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A textbook model of a contagious disease, the dynamics of which are represented by the SIS epidemic model with saturating treatment, is considered. I show that this model, as originally formulated, is not dimensionally consistent. The model can be fixed by including a dimensional constant [alpha] of value one (with units individuals[superscript -1]). At first sight, it appears that this is a cosmetic book-keeping exercise that will have no flow-on effects on the analysis of the model. In fact, we will discover that setting the value [alpha]=1 individuals[superscript -1] produces very unrealistic outcomes and that the parameter must have value [alpha]<<1 individuals[negative 1]. Necessary skills for students to work through this model are an understanding of steady-state solutions and linearized stability for a scalar differential equation and, most importantly, an understanding of units.

Australian and New Zealand universities commenced a new academic year in February/March 2020 largely with "business as usual." The subsequent Covid-19 pandemic imposed unexpected disruptions to anatomical educational practice. Rapid change occurred due to government-imposed physical distancing regulations from March 2020 that increasingly restricted anatomy laboratory teaching practices. Anatomy educators in both these countries were mobilized to adjust their teaching approaches. This study on anatomy education disruption at pandemic onset within Australia and New Zealand adopts a social constructivist lens. The research question was "What are the perceived disruptions and changes made to anatomy education in Australia and New Zealand during the initial period of the Covid-19 pandemic, as reflected on by anatomy educators?." Thematic analysis to elucidate "the what and why" of anatomy education was applied to these reflections. About 18 anatomy academics from ten institutions participated in this exercise. The analysis revealed loss of integrated "hands-on" experiences, and impacts on workload, traditional roles, students, pedagogy, and anatomists' personal educational philosophies. The key opportunities recognized for anatomy education included: enabling synchronous teaching across remote sites, expanding offerings into the remote learning space, and embracing new pedagogies. In managing anatomy education's transition in response to the pandemic, six critical elements were identified: community care, clear communications, clarified expectations, constructive alignment, community of practice, ability to compromise, and adapt and continuity planning. There is no doubt that anatomy education has stepped into a yet unknown future in the island countries of Australia and New Zealand.

Undergraduate education in the health professions is intended to produce competent health professional graduates. Infection prevention and control (IPC) is a necessary element of daily practice in many health professions, to safeguard patients and staff, however previous research has established poor knowledge and implementation of IPC precautions despite escalating rates of potentially lethal healthcare-associated infections (HAIs) across the globe. This paper will discuss three key areas of influence for graduates' IPC knowledge, intentions and practice: perceptions of science, health behaviour beliefs (perceived risk and self-efficacy) and applied knowledge (microbiology). To date, each of these areas have been researched individually however there is an urgent need for improved synthesis and integration of these factors in curriculum planning and design, both inside and outside the classroom, to enhance the development of competent, work-ready graduates.

The present research studied the symptomatologic overlap of AD/HD behaviours and retention of four primitive reflexes (Moro, Tonic Labyrinthine Reflex [TLR], Asymmetrical Tonic Neck Reflex [ATNR], Symmetrical Tonic Neck Reflex [STNR]) in 109 boys aged 7-10 years. Of these, 54 were diagnosed with AD/HD, 34 manifested sub-syndromal coordination, learning, emotional and/or behavioural symptoms of AD/HD, and 21 had no (or near to no) symptoms of AD/HD. Measures of AD/HD symptomatology and of the boys' academic performance were also obtained using the Conners' rating scale and the WRAT-3, respectively. Results indicated that, in general, boys diagnosed with AD/HD had significantly higher levels of reflex retention than non-diagnosed boys. Results also indicated both direct and indirect relationships between retention of the Moro, ATNR, STNR and TLR reflexes with AD/HD symptomatology and mathematics achievement. The pattern of relationships between these variables was also consistent with the notion of the Moro acting as a gateway for the inhibition of the other three reflexes. (Contains 8 tables and 1 figure.)

Victorian local governments (LGs) are required to develop evidence-based Municipal Public Health and Wellbeing Plans (MPHWPs) that improve health and wellbeing. This study evaluated the implementation of this requirement across 79 LGs. Evidence in 116 documents was categorised by source, issue, and policy specificity. Over 11,000 evidence-occurrences from 200 sources were recorded. More evidence on social determinants was identified than on epidemiology or health behaviours. Most (96%) evidence was descriptive and only 4% supported MPHWP actions. The results suggest the community is an important source of novel interventions, and proposes three related reasons for the dearth of intervention level evidence.

A "citizen science" outreach program was aimed at high school students in Western Australia with a focus on agricultural sciences. The program had two main objectives: the collection of samples and the mapping of the distribution of the leaf disease powdery mildew of barley across the state; and support for the teaching and learning of agricultural science. Nearly one thousand students participated in the Mildew Mania intervention that involved class experimental work for a Curtin University GRDC-funded project and interactions with scientists visiting schools. Alongside this, data was collected about attitudes towards agricultural science. Following the intervention, a moderate effect size (0.45) is reported for students wanting to learn more about investigative work on agricultural issues. Attitudinal data showed a negative correlation of interest in agriculture with the Index of Community Socio-Economical Advantage (ICSEA), and an increase in interest in careers in agriculture with older students. Limitations are the constraints in gaining appropriate permissions and consent for all parties to use survey data.

Epidemiology is the study of the distribution of disease in human populations. This means that authentically teaching primary data collection in epidemiology is difficult as students cannot easily access suitable human populations. Using an action research methodology, this paper studied the use of a virtual human population (called "The Island") to enable students to experience many features of authentic primary data collection in epidemiological research. "The Island" was used in a course introducing epidemiology and biostatistics for students in non-quantitative disciplines. This paper discusses how "The Island" was introduced into the course, and then evaluates the change. Students were highly engaged, and students and teaching staff responded favourably to the use of "The Island," with 70% of students agreeing or strongly agreeing that "The Island" was easy to use, and 64% agreeing or strongly agreeing that the use of a virtual population was beneficial to their understanding of epidemiology.

