of prevalence vary. Using a selection of cardiovascular diseases, we aimed to describe the implications of using different disease models and linked administrative data on prevalence estimation within three Australian burden of disease studies. Methods Three different methods (A = 2011 Australian Burden of Disease Study; B = 2015 Australian Burden of Disease Study; C = 2015 Western Australian Burden of Disease Study), which used linked data, were used to compare prevalence estimates of stroke, aortic aneurysm, rheumatic valvular heart disease (VHD) and non-rheumatic VHD. We applied these methods to 2015 Western Australian data, and calculated crude overall and age-specific prevalence for each condition. Results Overall, Method C produced estimates of cardiovascular prevalence that were lower than the other methods, excluding non-rheumatic VHD. Prevalence of acute and chronic stroke was up to one-third higher in Method A and B compared to Method C. Aortic aneurysms had the largest change in prevalence, with Method A producing an eight-fold higher estimate compared to Method C, but Method B was 10-20% lower. Estimates of VHD varied dramatically, with an up to six-fold change in prevalence in Method C due to substantial changes to disease models and the use of linked data. Conclusions Prevalence estimates require the best available data sources, updated disease models and constant review to inform government policy and health reform. Availability of nation-wide linked data will markedly improve future burden estimates.

COVIDvid-19 Pandemic Effect on Non-Invasive Cardiac Stress Investigations

Non-invasive cardiac imaging is an important part of a patient's safe and effective investigation for ischaemic heart disease. In the midst of the COVID-19 pandemic, concerns were expressed about the close proximity necessary for these investigations and the aerosol-generating nature of stress tests, limiting access to these vital investigations. To evaluate the impact of COVID-19 on cardiac stress investigations. We analysed Medicare Australia data for exercise stress tests (EST), exercise or pharmacological stress echocardiography (ESE), CT coronary angiogram (CTCA), and exercise or pharmacological nuclear perfusion studies during the peak pandemic years of 2020 and 2021 and compared to data pre-COVID-19 in 2019. When compared to pre-pandemic statistics, the COVID-19 pandemic resulted in a 44 percent drop in all non-invasive stress examinations. Both EST and nuclear perfusion services saw the greatest reductions, with 89% and 33% reductions, respectively. CTCA services, on the other hand, increased by 30%, while stress echocardiography remained stable. This study's discovery of significant reductions in non-invasive stress investigations for ischaemic heart disease is alarming. While non-pandemic factors must be taken into account, the pandemic's enormous influence on patient engagement with healthcare services, as well as reduced access to non-invasive tests, cannot be overstated. Longitudinal studies are required to understand the impact of fewer investigations on the incidence and prevalence of ischaemic heart disease in Australia as a result of COVID-19.

The cost of care for children hospitalised with Invasive Group A Streptococcal Disease in Australia

BackgroundInvasive Group A Streptococcal (iGAS) disease exerts an important burden among Australian children. No Australian hospitalisation cost estimates for treating children with iGAS disease exist, so the financial impact of this condition is unknown.AimTo determine the minimum annual healthcare cost for children (< 18 years) hospitalised with iGAS disease in Australia from a healthcare sector perspective.MethodsA cost analysis including children with laboratory-confirmed iGAS disease hospitalised at the Royal Children’s Hospital (Victoria, Australia; July 2016 to June 2019) was performed. Results were extrapolated against the national minimum iGAS disease incidence. This analysis included healthcare cost from the 7 days prior to the index admission via General Practitioner (GP) and Emergency Department (ED) consultations; the index admission itself; and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations. Additional extrapolations of national cost data by age group, Aboriginal and Torres Strait Islander ethnicity and jurisdiction were performed.ResultsOf the 65 included children, 35% (n = 23) were female, 5% (n = 3) were Aboriginal and Torres Strait Islander, and the average age was 4.4 years (SD 4.6; 65% aged 0–4). The iGAS disease related healthcare cost per child was $67,799 (SD $92,410). These costs were distributed across the 7 days prior to the index admission via GP and ED consultations (0.2 and 1.1% of total costs, respectively), the index admission itself (88.7% of the total costs); and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations (5.3, 4.5 and 0.1% of total costs, respectively). Based on a national minimum paediatric incidence estimation of 1.63 per 100,000 children aged < 18 (95%CI: 1.11–2.32), the total annual healthcare cost for children with iGAS in 2019 was $6,200,862. The financial burden reflects the overrepresentation of Aboriginal and Torres Strait Islander people in the occurrence of iGAS disease. Costs were concentrated among children aged 0–4 years (62%).ConclusionAs these cost estimations were based on a minimum incidence, true costs may be higher. Strengthening of surveillance and control of iGAS disease, including a mandate for national notification of iGAS disease, is warranted.Trial registrationThe current study is a part of ongoing iGAS surveillance work across seven paediatric health services in Australia. As this is not a clinical trial, it has not undergone trial registration.

