Search

Introduction: Females of childbearing age with hepatitis C virus (HCV) face increased marginalisation with intersecting, sex‐specific barriers to direct acting antiviral (DAA) therapy. We assessed the factors associated with uptake of DAA therapy among females of childbearing age, including those with evidence of recent drug dependence. Methods: HCV notifications in New South Wales, Australia (1995–2017) were linked to opioid agonist therapy (OAT), hospitalisations, incarcerations, perinatal, HIV notifications, deaths and prescription databases. Recent drug dependence was defined as hospitalisation due to injectable drugs or receipt of OAT occurring in the DAA era (2016–2018). Logistic regression was used to analyse factors associated with DAA uptake among females of childbearing age (18–44), including those with recent drug dependence. Results: Among 57,467 people with evidence of chronic HCV in the DAA era (2016–2018), 20,161 (35%) were female, including 33% (n = 6563/20,161) of childbearing age (18–44). Among all females of childbearing age (n = 6563) and those with evidence of recent drug dependence (n = 2278/6563, 35%), DAA uptake was lower among those who had given birth in the DAA era (vs. no birth record, all females of childbearing age; aOR: 0.74, 95% CI 0.61, 0.89; those with recent drug dependence; aOR 0.69, 95% CI 0.51, 0.93) and Aboriginal and Torres Strait Islander peoples (all females of childbearing age; aOR 0.81, 95% CI 0.71, 0.93; those with recent drug dependence aOR 0.75, 95% CI 0.62, 0.90). Conclusion: Females of childbearing age should be considered a key population for DAA therapy. Enhancing antenatal and postnatal HCV care may be critical in the pursuit towards elimination. [ABSTRACT FROM AUTHOR]

Purpose: Facial trauma in women is complex with physical, psychosocial, and cultural influences impacting clinical presentations. Although multifactorial, assaults and falls are principally reported as the main causes. Methods: A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hospital and Royal Adelaide Hospital, Adelaide. All maxillofacial fractures in women that attended or were referred to the unit were included in this study. The primary objective was to analyse epidemiological trends of facial fractures and clinical outcomes in the South Australian female population. Results: There is a bimodal distribution of facial fractures at 25–35 years and 65 + years. Indigenous females were 19.5 years younger than non-indigenous females (30.5 vs 49.9, P < 0.001). Approximately half the cohort had a fall-related facial fracture, followed by assault (26.2%), and sports (10.3%). There was a higher proportion of non-alcohol-related trauma from assaults than alcohol-related assaults (72.5% vs 27.5%, P < 0.001). Over half (58.0%) of the cohort had a midface fracture. The elderly had increased odds of 1.9 fold for facial fractures in winter, largely from falls, compared to younger women. Associated injuries were present in almost half the elderly women with 2.6 times the risk compared to younger women. Younger women had higher incidences of surgical intervention (52.6% vs 14.3%, P < 0.05). Conclusions: Young women disproportionately experience larger incidences of non-alcohol-related assaults requiring operative intervention of the mandible, whereas elderly women principally suffer fall-related facial fractures with higher rates of associated injuries. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to explore the implications of the increasing range of sporting opportunities for girls and young females on traditional female sports such as netball. This paper emerged from a larger investigation and provided a qualitative descriptive account of the implications for netball based on individual interview and focus group data with 27 female participants (players, coaches, and administrators) in Australia. A reflexive thematic analysis was undertaken, leading to the development of four major themes: 'being a cross-coder', 'team size matters', 'wavering attraction', and 'pathway aspirations. Pathways and opportunities that may impact on how netball clubs engage with the contemporary female sporting landscape are presented. Despite the growing number of other sporting opportunities available to girls and young females, support for netball among its participants remains stable. However, the netball community will need to respond to changing cultural, personal, and organisational forces if they are to sustain strong female participation into the future. Possible implications for coaches, clubs and associations and potential avenues forward are discussed. [ABSTRACT FROM AUTHOR]

It appears that up to 80% of females with autistic spectrum disorder (ASD) have not been diagnosed by the age of 18. This translates to a prevalence of about 5–6%, and if true, has serious implications for female mental health. One way of finding the true value is to use Bayes' Theorem with a comorbid condition as a more easily recognizable flag. An obvious choice is anorexia nervosa (AN), but it transpires that the proportion of women with ASD who develop AN is unknown. This study uses published data in novel ways to provide two methods of estimating a range for this variable, and gives a median value of 8.3% for AN in ASD and, with four other methods, a median prevalence of 6% for female ASD. The clinical implications of the diagnosis and management of ASD and its comorbidities are discussed and, as an example, a solution is provided for the rate of ASD in symptomatic generalized joint hypermobility. It is probable that one in six women with a mental health condition is autistic. [ABSTRACT FROM AUTHOR]

Background: Despite diversity initiatives, inequities persist in medicine with negative implications for the workforce and patients. Little is known about workplace inequity in nephrology. Aim: To describe perceptions and experiences of bias by health professionals in the Australian and New Zealand Society of Nephrology (ANZSN), focussing on gender and race. Methods: A web‐based survey of ANZSN members recorded degree of perceived inequity on a Likert scale, ranging from 1 (none) to 5 (complete). Groups were compared using Mann–Whitney U‐test and logistic regression. Comments were synthesised using qualitative methods to explore themes of inequity and pathways to an inclusive future. Results: Of the 620 members of the ANZSN, there were 134 (22%) respondents, of whom 57% were women and 67% were White. The majority (88%) perceived inequities in the workforce. Perceived drivers of inequity were gender (84/113; 75%), carer responsibilities (74/113; 65%) and race (64/113; 56%). Half (74/131) had personally experienced inequity, based on gender in 70% (52/74) and race in 39% (29/75) with perceived discrimination coming from doctors, patients, academics and health administrators. White males were least likely (odds ratio 0.39; 95% confidence interval 0.18–0.90) to experience inequity. Dominant themes from qualitative analysis indicated that the major impacts of inequity were limited opportunities for advancement and lack of formal assistance for those experiencing inequities. Proposed solutions to reduce inequity included normalising the discourse on inequity at an organisational level, with policy changes to ensure diverse representation on committees and in executive leadership positions. Conclusions: Inequity, particularly driven by gender and race, is common for nephrology health professionals in Australia and New Zealand and impacts career progression. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The role of the general obstetrician/gynaecologist completing routine urogynaecology procedures is controversial, and some research has suggested that these patients should be referred to high-volume subspecialists. In response to recent public and regulatory scrutiny of vaginal mesh procedures, credentialling guidelines have been released in Australia requiring surgeons to demonstrate a minimum caseload prior to performing tension-free vaginal tape (TVT) surgery for incontinence. Hence, a retrospective cohort study was conducted to evaluate the long-term quality of life outcomes of TVT procedures for high- and low-volume surgeons. Methods: One hundred seventy patients who had undergone TVT surgery between 1 May 2011 and 1 May 2016 in the Sunshine Coast health district were invited to complete the UDI-6 (Urinary Distress Inventory) and IIQ-7 (Incontinence Impact Questionnaire) surveys. Perioperative information was accessed from available health records. Mean UDI-6 and IIQ-7 scores were compared for high- and low-volume groups, and the groups were assessed for confounding factors. Results: Of the 170 patients eligible, 83 completed the surveys (47.2%). No differences in UDI-6 or IIQ-7 scores were found between high- and low-volume surgeons (p > 0.05). High-volume surgeons completed more concomitant procedures amongst survey respondents (p < 0.05), though this was not reproduced when considering all 170 patients eligible for the study. There were no significant differences in age, ASA (American Society of Anaesthesiologists) score or complication rate amongst survey respondents. Conclusions: Amongst the patients surveyed, high- and low-volume surgeons had similar long-term quality of life outcomes for TVT surgery, without any significant difference in complication rate. [ABSTRACT FROM AUTHOR]

Buruli ulcer (BU) is a necrotizing disease of skin and soft tissue caused by the bacterium Mycobacterium ulcerans (MU). In Australia, where the disease is emerging in new geographic areas and human case numbers are increasing, native possum species act as reservoir hosts. To better understand the life history of MU in one of its natural hosts, we conducted intra-dermal challenge of six wild caught, MU-naïve common ringtail possums (Pseudocheirus peregrinus). All six animals developed BU disease consistent with that observed in naturally infected ringtail possums. Time to ulceration varied between 49 and 77 days (mean = 61.8 days). Molecular evidence of systemic infection was detected in five animals and was supported by consistent histopathological findings in four animals. Pathological findings included random, multifocal, granulomatous hepatitis in four possums, one of which also had a mild, multifocal, interstitial granulomatous pneumonia. Acid-fast bacilli were only evident in inflammatory foci beyond the primary inoculation site in one possum. The ringtail possum model of MU infection is an important tool for the investigation of bacterial transmission dynamics, pathogenesis and immune response in a natural host. Data from this model may improve disease risk modelling and help identify intervention points to stop zoonotic transmission and disease spread., (© 2024. Crown.)