Purpose: The purpose of this study was to provide an epidemiological profile of injuries sustained by participants in fitness activities in Victoria, Australia, based on hospital admissions and emergency department (ED) presentations and to identify the most common types, causes, and sites of these injuries. Method: Hospital-treated fitness activity-related injury cases were identified from International Classification of Disease activity codes (for admissions) and from text narratives of injury events (for ED presentations) from 2003 to 2010, inclusive. Cases were categorized as being associated with aerobics/group exercise (n = 252), resistance/weight training (n = 830) or "other equipment" (motorized and general gym equipment; n = 1,156). Participation information was taken from the Exercise, Recreation and Sport Survey. Results: Overall, 2,238 cases were identified and 11.6% of all patients with ED presentations were subsequently hospitalized. Those participants with aerobics cases were generally female (76.6%) and aged 25 to 34 years old (35.3%), with injuries to the lower limbs (59.1%) and due to falls (57.9%). Resistance-training injuries increased significantly during the 8-year period (by 215.7%; 95% CI [133.5, 326.9]) and generally occurred in male participants (78.0%), in people aged 15 to 24 years old (36.4%), and with injuries to the upper limbs (45.1%) caused by being hit, struck, or crushed by weights or fellow exercisers (71.4%). The "other equipment" cases were equally distributed by gender; they occurred most commonly in people aged 15 to 24 years old (27.8%), with injuries to the lower limbs (41.5%) and due to falls (57.6%). Across all categories, dislocations, sprains, and strains were the most common injury types. Conclusions: Fitness activity-related injury prevention strategies should be targeted at different subgroups according to the type of fitness activity being undertaken.

Evidence-based parent-training programmes aim to reduce child behaviour problems; however, the effects of these programmes are often limited by poor participation rates. This study proposes a model of parent, child and family factors related to parental participation in parenting interventions. A computer-assisted telephone interview was used to survey parents of 4- to 7-year-old children (N = 2999). Logistic regression analyses showed that several parent and child variables were predictive of participation. In contrast, family variables, and other parent and child variables were not. Hierarchical multiple logistic regression showed that parental help-seeking behaviour and parenting style were the only significant predictors of participation. Mediation analyses found that help-seeking behaviour was a mediator between perceived child behaviour problems and participation, help-seeking behaviour was a mediator between parental depression and participation, perceived child behaviour problems was a partial mediator between parenting style and participation and parental depression was a partial mediator between perceived child behaviour problems and participation. Overall, the model was partially supported. The results extend previous research into parental participation in parenting programmes.

Following a biopsychosocial model, the study investigated the role of child factors (gender, IQ), maternal factors (psychological distress, maternal education and vocabulary, maternal distress) and environmental factors (SES) in the relationship between language impairment and behaviour problems in preschool children. Participants were drawn from the Early Language in Victoria Study (ELVS) a prospective, longitudinal study examining the epidemiology and natural history of language impairment. The study reports on 1257 participants from the ELVS who completed questionnaires at 2 and 4 years and also completed face-to-face assessments at 4 years of age. Information was collected on child language, non-verbal cognition and social-emotional development; maternal vocabulary, maternal psychological distress and parent--child interaction; and SES. This study showed that language impairment is specifically associated with hyperactivity and peer problems but not anxiety and conduct problems at the preschool stage. Children with language impairment were at a higher risk for clinical levels of 'abnormal' behaviour which could lead to a psychiatric diagnosis than typically developing children. An examination of biopsychosocial variables associated with language and behaviour revealed that although language ability was a predictor of behaviour at both 2 years and 4 years of age, maternal distress was a stronger predictor of behaviour, with the association stronger for boys than for girls. Early intervention directed to children, especially boys, with language impairment deserves further attention, especially during the preschool period, in order to ameliorate the impact of language impairment on peer relationships and disruptive behaviour in later school years.

The fatal effect of the Hendra virus was noticed first in Queensland, Australia in 1994 when several horses died from an "unidentified cause". This was followed by the death of trainers and veterinarians called to assist affected horses. It is now known that the "unidentified cause", is a virus harboured in native Australian fruit bats. It is transmitted to horses when the bats are under stress due to lack of food, severe meteorological conditions and habitat destruction caused by both weather and urbanisation. This paper details how new biological knowledge and understanding of emerging viruses, in this case Hendra, can be used to foster high school students' interest in learning about disease, in particular the virus as a causative agent, enhance their understanding of biodiversity and appreciate the need for Australia's strict quarantine legislation. Opportunities for incorporation of these into classroom practice are highlighted throughout the paper and referenced to the Australian Curriculum F-10 Science and Senior Secondary Curriculum Biology (http:// www.australiancurriculum.edu.au). The paper provides a current, succinct summary of knowledge and understanding about the Hendra virus suitable for high school students with cited references garnered from Australian government and CSIRO websites and research publications--the latter providing more in-depth content if sought by students. For Australian students, an understanding of the Hendra virus and its life cycle is pertinent given Australia's unique biodiversity. High media attention and research investment, knowledge about the pathology of Hendra and the ecology of Australian fruit bats is now beginning to be understood. Up to July 2013, over thirty-six properties have been affected, involving the death of eighty horses, four people and two dogs. In 2012, a vaccine became available for horses but not for humans. Since the first identification of Hendra, horse owners have become aware of the pathology of this virus and, its effects on horses and people. From an international perspective, the emergence of this virus highlights once again the potential of zoonotic viruses to wreak havoc on ecosystems, livestock and people. Hendra is lethal and remains a rare disease.

The International Collaboration for Autism Registry Epidemiology (iCARE) is the first multinational research consortium (Australia, Denmark, Finland, Israel, Norway, Sweden, USA) to promote research in autism geographical and temporal heterogeneity, phenotype, family and life course patterns, and etiology. iCARE devised solutions to challenges in multinational collaboration concerning data access security, confidentiality and management. Data are obtained by integrating existing national or state-wide, population-based, individual-level data systems and undergo rigorous harmonization and quality control processes. Analyses are performed using database federation via a computational infrastructure with a secure, web-based, interface. iCARE provides a unique, unprecedented resource in autism research that will significantly enhance the ability to detect environmental and genetic contributions to the causes and life course of autism.

Objective: To develop a totally online reality-based course that engages students and enables the development of enhanced teamwork and report-writing skills. Setting: Outbreaks of infectious diseases impacts upon commerce, trade and tourism as well as placing strains on healthcare systems. A general course introducing university students to epidemiology and public health would help public education into the consequences of worldwide outbreaks. Methods: Scaffolding of course activities was used to enable students to build upon skill acquisition and development. Student feedback was used to continuously improve the course. Results: The course enables around 80 students per year to engage efficiently and effectively with the courseware. Student satisfaction was high and has improved with fine-tuning of the course. Conclusions: We have developed an effective team-based course that has high student engagement and satisfaction. The model could be used to effectively deliver other science-based courses online.

Individuals with dementia carry an additional health burden of multiple comorbid conditions. Effectively assessing and treating these comorbid conditions requires the medical specialist to be aware of, understand, and manage the effects of dementia on their clinical subspecialty practice. This ecological study describes the dementia-related education available to medical specialists in Australia outside the domains of geriatrics, neurology, and psychiatry. The dementia-related content of specialist medical training curricula and dementia-related information published in high-impact medical journals between 2000-2012 was reviewed. Dementia-related education was found to be absent from the training curricula for 14 of the medical specialties within Australia. And less than 0.10% (1,921 articles) of the more than two million articles published in the 138 journals assessed were dementia related.