Patient care standards for primary mitochondrial disease in Australia: an Australian adaptation of the Mitochondrial Medicine Society recommendations.

This document provides consensus‐based recommendations for general physicians and primary care physicians who diagnose and manage patients with mitochondrial diseases (MD). It builds on previous international guidelines, with particular emphasis on clinical management in the Australian setting. This statement was prepared by a working group of medical practitioners, nurses and allied health professionals with clinical expertise and experience in managing Australian patients with MD. As new treatments and management plans emerge, these consensus‐based recommendations will continue to evolve, but current standards of care are summarised in this document.

Implementation and evaluation of a university&#x2013;hospital partnership program for Type 2 diabetes.

Objective The aims of this study were to determine whether a university-hospital partnership program for Type 2 diabetes (T2D) would: be well attended; reduce the number of patients on the diabetes out-patient waiting list who have been waiting longer than the recommended; increase discharge from the hospital clinic; increase university health clinic (UHC) occasions of service; be sustainable; and be acceptable to participants. Method A prospective observational study was conducted between 2016 and 2019. Participants with T2D were referred to a UHC, initially from a hospital diabetes wait list. The final program consisted of 10 weeks: before and after individual assessments, as well as 8 weeks of exercise and education facilitated by health professionals and students. Participant demographic characteristics and data on attendance, discharge and follow-up requirements, the percentage of patients waiting longer than the recommended for a new hospital out-patient appointment, university activity and patient satisfaction were collected. Results In all, 130 participants commenced the program, 80% completed at least six of eight group sessions and 80% attended the final assessment. The percentage of people waiting longer than recommended decreased from 63% to 16%. The hospital discharged 87% and 59% of participants from the dietitian and endocrinologist respectively. The UHC recorded 2056 occasions of service and 2056 student experiences including dietetics, exercise physiology, psychology, nursing, optometry, social work and podiatry students relating to the program. Satisfaction was high, as measured by the Short Assessment of Patient Satisfaction, with a mean score of 23.9 from a possible score of 28.0 (n = 93). Conclusion The partnership resulted in a new model of care for patients with T2D and increased learning experiences for students. What is known about the topic? Diabetes is the fastest growing disease in Australia, placing unsustainable demands on the health system. Access to patient-centred care and self-management education is essential to optimise glycaemic control, prevent or delay complications and maintain quality of life. The increasing demand of diabetes on the health system affects access to timely care, with unacceptably long wait times reported, resulting in an increase in morbidity and mortality and poor patient satisfaction. A potential solution is the use of clinical students to contribute to service delivery. Student-assisted and student-led health clinics have increased access to care across the globe for many years. What does the paper add? Although group education has the potential to reduce the burden on clinical service delivery, it was unclear whether a partnership program using students and university and hospital resources would be acceptable to people with T2D and whether this model delivered at a UHC would be sustainable and of benefit to both the health service and university. The results of the evaluation suggest that a university-hospital partnership program is well accepted by participants, well attended, reduces the number of patients waiting for a hospital appointment longer than the acceptable waiting times, increases UHC activity and provides interdisciplinary student experiences. As such, this paper provides evidence that this model of care offers a potential solution to increasing demands for health services for diabetes and student clinical experience. What are the implications for practitioners? Partnerships between UHCs and hospitals offer a sustainable solution to increasing demand for diabetes services and student training requirements. The description of the development, implementation and evaluation processes can be used by practitioners and educators as a framework for the translation of similar models of care to meet demands in other areas where demand for health services exceeds capacity.

