Arthropod-borne diseases (ABDs) represent an ongoing threat to global public health, affecting millions annually with viral, bacterial and parasitic infections worldwide. Data on prevalence and disability-adjusted life years (DALYs) for ABDs were obtained from the Global Burden of Disease (GBD) 2021 study. Based on DALYs, the nine ABDs were categorized into protozoan, helminthic, and viral diseases. Temporal trends were quantified using the average annual percentage change (AAPC) in age-standardized prevalence rates (ASPRs) and age-standardized DALY rates (ASDRs). Frontier analysis was applied to evaluate deviations from the expected disease burden according to sociodemographic index (SDI), and Bayesian age-period-cohort models were used to project future disease burdens through 2030. From 1990 to 2021, the global ASDR for ABDs declined from 1,219.26 to 884.16 per 100,000 population. Protozoiasis caused the most substantial burden (ASDR 819.83), followed by helminthiases and viral diseases. Although ASDRs declined across the three major disease categories overall, dengue fever exhibited a significant upward trend within the viral disease group (AAPC = 0.83%). Burdens remained concentrated in low and lower-middle SDI regions, though High-income Asia Pacific and Australasia experienced notable increases. Frontier analysis indicated that while parasitic burdens declined with rising SDI, viral disease patterns varied: dengue peaked at middle SDI, and Zika increased with SDI. Adolescents and young adults bore the greatest burden, with distinct sex-specific differences. Projections suggest that by 2030, ASPRs for malaria and African trypanosomiasis, as well as ASDRs for malaria, African trypanosomiasis, and leishmaniasis, will increase. Protozoan infections, particularly malaria, continue to dominate the burden of arthropod-borne diseases. Although the overall burden of viral diseases declined modestly, certain arboviral infections, including dengue, showed increasing trends. The distinct geographic concentration of these infections, coupled with the rising threat of arboviral diseases, underscores the urgent need for enhanced surveillance systems, expanded vaccination coverage, and strengthened global collaboration to mitigate future risks.
Many countries recommend 3-monthly chlamydia/gonorrhoea screening for gay, bisexual and other men who have sex with men (GBMSM). Evidence about the limited impact of frequent, asymptomatic gonorrhoea/chlamydia screening on population prevalence, coupled with concerns about overburdened health services and antimicrobial resistance (from frequent treatment), calls into question current approaches to asymptomatic screening. We explored sexual health professionals/experts' arguments in favour/against reducing asymptomatic screening using Polis (www.Pol.is), an online, crowdsourcing tool for understanding what large groups think. Recruited via global peak bodies/networks, 99 individuals in the field of sexually transmitted infections (STIs) (43.4 % clinicians, 35.4% researchers) primarily from Australasia (41.4%), UK/Europe (29.3%) and North America (22.2%) participated. Ninety-one statements were submitted in favour/against reduced screening for GBMSM (eg, 'Bisexual men who don't test regularly risk putting women at risk'). Participants voted on submitted statements (agree/disagree/pass). Statements with ≥80% agreement were considered as 'strong' support, 70%-79% 'moderate' and ≤69% 'mixed'. Statements were grouped using content analysis to assess support for clusters of related statements. There was 'mixed support' for statements on: (1) the impact of screening in reducing prevalence; (2) whether asymptomatic infections pose clinical harm/necessitate treatment; and (3) risk of antimicrobial resistance. Statements advocating for 6-monthly screening received 'moderate support', with arguments centring on resource use. Participants 'strongly supported' the need for community engagement and maintaining frequent HIV/syphilis screening. While there were mixed opinions about relative utility, risks and harms of reducing chlamydia/gonorrhoea screening for GBMSM, arguments relating to resource constraints may provide common ground for policy changes.