Purpose: To draw on multiple sources of information to determine prevalence of speech and language impairment in young Australian children. Method: Information about 4,983 children (ages 4-5 years) from Growing Up in Australia: The Longitudinal Study of Australian Children (Australian Institute of Family Studies, 2007) was obtained via parent interviews and questionnaires, teacher questionnaires, and direct assessment. Data were statistically weighted to the Australian population of 253,202 children in the target age group. Results: "Parent-reported prevalence": 25.2% had concerns about how their child talked and made speech sounds (11.8% "concerned"; 13.4% "a little concerned"), and 9.5% had concerns about how their child understood language (4.4% "concerned"; 5.1% "a little concerned"). Parents who reported concerns identified "speech not clear to others" as the most frequent area of difficulty (12.0%). "Teacher-reported prevalence": 22.3% of children were considered to be less competent than others in their expressive language ability (6.7% "much less competent"; 15.6% "less competent"); 16.9% were considered to be less competent than others in their receptive language ability (4.0% "much less competent"; 12.9% "less competent"). The match between parent and teacher identification was higher for expressive speech and language concern than for receptive language. "Direct assessment": 13.0% of children were 1-2 "SD"s below the mean on the Adapted Peabody Picture Vocabulary Test-III (S. Rothman, 2003), and a further 1.7% were greater than 2 SDs below the mean. Parent and teacher reports were significantly correlated with scores obtained via direct assessment. "Period prevalence": Parents and teachers reported that 14.5% of children had accessed speech-language pathologist (SLP) services. 2.2% indicated that they needed but could not access an SLP. Conclusion: Multiple indicators of speech and language impairment in diverse contexts confirmed the high prevalence of this condition in early childhood and a concomitant need for SLP services.

The aim of this study was to summarize both practical and methodological issues in using pedometers to assess physical activity in a large epidemiologic study. As part of a population-based survey of cardiovascular disease risk factors, physical activity was assessed using pedometers and activity diaries in 775 men and women ages 25-64 years who were residents of Burnie, Tasmania, 1998-99. Common data problems were classified by type. The frequency of each problem and the methods used to identify it are reported along with strategies to correct or prevent each problem type. Pedometer data from 15 (1.9%) participants could not be used due to errors in completing the pedometer protocol. Among 760 participants with usable data, the median number of steps was 9,729 for men and 10,388 for women. Pedometer steps per day were modestly correlated (r = 0.20, p less than 0.0001) with the duration of pedometer wear, which ranged from 4.50 to 21.75 hr. Adjustment for wear time, however, did not alter observed correlations between pedometer steps and cardiovascular risk factors. The authors conclude that pedometers can be used in large population studies with a relatively low frequency of data errors. However, guidelines for consistent data collection and interpretation are needed. (Contains 4 tables and 2 figures.)

The promotion of suicide and description of suicide methods on the Internet have led to widespread concern that legal control is mandated. Apart from value concerns pertaining to attitudes about suicide, the guarantee of freedom of expression presents a serious challenge to the introduction of restrictive laws. Recent developments in Australia and Europe are presented, noting jurisdictional complexity as an obstacle to effective application. Finally, scientific data of an epidemiological nature are revealed to be insufficient to warrant making causal assertions about the Internet and its relation to suicidal acts, including those of vulnerable populations. Recommendations are made with respect to public education, suicide prevention, and future research.

The paper reports epidemiological and phenomenological investigations of aberrant eating among 347 pre-adolescent children in court-ordered foster and kinship care, in New South Wales, Australia. A quarter of children displayed clinically significant aberrant eating problems, with no evidence of gender or age effects. Two distinct patterns were identified. The first is a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity (termed "Food maintenance" syndrome), resembling the behavioral correlates of Hyperphagic Short Stature (Psychosocial Dwarfism). Various data suggest this pattern is primarily triggered by acute stress, including maltreatment in care, against a background of complex psychopathology and developmental disabilities. The second is a cluster of pica-type eating behaviors that correlates with self-injurious behavior, and is closely associated with developmental disabilities. The paper includes recommendations for clinicians working with pre-adolescent children in care.

As part of a broader study on Indigenous illegal drug use, the authors undertook skills training to increase cross-cultural mutual understanding of the often different approaches and methodologies between research and practice, as well as Aboriginal and non-Aboriginal understandings of these approaches. The study and the skills transfer training were part of a longer-term partnership between Winnunga Nimmityjah Aboriginal Health Service and the National Centre for Epidemiology and Population Health at The Australian National University, Canberra, Australia. The authors describe the skills transfer process involving specific training in the ethical issues relating to research generally and this particular study, research funding processes, basic epidemiological and biostatistical concepts, and aspects of interviewing and questionnaire design. They use five vignettes to illustrate how the skills transfer process fulfilled their broader aim related to the ethical conduct of research with Aboriginal and Torres Strait Islander communities. (Contains 2 footnotes and 2 tables.)

This article on young adults with brain damage in New South Wales (Australia) focuses on epidemiological considerations and implications for management. Jointly planning for provision of services for individuals who have either congenital or acquired brain damage is recommended, in view of their similar needs. (JDD)