Introduction: Rett syndrome (RTT) is a rare neurodevelopmental disorder with developmental impairments, comorbidities, and abnormal behaviours such as hand stereotypies and emotional features. The Rett Syndrome Behaviour Questionnaire (RSBQ) was developed to describe the behavioural and emotional features of RTT. Little is known how RSBQ scores are associated with genetic and clinical characteristics in RTT. This study investigated relationships between genotype, age, walking, hand function, sleep, and RSBQ total and subscale scores in RTT., Methods: This is a cross-sectional analysis of data collected in the Australian Rett Syndrome Database and the International Rett Syndrome Phenotype Database. Parent caregivers completed the RSBQ and Sleep Disturbance Scale for Children [subscales for disorders of initiating and maintaining sleep (DIMS), disorders of excessive somnolence (DOES)], and provided information on age, variant type, functional abilities (mobility, hand function), seizure frequency and gastrointestinal problems. Associations between the RSBQ scores and the independent variables were modelled using linear regression., Results: Data were available for 365 individuals with RTT [median (range) age 17.8 (2.9-51.9) years, 2 males]. Compared to adults, 2- to 12-year-old children had higher mean Total, Night-time Behaviour and Fear/Anxiety scores. Compared to individuals with a C-terminal deletion, individuals with the p.Arg255* variant had higher mean Total and Night-time Behaviours scores, whereas the p.Arg294* variant had higher mean Mood scores. Individuals with intermediate mobility and hand function abilities had a higher mean Total score. Total RSBQ and subscale scores were similar across categories for seizures, constipation, and reflux, but were higher with abnormal DIMS and abnormal DOES scores., Conclusion: Except for associations with sleep, the RSBQ measures the behavioural phenotype rather than clinical severity in RTT, as traditionally conceptualised in terms of functional abilities and comorbidities. When designing clinical trials, the RSBQ needs to be complemented by other outcome measures to assess specific core functions and associated comorbidities in RTT., (© 2024. The Author(s).)

Background: GP registrars (specialist vocational trainees in general practice) are interested in teaching, and there are considerable benefits to teaching during training. There are, however, significant barriers for registrars as teachers, including inadequate funding, time pressures, and limited teacher training. Current evidence does not include medical educator (ME) perspectives or compare teaching settings (e.g. university vs. in-practice). Further evidence is needed to inform programs supporting registrar teaching roles. This project aimed to explore the experiences of Australian GP registrars as teachers in different contexts and from multiple stakeholder perspectives., Methods: A qualitative study with GP registrars, GP supervisors, MEs, and medical students was conducted. Participants were registrars and new (within 12 months) Fellows with teaching experience during training, supervisors who supervised a registrar in the preceding 12 months, Royal Australian College of General Practitioner MEs, and medical students with experiences of being taught by registrars. Recruitment was open to participants nationwide and sampling was purposive, aiming for a maximum variation sample. Data collection was performed via videoconference and analysed using reflexive thematic analysis., Findings: Interviews were conducted with 15 registrars, 10 supervisors, and one ME. Two focus groups involved four MEs and five medical students respectively. Registrar participants taught in a variety of settings, including in-practice, universities, hospitals, and at educational workshop days. Three had experience in GP academic posts and one as a registrar ME. There were four major themes. 1) Near-peer teaching by registrars is valuable - both for medical students and registrars. 2) Teaching makes you a better GP - participants noted the transferability of teaching skills to clinical practice. 3) The importance of the teaching context - this was identified as an important determinant for registrars in teaching roles. 4) Registrar teaching strengthens the GP workforce - participants noted that teaching could elevate general practice as a specialty and increase interest in GP training., Conclusions: Study participants saw teaching as a core skill for GPs, with transferability to their clinical practice. Registrar participants wanted greater promotion and support for teaching opportunities that counted towards attainment of Fellowship. These findings have implications for teaching practices, MEs, universities, and training providers., (© 2024. The Author(s).)

Background: Catch-up vaccination is a personalised process through which children with missing recommended vaccinations or incomplete vaccination records are brought up to date with the Australian vaccination schedule. Navigating childhood catch-up vaccination can be difficult for migrant parents with inadequate health system knowledge and competing priorities during settlement. This study aimed to understand the experiences of migrant parents with childhood catch-up vaccination and co-design an intervention to improve the process., Methods: We recruited migrant parents who had attended the City of Melbourne Immunisation Service in Melbourne, Australia to participate in a qualitative co-design study between June and August 2022. Expression of interest emails were sent by the service, and we recruited eligible participants. In Phase One, we conducted group interviews with parents to understand their experiences and preferences for an intervention, these were analysed using inductive and framework analysis. In Phase Two, we designed prototype interventions based on parents' preferences and suggestions. In Phase Three, parents shared their feedback on each prototype., Results: Fourteen migrant parents participated in the study. Most parents did not discover the need for catch-up vaccination until childcare or kindergarten enrolment. The lack of information received about vaccination requirements and difficulty navigating the health system made the process challenging and time-consuming. Based on these Phase One themes, we designed a printout, mobile application, and website prototype. All three were well-received in Phase Three. Overall, parents' top three considerations for any intervention were 1) digital and online accessibility, 2) inclusion of step-by-step processes outlining catch-up vaccination; and 3) inclusion of a checklist., Conclusions: Migrant parents lack information about childhood catch-up vaccination in Australia. A relatively simple intervention could help parents more easily navigate the process, thereby saving time and stress. The next steps are to seek funding to pilot such an intervention to assess practicality and usefulness., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: JT is an investigator on a project grant sponsored by Industry. Her institution has received funding from Industry (GlaxoSmithKline) for investigator-led research. She does not receive any personal payments from Industry. All other authors have no conflicts to declare. They declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Abstract: In July 2023, a carbapenemase-producing Klebsiella pneumoniae (CPKP) with New Delhi metallo-beta-lactamase (NDM-5) and oxacillinase (OXA-48) carbapenemase genes was detected in the urine sample of a patient. A similar CPKP organism had previously been isolated from a surveillance rectal swab of an admitted patient, prompting an outbreak investigation. A confirmed case was defined as any suspected case in which a species of Enterobacterales was isolated from a clinical or surveillance specimen (infection or colonisation) exhibiting an NDM-5 or OXA-48 CPE gene or both, irrespective of phenotypic susceptibility. A descriptive epidemiological investigation was conducted to describe the investigation, infection prevention and control responses, and public health intervention carried out. Three confirmed cases of CPKP were identified, including the index case; 62 contacts were identified, of which 13 contacts were screened. CPKP transmission occurred between two patients on contact transmission-based precautions in separate single ensuite rooms. Despite being in the same ward, the patients did not share medical teams but shared nursing teams and ancillary staff. This study emphasises the importance of strict adherence to infection prevention and control practices and contact transmission-based precautions for patients admitted with carbapenemase-producing Enterobacterales., (© Commonwealth of Australia CC BY-NC-ND.)

Objectives: The Australian Government, through the National Obesity Strategy 2022-2032, has set an aspirational goal of reducing the prevalence of childhood and adolescent overweight and obesity by 5% by 2030 (from 25% to 20%). Our objective was to quantify the long-term economic benefits of achieving this goal., Methods: Using a microsimulation model and a synthetic cohort of Australian children and adolescents aged 4-17 years, we estimated the excess per capita lifetime costs of overweight and obesity. Using these results and population projections for 2030, we estimated the potential lifetime cost savings that could be achieved through attaining the National Obesity Strategy goal., Results: Compared with their peers of a healthy weight, children and adolescents with overweight and obesity were estimated to incur, per capita, excess lifetime costs (discounted) of approximately $19 700 and $46 700, respectively (in 2030 Australian dollars). Achieving the National Obesity Strategy's goal was estimated to save approximately $7.44 billion, predominantly through reductions in lifetime obesity-related healthcare costs and premature mortality., Conclusion: Our results demonstrate the considerable economic benefits that could be achieved by reducing the current prevalence of childhood and adolescent overweight and obesity in Australia; they provide justification for investment in prevention and treatment for this demographic., Competing Interests: None declared

Abstract: Fresh produce is an important source of foodborne outbreaks in Australia. Using descriptive analysis, we examined confirmed and suspected foodborne outbreaks associated with fresh produce in Australia recorded in the OzFoodNet outbreak register from 2001 to 2017. The outbreak register contains reports of foodborne disease outbreaks collected by OzFoodNet epidemiologists and public health officials. A fresh produce outbreak was defined as the occurrence of two or more cases of the same illness in which the investigation had implicated a common food and this food contained fresh produce. A total of 92 fresh produce outbreaks were reported, encompassing 3,422 reported illnesses, 446 hospitalisations and four deaths. Of these outbreaks, 76.1% (70/92) were caused by a known pathogen, with the majority caused by either Salmonella enterica (n = 30) or Norovirus (n = 29). Most outbreaks (77.2%; 71/92) were associated with consumption of foods containing multiple ingredients, some of which were not fresh produce. The largest outbreaks associated with a single fresh produce item included bean sprouts contaminated with S. enterica serovar Saintpaul (419 illnesses and 76 hospitalisations) and semi-dried tomatoes contaminated with Hepatitis A (372 illnesses and 169 hospitalisations). Restaurants (45.7%; n = 42/92) and commercial catering (15.2%: n = 14/92) were common settings for fresh produce outbreaks. Outbreaks occurred in all states and territories of Australia and in all seasons, with an increased frequency in the warmer months (September-May). Although the number of fresh produce-associated outbreaks did not seem to be increasing in Australia, integrated surveillance is needed to rapidly identify sources of infection due to the propensity of these outbreaks to be large and widespread., (© Commonwealth of Australia CC BY-NC-ND.)