To explore families' experiences participating in a 10-week web-based lifestyle programme for school-aged children with overweight or obesity. A qualitative study using inductive analysis of semi-structured interview data. Victoria, Australia. Families (children aged 7-13 years with overweight or obesity-body mass index ≥85th percentile-and accompanying parent) recruited for a randomised controlled trial that evaluated the effectiveness of the web-based programme and who received the programme (n=102 children/85 families) were invited to participate in a semi-structured interview at 3 months post-programme. Families received a 10-week family-focused electronic health (e-Health; web-based) lifestyle programme with health coaching sessions-an evidence-based programme adapted from its in-person, group-based counterpart. A total of 28 families, including 34 children (eight siblings) and mostly mothers, shared their experiences. 10 themes were identified on family members' experiences and aligned with the socioecological model: intrapersonal-knowledge development on healthy living; experiences and stigma related to overweight, obesity or weight; engaging with structural features of the web-based programme, interpersonal-family dynamic; connections with others (non-healthcare professionals) outside of home; relationship with healthcare professionals, environmental/institutional-impact of COVID-19 lockdowns; health-promoting environments; promotion of and access to overweight or obesity management programmes; web-based programme as part of a larger or established system. Each theme highlighted factors that influenced programme uptake and engagement. Valuable insights were gained on ways to better adapt e-Health (web-based) lifestyle programmes for children with overweight or obesity. Families perceived advantages in a web-based lifestyle programme and highly regarded humanised features and elements comparable to conventional in-person programmes. Further research is needed to explore the perspectives of families from diverse populations, fathers and families who decline participation in the follow-up period. Web-based lifestyle programmes that incorporate contemporary e-Health technologies, including responsive AI, also warrant further investigation to maximise programme benefits. ACTRN12621001762842.
Healthcare costs not subsidized by the government and are covered by patients, are known as out-of-pocket healthcare expenditure (OOPHE). In Australia, OOPHE disproportionately impacts Aboriginal households, particularly in rural and remote regions. Currently no patient reported measures (PRM) to assess OOPHE exist, despite being an identified priority in Aboriginal communities. This study developed and psychometrically evaluated (validity and test-retest reliability) of an OOPHE PRM for Aboriginal households in outer regional to remote areas. This Aboriginal led study was governed by an Aboriginal Governance Group, which involved a 4-stage process: (i) identification of community-derived OOPHE themes; (ii) item development and expert judgment quantification; (iii) exploratory factor analysis (EFA) to determine factor structure through pilot testing with Aboriginal participants; and (iv) assessment of reliability and stability through test-retest methods. Stage 1 identified OOPHE themes (i.e. barriers, financial strain), informing development of a 15 item PRM in Stage 2. In Stage 3, 39 Aboriginal participants completed Test 1, with EFA revealing a two-factor model; Factor 1 (8 items, internal consistency = 0.91) and Factor 2 (6 items, internal consistency = 0.85). In Stage 4, 32 participants completed Test 2, with over 60% of items showing substantial to perfect agreement (κ = 0.61-0.87) and scale-level reliability as good to excellent (ICC = 0.75-0.92). Two items performed poorly and were removed, resulting in a final 13-item PRM. The OOPHE PRM demonstrates promising psychometric properties as a culturally grounded measure of OOPHE burden among Aboriginal families, supporting advocacy for equitable policy, funding, and health system reform.
Trichinellosis is a food-borne zoonosis caused by Trichinella spp., typically acquired through consumption of raw or undercooked meat. Given its broad geographic distribution and persistent gaps in surveillance and reporting, we conducted a global systematic review and meta-analysis to estimate the prevalence of human Trichinella infection and identify major sources of heterogeneity. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), PubMed, Web of Science, ScienceDirect, Scopus, and Google Scholar were searched from inception to 15 May 2025. Eligible studies reported human Trichinella infection with extractable numerator/denominator data. Random-effects meta-analysis was performed in R. A total of 127 studies were included. Across these studies, 425,225 individuals were examined and 31,401 cases were identified, yielding an overall pooled prevalence of 18 %. Pooled prevalence differed significantly by continent (ranging from 6.30 % in South America to 24.42 % in Oceania, p = 0.0279) and sampling period (20.59 % after 2000 vs. 10.02 % in 2000 or before, p = 0.0290). At the country level, the highest pooled prevalences were observed in Thailand, Germany, and Türkiye. Occupation also differed significantly (p = 0.0145), with the highest prevalence observed in military personnel (41.47 %). Clinical manifestations differed significantly (p < 0.0001), and the most frequently reported symptoms were myalgia (63.19 %), fever (60.77 %), and facial edema (58.98 %). Temporal meta-regression showed no significant trend. Human Trichinella infection remains a global public health concern, with higher prevalence observed in Asia and Europe. Individuals with risk exposure who develop symptoms such as myalgia, fever, or facial edema should undergo prompt medical examination. A One Health approach integrating human, animal, and food-safety surveillance is essential for effective prevention and control of Trichinella infection.