The objective of this article is to summarise the current knowledge regarding the prevalence of six rheumatological conditions in indigenous Australians – rheumatoid arthritis (RA), osteoarthritis (OA), osteoporosis (OSP), systemic lupus erythematosus (SLE), gout and musculoskeletal (MSK) pain. Online medical literature databases were searched for 'indigenous', 'Aboriginal' and 'Torres Strait Islander', as well as the names of the six conditions. Other included search terms were 'crystal', 'urate', 'arthritis' and 'arthropathy'. No limitations were placed on publication data or language. Forty‐five articles examining the prevalence of the six conditions were identified. Based on the published literature, SLE appears to have a higher prevalence, while RA appears to have a lower prevalence in indigenous Australians compared to the non‐indigenous community. MSK pain is prevalent, has a significant impact on indigenous people and is perceived as an important area of need. There is a paucity of data regarding these conditions in indigenous Australians. This may be impacted by the uncertainty of case ascertainment by self‐report, differences in disease phenotypes and prevalence between the metropolitan compared to the rural or remote indigenous population, and difficulty with access to healthcare. Further studies in conjunction with local indigenous communities are needed to accurately determine the burden of rheumatological disease in the indigenous population. This will assist with resource and workforce planning to deliver culturally appropriate interventions. Strategies for future clinical work and research include the development and dissemination of culturally safe rheumatology resources, rheumatology training of Aboriginal Health Workers and wider integration of rheumatology clinics into community‐controlled Aboriginal Health Services. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine the proportion of Australians dispensed psychotropic medications between 2013 and 2022 according to their age. Methods: Services Australia provided a de-identified 10% random Pharmaceutical Benefits Scheme sample that allowed us to determine, for each year, the proportion of Australians dispensed at least one script for antipsychotics, antidepressants, anxiolytics, or hypnotics. The classification of medications followed Anatomical Therapeutic Chemical coding. Participants were stratified into 10-year age groups from 0–9 to ⩾90 years, and sex was coded as male/female. We retrieved population numbers from the Australian Bureau of Statistics. Results: The number of records per year ranged from 1,540,520 to 1,746,402, and 54.10% were for females. A greater proportion of older adults, particularly those aged ⩾70 years, were dispensed antipsychotics, antidepressants, anxiolytics and hypnotics than any other age group. The proportion of people who dispensed antipsychotics, anxiolytics and hypnotics declined between 2013 and 2022 but increased for antidepressants, most markedly for adolescents and young adults. Females were more frequently dispensed antidepressants, anxiolytics and hypnotics than males, but males were more frequently dispensed antipsychotics than females, albeit not in later life. Conclusion: Older age groups and females are the most frequent recipients of psychotropic medications dispensed in Australia. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disabilities are at much higher risk of preventable deaths compared to the general community. However, studies identifying the cause of death in people with intellectual disability are generally based on one primary cause which is frequently attributed to the person's disability. Therefore, the aim of this study was to identify the most common associated causes that may have contributed to the deaths of Australians with intellectual or learning disabilities, particularly those that may be avoidable. Methods: Linked data that had previously been used to identify underlying causes of deaths were re‐analysed to determine other contributing causes of death in Australians with intellectual disabilities aged under 65 years who accessed disability services between July 2013 and June 2018. Findings: Two thousand three hundred and thirty‐three deaths occurred among 180,790 people with intellectual disability. Contributing causes of death with the greatest disparities compared to the general community were lung diseases due to external agents (adjusted rate ratio (RR) 70.6 (95% confidence interval [95% CI] 63.7–78.2), influenza and pneumonia (RR 18.3; 95% CI 16.4–20.4), and coronary heart disease (RR 3.3; 95% CI 2.8–3.8). Conclusions: Analysing all contributing causes of death in people with intellectual disabilities can ensure that the higher rates of preventable deaths in people with intellectual disability are identified and addressed earlier in the disability and health sectors. Accessible Summary: Only one major cause of a person's death is usually counted, but other information on contributing causes is often available.We used national data across Australia to look at contributing causes of death in people with intellectual or learning disabilities.Counting contributing causes of death is important because it can help to find ways that deaths of people with intellectual disabilities may be prevented.We found that people with intellectual disabilities were much more likely than other people to have contributing causes of death from lung infections, choking, flu and heart problems.Knowing that these causes happen more often in people with intellectual disabilities, can help health and disability services to identify these causes earlier and may prevent deaths. [ABSTRACT FROM AUTHOR]

The recognition of Pseudomonas stutzeri as a cause of infections in humans has been increasing. However, only case reports and small series of P. stutzeri bloodstream infections have been published. Epidemiological data on these infections are extremely scarce. Our objective was to describe the incidence, epidemiology, antimicrobial resistance rates, and outcomes of P. stutzeri bloodstream infections in a large population-based cohort in Australia. Retrospective, laboratory-based surveillance study conducted in Queensland, Australia (population ≈ 5 million) during 2000–2019. Clinical information was obtained from public hospital admissions and vital statistics databases. In total, 228 episodes of P. stutzeri bloodstream infections were identified. Increased incidence was observed in the later years, especially in older men, and was higher during the rainy months of the year and in the warmest and more humid regions of the state. The majority of bloodstream infections were community-onset with 120 (52.6%) community-associated and 59 (25.9%) ambulatory healthcare-associated episodes. Only 49 cases (21.5%) were nosocomial. The most common foci of infection were skin and soft tissue, lower respiratory tract, and intra-abdominal. No isolate showed antimicrobial resistance. Thirty-one patients (13.6%) died. The mortality rate in patients with a respiratory infectious source was higher (21%). P. stutzeri bloodstream infection was predominantly a community-onset condition including ambulatory healthcare related cases, with increasing incidence, especially in older males. No antimicrobial resistance was observed. Mortality was high in patients with respiratory infectious source. This new observational data have implications when considering the epidemiology of these infections and for patient management. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is a global pandemic, however, estimating its burden is a complex process. As a result, many countries rely on global estimates to infer burden within their own setting. With a growing number of recent publications quantifying AMR burden in Australia, and an expansion of surveillance programs, enumerating AMR mortality for Australia is feasible. We aimed to leverage existing published data to assess methodological factors contributing to the considerable variation in AMR-related mortality and provide two reliable estimates of AMR mortality in Australia. This is a necessary step towards generating meaningful measures of AMR burden in Australia. What is known about the topic? Antimicrobial resistance is a significant global health threat, but estimating the burden of disease is complicated by data challenges. What does this paper add? This paper highlights progress in estimating the number of people dying from antimicrobial resistance in Australia and highlights the importance of rigorous antimicrobial resistance mortality estimates in Australia to assess burden of disease. What are the implications for practitioners? Practitioners should use only rigorous estimates of burden of disease to inform actions on reducing the threat of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Objectives: To examine changes in multiple myeloma incidence and mortality rates during 1982–2018, and to estimate its incidence, mortality, and prevalence for 2019–2043. Study design: Population‐based statistical modelling study; analysis of and projections based on Australian Institute of Health and Welfare multiple myeloma incidence, mortality, and survival data. Setting: Australia, 1982–2018 (historical data) and projections to 2043. Main outcome measures: Changes in multiple myeloma incidence and mortality rates, 1982–2018, determined by joinpoint regression analysis (age‐standardised to 2021 Australian population); projection of rates to 2043 based on age–period–cohort models; estimated 5‐ and 30‐year prevalence of multiple myeloma (modified counting method). Results: The incidence of multiple myeloma increased during 1982–2018 (eg, annual percentage change [APC], 2006–2018, 1.9%; 95% confidence interval [CI], 1.7–2.2%), but the mortality rate declined during 1990–2018 (APC, –0.4%; 95% CI, –0.5% to –0.2%). The age‐standardised incidence rate was projected to increase by 14.9% during 2018–2043, from 8.7 in 2018 to 10.0 (95% CI, 9.4–10.7) new cases per 100 000 population in 2043; the mortality rate was projected to decline by 27.5%, from 4.0 to 2.9 (95% CI, 2.6–3.3) deaths per 100 000 population. The annual number of people newly diagnosed with multiple myeloma was estimated to increase by 89.2%, from 2120 in 2018 to 4012 in 2043; the number of deaths from multiple myeloma was projected to increase by 31.7%, from 979 to 1289. The number of people living with multiple myeloma up to 30 years after initial diagnosis was projected to increase by 163%, from 10 288 in 2018 to 27 093 in 2043, including 13 019 people (48.1%) diagnosed during the preceding five years. Conclusion: Although the decline in the mortality rate was projected to continue, the projected increases in the incidence and prevalence of multiple myeloma in Australia over the next 25 years indicate that investment in prevention and early detection research, and planning for prolonged treatment and care, are needed. [ABSTRACT FROM AUTHOR]