Objectives and importance of study: Australian children frequently travel overseas, but little is known about their travel-related morbidity. We aimed to describe the spectrum of illness and injury in returned travellers presenting to the largest paediatric referral centre in NSW, the Children's Hospital at Westmead (CHW)., Study Type: Observational cohort study., Methods: In the 18 months immediately before the COVID-19 pandemic (2018-2020), we prospectively collected demographic, travel and clinical data from children with travel-acquired illness or injury identified by active surveillance of CHW Emergency Department attendees and referrals to the infectious diseases service., Results: We identified 587 returned child travellers with an illness or injury associated with overseas travel. Most were aged younger than 5 (62.8%) and had travelled within the Asia-Pacific region (84.6%). The main reason for travel, where recorded (50.3%), was visiting friends and relatives (VFR)(65.4%). Most travellers (90.1%) had a common childhood infection, illness or injury coincidentally acquired during travel, including respiratory infection (37.5%), acute diarrhoea (15.7%) and nonspecific febrile illness (13.1%). Exotic/nonendemic infections were uncommon (9.9%, including potential rabies exposure) but were associated with much higher admission rates than 'cosmopolitan' (globally distributed) diseases (74.2% vs 21.9%). Most of these occurred in VFR travellers (86.3%); enteric fever, largely acquired in South Asia, predominated (51.7%). One in five admitted patients had a disease for which specific pretravel vaccination is available. Receipt of pretravel vaccines was infrequently recorded., Conclusions: Returned child travellers in Western Sydney frequently presented with respiratory infections and may be a key population for surveillance of imported respiratory viruses. The burden of exotic disease was small and borne by VFR travellers. Travel-related illness in Western Sydney could be reduced by health education of travellers and targeted pretravel vaccination, especially typhoid vaccination for VFR travellers to South Asia. Universal, systematic screening of emergency department attendees for recent overseas travel would improve surveillance of travel-related illness., Competing Interests: None declared

Objectives and importance of the study: Pharmacist-administered vaccination has expanded in Australia but has not been comprehensively assessed. We aimed to assess the pharmacists' role in vaccination in Australia before and during the first year of the COVID-19 pandemic, as well as the completeness of data on pharmacist-administered immunisations., Study Type: Cross-sectional study., Methods: We analysed data on pharmacist-administered vaccinations that were reported to the Australian Immunisation Register (AIR) between 2016 and 2019, categorised by gender, jurisdiction, age group and vaccine type. We conducted a national survey of community pharmacists providing vaccination services during June and July 2020 to understand how pharmacists record and report vaccinations to the AIR. We assessed data completeness by comparing the number of vaccinations reported by surveyed pharmacists to the number recorded on the AIR., Results: 576 780 pharmacist-administered vaccinations were recorded on the AIR between 2016 and 2019, of which 94.7% were influenza vaccines. The proportion of vaccinations given by pharmacists increased each year, from <0.001% in 2016 to 2.7% in 2019. Between 2017 and 2019, rates of pharmacist-administered vaccinations were highest among people aged 60-64 years (2046 per 100 000 people) and those living in regional areas (1074 per 100 000 people). Among 243 survey respondents, 57.8% (126/223) reported vaccinations to the AIR automatically via software, 27.8% (62/223) manually entered data and 13.5% (30/223) used both methods. Of the 87 665 vaccination encounters recorded by 121 respondents, 82.2% (72 045/87 665) were recorded on the AIR. There were more AIR-recorded encounters from those who reported automatically via software (84.8% [49 309/58 134]) than from those who manually entered data (68.3% [12 127/17 746])., Conclusions: Pharmacists have an increasing role in providing vaccination services in Australia, with great potential to improve coverage among adults and populations in regional locations. Measures introduced during the COVID-19 pandemic may have increased the uptake of electronic methods of recording and reporting data, which can improve data completeness. Our results provide an assessment of the first 5 years of pharmacist vaccination services in Australia, against which future evaluations of the impacts of policy changes during the COVID-19 pandemic can be compared., Competing Interests: None declared

Currently, in Australia, 1 in 8 women are diagnosed with breast cancer. A common adjuvant treatment for breast cancer is radiation therapy (RT). The amalgamation of side effects caused by RT treatment can ultimately affect a patient's quality of life (QoL). With increasing breast cancer survival, a greater focus on the non-lethal consequences of this disease and its treatment is warranted. Exercise and nutrition have proven beneficial in promoting and supporting overall health and managing chronic diseases. Furthermore, exercise has demonstrated improvement and sustainment to QoL. The focus of this scoping literature review was to determine the scale of evidence regarding the effectiveness of exercise and/or nutritional interventions for women with breast cancer receiving radiation therapy. An online search of five databases was conducted to identify studies published between 2000 and 2023. The 58 studies included in the scoping review comprised 46 interventions and 4615 women with breast cancer who received radiation therapy participated. Most studies (90%; n = 52) were 'exercise only' based, 3% (n = 2) were 'nutrition only', and the remaining 7% (n = 4) of studies were combined exercise and nutrition interventions. The findings from this review highlight most studies are dedicated to investigating exercise. Further research is required to fully understand the potential benefits of these interventions and their synergistic impact on the quality of life of women with breast cancer receiving radiation therapy., (© 2024. The Author(s).)

Objective: More than 95% of melanomas in Australia are caused by UV radiation from the sun. Young adults are particularly at risk, with 18-24-year-olds spending more time in the sun and protecting their skin less than older adults. A new mass media campaign was delivered in New South Wales, Australia, to motivate this hard-to-reach group to protect their skin from harmful UV radiation. This paper shares learnings from this campaign for public health educators working across diverse fields., Program: Guided by audience research and testing, the campaign combined fear-based and self-efficacy messaging. UV radiation was portrayed as arrows descending from the sky, transforming it into a visible and ever-present threat. High-reach channels such as cinema, outdoor advertising, online videos, audio apps and social media were used to reach the audience., Methods: The campaign was evaluated through an online tracking survey (n = 750, 18-24-year-olds) measuring prompted recognition, message take-out, key diagnostics, and self-reported sun protection intentions and behaviours., Results: The evaluation found that 57% of survey participants recognised the campaign when prompted. Among those that recognised the campaign, 76% said they had used sun protection when outdoors over the summer campaign period (vs 64% of non-recognisers, p < 0.05), and 45% said they had adopted at least three of the five sun protection behaviours (Slip, Slop, Slap, Seek and Slide) 'always' or 'often' (vs. 36% of non-recognisers, p < 0.05)., Lessons Learnt: A mass-media campaign that aimed to elicit emotional (fear) and cognitive (perceived efficacy) responses and which drew upon social and heuristic cues was associated with greater self-reported sun protection among the target audience. Delivering a combination of message strategies simultaneously within a campaign tailored to young adults may be more effective than adopting a more singular focus., Competing Interests: None declared.

Objective: The Australian Government Tackling Indigenous Smoking (TIS) program aims to reduce tobacco use among Aboriginal and Torres Strait Islander peoples, delivering locally tailored health promotion messages, including promoting the Quitline. We aimed to analyse data on use of the Quitline by Aboriginal and Torres Strait Islander peoples nationally, specifically in TIS and non-TIS areas., Methods: We analysed usage of the Quitline in seven jurisdictions across Australia in areas with and without TIS teams (TIS areas and non-TIS areas respectively) between 2016-2020. Demographic and usage characteristics were quantified. Clients and referrals as a proportion of the current smoking population were calculated for each year, 2016-2020., Results: From 2016-2020, 12 274 Aboriginal and Torres Strait Islander people were clients of the Quitline in included jurisdictions. Most (69%) clients were living in a TIS area. Two-thirds (66.4%) of referrals were from third‑party referrers rather than self-referrals. Overall, between 1.25% and 1.62% of Aboriginal and Torres Strait Islander peoples who currently smoked were clients of Quitline (between 1.15-1.57% in TIS areas and 0.82-0.97% in non-TIS areas)., Conclusions: The Quitline provided smoking cessation support to approximately 2500-3000 Aboriginal and Torres Strait Islander clients annually between 2016-2020. Referrals from third parties including Aboriginal and Torres Strait Islander services are an important pathway connecting community members to an evidenced-based cessation support service., Competing Interests: None declared.

Asthma is one of the most common chronic illnesses affecting children. Long-term asthma control medications (LTACMs) are an important aspect of asthma management, with under-prescription associated with poor asthma control and increased asthma deaths. This study aimed to document temporal trends in the prescribing of LTACMs for paediatric patients for asthma-related presentations to Australian general practice registrars (trainees). Longitudinal analyses of data from 2010 to 2022 from the Registrars Clinical Encounters in Training study were undertaken. Proportions of paediatric presentations where LTACMs were prescribed were calculated, and temporal trends analysed and graphed. There was no change over time in registrar prescribing of LTACMs for paediatric asthma, although temporal changes were seen in the types of LTACMs prescribed. The lack of temporal increase in overall LTACMs prescription, despite evidence showing their importance in preventing asthma morbidity and mortality, has significant educational, clinical, and policy implications., (© 2024. The Author(s).)

Background: Vaping among 18-24-year-old Australians has increased from 5.8% in 2019 to 21% in 2023. This protocol describes a trial to investigate the dissemination and engagement achieved by three anti-vaping messages on Facebook., Methods: This research employs a 3-arm randomised experimental design. Three distinct anti-vaping messages will be disseminated via Facebook using Meta Ads Manager. Each arm has a message that focuses on either health risks, environmental impact, or anti-vape industry sentiment. The campaign will run for three months. The primary outcome is the engagement rate as a measure of the effectiveness of anti-vaping message, and the secondary outcomes include network indicators: size, density, centralisation, and centrality to evaluate the extent to which the messages are disseminated. Participants will be randomly exposed to one of the three messages. Data on reach and engagement will be compared across the groups., Discussion: This study will provide insights into the dissemination of social media-based anti-vaping campaigns. By evaluating engagement rates and network indicators, the research aims to identify which message themes engage most with young Australians. The findings will contribute to the development of more effective public health strategies for vaping cessation and prevention among youth., Trial Registration: The study was registered on July 19th 2024 with the Australian New Zealand Clinical Trials Registry (ACTRN12624000885594)., (© 2024. The Author(s).)