Prenylopathies such as mevalonate kinase deficiency (MKD) are an emerging family of monogenic autoinflammatory diseases with an underlying defect in isoprenoid lipid synthesis and protein prenylation. The mechanisms linking defective protein prenylation to systemic inflammation remain unclear. We revealed that mice and humans with MKD had significant decreases in the frequency of mature natural killer (NK) cells, impaired trafficking of cytolytic granules, reduced cytotoxic activity, and increased production of the cytokine interferon γ (IFN-γ). Mice with MKD failed to clear murine cytomegalovirus (MCMV) infections and had elevated serum IFN-γ and inflammatory pathology, likely the result of decreased and dysregulated cytotoxic cells. Finally, we describe the beneficial effect of cytokine signaling blockade with a Janus kinase (JAK) inhibitor in an infant with severe MKD. Together, these findings reveal a fundamental role for dysregulated cytotoxic cells and IFN-γ production in MKD and likely other prenylopathies. Importantly, this work provides a rationale for the use of JAK inhibitors in the treatment of MKD.
Adolescent vaping has become a persistent health and behavioural challenge in schools, yet many institutions lack reliable tools to detect and respond to concealed e-cigarette use. This study addresses this problem by evaluating the real-world performance of a low-cost "Internet of Things" (IoT) vape detection system deployed across 37 high-risk restroom and change-room locations at a large Australian Independent school. The aim was to determine whether an IoT-based environmental monitoring platform could accurately identify vaping events, support timely staff intervention, and provide actionable insights into student behaviour patterns. A longitudinal case study design was used, collecting continuous particulate matter (PM2.5 and PM10) data at one-minute intervals over an 18-month period, where PM2.5 and PM10 refer to particulate matter with aerodynamic diameters ≤ 2.5 µm and ≤10 µm, respectively, reported in micrograms per cubic metre (µg/m3. Threshold-based alerting, cloud-based data processing, and school-led Closed-circuit television (CCTV) verification were combined to assess detection accuracy, temporal trends, and operational responses. The system recorded more than 300 vaping-related incidents, with clusters aligned to predictable times of day and higher prevalence among senior students. Operational detection performance was high, with alert events characterised by rapid, concurrent PM2.5 and PM10 excursions consistent with vaping-related aerosol profiles, although staff responsiveness declined over time due to alert fatigue and competing priorities. A major environmental smoke event demonstrated the need for context-aware logic to reduce false positives. The findings demonstrate that real-time aerosol monitoring is not only technically reliable but also highly effective in detecting vaping within school environments. These perspectives help explain why user engagement, alert fatigue, and institutional follow-through are as critical as sensor accuracy itself. Ultimately, the effectiveness of vape detection relies on strong organisational commitment, well-defined response workflows, and alignment with broader wellbeing and policy strategies. When these elements are in place, such systems can evolve from simple detection tools into intelligent, integrated components of school health governance.
Maternal mortality ratio (MMR) and neonatal mortality rate (NMR) are key indicators of population health and health system performance. Yet longitudinal cross-country evidence on how macroeconomic conditions-such as income growth, inflation, and unemployment-relate to maternal and neonatal mortality remains limited. We assembled a balanced country-level panel of 152 countries for 1991-2023 using World Health Organization mortality series and World Bank World Development Indicators. Outcomes (MMR, NMR) were modelled in natural logarithms; GDP per capita was log-transformed, inflation was expressed as ln(1 + IR/100), and unemployment as the first difference of log unemployment. Cross-sectional dependence was assessed using Pesaran's CD test, and-given dependence-stationarity was evaluated with Pesaran's second-generation CIPS test. Associations were estimated using two-way fixed-effects panel regressions (country and year effects) with Driscoll-Kraay standard errors (lag = 2), with sensitivity