The discovery of tomato spotted wilt virus (TSWV) was an important finding in Australian science, involving a self-educated field naturalist and a small team of plant pathologists who had to work in relative academic isolation and with inadequate glasshouse facilities. After its discovery in Melbourne in 1915, TSWV rapidly spread throughout Australia and by 1929, it posed an existential threat to the tomato industry. To address this problem, a joint project between the Waite Agricultural Research Institute and the Council for Scientific and Industrial Research was initiated in 1926. This collaboration, led by University of Adelaide plant pathologist Geoffrey Samuel, was initially turbulent but ultimately highly productive. Within an eight-year period, significant advances were made in understanding the aetiology of the disease, particularly by establishing that it was caused by a thrips-transmitted virus. Aspects of the epidemiology and control of the virus were also elucidated such as investigating alternative hosts of the virus. This research was made possible through substantial improvements in mechanical inoculation techniques. Tomato spotted wilt virus (TSWV) is one of the most economically important viruses in the world. Before it became a global problem, it devastated tomato crops in Australia. This paper describes how TSWV was identified and biologically characterised by Australian scientists at a time when few techniques existed to detect the virus. It is a remarkable story of human endeavour by a small team of people working in academic isolation. [ABSTRACT FROM AUTHOR]

Background: Highly effective hepatitis C therapies are available in Australia. However, people living with hepatitis C face various barriers to accessing care and treatment. Aims: To identify gaps in the cascade of care for hepatitis C and generate estimates of the number living with untreated infection according to population group, using a representative longitudinal study population. Methods: We linked hepatitis C notification data from Victoria to national pathology, prescribing and death registry data. We assessed receipt of key clinical services in a large cohort who tested positive for hepatitis C from 1 January 2000 to 31 December 2016, with follow‐up to 30 June 2018. We estimated the number still living with hepatitis C, adjusting for spontaneous clearance and mortality. Results: The cohort comprised 45 391 people positive for hepatitis C. Of these, 13 346 (29%) received treatment and an estimated 28% (95% confidence interval (CI): 26–30%) were still living with chronic infection at 30 June 2018, with the remainder still living following spontaneous clearance (30%, 95% CI: 29–32%) or having died (12%, 95% CI: 12–12%). Half (50%) of those still living with hepatitis C were born from 1965 to 1980, and 74% first tested positive before 2011. Conclusions: Despite an enabling policy environment and subsidised therapy, many people in this cohort were not treated. Increased measures may be needed to engage people in care, including those who acquired hepatitis C more than 10 years ago. [ABSTRACT FROM AUTHOR]

Introduction: Farm workers are at high risk for injuries, and epidemiological data are needed to plan resource allocation. Objective: This study identified regions with high farm‐related injury rates in the Barwon South West region of Victoria, Australia, for residents aged ≥50 yr. Design: Retrospective synthesis using electronic medical records of emergency presentations occurring during 2017–2019 inclusive for Local Government Areas (LGA) in the study region. For each LGA, age‐standardised incidence rates (per 1000 population/year) were calculated. Findings: For men and women combined, there were 31 218 emergency presentations for any injury, and 1150 (3.68%) of these were farm‐related. The overall age‐standardised rate for farm‐related injury presentations was 2.6 (95% CI 2.4–2.7); men had a higher rate than women (4.1, 95% CI 3.9–4.4 versus 1.2, 95% CI 1.0–1.3, respectively). For individual LGAs, the highest rates of farm‐related emergency presentations occurred in Moyne and Southern Grampians, both rural LGAs. Approximately two‐thirds of farm‐related injuries occurred during work activities (65.0%), and most individuals arrived at the hospital by transport classified as "other" (including private car, 83.3%). There were also several common injury causes identified: "other animal related injury" (20.2%), "cutting, piercing object" (19.5%), "fall ⟨1 m" (13.1%), and "struck by or collision with object" (12.5%). Few injuries were caused by machinery (1.7%) and these occurred mainly in the LGA of Moyne (65%). Discussion and Conclusion: This study provides data to inform future research and resource allocation for the prevention of farm‐related injuries. [ABSTRACT FROM AUTHOR]

Understanding the relationship between disability and physical activity and whether it differs across local government jurisdictions may aid in the development of placed-based approaches to reducing disability-related inequalities in physical activity. The objectives of this study were to examine the association between disability and physical activity and assess whether this association varied between Australian Local Government Areas. The sample included 13,315 participants aged 18–64 years from the Household Income and Labour Dynamics Australia Survey, 2017. Participants self-reported disability and physical activity. Linear mixed-effects models estimated the association between disability and physical activity. People with disability reported less physical activity per week. We did not find evidence that this association varied across LGAs. Our findings do not add evidence towards local government-based approaches in Australia to reducing physical activity inequalities between people with and without a disability. [ABSTRACT FROM AUTHOR]

We aimed to report the epidemiology of lower-limb and lumbosacral injuries in Police Force recruits. We performed a cohort study of Police Force recruits undergoing a six-month training program with prospective injury data collected between 2018 and 2021. Cardiorespiratory fitness was quantified by the beep-test and police-specific-functional-capacity was quantified using a specifically designed physical performance evaluation (PPE) tool. Injury frequency and prevalence were reported. Fifteen percent (n = 180) of study Police Force recruits (n = 1,181) sustained a lower-limb or lumbosacral injury. The six-month training program significantly improved cardiorespiratory fitness (p < 0.001) and functional capacity (p < 0.001). Increased cardiorespiratory fitness at baseline decreased injury risk (OR = 0.8, 95%CI: 0.66–0.97, p = 0.019). Injury rates decreased over time and females were injured significantly earlier than males (HR = 0.70, 95%CI: 0.52 to 0.95, p = 0.021). Interventions that can pre-condition Police Force recruits prior to the commencement of their basic physical training may reduce the number of lower-limb and lumbosacral injuries. [ABSTRACT FROM AUTHOR]