Self-harm within immigration detention centres has been a widely documented phenomenon, occurring at far higher rates than the wider community. Evidence suggests that factors such as the conditions of detention and uncertainty about refugee status are among the most prominent precipitators of self-harm. While important in explaining self-harm, this is not the entire story. In this paper, we argue for a more overtly political interpretation of detainee self-harm as resistance and assess the ethical implications of this view, drawing on interviews with detainees from Australia's offshore system. Self-harm by detainees is not only a medical 'condition' arising in response to oppression but a form of political action to lessen or contest it. We first establish how self-harm could be conceptualised as resistance. We then discuss its political purpose, noting it serves at least three functions: intrinsic, instrumental and disruptive or coercive. Viewing detainee self-harm as political resistance is a supplement to (rather than a substitute for) a medical approach. However, conceptualising self-harm this way has several advantages, namely, moving away from the idea that such behaviour is 'maladaptive', recognising detainees as political agents, combatting government claims of 'manipulation' and 'blackmail' and clarifying the duties of healthcare workers who work in detention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Young adults (YA) are attempting to quit vaping, with many accessing smoking cessation programs with a lack of reported efficacy, highlighting the need for targeted vaping cessation support. Young people report seeing health professionals (HPs) as potential sources of support in the quitting process. Additionally, the current changing regulatory landscape around vaping in Australia potentially increases the number of those seeking health professional help for cessation. However, limited research exists on HPs' views and preparedness to assist YA with their vaping cessation; thus, this exploratory study aimed to gain insights into their readiness to support YA in quitting vaping., Aims and Methods: Data were gathered via eight co-design workshops (two groups each of two hours duration and six semi-structured interviews of 1-hour duration), facilitated online with 12 HPs. Data underwent thematic analysis., Results: HPs expressed a need for more information in supporting YA to quit vaping, with them presently relying on informal pathways of support and information for their practice. Participants reported a lack of evidence-based guidelines and a reluctance to prescribe nicotine vapes, expressing conflict with the changing regulatory landscape in Australia., Conclusions: Our findings identify a significant gap in health professional preparedness in supporting vaping cessation. HPs are working within a rapidly evolving regulatory environment and are feeling unprepared to address the widely spread issue of vaping, especially among young people. We demonstrate the critical need for guidelines and training of HPs to enable them to better support young people in quitting vaping., Implications: This qualitative study offers unique insights into the views and readiness of Australian HPs to support young people to quit vaping, specifically in the context of recent regulatory reforms. The results highlight the need for evidence-based guidance and training for HPs to inform their vaping cessation support practice., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Scabies outbreaks cause significant morbidity and disruption in aged care facilities and other institutional settings. Failure to manage scabies outbreaks may be attributable to low awareness amongst healthcare workers. A survey was distributed to healthcare workers across aged care facilities in South-East Queensland, Australia. The survey captured demographics, prior scabies experience, knowledge-based questions, and attitudes. Scabies was common in aged care facilities, with 41% of 128 respondents encountering the disease while working in aged care. Participants demonstrated sound theoretical knowledge regarding scabies (median knowledge score 82%). Scabies knowledge was not associated with years of experience in the sector or educational level but was associated with respondent age ( p  = 0.017). Knowledge gaps were evident regarding diagnosis, incubation periods, and treatment. Respondents demonstrated an inconsistent ability to identify atypical clinical presentations of scabies, showing discordance between theoretical knowledge and its practical application. The ability to identify crusted scabies was low, reflecting the high frequency of misdiagnosis of index cases in scabies outbreaks. Respondents considered scabies to be a problem and were supportive of improved management guidelines. These study outcomes will inform the design of accessible, targeted educational resources for scabies to help prevent and reduce the impact of outbreaks.

Background: Strong research capacity and culture (RCC) within professional groups predict engagement in high-quality research and the integration of evidence into practice. However, factors affecting RCC participation and development are currently unknown in Australian Orthopaedic Surgeons., Study Design: Cross-sectional survey., Methods: All Australian Orthopaedic Association members were invited to complete the individual domain of the validated Research Capacity and Culture tool., Results: One hundred and sixty-three Australian Orthopaedic Association members (9%) provided survey answers. Survey findings indicated that AOA members scored moderate or high for most RCC domains (14 out of 15). Barriers to the completion of research included a lack of time, other work roles taking priority, and a lack of funds for research., Conclusion: The Australian Orthopaedic Association members surveyed in this study demonstrated adequate research skills and experience, although reported they could benefit from additional support securing funding and navigating specific research tasks. Increasing future collaboration with academic institutions and clinician-researcher roles may enhance the output of high-quality orthopaedic research in Australia., (© 2024. The Author(s).)

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).)

Background: The increasing incidence of breast cancer and disease burden is a significant public health concern. While 30% of breast cancers could be prevented through addressing modifiable risk factors, misconceptions among women about breast cancer risks hamper primary prevention. In the absence of primary prevention, secondary prevention such as mammography increases the early detection of breast cancer and improves health outcomes. However, current population-level screening rates indicate secondary prevention is suboptimal. More effective public health efforts to improve breast cancer prevention are required. Given breast cancer is socially patterned, this work explores how social class impacts women's breast cancer prevention practices. This study uses the concepts of lay epidemiology and candidacy as a mechanism to understand women's breast cancer risk perspectives. It engages Bourdieu's relational social class theory to unpack how women's social, cultural, and structured life contexts shape these perspectives and their considerations regarding primary and secondary prevention., Methods: In this qualitative study 43 Australian midlife women (aged 45-64 years), were interviewed to explore their understandings of breast cancer risks, how they perceived their own risk, and how this shaped their prevention behaviours. A theory-informed thematic analysis applying Bourdieu's concepts of habitus, capital, and fields to understand how women's social class positions shapes risk perspectives and prevention practices was conducted., Results: This social class analysis showed differences in how women engage in breast cancer discourse, consider risks, and participate in breast cancer prevention. Middle-class women prioritise health promoting practices and were more likely than working-class and affluent women to attend mammography screening. Working-class women experience structural factors, like low income, stress and difficult life circumstances, which hamper primary prevention practices and for some screening is not considered or prioritised, and their decisions not to screen are less active. Affluent women often do not consider themselves at-risk due to their healthier 'lifestyles. 'They suggest that this, and their knowledge of screening benefits and harms allows them to make informed decisions not to screen., Conclusions: Women interpret and understand breast cancer risks differently and enact prevention practices within the parameters afforded by their social class positions. These findings are useful to inform improved public health approaches regarding both modifiable breast cancer risks and increasing mammography screening. To improve equity in breast cancer prevention efforts, such approaches must respond to limitations based on social class and address structural factors that impact prevention practices., (© 2024. The Author(s).)

Introduction: The 2024 Australian evidence-based guideline for unexplained infertility provides clinicians with evidence-based recommendations for the optimal diagnostic workup for infertile couples to establish the diagnosis of unexplained infertility and optimal therapeutic approach to treat couples diagnosed with unexplained infertility in the Australian health care setting. The guideline recommendations were adapted for the Australian context from the rigorous, comprehensive European Society of Human Reproduction and Embryology (ESHRE) 2023 Evidence-based guideline: unexplained infertility, using the ADAPTE process and have been approved by the Australian National Health and Medical Research Council., Main Recommendations: The guideline includes 40 evidence-based recommendations, 21 practice points and three research recommendations addressing: definition - defining infertility and frequency of intercourse, infertility and age, female and male factor infertility; diagnosis - ovulation, ovarian reserve, tubal factor, uterine factor, laparoscopy, cervical/vaginal factor, male factor, additional testing for systemic conditions; and treatment - expectant management, active treatment, mechanical-surgical procedures, alternative therapeutic approaches, quality of life. CHANGES IN ASSESSMENT AND MANAGEMENT RESULTING FROM THE GUIDELINE: This guideline refines the definition of unexplained infertility and addresses basic diagnostic procedures for infertility assessment not considered in previous guidelines on unexplained infertility. For therapeutic approaches, consideration of evidence quality, efficacy, safety and, in the Australian setting, feasibility, acceptability, cost, implementation and ultimately recommendation strength were integrated across multidisciplinary expertise and consumer perspectives in adapting recommendations to the Australian context by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework, which had not been used in past guidelines on unexplained infertility to formulate recommendations. The Australian process also included an established data integrity check to ensure evidence could be trusted to guide practice. Practice points were added and expanded to consider the Australian setting. No evidence-based recommendations were underpinned by high quality evidence, with most having low or very low quality evidence. In this context, research recommendations were made including those for the Australian context. The full guideline and technical report are publicly available online and can be accessed at https://www.monash.edu/medicine/mchri/infertility and are supported by extensive translation resources, including the free patient ASKFertility mobile application (https://www.askfertility.org/)., (© 2024 The Author(s). Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Background: Implementation of recommended gestational weight gain (GWG) care by antenatal care providers is poor. It is unclear whether practice implementation and barriers differ between antenatal care provider profession or experience. This study aimed to assesses the provision of and barriers to guideline care for GWG and examine associations with professional discipline and years of experience., Methods: A cross sectional survey was conducted with antenatal care providers working in three public maternity services in a regional city in Australia. Data were collected on the provision of and barriers (informed by the Theoretical Domains Framework) to recommended GWG care. Data were summarised using descriptive statistics. Associations between health profession characteristics (professional discipline and years providing antenatal care) and GWG care practices and barrier outcomes were assessed using multivariate logistic regression., Results: 117 antenatal care providers completed the survey (75% participation rate). One quarter (25%) reported that they routinely provided recommended GWG assessment at the first antenatal visit, and 9% at subsequent visits. Only 7% routinely provided recommended advice on GWG, healthy eating and physical activity. Professional discipline or years of experience were not associated with higher odds of GWG practices. Skills, belief about capabilities, belief about consequences and environmental context and resources were barriers to providing care. Medical professionals had higher odds of agreeing that they have been adequately trained to address GWG (OR = 9.14, 95%CI:3.10-26.90) and feel competent in having sensitive conversations with pregnant women about GWG (OR = 8.60, 95%CI:2.29-32.28) than midwives. Midwives had higher odds of agreeing that there are services they can refer pregnant women to for further support (OR = 2.80, 95%CI:1.13-6.91)., Conclusions: The provision of antenatal care for GWG was low, inconsistently provided and did not differ by professional discipline or years of experience. Antenatal care providers report numerous barriers including skills, belief about capabilities, belief about consequences, and environmental context and resources. Barriers to GWG care provision differed by professional discipline, but not years of providing care. The findings demonstrate that the type and prioritisation of practice-change implementation strategies may need to be tailored to address the differential barriers faced by professional groups., (© 2024. Crown.)