analyses using lagged GDP per capita (t - 1, t - 2) and continent-stratified models. In the global two-way Driscoll-Kraay fixed-effects models (country and year fixed effects; Driscoll-Kraay standard errors, maximum lag = 2), GDP per capita was inversely associated with both ln(MMR) (B = - 0.233, p < 0.001) and ln(NMR) (B = - 0.139, p < 0.001), while inflation (LINF) was positively associated with both outcomes (lnMMR: B = 0.055, p < 0.001; lnNMR: B = 0.042, p < 0.001). Changes in unemployment (dLUR) were positively associated with ln(NMR) in the global model (B = 0.102, p < 0.05) and in Asia (B = 0.063, p < 0.05), but were not significant for ln(MMR) in continent-specific models under the contemporaneous income specification (Table 6). This pattern may partly reflect measurement limitations of official unemployment rates in settings with large informal sectors and weaker labour-market registration; however, in the lagged-income specification (GDP per capita t - 1), dLUR was positive and statistically significant in Europe (Supplementary Table S2), suggesting that unemployment effects on maternal mortality may be specification- and context-dependent and should be interpreted cautiously. Macroeconomic conditions were associated with maternal and neonatal survival. Globally, higher GDP per capita was associated with lower maternal and neonatal mortality, and this inverse association remained in sensitivity analyses using lagged GDP per capita (t - 1, t - 2). Although the strength of income-mortality associations varied across continents and some region-outcome models were imprecisely estimated, particularly in Oceania (small number of countries), the overall pattern suggests that macroeconomic conditions may be relevant correlates of RMNCH outcomes. Inflation was related to worse outcomes in some settings, underscoring the importance of growth that preserves purchasing power and protects health-system inputs, but the inflation-mortality relationship was heterogeneous across regions. Unemployment effects appeared context-specific, with evidence most clearly observed for neonatal mortality in Asia, suggesting that labour-market and social-protection responses may be most relevant where vulnerability and out-of-pocket financing are high. These findings should be interpreted as adjusted associations rather than causal effects. Aligning macroeconomic management with RMNCH financing and access policies may help support progress in preventable maternal and neonatal deaths. Not applicable.
Air ambulance helicopters are a scarce and costly resource in New Zealand. Despite widespread use of the Advanced Medical Priority Dispatch System (AMPDS), no validated framework exists to determine which determinant codes are associated with helicopter tasking. This study aimed to examine whether specific AMPDS codes are associated with an increased likelihood of helicopter arrival at the scene in New Zealand. A retrospective observational study using all AMPDS-coded incidents recorded by the Emergency Ambulance Communications Centre from January 1, 2023, to December 31, 2024, was conducted. Exclusions included interhospital transfers, search and rescue events, direct air desk notifications, and nonpatient incidents. For each code, incident volume and helicopter arrivals at the scene were measured. Codes were classified as high volume (≥ 50 helicopter arrivals) or high yield (arrival ratio, ≤ 1:10). Among 1,161,169 AMPDS-coded incidents, 34,869 (3.0%) were reviewed by an air desk clinician and 7,688 (0.66%) resulted in a helicopter arrival. Thirty-seven codes generated ≥ 50 arrivals, accounting for 59.3% of helicopter responses but representing 440,781 incidents overall. An additional 102 codes had arrival ratios of ≤ 1:10, although most had low absolute volumes. Only 3 traffic-related codes (29D06, 29D02N, 29D02K) met both criteria, accounting for 823 incidents (0.07%) and 192 arrivals (2.5%). In contrast, 791 codes never produced a helicopter arrival, including 133 with > 100 incidents. AMPDS codes alone have limited discriminative capacity for helicopter tasking in New Zealand. A small subset of traffic-related codes demonstrated predictive value and may support more targeted referral pathways. Integrating selected high-yield codes with geospatial thresholds and availability of local critical care resources may streamline clinician review, reduce overtriage, and optimize deployment of scarce aeromedical assets.