Low fitness and obesity at midlife are individually associated with later‐life decline in cognition and health. However, the relationship between profiles of midlife fitness and obesity with midlife cognition is unclear and was examined by this study. Participants from the third follow‐up of the Childhood Determinants of Adult Health study (2014–2019; aged 36–49 years) were assessed for obesity (body mass index [BMI]), cardiorespiratory (physical work capacity) and muscular fitness (isometric grip and leg strength), and these factors were entered into a latent profile analysis. Psychomotor‐attention, learning–working memory and global cognition composites were derived from z‐scores of individual CogState battery tests. Linear regression analyses examined associations between profiles of fitness and obesity with cognition, adjusting for age, sex, education, alcohol and smoking. Using data from 617 participants [44.4 ± 2.6 (mean ± SD) years, 52% female], we identified 5 mutually exclusive profiles of obesity and fitness. Relative to those with the lowest fitness and highest BMI (5% of sample), those with a profile of (1) highest muscular fitness and average BMI (9%), (2) average muscular fitness and BMI (61%) and (3) highest cardiorespiratory fitness (CRF) and below average BMI (7%) all exhibited better global cognition [at least 0.44 (0.12, 0.77) SD, 95% CI] and psychomotor‐attention performance [at least 0.59 (0.27, 0.91) SD, 95% CI]. Compared with low fitness and unhealthy BMI levels, possessing average or high muscular and CRF and a healthy BMI in midlife was associated with better cognitive performance. Enhancing fitness and reducing obesity in midlife could contribute to improved cognitive performance in middle age. Highlights: Profiles containing adults with a combination of low levels of cardiorespiratory and muscular fitness and higher levels of obesity were associated with lower psychomotor‐attention and global cognition at midlife.Possessing average or higher levels of fitness, and lower obesity at midlife, was associated with better cognitive performance at midlife compared to those with lower fitness and unhealthy BMIs.Maintaining fitness and reducing obesity at midlife may contribute to greater cognitive performance at midlife and beyond and reduce the risk of cognitive decline. [ABSTRACT FROM AUTHOR]

This article presents global cancer statistics by world region for the year 2022 based on updated estimates from the International Agency for Research on Cancer (IARC). There were close to 20 million new cases of cancer in the year 2022 (including nonmelanoma skin cancers [NMSCs]) alongside 9.7 million deaths from cancer (including NMSC). The estimates suggest that approximately one in five men or women develop cancer in a lifetime, whereas around one in nine men and one in 12 women die from it. Lung cancer was the most frequently diagnosed cancer in 2022, responsible for almost 2.5 million new cases, or one in eight cancers worldwide (12.4% of all cancers globally), followed by cancers of the female breast (11.6%), colorectum (9.6%), prostate (7.3%), and stomach (4.9%). Lung cancer was also the leading cause of cancer death, with an estimated 1.8 million deaths (18.7%), followed by colorectal (9.3%), liver (7.8%), female breast (6.9%), and stomach (6.8%) cancers. Breast cancer and lung cancer were the most frequent cancers in women and men, respectively (both cases and deaths). Incidence rates (including NMSC) varied from four‐fold to five‐fold across world regions, from over 500 in Australia/New Zealand (507.9 per 100,000) to under 100 in Western Africa (97.1 per 100,000) among men, and from over 400 in Australia/New Zealand (410.5 per 100,000) to close to 100 in South‐Central Asia (103.3 per 100,000) among women. The authors examine the geographic variability across 20 world regions for the 10 leading cancer types, discussing recent trends, the underlying determinants, and the prospects for global cancer prevention and control. With demographics‐based predictions indicating that the number of new cases of cancer will reach 35 million by 2050, investments in prevention, including the targeting of key risk factors for cancer (including smoking, overweight and obesity, and infection), could avert millions of future cancer diagnoses and save many lives worldwide, bringing huge economic as well as societal dividends to countries over the forthcoming decades. [ABSTRACT FROM AUTHOR]

Background: Liver disease is an important contributor to the mortality gap between First Nations Peoples and non-Indigenous Australian adults. Despite a high burden of metabolic comorbidities among First Nations Peoples, data about the epidemiology of metabolic dysfunction-associated steatotic liver disease (MASLD) in this population is scarce. Methods: A retrospective analysis of all adults hospitalized with MASLD or metabolic dysfunction-associated steatohepatitis (MASH) with/without cirrhosis during 2007–2019 in the state of Queensland was performed. Patients were followed from the first admission with MASLD/MASH (identified based on validated algorithms) to decompensated cirrhosis and overall mortality. We explored differences according to Indigenous status using Multivariable Cox regression. Findings: 439 First Nations Peoples and 7,547 non-Indigenous Australians were followed for a median of 4.6 years (interquartile range 2.7–7.2). Overall, women were overrepresented, but more so in the First Nations cohort (72.7% vs. 57.0%, p < 0.001). First Nations patients were younger, a higher proportion lived in remote and socioeconomic disadvantaged areas, and had higher comorbidity compared to non-Indigenous Australians (all p < 0.001). Diabetes, the most common comorbidity affecting both groups, was overrepresented in First Nations Peoples versus non-Indigenous Australians (43.5% vs. 30.8%, p < 0.001, respectively). Nineteen (4.3%) First Nations Peoples and 332 (4.4%) of non-Indigenous patients progressed to cirrhosis decompensation (9.0% [95%CI 4.5–17.7] vs. 7.7% [95%CI 6.6–8.9; p = 0.956] respectively within 10 years). In multivariable analysis, there was no association between Indigenous status and progression to decompensated cirrhosis (p = 0.759) and survival (p = 0.437). Conclusions: This study provides the first population-based epidemiological data on MASLD in First Nations Australians. The high prevalence of diabetes (that is associated with advanced fibrosis and liver disease mortality) among young First Nations Peoples with MASLD raises concern about future risk of progressive liver disease in this patient population. These data highlight the importance of early identification of MASLD, and providing culturally appropriate intervention to reduce disease progression in parallel with the management of cardiometabolic comorbidities. [ABSTRACT FROM AUTHOR]