Objective: To evaluate the importance of rural internships to observed medical workforce distribution outcomes up to 8 years post-medical school., Design and Setting: Cohort study of medical graduates of The University of Queensland (UQ), Australia., Participants: UQ graduates who were medical interns in Queensland's public health system between 2014 and 2021 and observed working in Australia in 2022. Internship location was defined as being metropolitan or rural, along with other key rural exposures of whether they are of rural origin (childhood) and whether at least 1 year of clinical training at medical school was in a rural location., Primary Outcome Measure: Current work location was collected from the Australian Health Practitioner Regulation Agency (AHPRA) in 2022, classified as either rural or metropolitan and measured in association with their internship location., Results: From 1930 eligible graduates, 21.5% took up a rural internship, which was associated with rural origin (OR 1.5, 95% CI 1.2 to 2.0) and medical school rural immersions of either 1 year (OR 2.8, 95% CI 2.1 to 3.7) or 2 years (OR 5.8, 95% CI 4.4 to 7.7). Completing a rural internship was associated with currently working rural (47% vs 14%, OR 4.6, 95% CI 3.5 to 5.9), which weakened the observed (adjusted) effect of rural origin (OR 1.5, 95% CI 1.2 to 2.0) or medical school rural immersions (1 year: OR 1.4, 95% CI 1.0 to 1.9; 2 years: OR 1.7, 95% CI 1.2 to 2.3). All combinations of the key rural exposures that included rural internship had the highest proportions currently working rurally (range 32-69%) compared with the combinations with a metropolitan internship (range 12-22%)., Conclusions: Internship location appears to be a critical factor in shaping medical workforce distribution decisions. This evidence supports the need for strengthened and expanded rural training pathways after medical school. In particular, clearer pathways into specialty programmes via rural internships are likely to support increased numbers choosing (with confidence) to preference rural internship first and subsequently more working in rural areas long term., 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: Stroke is a leading cause of death and disability worldwide. As health resources become digitized, it is important to understand how people who have experienced stroke engage with online health information. This understanding will aid in guiding the development and dissemination of online resources to support people after stroke., Objective: This study aims to explore the online health information-seeking behaviors of people who have experienced stroke and any related barriers or navigational needs., Methods: Purposeful sampling was used to recruit participants via email between March and November 2022. The sampling was done from an existing cohort of Australian stroke survivors who had previously participated in a randomized controlled trial of an online secondary prevention program. The cohort consisted of people with low levels of disability. Semistructured one-on-one interviews were conducted via phone or video calls. These calls were audio recorded and transcribed verbatim. The data were analyzed by 2 independent coders using a combined inductive-deductive approach. In the deductive analysis, responses were mapped to an online health information-seeking behavior framework. Inductive thematic analysis was used to analyze the remaining raw data that did not fit within the deductive theoretical framework., Results: A sample of 15 relatively independent, high-functioning people who had experienced stroke from 4 Australian states, aged between 29 and 80 years, completed the interview. A broad range of online health information-seeking behaviors were identified, with most relating to participants wanting to be more informed about medical conditions and symptoms of their own or of a family member or a friend. Barriers included limited eHealth literacy and too much generalization of online information. Online resources were described to be more appealing and more accessible if they were high-quality, trustworthy, easy to use, and suggested by health care providers or trusted family members and friends. Across the interviews, there was an underlying theme of disconnection that appeared to impact not only the participants' online health information seeking, but their overall experience after stroke. These responses were grouped into 3 interrelated subthemes: disconnection from conventional stroke narratives and resources, disconnection from the continuing significance of stroke, and disconnection from long-term supports., Conclusions: People who have experienced stroke actively engage with the internet to search for health information with varying levels of confidence. The underlying theme of disconnection identified in the interviews highlights the need for a more comprehensive and sustained framework for support after stroke beyond the initial recovery phase. Future research should explore the development of tailored and relatable internet-based resources, improved communication and education about the diversity of stroke experiences and ongoing risks, and increased opportunities for long-term support., (©Brigid Clancy, Billie Bonevski, Coralie English, Ashleigh Guillaumier. Originally published in JMIR Formative Research (https://formative.jmir.org), 18.10.2024.)

Introduction: Rheumatic heart disease (RHD) is underdiagnosed globally resulting in missed treatment opportunities and adverse clinical outcomes. We describe the protocol for a study which aims to co-design, implement and conduct an evaluation of a task-sharing approach to echocardiographic active case finding for early detection and management of RHD in high-risk settings in Australia and Timor-Leste., Methods and Analysis: Echocardiograms will be obtained by trained local staff using hand-held echocardiographic devices employing the 'Single Parasternal Long Axis view with a Sweep of the Heart' (SPLASH) technique and interpreted by experts remote from the site of acquisition. Approximately 1500 children and pregnant women will be screened across high-risk communities in Australia and Timor-Leste over an 18-month period. The study will use a type II effectiveness-implementation hybrid design. A tailored package of implementation strategies will be co-designed with communities and health services and mapped onto a Theory of Change framework. The clinical effectiveness will be assessed as the change in the proportion of the target population that are prescribed secondary prophylaxis for RHD by the end of the study compared with baseline. The implementation will be assessed as the adoption, penetration, sustainability, fidelity and cost of the programme with a mixed-methods theory-based and economic evaluation. Data will include numbers of normal, abnormal and uninterpretable SPLASH echocardiograms obtained, numbers of participants progressing through the cascade of care, interviews with staff and programme costs., Ethics and Dissemination: Ethical approval has been obtained from the Human Research Ethics Committee of the NT Department of Health and Menzies School of Health Research, Darwin (HREC-2022-4479), the Western Australian Aboriginal Health Ethics Committee (HREC-1237) and the Instituto Nasional Saude Publika Timor-Leste Ethics and Technical Committee (03-UEPD/INSP-TL/V/2023). Informed consent is required to be enrolled. Study findings will be disseminated in the communities involved and submitted for publication., Trial Registration Number: NCT06002243., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: In Australia, lived experience peer support workforces are expanding making it one of the fastest growing emerging disciplines in transdisciplinary mental health settings. This article provides insight for organisations on the contextual realities peer workers face, increases understanding of peer support services to improve service delivery environments and contributes to mental health systems reform. This study aimed to qualitatively explore peer support workers experience integrating into and working within transdisciplinary mental health service teams., Method: Semi-structured interviews were undertaken with 18 peer support workers currently working in mental health services in Australia. The research was a qualitative descriptive study design. All data collected were analysed utilising thematic analysis., Results: Peer workers found their experience in the workplace was influenced by their colleagues and the organisation's understanding of the peer role. Factors relating to organisational culture and climate were a central theme throughout discussions noting that a negative climate was perceived as harmful to peer workers. Themes established through results include (1) the role of leadership, (2) attitudes and behaviours of colleagues, (3) provision of psychologically safe environments, (4) the organisations messaging and use of language and (5) organisational structures and policy., Conclusion: This study contributes to evidence for the impact of organisational culture on integrating and supporting peer support workers in mental health service delivery. This study provides insights into peer worker experiences integrating into transdisciplinary teams, confirming findings established in previous studies, highlighting a lack of movement or change in workplace culture to support peer worker integration into mental healthcare settings., (© 2024. The Author(s).)

Introduction: Emergency department clinicians, and particularly nurses in triage, frequently perform routine blood tests on patients whose allocated triage category is not time critical (triage categories 3, 4 and 5 of the Australasian Triage Scale). Some observers have questioned the utility of routine blood testing in these acute healthcare settings given the cost and workload implications., Methods: A quantitative method using retrospective observational design was utilised guided by STROBE checklist. Electronic medical records of patient data collected at a quaternary Australian metropolitan hospital emergency department were reviewed., Results and Discussion: A total of 74,878 adult patients attended the emergency department between 1st January and 31st December 2021 and a sample of 383 were randomly allocated for this study. Of the 383 patients included, 51% were female, age ranges were 18-99 years (mean 51.6). The majority were Australasian Triage scale (ATS) triage category 3 (55%) and 62% had blood tests performed. Blood test performance was found to be associated with advancing age (p < 0.001) but not with department occupancy as determined by the national emergency department overcrowding scale (p = 0.230)., Conclusion: Blood testing in the emergency department in triaged non-time critical patients was found to be frequent thereby affecting nurses' already stretched time resource. Older patients were found to be more likely to have a blood test. There is a positive correlation between blood test performance and length of stay in the emergency department., (© 2024. Crown.)

