Search

Abstract Background Measuring treatment burden is important for the effective management of Type 2 Diabetes Mellitus (T2DM) care. The purpose of this systematic review was to identify the most robust approach for measuring treatment burden in people with T2DM based on existing evidence. Methods Articles from seven databases were retrieved. Qualitative, quantitative, and mixed-methods studies examining treatment burden in adults with T2DM and/or reporting relevant experiences were included. A convergent segregated approach with a mixed-methods design of systematic review was employed, creating a measurement framework in a narrative review for consistent critical appraisal. The quality of included studies was assessed using the Joanna Briggs Institute tool. The measurement properties of the instruments were evaluated using the Consensus based Standards for selection of Health Measurement Instruments (COSMIN) checklist. Results A total of 21,584 records were screened, and 26 articles were included, comprising 11 quantitative, 11 qualitative, and 4 mixed-methods studies. A thematic analysis of qualitative data extracted from the included articles summarised a measurement framework encompassing seven core and six associated measurements. The core measurements, including financial, medication, administrative, lifestyle, healthcare, time/travel, and medical information burdens, directly reflect the constructs pertinent to the treatment burden of T2DM. In contrast, the associated measurement themes do not directly reflect the burdens or are less substantiated by current evidence. The results of the COSMIN checklist evaluation demonstrated that the Patient Experience with Treatment and Self-management (PETS), Treatment Burden Questionnaire (TBQ), and Multimorbidity Treatment Burden Questionnaire (MTBQ) have robust instrument development processes. These three instruments, with the highest total counts combining the number of themes covered and "positive" ratings in COSMIN evaluation, were in the top tertile stratification, demonstrating superior applicability for measuring T2DM treatment burden. Conclusions This systematic review provides evidence for the currently superior option of measuring treatment burden in people with T2DM. It also revealed that most current research was conducted in well-resourced institutions, potentially overlooking variability in under-resourced settings.

Abstract Background Understanding treatment burden is a critical element to the effective management of Type 2 Diabetes Mellitus (T2DM). The current study aims to address the knowledge gap surrounding treatment burden of T2DM from the patient’s perspective in China’s primary care settings. Methods A narrative review informed the creation of an a priori coding structure to identify aspects of T2DM treatment burden. Focus groups were conducted, employing a maximum variation sampling strategy to select participants from diverse sociodemographic backgrounds across urban, suburban, rural, and remote areas in China. Participants included adults with T2DM care in primary care settings for over a year and a Treatment Burden Questionnaire score of 25 or higher. Deductive thematic analysis, guided by the coding structure, facilitated a comprehensive exploration and further development of the conceptual framework of T2DM treatment burden. Results Four focus groups, each comprising five participants from diverse areas, were conducted. Utilising the Cumulative Complexity Model and Normalisation Process Theory as theoretical underpinnings, the thematic analysis refined the conceptual framework based on the coding structure from the narrative review. Five key themes were refined, encompassing medical information, medication, administration, healthcare system, and lifestyle. Additionally, the financial and time/travel themes merged into a new theme termed "personal resources", illustrating their overlapping within the framework. Participants in these focus groups highlighted challenges in managing medical information, an aspect often underrepresented in prior treatment burden research. The thematic analysis culminated in a finalised conceptual framework, offering a comprehensive understanding of the treatment burden experiences of people with T2DM in China’s primary care settings. This framework includes six key constructs, delineating T2DM treatment burden and associated factors, such as antecedents and consequences. Conclusions This study provides insights into the treatment burden of T2DM. A conceptual framework was finalised to deepen the understanding of the multifaceted constructs and the nature of treatment burden in people with T2DM. Furthermore, it emphasises the need to tailor T2DM treatment to individual capacities, considering their personal resource allocation and treatment utilisation.

This study evaluates bushfire smoke as a workplace hazard for firefighters by characterising its chemical composition and potential health risks in Western Australia. Portable Fourier Transform Infrared (FTIR) spectrometry was used to measure airborne chemical concentrations at prescribed burns across five regions, including peat (acid sulphate) fire events. Samples were collected during both flaming and smouldering phases, as well as in perceived “clear” air resting zones. Results indicated that carbon monoxide (CO) was the dominant gas, reaching concentrations of 205 ppm at the fire front, followed by nitrogen monoxide (26 ppm) and methane (19 ppm). Peat fires produced distinct profiles, with ammonia (21.5 ppm) and sulphur dioxide (9.5 ppm) concentrations higher than those observed in typical bushfires. Smouldering phases emitted higher chemical concentrations than flaming phases 75% of the time. Even clear air zones contained measurable chemicals, with CO levels averaging 18 ppm, suggesting that firefighters are not free from exposure during rest periods. These findings highlight the need for fit-for-purpose respiratory protective equipment (RPE) and improved rest protocols to minimise exposure. The study underscores the importance of comprehensive health monitoring programs for firefighters to mitigate long-term health risks.