Background Malaria continues to pose a significant burden in endemic countries, many of which lack access to molecular surveillance. Insights from malaria cases in travellers returning to non-endemic areas can provide valuable data to inform endemic country programmes. To evaluate the potential for novel global insights into malaria, we examined epidemiological and molecular data from imported malaria cases to Australia. Methods We analysed malaria cases reported in Australia from 2012 to 2022 using National Notifiable Disease Surveillance System data. Molecular data on imported malaria cases were obtained from literature searches. Results Between 2012 and 2022, 3204 malaria cases were reported in Australia. Most cases (69%) were male and 44% occurred in young adults aged 20–39 years. Incidence rates initially declined between 2012 and 2015, then increased until 2019. During 2012–2019, the incidence in travellers ranged from 1.34 to 7.71 per 100 000 trips. Cases were primarily acquired in Sub-Saharan Africa (n  = 1433; 45%), Oceania (n  = 569; 18%) and Southern and Central Asia (n  = 367; 12%). The most common countries of acquisition were Papua New Guinea (n  = 474) and India (n  = 277). Plasmodium falciparum accounted for 58% (1871/3204) of cases and was predominantly acquired in Sub-Saharan Africa, and Plasmodium vivax accounted for 32% (1016/3204), predominantly from Oceania and Asia. Molecular studies of imported malaria cases to Australia identified genetic mutations and deletions associated with drug resistance and false-negative rapid diagnostic test results, and led to the establishment of reference genomes for P. vivax and Plasmodium malariae. Conclusions Our analysis highlights the continuing burden of imported malaria into Australia. Molecular studies have offered valuable insights into drug resistance and diagnostic limitations, and established reference genomes. Integrating molecular data into national surveillance systems could provide important infectious disease intelligence to optimize treatment guidelines for returning travellers and support endemic country surveillance programmes. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) incidence is decreasing in the Northern Territory (NT) but still exceeds rates elsewhere in Australia. Deaths and morbidity from advanced TB continue, with delay in diagnosis a contributor to adverse outcomes. Aims: We aimed to describe the delay in diagnosis of TB, identify risk factors for delay and examine the associations between delay and clinical outcomes. Methods: We conducted a historical cohort analysis which included adult inpatients diagnosed with TB at the Royal Darwin Hospital from 2010 to 2020. Patient delay was measured as time from symptom onset to first seeking care, and health system delay was quantified as time from first relevant clinical contact to diagnosis. The sum of these two periods was the total delay. Ethics approval was granted by NT HREC (2020‐3852). Results: Eighty‐four cases were included; the median total delay was 90 days (interquartile range (IQR): 60–121), patient delay was 53 days (IQR: 30–90), and health system delay was 21 days (IQR: 12–45). Patient delay was longer among patients with extrapulmonary (median: 100 days (IQR: 90–105) compared with pulmonary TB patients (39 days (IQR: 27–54), P < 0.0001). Health system delay was longer in those aged ≥45 years (30 days (IQR: 16–51) vs younger patients (14 days (IQR: 8–30), P = 0.007) and among non‐smokers (31 days (IQR: 21–55) vs 21 days (IQR: 10–40), P = 0.048). Median delay was longer among patients with non‐drug‐related complications of disease (P < 0.0001), those admitted to critical care (P < 0.0001), and those with respiratory failure (P = 0.001). Conclusion: The patient delays we report are longer than reported elsewhere in Australia. The next steps will require concerted efforts to improve community awareness of TB and strategies to strengthen health systems through better resourcing and healthcare provider support. [ABSTRACT FROM AUTHOR]

Background Emergency department (ED) clinicians are more frequently providing care, including end-of-life care, to older people. Objectives To estimate the need for ED end-of-life care for people aged ≥65 years, describe characteristics of those dying within 48 hours of ED presentation and compare those dying in ED with those dying elsewhere. Methods We conducted a retrospective cohort study analysing data from 177 hospitals in Australia and New Zealand. Data on older people presenting to ED from January to December 2018, and those who died within 48 hours of ED presentation, were analysed using simple descriptive statistics and univariate logistic regression. Results From participating hospitals in Australia or New Zealand, 10,921 deaths in older people occurred. The 48-hour mortality rate was 6.43 per 1,000 ED presentations (95% confidence interval: 6.31–6.56). Just over a quarter (n = 3,067, 28.1%) died in ED. About one-quarter of the cohort (n = 2,887, 26.4%) was triaged into less urgent triage categories. Factors with an increased risk of dying in ED included age 65–74 years, ambulance arrival, most urgent triage categories, principal diagnosis of circulatory system disorder, and not identifying as an Aboriginal or Torres Strait Islander person. Of the 7,677 older people admitted, half (n = 3,836, 50.0%) had an encounter for palliative care prior to, or during, this presentation. Conclusions Our findings provide insight into the challenges of recognising the dying older patient and differentiating those appropriate for end-of-life care. We support recommendations for national advanced care planning registers and suggest a review of triage systems with an older person-focused lens. [ABSTRACT FROM AUTHOR]

Background: Preclinical studies suggest synergistic effects of maternal inflammatory exposures on offspring neurodevelopment, but human studies have been limited. Objectives: To examine the cumulative association and potential interactions between seven maternal exposures related to inflammation and child attention‐deficit/hyperactivity disorder (ADHD). Methods: We conducted a population‐based cohort study of children born from July 2001 to December 2011 in New South Wales, Australia, and followed up until December 2014. Seven maternal exposures were identified from birth data and hospital admissions during pregnancy: autoimmune disease, asthma, hospitalization for infection, mood or anxiety disorder, smoking, hypertension, and diabetes. Child ADHD was identified from stimulant prescription records. Multivariable Cox regression assessed the association between individual and cumulative exposures and ADHD and potential interaction between exposures, controlling for potential confounders. Results: The cohort included 908,770 children, one‐third (281,724) with one or more maternal exposures. ADHD was identified in 16,297 children (incidence 3.5 per 1000 person‐years) with median age of 7 (interquartile range 2) years at first treatment. Each exposure was independently associated with ADHD, and risk increased with additional exposures: one exposure (hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.54, 1.65), two exposures (HR 2.25, 95% CI 2.13, 2.37), and three or more exposures (HR 3.28, 95% CI 2.95, 3.64). Positive interaction was found between smoking and infection. The largest effect size was found for cumulative exposure of asthma, infection, mood or anxiety disorder, and smoking (HR 6.12, 95% CI 3.47, 10.70). Conclusions: This study identifies cumulative effects of multiple maternal exposures related to inflammation on ADHD, most potentially preventable or modifiable. Future studies should incorporate biomarkers of maternal inflammation and consider gene–environment interactions. [ABSTRACT FROM AUTHOR]