Background: People differ in their preferred time for intellectual activities. Morningness-eveningness preferences describe the preferred time for performing daily activities and are determined by chronotype. Chronotype reflects circadian preference in humans and is divided into morning, intermediate, and evening types. Learning motivation is a key predictor of student success and may influence learning and study, academic performance, intention to continue medical research, and well-being. Helping students develop learning motivation may improve their educational achievement and health. There are opposing studies regarding chronotype and academic achievement. We hypothesized that chronotype affects the learning motivation of medical school students., Methods: We used the reduced Morningness-Eveningness Questionnaire (rMEQ), and the Motivated Strategies for Learning Questionnaire (MSLQ) for Russian, Polish, Japanese, and Australian students in the first and second years of medical university. A total of 540 medical students answered the questionnaires. The MSLQ contains six subscales: intrinsic goal orientation, extrinsic goal orientation, self-efficacy for learning and performance, control of learning beliefs, task value, and test anxiety., Results: The rMEQ was used to classify the students into three types, which were morning (26.7%), intermediate (60.5%), or evening chronotypes (12.7%) based on their scores. The learning motivation scores for the intrinsic and extrinsic goal orientations, task value, and self-efficacy were lower in evening chronotypes., Conclusions: Our findings suggest that the evening chronotype had a lower learning motivation than the morning chronotype. Evening-oriented students may need a more flexible schedule, and a shift of the most important courses in the university to the afternoon may help them to attain higher motivation for learning medicine., (© 2024. The Author(s).)

Background: Limited data exist on the motivations and expectations of participants when enrolling in dermatology clinical trials, including melanoma early detection trials. Understanding participant motivators for research engagement has been identified as a prioritized area for trial methodology research., Objective: The study aimed to determine motivators of participation and expectations from trial involvement among patients enrolled in the MEL-SELF randomized clinical trial of patient-led surveillance for new or recurrent melanoma., Methods: The MEL-SELF trial is recruiting patients previously treated for localized melanoma, who own a smartphone, have a partner to assist with skin self-examination (SSE), and attend routinely scheduled follow-up at specialist and primary care skin clinics in Australia. We evaluated responses from the first 100 randomized participants to 2 open-ended questions about their motivations and expectations for participating in the trial, administered through the internet-based baseline questionnaire. A total of 3 coders independently coded the free-text responses and resolved discrepancies through consensus. Qualitative content analysis by an iterative process was used to group responses into themes. Responses from potential participants who were not randomized and the 404 participants randomized subsequently into the trial, were also checked for new themes. Coding and analysis were conducted in Microsoft Excel., Results: Out of the 100 survey participants, 98 (98%) answered at least 1 of the 2 questions. Overall, responses across the motivation and expectation items indicated 3 broad themes: community benefit, perceived personal benefit, and trusting relationship with their health care provider. The most common motivators for participation were related to community benefit. These included progressing medical research, benefitting future melanoma patients who may have similar experiences, and broader altruistic sentiments such as "helping others" or "giving back." The most common expectations from the trial related to personal benefit. These included perceived improved outcomes such as earlier diagnosis and treatment, access to additional care, and increased self-empowerment to take actions themselves that benefit their health. Patients expressed a desire to gain health-related knowledge and skills and were interested in the potential advantages of teledermatology. There were no new themes in responses from those who were not randomized or were randomized subsequent to the first 100., Conclusions: We report a tailorable, patient-focused approach to identify drivers of research engagement in clinical research. Clinical trials offer an opportunity to collate a substantial evidence base on determinants of research participation and to identify context-specific factors. Results from the MEL-SELF trial emphasized notable altruism, self-empowerment, and perceived advantages of teledermatology as specific motivators. These findings informed consent processes, recruitment, retention, response to trial tasks, and intervention adherence for the MEL-SELF host trial., Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000176864. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379527., (©Deonna Ackermann, Jolyn Hersch, Dana Jordan, Emily Clinton-Gray, Karen Bracken, Monika Janda, Robin Turner, Katy Bell. Originally published in JMIR Dermatology (http://derma.jmir.org), 17.10.2024.)

Objective: To examine the feasibility of implementing remote atrial fibrillation (AF) self-screening among older people supported by a remote central monitoring system., Design: Process evaluation of the Mass AF randomised clinical trial (ACTRN12621000184875) with one-to-one semistructured interviews using interview guides underpinned by the Critical Realism approach and coded using the UK Medical Research Council Guidance of Process Evaluation Framework., Setting and Participants: Community-dwelling people aged ≥75 years from both genders (ratio 1:1) and urban/rural (ratio 2:1) in Australia., Interventions: Participants were provided handheld single-lead electrocardiogram (ECG) devices and trained to self-record ECGs once daily on weekdays for at least 6 months. A remote central team notified participants and general practitioners (GPs) of AF., Primary Feasibility Outcomes: The strengths, weaknesses, opportunities and threats (SWOT) analysis examined enablers (ie, strengths and opportunities) and barriers (ie, weaknesses and threats)., Results: Overall, 200 participants; 98.5% completed the 6-month programme, 96% reported being satisfied with screening and 48 were interviewed: mean age 79 years, 54% male and 71% urban. 11 GPs were interviewed: 55% female and 64% urban. Programme participants trusted the remote monitoring system that supported the screening programme and provided follow-up pathways where required. GPs saw opportunities to introduce this self-screening programme to at-risk patients and improve patients' risk profiles. Programme participants reported that after being trained to use the device, they felt empowered to do self-screening and found it convenient. GPs saw empowerment could enhance the doctor-patient relationship. Participants and GPs valued screening in diagnosing AF that would otherwise be missed in usual care, but the uncertainty of effective screening duration could be a barrier., Conclusions: This screening programme was feasible with the reinforcement of the underpinning enablers. Several implementation strategies were identified using SWOT analysis, including leveraging the opportunity for GPs to introduce this screening programme to at-risk patients., Trial Registration Number: ACTRN12621000184875., 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: In Australia, diabetes is the fastest growing chronic condition, with prevalence trebling over the past three decades. Despite reported sex differences in diabetes outcomes, disparities in management and health targets remain unclear. This population-based retrospective study used MedicineInsight primary healthcare data to investigate sex differences in diabetes prevalence, incidence, management, and achievement of health targets., Methods: Adults (aged ≥ 18 years) attending 39 general practices in Western Australia were included. Diabetes incidence and prevalence were estimated by age category. Health targets assessed included body mass index (BMI), blood pressure, blood lipids, and glycated haemoglobin (HbA 1c ) levels. Medical management of diabetes-associated conditions was also investigated. Time-to-incident diabetes was modelled using a Weibull regression. A multilevel mixed-effects logistic regression model investigated risk-adjusted sex differences in achieving the HbA 1c health target (HbA 1c  ≤ 7.0% (≤ 53 mmol/mol))., Results: Records of 668,891 individuals (53.4% women) were analysed. Diabetes prevalence ranged from 1.3% (95% confidence interval (CI) 1.2%-1.3%) in those aged < 50 years to 7.2% (95% CI 7.1%-7.3%) in those aged ≥ 50 years and was overall higher in men. In patients younger than 30 years, incidence was higher in women, with this reversing after the age of 50. Among patients with diabetes, BMI ≥ 35 kg/m 2 was more prevalent in women, whereas current and past smoking were more common in men. Women were less likely than men to achieve lipid health targets and less likely to receive prescriptions for lipid, blood pressure, or glucose-lowering agents. Men with incident diabetes were 21% less likely than women to meet the HbA1 c target. Similarly, ever recorded retinopathy, nephropathy, neuropathy, hypertension, dyslipidaemia, coronary heart disease, heart failure, peripheral vascular disease and peripheral artery disease were higher in men than women., Conclusions: This research underscores variations in diabetes epidemiology and management based on sex. Tailoring diabetes management should consider the patient's sex., (© 2024. The Author(s).)

Misinformation campaigns target wind farms, but levels of agreement with this misinformation among the broader public are unclear. Across six nationally quota-based samples in the United States, United Kingdom, and Australia (total N = 6008), over a quarter of respondents agree with half or more of contrarian claims about wind farms. Agreement with diverse claims is highly correlated, suggesting an underlying belief system directed at wind farm rejection. Consistent with this, agreement is best predicted (positively) by a conspiracist worldview (i.e., the general tendency to believe in conspiracy theories; explained variance ΔR² = 0.11-0.20) and (negatively) by a pro-ecological worldview (ΔR² = 0.04-0.13). Exploratory analyses show that agreement with contrarian claims is associated with lower support for pro-wind policies and greater intentions to protest against wind farms. We conclude that wind farm contrarianism is a mainstream phenomenon, rooted in people's worldviews and that poses a challenge for communicators and institutions committed to accelerating the energy transition., (© 2024. The Author(s).)

