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Background: Most people diagnosed with dementia live and die in community settings. This study aimed to: (i) describe the palliative care needs of patients with dementia at commencement of community palliative care; (ii) compare palliative care needs between patients with dementia and those with lung cancer and cardiovascular disease (CVD). Methods: This is a population-based descriptive study that involved 8,727, 7,539 and 25,279 patients who accessed community palliative care across Australia principally because of dementia, CVD and lung cancer. Patients' functional abilities, symptom burden and clinical condition were assessed at commencement of community alliative care using five validated instruments: Resource Utilisation Groups—Activities of Daily Living, Australia-modified Karnofsky Performance Status, Symptoms Assessment Scale, Palliative Care Problem Severity Score and Palliative Care Phase. We fitted ordinal logistic regression models to examine the differences in these assessments for dementia versus CVD and lung cancer, respectively. Results: Overall, patients with dementia generally had low levels of distress from symptoms but poor functional problems. Compared to the other two diagnostic groups, palliative care for dementia was often initiated later and with shorter contacts. Also, patients with dementia presented with poorer functional performance (adjusted OR (aOR) = 4.02, Confidence Interval (CI): 3.68 – 4.38 for dementia vs CVD; aOR = 17.59, CI: 15.92 – 19.44 for dementia vs lung cancer) and dependency (aOR = 5.68, CI: 5.28 – 6.12 for dementia vs CVD; aOR = 24.97, CI: 22.77 – 27.39 for dementia vs lung cancer), but experienced lower levels of distress and problem severity for the majority of symptoms. Conclusion: Community palliative care is often an ideal care option for many patients, particularly for those with dementia. We call for expansion of the palliative care workforce and options for home care support to optimize accessibility of community palliative care for dementia. [ABSTRACT FROM AUTHOR]

Many trans young people seek mental health support and gender-affirming medical interventions including puberty suppression, gender-affirming hormones and/or surgeries. Trans young people and their parents face multiple barriers in accessing gender-affirming care and mental health support, however little is known about the parent perspective on accessing services for their trans child. This study aimed to understand the experiences of parents accessing medical and mental health services with and for their trans children within Australia. Using data from Trans Pathways, a large mixed-methods cross-sectional study, we examined the experiences of parents (N = 194) in Australia accessing primary care, psychiatry, therapy/counseling, mental health inpatient, and gender-affirming medical services with/for their trans children (aged 25 years or younger). Qualitative data on service experiences were thematically analyzed. Quantitative analyses included frequency of access to services, wait times, service satisfaction, and mental health diagnoses of the parents' trans child. Services were mostly first accessed when the young person was between 12 and 17 years of age, with primary care physicians being the most accessed service. Parents reported that some practitioners were respectful and knowledgeable about gender-affirming care, and others lacked experience in trans health. Across all services, common barriers included long wait times, complicated pathways to navigate to access support, as well as systemic barriers such as sparsity of gender speciality services. Across services, parents reported feeling as though they do not have the necessary tools to best support their child in their gender affirmation. This study highlights the crucial need for systemic changes in the processes of accessing gender-affirming care and mental health support to enable access to appropriate and timely care. These findings also indicate the importance of improving individual practitioner knowledge around trans health, to enhance the support provided to trans young people and their parents. [ABSTRACT FROM AUTHOR]

Musicians have been described as a 'high-risk' group for experiencing musculoskeletal symptoms (MSSs), yet few studies have tested this assumption. We aimed to determine whether the prevalence and profile of MSS outcomes differed between university music students and a reference group (science students). A survey was conducted of university music and science students. Reported MSS outcomes among the two groups were compared using regression analyses. The majority of participants in both groups reported experiencing MSSs in the last 12 months and 7 days. Music students reported a higher prevalence of wrist/hand MSSs compared with science students. Compared with symptomatic science students, music students reported a higher emotional impact of MSSs. We recommend prioritizing research into interventions for music students that address MSSs in the wrist/hand region, and the emotional impact of MSSs. Addressing these MSS outcomes could reduce the MSS burden for musicians during and beyond their studies. [ABSTRACT FROM AUTHOR]

Previous research on general practitioners' (GPs') involvement in end‐of‐life care has largely focused on a specific aspect of care or has provided broad overviews that failed to capture individual variations in patient management. This qualitative study aimed to explore Australian GPs' feedback and reflections on the individual‐level care provided for patients in their last year of life. The findings of the study were drawn from a nation‐wide survey of GPs' experiences in end‐of‐life care. We analysed responses from 63 GPs for 267 of the 272 reported deaths. Factors influencing delivery of optimal end‐of‐life care reported by GPs were categorised into four groups: patient‐related factors, carer‐related factors, interactions between GPs and patients/carer‐related factors and broader health system issues. Each group included both barriers and facilitators. Our study highlighted importance of the emotional dimensions of therapeutic relationships with patients and their family, availability and capacity of family support and smooth communication and continuity of care between GPs and hospitals in delivery of optimal end‐of‐life care. Lack of these facilitators, misconceptions of palliative care and conflicts on implementing care plans among patients and their family tended to impede delivery of such care. On the basis of our findings in the present study and previous literature, we conclude that improved end‐of‐life care in general practice requires comprehensive approaches to supporting both the GP and family to provide care in patients' preferred place, such as enhanced palliative care training and improved availability of external support for GPs, higher levels of hospital‐based services reaching into community settings and broader community‐based resources for families beyond simply the healthcare system. [ABSTRACT FROM AUTHOR]