Background Dengue is the most important arboviral disease globally and poses ongoing challenges for control including in non-endemic countries with competent mosquito vectors at risk of local transmission through imported cases. We examined recent epidemiological trends in imported and locally acquired dengue in Australia, where the Wolbachia mosquito population replacement method was implemented throughout dengue-prone areas of northern Queensland between 2011 and 2019. Methods We analysed dengue cases reported to the Australian National Notifiable Disease Surveillance System between January 2012 and December 2022, and Australian traveller movement data. Results Between 2012 and 2022, 13 343 dengue cases were reported in Australia (median 1466 annual cases); 12 568 cases (94.2%) were imported, 584 (4.4%) were locally acquired and 191 (1.4%) had no origin recorded. Locally acquired cases decreased from a peak in 2013 (n  = 236) to zero in 2021–22. Annual incidence of imported dengue ranged from 8.29/100 000 (n  = 917 cases) to 22.10/100 000 (n  = 2203) annual traveller movements between 2012 and 2019, decreased in 2020 (6.74/100 000 traveller movements; n  = 191) and 2021 (3.32/100 000 traveller movements; n  = 10) during COVID-19-related border closures, then rose to 34.79/100 000 traveller movements (n  = 504) in 2022. Imported cases were primarily acquired in Southeast Asia (n  = 9323; 74%), Southern and Central Asia (n  = 1555; 12%) and Oceania (n  = 1341; 11%). Indonesia (n  = 5778; 46%) and Thailand (n  = 1483; 12%) were top acquisition countries. DENV-2 (n  = 2147; 42%) and DENV-1 (n  = 1526; 30%) were predominant serotypes. Conclusion Our analysis highlights Australia's successful control of locally acquired dengue with Wolbachia. Imported dengue trends reflect both Australian travel destinations and patterns and local epidemiology in endemic countries. [ABSTRACT FROM AUTHOR]

Aims: This population‐based study sought to explore in detail the conditions driving the diversification in causes of death among people with diabetes. Methods: We linked Australians with type 1 or type 2 diabetes of all ages on the National Diabetes Services Scheme to the National Death Index for 2002–2019. We investigated the proportional contributions of different causes of death to total deaths over time across eight categories of causes of death, stratified by sex and diabetes type. The underlying causes of death were classified according to the International Classification of Diseases, Tenth Revision codes. Results: Between 2002 and 2019, there was a shift in the causes of death among Australians with diabetes away from cardiovascular disease. The proportion of deaths attributed to cardiovascular disease declined in both sexes (ptrend <0.001), most substantially among women with type 2 diabetes from 48.2% in 2002 to 30.7% in 2019. Among men with type 2 diabetes, cancer replaced cardiovascular disease as the leading cause of death. The proportion of deaths due to dementia increased overall, from 2% in 2002 to over 7% in 2019, and across all age groups, notably from 1% to 4% in those aged 70–79. The proportion of deaths due to falls and Parkinson's disease also increased. Conclusions: There has been a shift of causes of death among those with diabetes away from cardiovascular disease. The proportion of deaths due to conditions such as dementia and falls is increasing among those with diabetes, which will require consideration when planning future resource allocation. [ABSTRACT FROM AUTHOR]

For over a decade, bovine anaemia caused by Theileria orientalis Ikeda has been a significant disease in the Australian cattle industry. In this study, we conducted a spatial and temporal analysis of theileriosis in Australia using historic data from submissions to the New South Wales Department of Primary Industries (NSW DPI) from 2006 to 2022, where herd history, clinical signs, and PCR results were available. Since the first detections of bovine theileriosis in the Sydney area in 2006, the disease spread north- and southward and is now endemic to the southeast coast of Australia, closely mirroring the distribution of the principal vector Haemaphysalis longicornis. Across all years, the prevalence of the Ikeda genotype was 88%, while the prevalence of the benign Chitose and Buffeli genotypes was 55% and 38%, respectively. The majority of submissions were from beef cattle in coastal NSW, with anaemia, fever, jaundice, abortion, and lethargy the most frequently reported clinical signs. Transportation was identified as the major risk factor for disease. Until 2015, the majority of cases were reported in adult cattle, while in later years, calves made up the majority of cases, most likely due to the widespread acquisition of immunity in adults. Calves were significantly more likely to present with diarrhoea, lethargy, and anaemia, and to suffer mortality, while adults were significantly more likely to present with jaundice. Instances of abortion were observed to be significantly associated with beef cattle. The relationship between the level of parasitaemia and anaemia revealed a strong negative correlation for all animals examined. [ABSTRACT FROM AUTHOR]

Objective. Data linkage is a very powerful research tool in epidemiology, however, establishing this can be a lengthy and intensive process. This paper reports on the complex landscape of conducting data linkage projects in Australia. Methods. We reviewed the processes, required documentation, and applications required to conduct multi-jurisdictional data linkage across Australia, in 2023. Results. Obtaining the necessary approvals to conduct linkage will likely take nearly 2 years (estimated 730 days, including 605 days from initial submission to obtaining all ethical approvals and an estimated further 125 days for the issuance of unexpected additionally required approvals). Ethical review for linkage projects ranged from 51 to 128 days from submission to ethical approval, and applications consisted of 9-25 documents. Conclusions. Major obstacles to conducting multi-jurisdictional data linkage included the complexity of the process, and substantial time and financial costs. The process was characterised by inefficiencies at several levels, reduplication, and a lack of any key accountabilities for timely performance of processes. Data linkage is an invaluable resource for epidemiological research. Further streamlining, establishing accountability, and greater collaboration between jurisdictions is needed to ensure data linkage is both accessible and feasible to researchers. [ABSTRACT FROM AUTHOR]

Introduction: The use and costs of mental health services by rural and remote Australian women are poorly understood. Objective: To examine the use of the Better Access Scheme (BAS) mental health services across geographical areas. Design: Observational epidemiology cohort study using a nationally representative sample of 14 247 women from the Australian Longitudinal Study on Women's Health born 1973–1978, linked to the Medical Benefits Schedule dataset for use of BAS services from 2006 to 2015. The number and cost of BAS services were compared across metropolitan and regional/remote areas for women using the mental health services. Findings: 31% of women accessed a BAS mental health service, 12% in rural populations. Overall, 90% of women with estimated high service need had contact with professional services (83% rural vs 92% metropolitan regions). Mean mental health scores were lower for women accessing a BAS service in remote areas compared with metropolitan, inner and outer regional areas (61.9 vs 65.7 vs 64.8 vs 64.2, respectively). Higher proportion of women in remote areas who were smokers, low/risky drinkers and underweight were more likely to seek treatment. Compared with metropolitan areas, women in inner, outer regional and remote areas accessed a lower mean number of services in the first year of diagnosis (6.0 vs 5.0 vs 4.1 vs 4.2, respectively). Actual mean overall annual costs of services in the first year of diagnosis were higher for women in metropolitan areas compared with inner, outer regional or remote areas ($733.56 vs $542.17 vs $444.00 vs $459.85, respectively). Discussion: Women in rural/remote areas not accessing services need to be identified, especially among those with the highest levels of distress. In remote areas, women had greater needs when accessing services, although a substantial proportion of women who sought help through the BAS services lived in metropolitan areas. Conclusion: Regardless of lower cost to services in rural/remote areas, geographic and economic barriers may still be major obstacles to accessing services. [ABSTRACT FROM AUTHOR]