Context: Hyperglycemia in hospital inpatients without pre-existing diabetes is associated with increased mortality. However, the independent contribution of hyperglycemia to health care-associated infection (HAI), acute kidney injury (AKI), and stroke is unclear., Objective: To investigate the relationship between hyperglycemia and adverse clinical outcomes in hospital for patients with and without diabetes., Methods: Diabetes IN-hospital: Glucose and Outcomes (DINGO) was a 26-week (October 2019-March 2020) prospective cohort study. Clinical and glucose data were collected up to the 14th day of admission. Primary stratification was by hyperglycemia, defined as ≥2 random capillary blood glucose (BG) measurements ≥11.1 mmol/L (≥200 mg/dL). Propensity weighting for 9 clinical characteristics was performed to allow interrogation of causality. To maintain the positivity assumption, patients with HbA1c >12.0% were excluded and prehospital treatment not adjusted for. The setting was the Royal Melbourne Hospital, a quaternary referral hospital in Melbourne, Australia. Admissions with at least 2 capillary glucose values and length of stay >24 hours were eligible, with half randomly sampled. Outcome measures were HAI, AKI, stroke, and mortality., Results: Of 2558 included admissions, 1147 (45%) experienced hyperglycemia in hospital. Following propensity-weighting and adjustment, hyperglycemia in hospital was found to, independently of 9 covariables, contribute an increased risk of in-hospital HAI (130 [11.3%] vs 100 [7.1%], adjusted odds ratio [aOR] 1.03, 95% CI 1.01-1.05, P = .003), AKI (120 [10.5%] vs 59 [4.2%], aOR 1.07, 95% CI 1.05-1.09, P < .001), and stroke (10 [0.9%] vs 1 [0.1%], aOR 1.05, 95% CI 1.04-1.06, P < .001)., Conclusion: In hospital inpatients (HbA1c ≤12.0%), irrespective of diabetes status and prehospital glycemia, hyperglycemia increases the risk of in-hospital HAI, AKI, and stroke compared with those not experiencing hyperglycemia., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Little is known about the degree to which the COVID-19 pandemic, and associated restrictions and disruptions to health services, impacted the accessibility of hormonal long-acting reversible contraception (LARC) devices within Australia. Here, we explore longitudinal patterns of dispensing of the contraceptive implant and hormonal intrauterine devices (IUDs) within Australia, before and during the COVID-19 pandemic., Methods: Population-based cohort study; analysis of 10% random sample of national Pharmaceutical Benefits Scheme dispensing data, for females aged 15-49 years dispensed a hormonal LARC device between February 2017 and November 2021., Results: Interrupted time-series analysis demonstrated overall that there were no significant differences in monthly dispensing rates of hormonal LARC following the Australian onset of the pandemic in April 2020, with no subsequent change in the trend. However, when stratified by LARC type, a significant increase was evident during the pandemic period (April 2020-November 2021) in the rate of hormonal IUD dispensing per month (0.20 per 10 000 95% CI 0.01 to 0.38)), compared with a decrease for the implant (-0.08 per 10 000 (95% CI -0.16 to 0.01)). Increases in hormonal IUD dispensing during the pandemic were most pronounced for those aged 20-24 years, new users, those without a Commonwealth concession card, and in the State of Victoria., Conclusions: Within Australia in the defined pandemic period, access to hormonal LARC devices was not negatively impacted. Rather a significant increase in dispensing of hormonal IUDs was evident., Competing Interests: Competing interests: DB and DM have received honoraria, and research and travel funding from pharmaceutical companies marketing long-acting reversible contraception (LARC) products including Bayer and Organon., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Adverse childhood experiences (ACEs) have a profound impact on individuals, shaping their long-term health and life opportunities. This study delves into the complex ties between ACEs and the socioemotional development of Australian children and youth by examining the relationships between adverse childhood experiences and externalizing, internalizing, and prosocial behaviors., Methods: This study utilized data from the Longitudinal Study of Australian Children and employed the generalized estimating equation method to investigate the relationships between adverse childhood experiences and externalizing, internalizing, and prosocial behaviors in Australian children and adolescents., Results: Adverse childhood experiences such as physical punishment, hostile parenting, parental conflicts, separation, financial strain, and parental mental health issues increased the risk of externalizing and internalizing behaviors while reducing prosocial behaviors. The risk increases with the number of ACEs, as evidenced by the incidence ratio (IR); for example, for externalizing behaviors, an ACEs score of one leads to IR = 1.69, while an ACEs score of 4 results in IR = 3.34. Similar trends were observed for internalizing and prosocial behaviors., Limitations: The presence of imbalanced longitudinal data, arising from variations in the number of observations across different time points, challenges robust inferences. Furthermore, this study investigates the relationship between ACEs and behavioral problems, without establishing causality. Consequently, the results should be interpreted with caution., Conclusions: The findings of this study highlight that adverse childhood experiences significantly influence behavioral outcomes in children and adolescents. These findings underscore the critical need for early detection and intervention to mitigate the consequences of traumatic childhood experiences., Competing Interests: Declaration of competing interest The authors declare no financial and personal competing interests., (Copyright © 2024. Published by Elsevier B.V.)

Background: A barrier to hepatitis C virus (HCV) cure is conventional testing. The aim of this study was to evaluate the effect of HCV antibody and RNA point-of-care testing (POCT) on testing rates, linkage to care, treatment, and acceptability of testing in 3 priority settings in Australia., Methods: Participants were enrolled in an interventional cohort study at a reception prison, inpatient mental health service, and inpatient alcohol and other drug unit, between October 2020 and December 2021. HCV POCT was performed using SD Bioline HCV antibody fingerstick test and a reflexive Xpert HCV Viral Load Fingerstick test using capillary blood samples. A retrospective audit of HCV testing and treatment data was performed at each site for the preceding 12-month period to generate a historical control., Results: A total of 1549 participants received a HCV antibody test with 17% (264 of 1549) receiving a positive result, of whom 21% (55 of 264) tested HCV RNA positive. Across all settings the rate of testing per year significantly increased between the historical controls and the study intervention period by 2.57 fold (rate ratio, 2.57 [95% confidence interval, 2.32-2.85]) for HCV antibody testing and 1.62 (rate ratio, 1.62 [95% confidence interval, 1.31-2.01]) for RNA testing. Treatment uptake was higher during the POCT intervention (86% [47 of 55]; P = .01) compared to the historical controls (61% [27 of 44])., Conclusions: This study demonstrated across 3 settings that the use of HCV antibody and RNA POCT increased testing rates, treatment uptake, and linkage to care. The testing model was highly acceptable for most participants., Clinical Trials Registration: ACTRN-12621001578897., Competing Interests: Potential conflicts of interest. E. M. M. reports grants paid to Royal Adelaide Hospital from the Gilead Research Fellowship. J. R. reports payments from AbbVie for education. A. W. reports Medical Research Future Fund grants for 2021–2022. V. C. reports an National Health & Medical Research Council grant partnership, serving as principal investigator for the National Australian HCV Point-of-Care Testing Program, and participation as a member of the Clinical Advisory Group for the Kirby National Australian HCV Point-of-Care Testing. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Suicidal ideation, a significant public health issue, necessitates further investigation of its correlates and precursors. Extensive research highlights the association between Work Family Conflicts (WFC) and psychological distress, including depression. However, research examining the correlation between high WFC experiences and suicidal ideation is sparse. This study explores the association between WFC and suicidal ideation within an occupation non-specific community sample., Methods: Community-based, representative data from the Australian-based Personality and Total Health (PATH) Through Life project formed the basis of this study. Participants eligible for the study (N = 1312) were employed either full-time or part-time and took part in an online questionnaire. Importantly, the data include robust measures of WFC, active suicidal ideation, and depression., Results: After adjusting for psychosocial job characteristics, history of suicidal ideation, and other socio-demographic factors, high WFC was associated with increased odds of active suicidal ideation (Model 4: OR: 1.58, CI: 1.04-2.40). Further, supplementary analyses indicated that depression is an important component of this relationship. Analyses exploring an interaction effect by gender showed that while a significant association between high WFC and suicidality was observed among men after adjustment for all covariates, this association was not evident for women., Limitations: A small number of participants reported suicidal ideation, potentially affecting the statistical power to detect significant effects. WFC was measured at one time-point, prohibiting the exploration of its causal and/or chronic impact on suicidal ideation., Conclusion: We find evidence that high WFC is linked to increased active suicidal ideation - specifically for men., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Introduction: Hepatitis B is a significant public health concern and a leading cause of liver cancer across the world. In Australia, hepatitis B is largely endemic in migrant communities, particularly amongst the Chinese and Vietnamese communities. Negative attitudes towards hepatitis B can be a major barrier to hepatitis B testing and linkage to care. This mixed-methods research explores the attitudes and beliefs, including stigma, about hepatitis B among students of Vietnamese and Chinese background in Australia. Students were chosen as participants as there is little research examining hepatitis B among university students in Australia and they provide a point of entry to communities with high prevalence of hepatitis B, that otherwise may be hard to access., Methods: Online surveys were distributed in Chinese, Vietnamese, and English via social media and completed by 112 students of Chinese and 95 students of Vietnamese backgrounds. In-depth interviews were also conducted with 13 Vietnamese and 10 Chinese participants to further explore the survey results., Results: Survey findings suggest that students have varied attitudes towards people living with hepatitis B. Around half of the participants reported they would behave negatively towards other people with hepatitis B and that they would expect to experience stigma or discrimination if they had hepatitis B. While over 70% in both samples reported that people who have hepatitis B should not be isolated by family and friends, 47.6% of the Chinese sample and 28.3% of the Vietnamese sample reported they would avoid close contact with someone with hepatitis B. The qualitative data expands on the quantitative data. Four key themes were identified: (1) Caution not discrimination (2) Hepatitis B as a sign of immoral behaviour (3) Discriminatory behaviour based on perceived effects of hepatitis B and (4) Shifting attitudes., Conclusion: This research provides insights that could inform culturally sensitive health promotion programs to address negative attitudes towards hepatitis B among the broader Chinese and Vietnamese communities living in Australia., (© 2024. The Author(s).)