There are potential benefits associated with advance care planning (ACP), and general practitioners (GPs) are well placed to coordinate ACP initiatives with their patients. Few studies have reported on the uptake of different forms of advance care plan conducted by GPs and how this affects patients' place of death. The primary aims of the study were to examine uptake of verbal (conversations regarding care preferences) and written (documented care preferences) advance care plans and their associated factors from the perspective of Australian GPs. The secondary aim was to determine the impact of different types of advance care plans on place of death. Sixty‐one GPs from three Australian states used a validated clinic‐based data collection process to report on care provided for decedents in the last year of life, including provision of services, place of death, and uptake of ACP. We found that 58 (27.9%), 91 (43.7%) and 59 (28.4%) reported decedents had no advance care plans, verbal plans or written plans, respectively. There were increased uptake of both verbal plans (relative risk ratio [RRR] = 13.10, 95% confidence interval [CI]: 2.18–77.34) and written plans (RRR = 10.61, 95% CI: 1.72–65.57) if GPs foresaw the death for >90 days versus <7 days. Palliative care training history for GPs predicted uptake of verbal plans (RRR = 5.83, 95% CI: 1.46–31.93). Patients with verbal plans versus no plans were more likely to die at a private residence (odds ratio = 4.97, 95% CI: 1.32–18.63). Our findings suggest that expectation of death for at least three months prior to the event (where clinically possible) and palliative care training for GPs improve the uptake of ACP in general practice. Larger pragmatic trials are required to determine the impact of ACP on patients' place of death. [ABSTRACT FROM AUTHOR]

Issues Addressed: To explore adolescents' experiences of access to and continued use of mental health services, and identify factors influencing their perceived satisfaction with their care. This paper focusses on the role of organisational and policy-level factors in the mental health system.Method: Qualitative semi-structured face-to-face interviews with 22 adolescents aged 14-18 years living in Perth, Western Australia.Results: Adolescents identified key policy, systemic and service-based factors which influenced their access to and continued use of mental health services. These were strongly related to the processes of service intake, level of orientation towards person-centred care and adequacy of service resourcing and funding. Areas of concern for adolescents included, complex service intake procedures, suboptimal mental health service environments, lack of client-centred care and the quality of mental health support provided in school settings.Conclusions: Our research has identified a wide spectrum of factors influencing mental health service access and use amongst adolescents. The findings further support the growing national consensus for major reform to address the mental health needs of this age group. The current strengths within mental health services and the system identified by adolescents need to be supported and extended. SO WHAT?: Although there have been numerous recommendations on ways to improve mental health service access and ongoing engagement for Australian adolescents, a number of the major challenges faced by this high-risk population have shown little improvement. The findings of this research indicate the importance of now moving towards implementing meaningful plans for action. [ABSTRACT FROM AUTHOR]

Objective: Trans and gender diverse young people experience mental health difficulties self-harm and suicidality at markedly higher rates than the general population, yet they often feel isolated from mental health services. There is little qualitative research on the experiences of trans and gender diverse young people accessing mental health support in Australia. The objective of this study was to comprehensively explore the experiences of trans and gender diverse young people in Australia who have sought mental health support from therapists, counsellors, psychiatrists and/or inpatient care providers. Methods: We report on findings from the Trans Pathways study, which was a mixed-methods study to evaluate the experiences of trans and gender diverse young people accessing mental health services: specifically, therapy and counselling services, psychiatric services and mental health inpatient services. Results: A total of 859 trans and gender diverse young people aged 14–25 years across Australia completed an anonymous online questionnaire. Therapy and/or counselling services (64.4%) were most frequently sought by trans and gender diverse young people in this study, followed by psychiatric services (43.0%) and mental health inpatient services (12.3%). The findings demonstrated that many mental health professionals lacked expertise in gender diversity, and that trans and gender diverse young people found it difficult to locate mental health professionals who were able to meet their needs in a timely manner. Conclusion: These findings indicate that training is necessary for all mental health professionals to improve their knowledge of gender diversity, enhance the support provided to trans and gender diverse young people and help to address the high rates of poor mental health. The findings outlined here provide insight into the areas in which clinicians could optimise their care of trans and gender diverse young people. [ABSTRACT FROM AUTHOR]

Objectives: To (a) compare palliative care needs of lung cancer patients on their final admission to community‐based and inpatient palliative care services; and (b) explore whether and how these care needs affect their utilisation of different palliative care services in the last days of life. Methods: Descriptive study involving 17,816 lung cancer patients who received the last episode of palliative care from specialist services and died between 1 January 2013 and 31 December 2018. Results: Both groups of patients admitted to community‐based and inpatient palliative care services generally experienced relatively low levels of symptom distress, but high levels of functional impairment and dependency. "Unstable" versus "stable" palliative care phase (Odds ratio = 11.66; 95% Confidence Interval: 9.55–14.24), poorer functional outcomes and severe levels of distress from many symptoms predicted greater likelihood of use of inpatient versus community‐based palliative care. Conclusions: Most inpatient palliative care admissions are not associated with high levels of symptom severity. To extend the period of home care and rate of home death for people with lung cancer, additional investment is required to improve their access to sufficiently skilled palliative care staff, multi‐disciplinary teams and 24‐hour home support in community settings. [ABSTRACT FROM AUTHOR]

Therapeutic use of spring waters has a recorded history dating back to at least 1550 BC and includes both bathing in and drinking such waters for their healing properties. In Australia and New Zealand the use of therapeutic spring waters is a much more recent phenomenon, becoming a source of health tourism from the late 1800s. We conducted a systematic review aimed at determining the potential health outcomes relating to exposure to Australian or New Zealand natural spring water. We found only low-level evidence of adverse health outcomes relating to this spring water exposure, including fatalities from hydrogen sulphide poisoning, drowning and primary amoebic meningoencephalitis. We found no studies that investigated the therapeutic use of these waters, compared with similar treatment with other types of water. From the broader literature, recommendations have been made, including fencing potentially harmful spring water, and having signage and media messages to highlight the potential harms from spring water exposure and how to mitigate the risks (e.g. not putting your head under water from geothermal springs). Sound research into the potential health benefits of Australian and New Zealand spring waters could provide an evidence base for the growing wellness tourism industry. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether the Koorliny Moort program could reduce emergency department presentations, hospital admissions and length of stay, and improve attendance at out-of-hospital appointments for Aboriginal and Torres Strait Islander children in Western Australia.Design: Children were enrolled in the program from 1 August 2012. Each child acted as their own control. Evaluation data were collected from 1 August 2010 to 31 July 2014. Occasions of service and person-time in days were compared for each child before and after referral to the program.Setting and Participants: Aboriginal children aged 0-16 years residing in three WA regions (Kimberley, Pilbara, Perth metropolitan) who were referred to the Koorliny Moort program.Interventions: Partnerships with primary care providers; nurse-led care coordination; and outreach care by paediatricians, nurses and social workers closer to the home of the child.Main Outcome Measures: Emergency department presentations; hospital admissions; length of hospital stay; non-attended appointments.Results: A total of 942 children were referred to the program. There were significant decreases after referral to the program in the incidence of emergency department presentations (incident rate ratio [IRR], 0.47; 95% CI, 0.43-0.53; P < 0.001), of hospitalisation (IRR, 0.70; 95% CI, 0.62-0.79; P < 0.001), and of non-attended appointments (IRR, 0.83; 95% CI, 0.74-0.94; P < 0.001), as well as in the mean length of hospital stay (IRR, 0.23; 95% CI, 0.21-0.25; P < 0.001).Conclusions: Health-seeking behaviour and health outcomes for Aboriginal children can be improved by engaging Aboriginal families in their health care, providing effective communication between health service providers, and delivering a coordinated program of Aboriginal service provider-led care. [ABSTRACT FROM AUTHOR]