Epidemiology of Kawasaki disease in Australia using two nationally complete datasets

The incidence of Kawasaki disease (KD) is reported to be increasing in some populations. We sought to describe long-term trends in the incidence and epidemiology of KD in Australia over 25 years. Two nationally complete administrative datasets relevant to KD in Australia were analysed and compared. The Australian Red Cross Lifeblood Supply Tracking Analysis Reporting System (STARS) recorded all doses of immunoglobulin (IVIG) approved in Australia between January 2007 and June 2016. The Australian Institute of Health and Welfare National Hospital Morbidity Database (NHMD) records all episodes of care in hospitals across Australia. Data relevant to KD were extracted an analysed, with comparisons made for the period of data overlap. During the period of data overlap (2007-2015) the IVIG treatment rate in the 0- to 4-year age group (calculated from STARS) was 14.31 per 100 000 person-years (95% confidence interval 13.67-14.97). The hospitalisation rate in the same age group (calculated from the NHMD) was 14.99 per 100 000 person-years (95% confidence interval 14.33-15.66). Hospitalisation rates rose at an average rate of 3.54% annually over the 25 years to 2017 in the 0- to 4-year age group, almost exclusively in the 1- to 4-year age group. There is evidence of increasing KD diagnosis in Australia. Similar trends have also been reported in Asia but not in North America or Europe. Increasing diagnosis may reflect a true increase in disease incidence, increasing recognition or overdiagnosis. Further research is needed to determine the cause for these trends.

Gazing through time and beyond the health sector: Insights from a system dynamics model of cardiovascular disease in Australia.

To construct a whole-of-system model to inform strategies that reduce the burden of cardiovascular disease (CVD) in Australia. A system dynamics model was developed with a multidisciplinary modelling consortium. The model population comprised Australians aged 40 years and over, and the scope encompassed acute and chronic CVD as well as primary and secondary prevention. Health outcomes were CVD-related deaths and hospitalisations, and economic outcomes were the net benefit from both the healthcare system and societal perspectives. The eight strategies broadly included creating social and physical environments supportive of a healthy lifestyle, increasing the use of preventive treatments, and improving systems response to acute CVD events. The effects of strategies were estimated as relative differences to the business-as-usual between 2019-2039. Probabilistic sensitivity analysis produced uncertainty intervals of interquartile ranges (IQR). The greatest reduction in CVD-related deaths was seen in strategies that improve systems response to acute CVD events (8.9%, IQR: 7.7-10.2%), yet they resulted in an increase in CVD-related hospitalisations due to future recurrent admissions (1.6%, IQR: 0.1-2.3%). This flow-on effect highlighted the importance of addressing underlying CVD risks. On the other hand, strategies targeting the broad environment that supports a healthy lifestyle were effective in reducing both hospitalisations (7.1%; IQR: 5.0-9.5%) and deaths (8.1% reduction; IQR: 7.1-8.9%). They also produced an economic net benefit of AU$43.3 billion (IQR: 37.7-48.7) using a societal perspective, largely driven by productivity gains. Overall, strategic planning to reduce the burden of CVD should consider the varying effects of strategies over time and beyond the health sector.

1260Contribution of risk factors to disease burden in Australia in 2018

Abstract Background The Australian Burden of Disease Study 2018 estimated the burden due to 219 diseases and injuries and 40 risk factors (attributable burden). Attributable burden is the amount of health loss that would be prevented if exposure to the risk factor had been avoided or reduced to the lowest possible exposure. Methods Attributable burden was estimated for 2003, 2011, 2015 and 2018 using comparative risk assessment methodology. Estimates of exposure to risk factors were sourced from Australian survey data and used with global measures of effect size to estimate population attributable fractions (PAFs). Results In 2018, 37% of the burden of disease in Australia could have been prevented by reducing or avoiding exposure to the modifiable risk factors included in the study. The leading five risk factors contributing to total burden were: tobacco use (8.6%), overweight &amp; obesity (8.4%), dietary risks (5.4%), high blood pressure (5.1%) and alcohol use (4.5%). While tobacco use remains the leading risk factor causing burden, the gap between tobacco use and overweight &amp; obesity has almost closed. The burden attributable to most risk factors was higher in males than in females. The lowest socioeconomic group experienced greater burden compared with the highest group for all risk factors. Conclusions Addressing modifiable risk factors could prevent up to 37% of disease burden in Australia. Key messages In 2018, 37% of the burden of disease could have been prevented. Tobacco use and overweight &amp; obesity were the leading risk factors.