Evidence has previously shown that outer tunics (turnout coats) worn by firefighters at structural fires are contaminated with harmful chemicals which subsequently off-gas from the material. However, there is limited research on whether this phenomenon extends to wildland firefighter uniforms. This pilot study aimed to explore if the tunics of volunteer bushfire and forestry firefighters in Western Australia off-gas any contaminants after exposure to prescribed burns or bushfires, and whether there is a need to explore this further. Nine tunics were collected from firefighters following nine bushfire and prescribed burn events, with a set of unused tunics serving as a control. Chemical analysis was performed on these tunics to assess levels of acrolein, benzene, formaldehyde, and sulphur dioxide contamination. The assessment involved measuring chemical off-gassing over a 12 h period using infrared spectrometry. Tunics worn by firefighters appear to adsorb acrolein, benzene, formaldehyde, and sulphur dioxide from bushfire smoke and these contaminants are emitted from firefighting tunics following contamination at elevated concentrations. Further investigation of this research with a larger study sample will be beneficial to understand this phenomenon better and to determine the full extent and range of chemical contaminants absorbed by all firefighter clothing.

There has been a critical shortage of qualified Environmental Health Officers (EHOs) both globally and in Australia that has plagued the profession for decades. At Edith Cowan University (ECU), Perth, Western Australia, an undergraduate degree in Environmental Health (EH) was developed in 2006, however, viability was problematic, and the course was under threat of closure. In 2016 both the EH and occupational safety and health (OSH) majors were due for re-accreditation and since there was significant overlap between the two courses both majors were revised and combined into one (Occupational and Environmental Health and Safety). This new qualification has subsequently been accredited by Environmental Health Australia (EHA), as well as the Australian OHS Education Accreditation Board (AOHSEAB) and the British Institution of Occupational Safety and Health (IOSH). The new dual accredited course has had excellent graduate outcomes and provides graduates with the flexibility to move between traditional OHS and EH roles. In some smaller local governments, and in industry, ECU graduates have been employed to work in both roles. The curriculum was developed in consultation with industry and has an embedded year-long diploma course that consists of eight units (subjects/courses) that prepare graduates to work in a support role to EHOs. The Diploma of Environmental Health course is a scaffolded course that is embedded in the degree, and it has been recognized by the State Government as a qualification leading to appointment as authorized officers under the Public Health Act 2016 (WA). The diploma is more than a pathway course as it is a stand-alone qualification that leads to gainful employment. Most students now enroll in the diploma, initially and gain employment as a Technical Officer, and then progress on to complete the EH degree on a part-time basis while employed in the profession. The diploma is also an exit option for students who struggle with the academic requirements of some of the more traditionally difficult units such as physics, chemistry, and statistics and the EH degree is now a viable university course with excellent graduate employment outcomes.

Worldwide, mosquito monitoring and control programs consume large amounts of resources in the effort to minimise mosquito-borne disease incidence. On-site larval monitoring is highly effective but time consuming. A number of mechanistic models of mosquito development have been developed to reduce the reliance on larval monitoring, but none for Ross River virus, the most commonly occurring mosquito-borne disease in Australia. This research modifies existing mechanistic models for malaria vectors and applies it to a wetland field site in Southwest, Western Australia. Environmental monitoring data were applied to an enzyme kinetic model of larval mosquito development to simulate timing of adult emergence and relative population abundance of three mosquito vectors of the Ross River virus for the period of 2018–2020. The model results were compared with field measured adult mosquitoes trapped using carbon dioxide light traps. The model showed different patterns of emergence for the three mosquito species, capturing inter-seasonal and inter-year variation, and correlated well with field adult trapping data. The model provides a useful tool to investigate the effects of different weather and environmental variables on larval and adult mosquito development and can be used to investigate the possible effects of changes to short-term and long-term sea level and climate changes.