Abstract: Our hypothesis is that symptoms of high altitude syndromes are detectable even at intermediate altitudes, as commonly encountered under Australian conditions (<2500m above sea level). High altitude medicine has long recognised several syndromes associated with rapid ascent to altitudes above 2500m, including high altitude pulmonary oedema (HAPE), high altitude cerebral oedema (HACE) and high altitude flatus expulsion (HAFE). Symptoms of high altitude syndromes are of growing concern because of the global trend toward increasing numbers of tourists and workers exposed to both rapid ascent and sustained physical activity at high altitude. However, in Australia, high altitude medicine has almost no profile because of our relatively low altitudes by international standards. Three factors lead us to believe that altitude sickness in Australia deserves more serious consideration: Australia is subject to rapid growth in alpine recreational industries; altitude sickness is highly variable between individuals, and some people do experience symptoms already at 1500m; and there is potential for an occupational health and safety issue amongst workers. To test this hypothesis we examined the relationship between any high altitude symptoms and a rapid ascent to an intermediate altitude (1800m) by undertaking an intervention study in a cohort of eight medical clinic staff, conducted during July of the 2012 (Southern Hemisphere) ski season, using self-reporting questionnaires, at Mansfield (316m above sea level) and at the Ski Resort of Mt Buller (1800m), Victoria, Australia. The intervention consisted of ascent by car from Mansfield to Mt Buller (approx. 40min drive). Participants completed a self-reporting questionnaire including demographic data and information on frequency of normal homeostatic processes (fluid intake and output, food intake and output, symptoms including thirst and headaches, and frequency of passing wind or urine). Data were recorded in hourly periods extending over 18h before and 18h after ascent. We found that the frequency of flatus production more than doubled following ascent, with a post-ascent frequency of approximately 14 expulsions per person over the 18h recording period (Rate Ratio 2.31, CI 1.33–3.99, p =0.003). The frequency and severity of headaches also increased following ascent. These results support the hypothesis that high altitude symptoms can be significant issues even at the relatively lower altitudes encountered in Australian alpine regions. Increased awareness amongst clinicians of this possibility could contribute to a reduction in the disease burden from high altitude syndromes at intermediate altitudes. [Copyright &y& Elsevier]

At present, the extent of environmental health research in Australia is unclear and there are no recent overarching reviews of national publications on the subject. This study investigates the current status of environmental health research in Australia using a bibliometric analysis. Three databases (Medline, Web of Science, and AUSTHealth) were used to access original, peer-reviewed journal articles with Australian data published between 1 January 2001 and 11 June 2010. A total of 337 articles from 174 different journal titles were used in the analysis and were classified according to 15 pre-determined environmental health areas. The highest number of articles related to water health and resources (66 articles), exposure to hazardous chemicals (57 articles), and air pollution including indoor air (58 articles). These areas made up 54% of the total publication output over the past 10 years. The amount of environmental health research published in Australia over the past 10 years, and the topics explored in these studies, is comparable to that of other countries of similar socio-economic status. [ABSTRACT FROM AUTHOR]

Previous studies have linked poor mental human health with environmental degradation, but none have assessed additional diseases that may co-exist with these mental disorders. In previous work, depression was found to be associated with a major form of environmental degradation; dryland salinity. However, little is known about diseases co-morbid with depression in this environmental setting. In rural Australia, dryland salinity is a major form of environmental degradation contributing widely to deterioration and non-viability of farmland. Using georeferenced health record data, Bayesian spatial methods were used to determine the relationship between dryland salinity and a range of human health outcomes. Initial modelling found an increased relative risk for asthma, suicide and ischaemic heart disease in relation to dryland salinity (adjusted for Indigenous and socio-economic status). However, in this follow-up study, a further evaluation of the role of co-morbidities in this population revealed that: (i) the presence of depression was consistently linked to residence in areas with high salinity and (ii) the association of asthma, suicide and heart disease with salinity was most likely attributable to the co-morbidity of the conditions with depression. Given the predicted increase in dryland salinity and the elevated relative risk of depression in impacted areas, the relative risk of the co-morbid conditions can be expected to increase in rural areas in the future, further adding to the burden of disease associated with environmental degradation. [ABSTRACT FROM AUTHOR]