Background: This study evaluated an online childbirth education course on childbirth self-efficacy and, subsequent birth related posttraumatic stress disorder (PTSD) symptoms and mother-infant relationship quality., Method: Three group (intervention, passive control, active control) parallel randomised controlled trial. Groups were assigned using computer generated random allocation. For the passive control group participants were instructed to carry on with whatever they were currently undertaking with their pregnancy, while the active control group were asked to read a booklet comprised of twelve birth stories. The purpose of the active control was to check if the act of having an activity to complete would influence outcomes. For the online course group (intervention) participants were asked to complete the online version of a birthing course designed by She Births ® . One hundred and twenty-five women residing in Australia between 12 and 24 weeks pregnant were recruited online. Participants were asked to complete their required activity between 24 and 36 weeks pregnant. Childbirth self-efficacy scores were tested pre and post intervention (time one and time 2), PTSD symptoms and mother-infant relationship quality were tested at six weeks and six months postnatal., Results: There was no significant interaction by group for childbirth self-efficacy scores. Mean difference scores at time one (pre-intervention) and time two (post-intervention) for each group indicated a trend in the online group towards higher childbirth self-efficacy compared with the two control groups. The main effect of group on birth related PTSD scores was not statically significant at six weeks postnatal or at six months postnatal. The main effect of group on mother-infant relationship scores was not statically significant at six weeks postnatal or six months postnatal., Conclusions: Trends showed childbirth self-efficacy scores to be higher in the intervention group compared with the two control groups, demonstrating effectiveness for the intervention. Paradoxically, PTSD scores were higher in the intervention group compared with the two control groups and therefore also reported poorer mother-infant relationship quality. External factors may be more important than childbirth self-efficacy highlighting the need for a holistic approach that addresses systemic and socio-political influences to improve communication, autonomy, and respectful maternity care., Trial Registration: This trial was retrospectively registered with the Australian New Zealand Clinical Trials Registry number: ACTRN12624000241538 on March 11, 2024., (© 2024. The Author(s).)

Background: Accessing sexual and reproductive health (SRH) services in rural Australia presents complex challenges that negatively impact women's health and exacerbate health inequities across the life course. This systematic review synthesises evidence on the barriers and facilitators to women's access to SRH services in rural Australia, considering both supply and demand dimensions., Methods: We systematically searched peer-reviewed literature published between 2013 and 2023. Search terms were derived from three major topics: (1) women living in rural Australia; (2) spatial or aspatial access to SRH services; and (3) barriers or facilitators. We adopted the "best fit" approach to framework synthesis using the patient-centred access to healthcare model., Results: Database searches retrieved 1,024 unique records, with 50 studies meeting the inclusion criteria. Most studies analysed access to primary care services (n = 29; 58%), followed by hospital services (n = 14; 28%), health promotion and prevention (n = 5; 10%), and specialist care (n = 2; 4%). The type of care accessed was mostly maternity care (n = 21; 42%), followed by abortion services (n = 11; 22%), screening and testing (n = 8; 16%), other women's health services (n = 6; 12%), and family planning (n = 4; 8%). There were numerous barriers and facilitators in access from supply and demand dimensions. Supply barriers included fragmented healthcare pathways, negative provider attitudes, limited availability of services and providers, and high costs. Demand barriers encompassed limited awareness, travel challenges, and financial burdens. Supply facilitators included health system improvements, inclusive practices, enhanced local services, and patient-centred care. Demand facilitators involved knowledge and awareness, care preferences, and telehealth accessibility., Conclusion: This review highlights the urgent need for targeted interventions to address SRH service access disparities in rural Australia. Understanding the barriers and facilitators women face in accessing SRH services within the rural context is necessary to develop comprehensive healthcare policies and interventions informed by a nuanced understanding of rural women's diverse needs., (© 2024. The Author(s).)

Many people living with a rare disease (RD) face challenges accessing timely diagnosis and disease-specific specialist care. Early health-care challenges for people living with Epidermolysis Bullosa (EB), a rare genetic disease affecting 1:20,000 individuals, can begin in the antenatal period.People living with EB in Australia have access to a government funded disease specific antenatal education and support program through the National Epidermolysis Bullosa Dressing scheme (NEBDS). This article discusses two births involving families living with EB Simplex (EBS) in regional Australia. The education and support structures implemented by the NEBDS and clinical teams are discussed in line with the Australian National Strategic Action Plan for rare diseases, and includes access to genetic diagnosis, EB education, and complex care coordination., (© 2024. The Author(s).)

Background: Children's exposure to sugary beverage advertising may have changed during the COVID-19 pandemic due to shifts in media habits, which could subsequently have influenced intake. This study aimed to examine: 1) children's frequency and setting of exposure to advertisements of sugary beverages in six countries before and during the COVID-19 pandemic; 2) the association between exposure to sugary beverage advertisements and intake., Methods: Children aged 10-17 years (n = 28,908) in Australia, Canada, Chile, Mexico, the United Kingdom (UK) and the United States (US) completed online surveys in 2019, 2020 and 2021 as part of the International Food Policy Study using a repeat cross-sectional study design. Respondents self-reported frequency and setting of exposure to sugary beverage advertisements, location of school classes (in-person/online, 2020-2021 only), screen time, and sugary beverage intake. Adjusted weighted logistic and negative binomial regression models stratified by country examined associations between year and reported sugary beverage advertising exposure, and associations between sugary beverage advertising exposure and intake. Differences in reported advertising exposure between students taking online or in-person school classes were explored., Results: Self-reported exposure to advertisements for sugary beverages at least weekly was relatively stable across years within countries, with differences in settings of exposure. Exposure to sugary beverage advertisements increased on digital media independently of screen time from 2019 to 2021 in Australia, Canada, the UK and US, with a concomitant decrease in exposure in retail settings in all countries except the UK. In Australia and the UK, children attending all classes online were more likely to report at least weekly (vs less than once a week) exposure to sugary beverage advertisements, and children attending all classes online were more likely to report exposure to advertisements on digital media and in other settings (e.g., billboard, magazines) compared to children attending in-person classes in Australia, Canada and the UK. Exposure to sugary beverage advertisements at least weekly (IRR = 1.12,99%CI:1.09-1.15) and in each of the settings was associated with sugary beverage intake., Conclusions: Exposure to digital advertisements for sugary beverages increased from 2019 to 2021 in most countries, and exposure was associated with sugary beverage intake. Reducing children's exposure to advertising of less healthy foods, including on digital media, may reduce sugary beverage intake., (© 2024. The Author(s).)

Background: Artificial intelligence (AI) has been increasingly recognized as a potential solution to address mental health service challenges by automating tasks and providing new forms of support., Objective: This study is the first in a series which aims to estimate the current rates of AI technology use as well as perceived benefits, harms, and risks experienced by community members (CMs) and mental health professionals (MHPs)., Methods: This study involved 2 web-based surveys conducted in Australia. The surveys collected data on demographics, technology comfort, attitudes toward AI, specific AI use cases, and experiences of benefits and harms from AI use. Descriptive statistics were calculated, and thematic analysis of open-ended responses were conducted., Results: The final sample consisted of 107 CMs and 86 MHPs. General attitudes toward AI varied, with CMs reporting neutral and MHPs reporting more positive attitudes. Regarding AI usage, 28% (30/108) of CMs used AI, primarily for quick support (18/30, 60%) and as a personal therapist (14/30, 47%). Among MHPs, 43% (37/86) used AI; mostly for research (24/37, 65%) and report writing (20/37, 54%). While the majority found AI to be generally beneficial (23/30, 77% of CMs and 34/37, 92% of MHPs), specific harms and concerns were experienced by 47% (14/30) of CMs and 51% (19/37) of MHPs. There was an equal mix of positive and negative sentiment toward the future of AI in mental health care in open feedback., Conclusions: Commercial AI tools are increasingly being used by CMs and MHPs. Respondents believe AI will offer future advantages for mental health care in terms of accessibility, cost reduction, personalization, and work efficiency. However, they were equally concerned about reducing human connection, ethics, privacy and regulation, medical errors, potential for misuse, and data security. Despite the immense potential, integration into mental health systems must be approached with caution, addressing legal and ethical concerns while developing safeguards to mitigate potential harms. Future surveys are planned to track use and acceptability of AI and associated issues over time., (© Shane Cross, Imogen Bell, Jennifer Nicholas, Lee Valentine, Shaminka Mangelsdorf, Simon Baker, Nick Titov, Mario Alvarez-Jimenez. Originally published in JMIR Mental Health (https://mental.jmir.org).)

Snacking is a common dietary behaviour among adolescents contributing to more than one quarter of their total energy intake; however, the relationship between snacks and diet quality remains unclear. Hence, this study aimed to examine the characteristics of snacks among adolescents with different levels of diet quality. Dietary data collected from a nationally representative sample of Australian adolescents (12-18 years old, n = 935) using one 24-hour dietary recall in the National Nutrition and Physical Activity Survey were analysed. Snacks were defined based on participant-identified eating occasions, and diet quality was assessed using the Dietary Guideline Index for Children and Adolescents (DGI-CA). Marginal means and proportion of snack characteristics including snack frequency, snack energy density (ED), and commonly consumed foods at snack from the five food groups and discretionary foods at snack across DGI-CA tertiles (highest tertile indicating high guideline adherence) were estimated for both boys and girls using linear regression and logistic regression. Differences in means were tested using the F-test. The results showed no significant differences in the mean frequency of snacks across tertiles of DGI-CA scores. The mean ED of snacks decreased as DGI-CA scores increased in both boys (lowest tertile = 8.4, 95% CI [7.1, 10.0] kJ/g, highest tertile = 6.3 [5.4, 7.4] kJ/g) and girls (lowest tertile = 9.0 [7.8, 10.3] kJ/g, highest tertile = 5.9 [5.1, 6.9] kJ/g). As diet quality improved, the proportion of adolescents consuming discretionary (i.e., unhealthy) foods and foods from the five food group foods as snacks decreased and increased, respectively. In conclusion, adolescents with higher diet quality consumed snacks with a lower ED while lower proportion of them consume discretionary foods, and higher proportion of them consume from the five food groups. Encouraging the consumption of foods from the five food groups with lower ED as snacks presents an opportunity to enhance adolescent diet quality., (© 2024. The Author(s).)