Estimating the risk of recurrent invasive pneumococcal disease in Australia, 1991–2016

BackgroundIndividuals who experience an initial episode of invasive pneumococcal disease (IPD) are at increased risk of recurrent episodes. However, the magnitude of risk has not been well-quantified in the pneumococcal conjugate vaccine era. Individuals with a previous episode of IPD are not commonly identified as a high-risk group in vaccination guidelines. MethodsAustralian residents with at least one case of IPD between 1991 and 2016 were identified using routine public health surveillance data which included identified IPD risk factors. Incidence of recurrent IPD was calculated from 2001 onwards (after IPD became nationally notifiable) using time-to-event analyses with individuals contributing person-time at risk of recurrence if they survived greater than 14 days after initial episode onset. ResultsFrom 1991 to 2016 there were 28,809 IPD episodes in 28,218 individuals. A total of 512 (1.8%) persons experienced 591 recurrent episodes. From 2001 to 2016 the incidence of recurrent IPD was 216.2 per 100,000 person-years, 27 times greater than the population rate of primary IPD during this period (8.0 per 100,000 population per year). Between 2011 and 2016, more than one-quarter of individuals experiencing recurrence had no IPD risk factors identified at first episode. ConclusionsThere is substantially increased risk of recurrent IPD after an initial episode. At least one-quarter of those with recurrent episodes have no identified risk factors at the initial episode. Given the potential preventability of future episodes, those with a previous IPD episode should be identified as a high-risk group and receive pneumococcal vaccination.

1025Social interaction of middle-aged and older people with and without cardiovascular disease in Australia

Abstract Background Social interaction is important for social wellbeing and may be adversely affected in people with cardiovascular disease (CVD). Large-scale evidence on social interaction among older people with versus without CVD is limited. We quantified and compared social interaction in older people with and without CVD. Methods Survey data (2006-2009) from the 45 and Up Study were linked to hospitalisations data through CHeReL to ascertain CVD status. Four items from the Duke Social Support Index (social-visits/week, telephone-contacts/week, social-group-contact/week, and number of people to depend on) were examined, using generalised linear models to estimate prevalence ratios (PRs) of no social interaction in people with versus without CVD, adjusting for relevant factors, and separately according to CVD subtype and level of physical disability. Results There were 266,504 study participants, 21.4% had CVD. People with CVD were 8%, (95%CI: 5-11%), 7% (2-12%), 4% (3-5%) and 7% (3-11%) more likely than people without CVD to have no social-visits/week, telephone-contacts/week, social-group-meetings/week and people to depend on respectively. The magnitude but not direction of results varied by CVD subtype. People with CVD and severe physical functioning limitations were 30-80% more likely than those with neither of these to have no social interaction. Conclusions Levels of social interaction were slightly lower in people with versus without CVD, but they varied by social interaction items, CVD subtypes, population characteristics and physical disability. Key messages Management to improve quality of life for people living with CVD should consider the role of physical disability for social connectedness.

Australian Meningococcal Surveillance Programme Annual Report, 2020.

Invasive meningococcal disease (IMD) is a notifiable disease in Australia, and both probable and laboratory-confirmed cases of IMD are reported to the National Notifiable Diseases Surveillance System (NNDSS). In 2020, there were 90 notifications of IMD, the lowest number documented since records began in the NNDSS in 1991. Of these, 97% (87/90) were laboratory-confirmed cases, with 70% (61/87) confirmed by bacterial culture and 30% (26/87) by nucleic acid amplification testing. The serogroup was determined for 85/87 laboratory-confirmed cases of IMD: serogroup B (MenB) accounted for 64% of infections (54/85); MenW for 19% (16/85); MenY for 16% (14/85); and MenC 1.2% (1/85). Fine typing was available on 60/85 (71%) of cases with serogroup determined; of the typed MenW, all were PorA antigen type P1.5,2 and sequence type 11, the hypervirulent strain reported in recent outbreaks in Australia and overseas. The primary peaks of IMD notifications in Australia in 2020 were observed in infants less than 1 year (16/87, 18%) and in adults aged 45-64 years (14/87, 16%). MenB infections predominated in those aged less than 5 years and 15-19 years; MenW and MenY infections predominated in those aged 45 years or more. All 61 IMD isolates were tested for antimicrobial susceptibility: none were penicillin resistant; however, 56/61 (92%) had decreased susceptibility to penicillin. All isolates were susceptible to ceftriaxone, ciprofloxacin and rifampicin.

Excess respiratory mortality and hospitalizations associated with influenza in Australia, 2007-2015.