Abstract: The adverse environmental outcomes of disturbing acid sulfate soils have long been known, and there is a general consensus that avoiding disturbance is the most cost-efficient solution. However, canal estates are increasing in popularity on the west coast of Australia, in spite of a large proportion of the country''s acid sulfate soils being located along its coast. This study examined the mobility and concentration of metals in surface soil, dust and water sampled from one of the earliest canal developments in Western Australia. Soil metal concentrations were significantly elevated compared to an undisturbed reference site. While the dust fraction generally held higher metal concentrations in the original soil of the area, the total metal load was higher in the dredged and deposited material. None of the samples were above guideline values. The surface water of the canals had concentrations of iron and arsenic above the Australian drinking water guideline value while nickel concentrations were above the ecological guideline value. The pH of the water was not affected. The human health consequences of these findings may not be severe as the water is not used for drinking. However, the results highlight the need for transparency in the land development process, where developers are responsible for informing home buyers of the consequences related to developing acid sulfate soil areas and the steps that are being taken towards remediation or avoidance. Moreover, the results show the importance of monitoring metal concentrations in addition to pH in waters potentially affected by acid sulfate soils. [Copyright &y& Elsevier]

Aim: Helicobacter pylori (H. pylori) infection is usually acquired in childhood and may adversely affect growth, although data are inconsistent. This study investigated growth parameters in a paediatric cohort with a high prevalence of H. pylori and helminth infection. Methods: A cross-sectional study of African refugee children (<16 years) recruited at their initial health assessment following resettlement in Australia. Detailed demographic, infection and anthropometric data were obtained. H. pylori infection was diagnosed by monoclonal faecal antigen enzyme immunoassay testing (MFAT). Growth restriction was defined as children with any anthropometric measures below the fifth centile for age and gender. Results: H. pylori infection was detected in 149/182 (81.9%). Children with H. pylori infection were older (mean 8.5 years, standard deviation (SD) 4.2 years vs. 5.8 years, SD 4.5 years, p < 0.001). No gender differences were observed. After adjustment for age, H. pylori did not adversely affect body mass index or other anthropometric measurements. Helminth infections were common (41.8%) but not associated with reduced growth or with H. pylori infection. Conclusion: H. pylori and helminth infections are prevalent in African refugee children but neither is associated with growth restriction. Longitudinal growth velocity studies are necessary to identify any long-term consequences of H. pylori on childhood growth. [ABSTRACT FROM AUTHOR]

An assessment of potential health impacts of radioactive compounds in recycled water to augment drinking water supplies was conducted. Gross alpha and gross beta particle activity was selected for the screening of radioactive species. Samples both pre- and post-reverse osmosis treatment of secondary effluent in Perth, Australia were examined in both a full-scale and in a pilot water reclamation plant. Risk quotients (RQs) were estimated by expressing the mean (RQ mean) and the maximum concentration (RQ max) at each sampling point as a function of the recommended Australian screening levels of 0.5 Bq/L. The results indicate that reverse osmosis (RO) is able to reduce the concentration of gross alpha particle activity (average removal of almost 80%) and gross beta particle activity (average removal of 95%) and produce water of high quality. Maximum gross alpha particle activity in the recycled water was 0.023 Bq/L and maximum gross beta (excluding 40K) particle activity was 0.03 Bq/L, which correspond to an RQ max of 0.07 for gross alpha and 0.06 for gross beta particle activity, respectively. No increased human radiological risk is anticipated if recycled water is used to augment drinking water supplies in Perth. [ABSTRACT FROM AUTHOR]

Bushfire smoke contains an array of organic and inorganic compounds, including respirable and inspirable particles, aldehydes, and carbon monoxide. These compounds have been found to be a health hazard for firefighters in the United States. Despite the high frequency of bushfires in Australia, analyses of bushfire smoke components are scarce. As part of an occupational health study investigating the respiratory health effects of bushfire smoke in firefighters, air toxics sampling was undertaken in a smoke chamber and during prescribed burns. Levels of formaldehyde and acrolein were demonstrated at respectively 60% and 80% of the Short Term Exposure Limit in the smoke chamber. Carbon monoxide levels exceeded the peak limit of 400 ppm significantly. Although concentrations were lower during the prescribed burns, the study shows that Australian bushfire smoke contains air toxics of concern and provides justification for further research into the levels of air toxics measured at bushfires and the associated health impacts. [ABSTRACT FROM AUTHOR]

Land use change has the potential to cause severe ecosystem degradation and drive changes in disease transmission and emergence. Broadscale clearing of native vegetation for agriculture in southwestern Australia has resulted in severe ecosystem degradation, which has been compounded by the subsequent development of large areas of dryland salinity. The mosquito-borne disease, Ross River virus (RRV), has been noted as a potential adverse human health outcome in these salinity affected regions. The association between dryland salinity and RRV disease was therefore tested by undertaking a spatial analysis of disease notification records using standard and Bayesian techniques. To overcome inherent limitations with notification data, serological RRV antibody prevalence was also investigated. Neither method revealed a significant association with dryland salinity, however, the spatial scale imposed limited the sensitivity of both studies. Thus, further multidisciplinary studies are required to overcome these limitations and advance understanding of this ecosystem health issue, particularly using variables that can be investigated on a finer scale. [ABSTRACT FROM AUTHOR]

The city of Perth in Western Australia is facing a future of compromized water supplies. In recent years, this urban region has been experiencing rapid population growth, coupled with drying climate, which has exacerbated water shortages. As part of the government strategy to secure water sustainability and to address an agenda focused on all elements of the water cycle, a target of 20% reuse of treated wastewater by 2012 was established. This includes a feasibility review of managed aquifer recharge for indirect potable reuse. A characterization of contaminants in wastewater after treatment and an assessment of the health implications are necessary to reassure both regulators and the public. To date, the commonly used approach involves a comparison of measured contaminant concentrations with the established drinking-water standards or other toxicological guidelines for the protection of human health. However, guidelines and standards have not been established for many contaminants in recycled water (unregulated chemicals). This article presents a three-tiered approach for the preliminary health risk assessment of chemicals in order to determine key contaminants that need to be monitored and managed. The proposed benchmark values for the calculation of risk quotients are health based, systematically defined, scientifically defensible, easy to apply, and clear to interpret. The proposed methodology is based on the derivation of health-based levels for unregulated contaminants with toxicity information and a "threshold of toxicological concern" for unregulated contaminants without toxicity data. The application of this approach will help policymakers set guidelines regarding unregulated chemicals in recycled water. [ABSTRACT FROM AUTHOR]