General practitioners (GPs) play a pivotal role in a patient's health care journey. However, demands on general practice, including complex patient management, workforce shortages, and health system fragmentation, have been shown to adversely impact the delivery of high-quality care and health outcomes. Integrated care models, particularly those that offer virtual care options, can support improved access to quality care and efficiency of health care delivery across metropolitan and rural areas. The SUSTAIN model of care was created to provide an accessible option for integrated care. It consists of centralized pediatricians supporting GPs in their practice through virtual coconsultations, virtual "lunch and learn" case discussions, and phone or email support. There is limited evaluation literature on integrated models of care being implemented in a primary care setting where the GP and family are face to face and the non-GP specialist is virtual. To address this gap, a comprehensive implementation evaluation of the SUSTAIN model of care was conducted. This study aimed to examine what, why, and how different factors impact the uptake of the SUSTAIN model of care from the perspectives of the SUSTAIN pediatricians and metropolitan and rural GPs in New South Wales, Australia. A qualitative study was conducted as part of a mixed methods implementation evaluation of the SUSTAIN model of care. Data were collected via recorded online focus groups and interviews with GPs, practice managers, and pediatricians at 6 and 12 months after the commencement of SUSTAIN. Data were analyzed thematically using iterative thematic analysis informed by the Consolidated Framework of Implementation Research. Eighteen focus groups and 13 interviews were conducted. GPs, practice managers, and pediatricians found the SUSTAIN model acceptable, with the flexibility and practicality of the model highlighted. GPs valued the learning opportunities, collaboration, and support they gained from working alongside the pediatricians. Virtual delivery through telehealth was viewed as a positive means of receiving specialist support that would otherwise be inaccessible to many practices. Increased efficiency in workflow and working at the top of scope in pediatric care as well as opportunities for meaningful professional relationships and increased family trust in GP-delivered care were recognized as key benefits that enhanced uptake. The current landscape of Australian general practice, with fee-for-service billing and workflow pressures, was recognized as a barrier to engagement with SUSTAIN. GPs and pediatricians highlighted that more appropriate remuneration to support co-consultation is vital to the sustainability and scalability of the SUSTAIN model. The SUSTAIN model of care expands on our understanding of the benefits of integrated GP-pediatrician models of care in general practice by demonstrating the utility of a pediatrician supporting a GP in their practice via telehealth across metropolitan and rural environments in New South Wales, Australia.
School-based mental health screening typically relies on single-time-point assessments, which assume that students' emotional well-being is sufficiently stable for classification based on a single measurement. The present study examined this assumption by evaluating the stability of emotional well-being classifications under repeated mood monitoring. Students from two secondary schools (United Kingdom, n = 413; Australia, n = 354) completed the Brief Emotional Experience Scale weekly across six to seven weeks. Emotional well-being classifications were examined relative to a predefined low well-being threshold to assess stability across time, and a post-monitoring survey examined students' self-reported perceptions of the monitoring experience. Most students (78%) showed consistently above-threshold classifications across monitoring occasions, while a small proportion (5%) showed persistently low classifications. However, 17% of students fluctuated above and below the low well-being threshold across weeks, indicating that classification status for this group was sensitive to assessment timing. When monitoring data were aggregated using different decision rules, the proportion of students flagged as low well-being varied substantially, ranging from approximately 5% under a conservative stability-based criterion to around 12% when classifications were based on averaged monitoring scores. Classifications derived from averaged monitoring scores showed high agreement with single-time-point classifications, while identifying a partially different subset of students as low well-being, underscoring the sensitivity of threshold-based decisions to classification approach. Student feedback provided preliminary contextual insight into the acceptability of repeated monitoring under routine school conditions, with over half of respondents reporting that the process supported their emotional understanding. A substantial minority also reported greater inclination to talk with others about their well-being. Overall, the findings indicate that single-time-point screening may provide an incomplete basis for emotional well-being classification for some students, and that repeated assessment offers additional temporal context for interpreting threshold-based screening decisions.
The Island Mass Effect (IME) is the nearshore enhancement of primary productivity around islands and atolls relative to offshore waters. Although its physical and biogeochemical drivers are well characterized, the IME's influence on the diets and distributions of consumers remains poorly resolved. We applied amino acid compound-specific stable isotope analysis (AA-CSIA) to Hawaiian zooplankton sampled across nearshore-offshore and surface-deep gradients to test whether island-derived production alters isotopic composition and trophic structure in reef-associated assemblages relative to offshore counterparts across sites, seasons, and years. Essential amino acid δ13C values (δ13CEAA) normalized to their mean values displayed contrasting nearshore-offshore patterns: lysine and threonine δ13C values increased with distance from shore, whereas phenylalanine and valine values decreased. These patterns likely reflect shifts in zooplankton diet and the amino acid biosynthetic pathways of their primary producer prey along the coastal-oceanic gradient. Source amino acid δ15N values (δ15NSAA) declined offshore for lysine and phenylalanine but increased with depth, indicating spatial variation in nitrogen sources and greater reliance on microbially reworked organic matter at depth. Trophic position estimates based on δ15N values of glutamic acid and alanine relative to phenylalanine increased offshore and with depth, consistent with longer food webs and additional microzooplankton trophic steps in offshore waters. Multivariate analysis integrating δ13CEAA and δ15NSAA values clearly distinguished reef, offshore surface, and offshore deep zooplankton assemblages, revealing a conservative isotopic tracer of island-derived production in reef communities. These results demonstrate AA-CSIA's utility for tracing island-derived productivity to consumers and clarifying biogeochemical connectivity between coastal and open-ocean food webs.