Influenza is the most common vaccine-preventable disease in Australia, causing significant morbidity and mortality. We assessed the burden of influenza across all ages in terms of influenza-associated mortality and hospitalizations using national mortality, hospital-discharge and influenza surveillance data. Influenza-associated excess respiratory mortality and hospitalization rates from 2007 to 2015 were estimated using generalized additive models with a proxy of influenza activity based on syndromic and laboratory surveillance data. Estimates were made for each age group and year. The estimated mean annual influenza-associated excess respiratory mortality was 2.6 per 100 000 population [95% confidence interval (CI): 1.8, 3.4 per 100 000 population]. The excess annual respiratory hospitalization rate was 57.4 per 100 000 population (95% CI: 32.5, 82.2 per 100 000 population). The highest mortality rates were observed among those aged ≥75 years (35.11 per 100 000 population; 95% CI: 19.93, 50.29 per 100 000 population) and hospitalization rates were also highest among older adults aged ≥75 years (302.95 per 100 000 population; 95% CI: 144.71, 461.19 per 100 000 population), as well as children aged <6 months (164.02 per 100 000 population; 95% CI: -34.84, 362.88 per 100 000 population). Annual variation was apparent, ranging from 1.0 to 3.9 per 100 000 population for mortality and 24.2 to 94.28 per 100 000 population for hospitalizations. Influenza A contributed to almost 80% of the average excess respiratory hospitalizations and 60% of the average excess respiratory deaths. Influenza causes considerable burden to all Australians. Expected variation was observed among age groups, years and influenza type, with the greatest burden falling to older adults and young children. Understanding the current burden is useful for understanding the potential impact of mitigation strategies, such as vaccination.

Prevalence and risk factors of peripheral artery disease in a population with chronic kidney disease in Australia: A systematic review and meta‐analysis

There is a lack of clarity and guidance for screening peripheral artery disease (PAD) in persons with chronic kidney disease (CKD) and end stage kidney disease (ESKD) despite this group being at excess risk of cardiovascular disease (CVD). In this current study, we performed a systematic review and meta-analysis to examine the prevalence and risk factors for PAD in persons with CKD in Australian cohorts. We used the inverse variance heterogeneity meta-analysis with double arcsine transformation to summarize the prevalence of PAD (with 95% CIs). Nine studies and 18 reports from the Australia and New Zealand dialysis and transplant registry with 36 cohorts were included in the review. We found a substantially higher PAD prevalence in cohorts based on an ankle-brachial index (ABI) or toe systolic pressure (TBI) than cohorts based on self-reported history. Higher PAD prevalence was observed in ESKD persons than CKD persons without dialysis (PAD diagnosis based on ABI or TBI: 31% in ESKD persons and 23% in CKD persons, PAD diagnosis based on self-reported history: 17% in ESKD persons and 10% in CKD persons). Older age, Caucasian race, cerebrovascular disease and haemodialysis were associated with the presence of PAD in ESKD persons. Our findings indicated a considerable proportion of PAD in CKD and ESKD persons particularly in those with ESKD. To develop and provide an adequate plan to clinically manage CKD patients with PAD, evidence of cost-effectiveness and clinical benefit of early detection of PAD in persons with CKD in Australia is recommended for future studies.

Can National Oral Health Policy Reform Be Successfully Translated into Practice and Reduce the Burden of Disease in Australia?

BACKGROUND: The discrepancy between policy makers decisions, current research and clinical practice is of huge significance to the health industry and the Australian community. &#x0D; AIM: Evaluate of translational research frameworks and policy formulation within the Australian oral health context. &#x0D; METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a focused systematic search was conducted using an electronic search of the CINAHL database, including Medline, Cochrane and Scopus. A combination of key terms including “oral health”, “prevention’’, 'translational research’, “public policy”, were used for the searches. &#x0D; RESULTS: The initial literature search found 561 abstracts in CINAHL database. Review against the inclusion criteria and removal of duplicates yielded 129 abstracts; further reviewed against the inclusion criteria resulted in 35 included in the review of translational research models. Across the 35 papers 8 different frameworks for translation of research evidence into policy and practice were utilised across the literature. The results reported in this studies show that the PARiHS framework depicts successful translation as a function of the relationship between evidence, context and facilitation. These interplays of elements are particularly of relevance to oral health due to the complexity of the sector. Context (current and historical) and facilitation (including governance/regulation) are the foundational drivers of successful implantation of evidence into practice. &#x0D; CONCLUSION: The PARiHS framework for implementing research into practice is an appropriate model for oral health. Universal access is a feasible step in addressing the current inequities of access to oral health care.