There is a growing emphasis on the importance of availability of specialist palliative care for people living with dementia. However, for people imminently dying with dementia, we still have little knowledge about their palliative care needs and utilization of different specialist services. To (i) assess palliative care needs and other clinical and social characteristics of people imminently dying with dementia on their last admission in the context of community and inpatient palliative care services before death; (ii) compare care needs between patients requiring community-based and inpatient services; (iii) determine how and whether such care needs affect utilization of different palliative care services. Observational study using data from the Australian Palliative Care Outcomes Collaboration. Specialist palliative care services across Australia registered in the Palliative Care Outcomes Collaboration. A total of 3361 people who required specialist palliative care principally for dementia (including Alzheimer's disease and other dementias), and whose death occurred between 1 January 2013 and 31 December 2018. Five validated clinical instruments were used to collect point-of-care outcomes on each individual's function (Resource Utilisation Groups - Activities of Daily Living & Australia-modified Karnofsky Performance Status), symptom distress (Symptoms Assessment Scale & Palliative Care Problem Severity Score) and other clinical characteristics (Palliative Care Phases). We fitted multivariate logistic regression models to examine the association between these clinical outcomes and utilization of different specialist palliative care services. The majority of people imminently dying with dementia had absent or mild levels of symptom distress but experienced high levels of functional decline and needed substantial assistance with basic tasks of daily living in their last days of life. Large disparities in symptoms distress and functional decline between inpatient and community groups were not observed although differences in assessment scores were often statistically significant. Poor functional outcomes (odds ratio = 1.77, 95% confidence interval: 1.24–2.52) and "non-stable" palliative care phases (odds ratio =24.51, 95% confidence interval: 12.03–49.96) were positively associated with use of inpatient versus community palliative care, whereas there was no clear association between the majority of symptoms and use of different care services. The majority of people imminently dying with dementia could potentially benefit from greater access to supportive services in the community. Development of a dementia-specific palliative care pathway is needed to promote needs-based palliative care delivery models. the majority of people imminently dying with dementia could potentially benefit from greater access to supportive services in community. [ABSTRACT FROM AUTHOR]

Background: Few studies have specifically assessed the scope, nature and challenges of palliative and end-of-life care in rural general practice. These knowledge gaps limit the development of evidence-based policies and services for patients in the last months of life. This study aimed to explore the perspectives of general practitioners (GPs) and other stakeholders on rural GPs' involvement and challenges in providing palliative and end-of-life care in regional Australia. Methods: A qualitative study involving five focus groups with 26 GPs based in rural/regional Western Australia together with 15 individual telephone interviews with four GPs and 11 other stakeholders involved in end-of-life care across Australia. Results: The rural GPs' central role in end-of-life care was recognized by the majority of participants but multiple challenges were also identified. Some challenges were comparable to those found in urban settings but others were more pronounced, including resource limitations and lack of training. Inappropriate payment models discouraged GPs' involvement in some aspects of end-of-life care, such as case conferences and home visits. Compared to GPs in urban settings, those in rural/regional communities often reported closer doctor-patient relationships and better care integration and collaboration. These positive aspects of care could be further developed to enhance service provision. Our study highlighted the importance of regular interactions with other professionals and patients in providing end-of-life care, but many GPs and other stakeholders found such interactions more challenging than the more "technical" aspects of care. Conclusions: Rural/regional GPs appear to be disproportionately affected by inappropriate payment models and limited resources, but may benefit from closer doctor-patient relationships and better care integration and collaboration relative to urban GPs. Systematic collection of empirical data on GP management at end-of-life is required to build on these strengths and address the challenges. [ABSTRACT FROM AUTHOR]

Introduction: There is a dire paucity of research into the burden, correlates and motives of substance use among trans young people in Australia., Method: Using data from a national survey of Australian trans young people (N = 859, M age  = 19.4), we estimated prevalence of past 6-month substance use (tobacco, alcohol, cannabis, other drugs) and lifetime substance use disorder diagnoses. Covariate-adjusted multivariate logistic regression models tested associations between substance use types with 18 interpersonal factors. Open-ended responses regarding substance use motives (n = 489) were qualitatively analysed using thematic analysis with an interpretative phenomenological approach., Results: Prevalence of lifetime substance use disorder diagnosis was 13.5% (95% confidence interval [CI] 11.1, 16.1). Alcohol use was most reported (72.4%; 95% CI 68.9, 75.6) followed by tobacco (31.1%; 95% CI 27.7, 34.6) and cannabis (30.6%; 95% CI 27.2, 34.2). Trans women reported highest rates of alcohol and cannabis use; use of other drugs was highest among trans men. Highest risk of substance use was observed among trans youth who experienced discrimination, intimate partner abuse, peer rejection and lack of family support (adjusted odds ratios ranging 1.5 to 3.0). Four multi-levelled themes of substance use motives were identified: circumstantial use, somatic use, feeling better about oneself and one's life, and harm reduction., Discussion and Conclusions: While substance use among trans young is largely circumstantial, hedonistic and altruistic, facilitating self-exploration, friendship and community connectedness, substance use among trans young people is highly prevalent and may be used to cope with sleep difficulties, depression/anxiety and cisnormativity, including delays and waitlists for accessing gender-affirming care., (© 2024 The Author(s). Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background: The prevalence of dementia is increasing worldwide and many people with the condition require some level of palliative care. However, the trajectories of function and symptom burden in palliative care services at the end of life remain unclear. This study aimed to describe and compare the longitudinal trajectories of function and symptom burden among patients with dementia between hospital versus palliative community care services in the last two weeks of life., Methods: A retrospective cohort study used data from the Australian Palliative Care Outcomes Collaboration. Patients with dementia who died between 1 January 2013 and 31 December 2020 from the Australian Palliative Care Outcomes Collaboration. Four validated clinical instruments were used to collect outcomes on each individual's function and symptom distress and severity. Multilevel models were used to estimate the differences in clinical trajectories between hospital and community-based palliative care in the last two weeks of life., Results: Patients with dementia tended to have low levels of distress for most symptoms but increasing levels of functional impairment. There were no or only marginally significant differences in the symptom trajectories between the community and hospital groups (OR ranged from 0.57 to 1.97). Although clinical trajectories of function were relatively similar between two groups, statistically higher functional indicators were observed for people when admitted to community palliative care services (OR = 0.42 and 2.27, respectively)., Conclusions: Our findings suggest that community-based palliative care services can be as effective as hospital-based care for many patients with dementia nearing the end of life. With appropriate support for families, community-based care could serve as a viable alternative to hospital-based care for some patients in the final stages of dementia., (© 2024. The Author(s).)

Introduction: There is a growing emphasis on the importance of the availability of specialist palliative care for people with motor neuron disease (MND). However, the palliative care needs of this population and the utilisation of different specialist services remain poorly defined., Objectives: To (1) describe clinical characteristics, symptom burden and functional levels of patients dying with MND on their admission to palliative care services; (2) determine factors associated with receiving inpatient or community palliative care services., Design: An observational study based on point-of-care assessment data from the Australian Palliative Care Outcomes Collaboration., Participants: A total of 1308 patients who received palliative care principally because of MND between 1 January 2013 and 31 December 2020., Measures: Five validated clinical instruments were used to assess each individual's function, distress from symptoms, symptom severity and urgency and acuity of their condition., Results: Most patients with MND had no or mild symptom distress, but experienced a high degree of functional impairment. Patients who required 'two assistants for full care' relative to those who were 'independent' (OR=11.53, 95% CI: 4.87 to 27.26) and those in 'unstable' relative to 'stable' palliative care phases (OR=16.74, 95% CI: 7.73 to 36.24) were more likely to use inpatient versus community-based palliative care. Associations between the use of different palliative care services and levels of symptom distress were not observed in this study., Conclusions: Patients with MND were more likely to need assistance for decreased function and activities of daily living, rather than symptom management. This population could have potentially been cared for in the palliative phase in a community setting if greater access to supportive services were available in this context., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: There are no processes that routinely assess end-of-life care in Australian general practice. This study aimed to develop a data collection process which could collect observational data on end-of-life care from Australian general practitioners (GPs) via a questionnaire and clinical data from general practice software., Methods: The data collection process was developed based on a modified Delphi study, then pilot tested with GPs through online surveys across three Australian states and data extraction from general practice software, and finally evaluated through participant interviews., Results: The developed data collection process consisted of three questionnaires: Basic Practice Descriptors (32 items), Clinical Data Query (32 items) and GP-completed Questionnaire (21 items). Data extraction from general practice software was performed for 97 decedents of 10 GPs and gathered data on prescriptions, investigations and referral patterns. Reports on care of 272 decedents were provided by 63 GPs. The GP-completed Questionnaire achieved a satisfactory level of validity and reliability. Our interviews with 23 participating GPs demonstrated the feasibility and acceptability of this data collection process in Australian general practice., Conclusions: The data collection process developed and tested in this study is feasible and acceptable for Australian GPs, and comprehensively covers the major components of end-of-life care. Future studies could develop an automated data extraction tool to reduce the time and recall burden for GPs. These findings will help build a nationwide integrated information network for primary end-of-life care in Australia., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To describe general practitioners' (GPs) involvement in end-of-life care, continuity and outcomes of care, and reported management challenges in the Australian context., Methods: Sixty-three GPs across three Australian states participated in a follow-up survey to report on care provided for decedents in the last year life using a clinic-based data collection process. The study was conducted between September 2018 and August 2019., Results: Approximately one-third of GPs had received formal palliative care training. Practitioners considered themselves as either the primary care coordinator (53.2% of reported patients) or part of the management team (40.4% of reported patients) in the final year of care. In the last week of life, patients frequently experienced reduced appetite (80.6%), fatigue (77.9%) and psychological problems (44.9%), with GPs reporting that the alleviation of these symptoms were less than optimal. Practitioners were highly involved in end-of-life care (eg, home visits, consultations via telephone and family meetings), and perceived higher levels of satisfaction with communication with palliative care services than other external services. For one-third of patients, GPs reported that the last year of care could potentially have been improved., Conclusion: There are continuing needs for integration of palliative care training into medical education and reforms of healthcare systems to further support GPs' involvement in end-of-life care. Further, more extensive collection of clinical data is needed to evaluate and support primary care management of end-of-life patients in general practice., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: Hyperactive delirium (HD) is a common and distressing symptom among palliative care patients. This study aimed to describe the characteristics of HD and associated symptoms among palliative care inpatients and evaluate relationships between HD development and symptom trajectories in this population., Design: A retrospective study was conducted., Methods: A retrospective review of medical records was conducted for all patients who died in a large Australian specialist palliative care unit between 1 January and 31 December 2019. Patients were assessed daily using the Symptoms Assessment Scale (SAS) and Palliative Care Problem Severity Scale (PCPSS). Multilevel models were used to estimate the differences in symptoms trajectories in the last 7 days of life between the two groups., Results: Of the 501 included patients, 64.5% (323) had an episode of HD. For 30% (95) of patients, HD occurred prior to admission. Compared with patients without HD, those with HD had significantly higher odds ratios (ORs) for four of the seven SAS symptoms (sleep problems, appetite, fatigue and pain; OR range: 1.94-4.48, p < .05), and all four PCPSS items (OR range: 2.00-3.00, p < .05) in the last week of life., Conclusions: Palliative care inpatients commonly experience HD in their last week of life. There are higher levels of symptom distress, complexity, psychological concerns and family/carer concerns among patients with HD compared with those without HD., Impact: The high prevalence of HD, and its association with higher levels of symptom distress, highlights the importance of routine screening and optimal management for HD among palliative care patients. Given the widely recognized challenges facing palliative care professionals in assessment and management of delirium, provision of relevant training among these professionals is recommended., (© 2021 John Wiley & Sons Ltd.)

Recent research highlights an overlap of gender diversity and autism spectrum disorders (ASD); however, data on individuals who are trans and also on the autism spectrum are largely from clinical samples and may not be representative of individuals who are trans with ASD in the general population. In addition, there is scant literature on the mental health of these individuals and their experiences in accessing gender-affirming care. We investigated the prevalence of ASD in trans young people, their mental health (psychiatric diagnoses and self-harm and suicidal behaviors) and experiences in accessing gender-affirming care. This is an analysis of data collected in an Australian cross-sectional mixed methods survey (N = 859) of trans young people aged 14-25 years. Overall, 22.5% of participants had ever received a diagnosis of ASD from a health professional. This group was more likely to exhibit current psychopathology, have engaged in self-harming and suicidal behaviors, and was also more likely than the non-ASD diagnosed reference group to have received a psychiatric diagnosis. The ASD-diagnosed group were also more likely to experience barriers in accessing gender-affirming care. This is the first large population-based sample of trans individuals with ASD to report on mental health outcomes and experiences in accessing gender-affirming care. We highlight the necessity for clinicians working with either trans or ASD populations to have awareness of the co-occurrence, and to cultivate skills to work with individuals who are both trans and on the autism spectrum., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: Our aim was to (1) describe the clinical characteristics and symptoms of people diagnosed with dementia at the time of admission to inpatient palliative care; and (2) compare the nature and severity of these palliative care-related problems to patients with other chronic diseases., Design: Descriptive study using assessment data on point of care outcomes (January 1, 2013, to December 31, 2018)., Setting: A total of 129 inpatient palliative care services participating in the Australian Palliative Care Outcomes Collaboration., Participants: A total of 29,971 patients with a primary diagnosis of dementia (n = 1,872), lung cancer (n = 19,499), cardiovascular disease (CVD, n = 5,079), stroke (n = 2,659), or motor neuron disease (MND, n = 862)., Measurements: This study reported the data collected at the time of admission to inpatient palliative care services including patients' self-rated levels of distress from seven common physical symptoms, clinician-rated symptom severity, functional dependency, and performance status. Other data analyzed included number of admissions, length of inpatient stay, and palliative care phases., Results: At the time of admission to inpatient palliative care services, relative to patients with lung cancer, CVD, and MND, people with dementia presented with lower levels of distress from most symptoms (odds ratios [ORs] range from .15 to .80; P < .05 for all) but higher levels of functional impairment (ORs range from 3.02 to 8.62; P < .001 for all), and they needed more assistance with basic activities of daily living (ORs range from 3.83 to 12.24; P < .001 for all). The trends were mostly the opposite direction when compared with stroke patients. Patients with dementia tended to receive inpatient palliative care later than those with lung cancer and MND., Conclusion: The unique pattern of palliative care problems experienced by people with dementia, as well as the skills of the relevant health services, need to be considered when deciding on the best location of care for each individual. Access to appropriately trained palliative care clinicians is important for people with high levels of physical or psychological concerns, irrespective of the care setting or diagnosis. J Am Geriatr Soc 68:1825-1833, 2020., (© 2020 The American Geriatrics Society.)

Background: Trans and gender diverse (TGD) young people worldwide experience high rates of poor mental health; however, these rates were unknown in Australia. In addition, how negative life events affect the mental health of TGD young people has been largely unexplored., Methods: This paper reports on novel mental health findings of Trans Pathways, the largest study ever conducted in Australia with trans (transgender) and gender diverse young people (N = 859; aged 14-25 years). The study was an anonymous online cross-sectional survey undertaken in 2016. Logistic and linear regression models were used to test associations between mental health outcomes and negative life experiences., Results: TGD young people in Australia experience high levels of mental distress, including self-harming (79.7%), suicidal thoughts (82.4%), and attempting suicide (48.1%). Three in four participants had been diagnosed with depression and/or anxiety (74.6% and 72.2%, respectively). Many TGD young people had been exposed to negative experiences such as peer rejection (89.0%), precarious accommodation (22.0%), bullying (74.0%), and discrimination (68.9%). Most poor mental health outcomes were associated with negative experiences. The strongest associations were found for precarious accommodation and issues within educational settings. For example, participants with a prior suicide attempt were almost six times more likely to have experienced issues with accommodation, including homelessness., Conclusions: The current results highlight the urgent need for better mental health care and provide insight into areas for targeted mental health interventions. These findings are pertinent for clinicians working with trans young people and wider society.

Purpose: Trans and gender diverse (TGD) young people have reported high levels of mental distress in research studies, specifically depression, anxiety, self-harming, and suicidal behaviors. Rates of abuse are also high in TGD populations, but little is known about how this relates to mental health in populations of TGD young people. This study sought to examine associations between experiences of abuse and mental health outcomes. Methods: A cross-sectional study design was used. An anonymous online questionnaire was conducted to determine rates of abuse among Australian TGD young people ( N  = 859) and the potential association with poor mental health. Primary outcomes of interest were self-reported psychiatric diagnoses, self-harm and suicidal behaviors, and current anxiety and depressive symptoms. Results: Exposures to six forms of abuse are reported in this article: extrafamilial physical abuse, familial physical abuse, extrafamilial sexual abuse, familial sexual abuse, abuse within an intimate relationship, and other familial abuse (including emotional or verbal abuse and neglect). All six forms of abuse measured were associated with poor mental health overall; risk estimates for some forms of abuse were much stronger than others. Conclusion: The current findings have wide-ranging implications for clinical practice. Those working in TGD health care need to be aware of the high prevalence of violence and abuse among TGD young people and the association with poor mental health outcomes. The findings also have implications for broader societal change and interventions targeting increasing parental support to reduce familial violence against TGD young people.

Under current climate change projections, the capacity to provide safe drinking water to Australian communities will be challenged. Part of this challenge is the lack of an adaptive governance strategy that transcends jurisdictional boundaries to support integrated policy making, regulation, or infrastructural adaptation. Consequently, some water-related health hazards may not be adequately captured or forecast under existing water resource management policies to ensure safe water supplies. Given the high degree of spatial and temporal variability in climate conditions experienced by Australian communities, new strategies for national health planning and prioritization for safe water supplies are warranted. The challenges facing public health in Australia will be to develop flexible and robust governance strategies that strengthen public health input to existing water policy, regulation, and surveillance infrastructure through proactive risk planning, adopting new technologies, and intersectoral collaborations. The proposed approach could assist policy makers avert or minimize risk to communities arising from changes in climate and water provisions both in Australia and in the wider Asia Pacific region.

Objective: To determine whether changes in 24-hour average background ozone (O₃), nitrogen dioxide (NO₂), carbon monoxide (CO) and particulates < 10 μm (PM₁₀) increase the risk of hospital emergency department (ED) presentations for asthma among children., Design, Setting and Subjects: A time-stratified case-crossover method was used to analyse data of 603 children and young adults aged 0-19 years who were resident in a south-west metropolitan area of Perth, Western Australia, and who had presented with asthma at any public ED within Perth between 1 January 2002 and 31 December 2006. Effect sizes were assessed in relation to age group, sex and season of exposure. City-wide background air pollution was estimated from air monitoring network data., Main Outcome Measures: ED presentation with asthma., Results: Patients 0-4 years with 1-day lagged exposure to NO₂ and CO showed the most significant risk of ED presentation for asthma. An interquartile range (IQR) increase in NO₂ resulted in an odds ratio (OR) of 1.70 (95% CI, 1.08-2.69). An IQR increase in CO resulted in an OR of 1.40 (95% CI, 1.06-1.84)., Conclusions: The effect sizes observed in this study were higher than those of past studies, and indicated that children aged 0-4 years were the most vulnerable to the effects of air pollution. The period of exposure most clinically relevant is the day before ED presentation.

Background: Bushfire smoke contains a range of air toxics. To prevent inhalation of these toxics, fire fighters use respiratory equipment. Yet, little is known about the effectiveness of the equipment on the fire ground. Experimental trials in a smoke chamber demonstrated that, the particulate/organic vapor/formaldehyde (POVF) filter performed best under simulated conditions. This article reports on the field validation trials during prescribed burns in Western Australia., Methods: Sixty-seven career fire fighters from the Fire and Emergency Services Authority of Western Australia were allocated one of the three types of filters. Spirometry, oximetry, self-reported symptom, and personal air sampling data were collected before, during and after exposure to bushfire smoke from prescribed burns., Results: Declines in FEV(1) and SaO(2) were demonstrated after 60 and 120 min exposure. A significant higher number of participants in the P filter group reported increases in respiratory symptoms after the exposure. Air sampling inside the respirators demonstrated formaldehyde levels significantly higher in the P filter group compared to the POV and the POVF filter group., Conclusions: The field validation trials during prescribed burns supported the findings from the controlled exposure trials in the smoke chamber. Testing the effectiveness of three types of different filters under bushfire smoke conditions in the field for up to 2 hr demonstrated that the P filter is ineffective in filtering out respiratory irritants. The performance of the POV and the POVF filter appears to be equally effective after 2 hr bushfire smoke exposure in the field.

An assessment of potential health impacts of dioxin and dioxin-like compounds in recycled water for indirect potable reuse was conducted. Toxic equivalency factors (TEFs) for 2,3,7,8-substituted polychlorinated dibenzo-p-dioxins (PCDD) and dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (PCBs) congeners have been developed by the World Health Organization to simplify the risk assessment of complex mixtures. Samples of secondary treated wastewater in Perth, Australia were examined pre-and post-tertiary treatment in one full-scale and one pilot water reclamation plant. Risk quotients (RQs) were estimated by expressing the middle-bound toxic equivalent (TEQ) and the upper-bound TEQ concentration in each sampling point as a function of the estimated health target value. The results indicate that reverse osmosis (RO) is able to reduce the concentration of PCDD, PCDF and dioxin-like PCBs and produce water of high quality (RQ after RO=0.15). No increased human health risk from dioxin and dioxin-like compounds is anticipated if highly treated recycled water is used to augment drinking water supplies in Perth. Recommendations for a verification monitoring program are offered.

Background: Hepcidin, a key regulator of iron homeostasis, is increased in response to inflammation and some infections, but the in vivo role of hepcidin, particularly in children with iron deficiency anemia (IDA) is unclear. We investigated the relationships between hepcidin, cytokines and iron status in a pediatric population with a high prevalence of both anemia and co-morbid infections., Methodology/principal Findings: African refugee children <16 years were consecutively recruited at the initial post-resettlement health check with 181 children meeting inclusion criteria. Data on hematological parameters, cytokine levels and co-morbid infections (Helicobacter pylori, helminth and malaria) were obtained and urinary hepcidin assays performed. The primary outcome measure was urinary hepcidin levels in children with and without iron deficiency (ID) and/or ID anaemia (IDA). The secondary outcome measures included were the relationship between co-morbid infections and (i) ID and IDA, (ii) urinary hepcidin levels and (iii) cytokine levels. IDA was present in 25/181 (13.8%). Children with IDA had significantly lower hepcidin levels (IDA median hepcidin 0.14 nmol/mmol Cr (interquartile range 0.05-0.061) versus non-IDA 2.96 nmol/mmol Cr, (IQR 0.95-6.72), p<0.001). Hemoglobin, log-ferritin, iron, mean cell volume (MCV) and transferrin saturation were positively associated with log-hepcidin levels (log-ferritin beta coefficient (beta): 1.30, 95% CI 1.02 to 1.57) and transferrin was inversely associated (beta: -0.12, 95% CI -0.15 to -0.08). Cytokine levels (including IL-6) and co-morbid infections were not associated with IDA or hepcidin levels., Conclusions/significance: This is the largest pediatric study of the in vivo associations between hepcidin, iron status and cytokines. Gastro-intestinal infections (H. pylori and helminths) did not elevate urinary hepcidin or IL-6 levels in refugee children, nor were they associated with IDA. Longitudinal and mechanistic studies of IDA will further elucidate the role of hepcidin in paediatric iron regulation.