Effective communication is essential for health, quality of life and social participation. Adults with communication disabilities-particularly those with intellectual disabilities-often face systemic barriers to accessing appropriate support. A retrospective audit of 497 consultations from 276 adults with intellectual disabilities living in Australian group homes (2017-2022) was conducted at a private speech pathology clinic. The audit examined the proportion of patients recommended for and receiving a full communication assessment. A mixed method analysis was conducted and identified that of the 234 patients recommended for assessment, only 93 (39.7%) received one. Thematic analysis found that facilitators included dedicated funding, carer advocacy and multiple clinical contacts. Barriers were primarily related to funding limitations, competing clinical priorities and poor service access. There is a clear gap between recommended and delivered communication assessment. Systemic reform is needed to prioritise communication through improved funding pathways, carer training and access to speech pathology services. Many adults with intellectual disability living in group homes are missing out on important communication support. Even when a speech pathologist has recommended a communication assessment, only about 4 in 10 actually receive the assessment that they need. Funding, lack of advocacy and communication being seen as a low priority are three reasons that people don't get the communication assessment that they need. This happens, even though communication problems can seriously affect health, behaviour and quality of life.
Maternal stress and the developmental environment jointly affect offspring fitness and phenotype during early life. Mothers transmit stress to offspring through the deposition of hormones and energy into developing embryos, who are themselves subject to environmental stressors. A species' life-history strategy (e.g. size and number of eggs) may further buffer or exacerbate the effects of developmental stress on offspring. We experimentally tested the joint effects of stress hormones (exogenous corticosterone applied directly to eggs) and the developmental environment (incubation temperature) on the hatching success and size of two lizards (Lampropholis delicata and Lampropholis guichenoti) that differ in maternal investment strategy. Hatching success was reduced by corticosterone exposure, but only in L. delicata, which produces clutches of more numerous but smaller eggs than L. guichenoti. Hatchling size in both species, however, was reduced by corticosterone exposure, incubation at high temperatures or both. In both species, maternal investment (egg size) was the best predictor of hatching success and hatchling size, regardless of treatment. Our findings suggest that, both within species and between species, greater maternal investment buffers offspring from maternal and developmental stress effects on early-life fitness (survival) but does not prevent their effects on fitness-associated phenotypes (hatchling size).
To assess long-term trends, regional disparities, determinants, and quality of care for type 2 diabetes mellitus (T2DM) among women aged 55 years or above worldwide. Using Global Burden of Disease 2023 data, we quantified incidence, mortality, and disability-adjusted life years (DALYs) attributable to T2DM among women aged 55 years or above from 1990 to 2023. Temporal trends were evaluated using joinpoint regression. Regional determinants were identified through explainable machine learning models (XGBoost with Shapley Additive Explanations). A Quality-of-Care Index, derived from mortality, disability, and prevalence indicators, was constructed to evaluate health care performance. In 2023, South Asia recorded the largest absolute burden of T2DM among women aged 55 years or above, with 749,064 cases (95% uncertainty intervals [UI] 592,209-892,315), 274,542 deaths (171,620-381,640), and 8.11 million DALYs (5.82-10.43 million), followed by East Asia and high-income North America. From 1990 to 2023, Eastern Europe exhibited the steepest long-term increases in age-standardized incidence, mortality, and DALYs rates, with an average annual percent change of 2.49% for incidence and 3.97% for mortality. Mortality and DALYs burdens peaked among women aged 65-69 years. Across regions, high fasting plasma glucose, high body mass index, and low physical activity were the leading contributors to disease burden. Distinct regional risk patterns were observed, including air pollution in Asia, unhealthy dietary patterns in high-income North America, sedentary behavior in Oceania, and alcohol use in South Asia. Lower Quality-of-Care Index scores were strongly associated with higher mortality and DALYs rates, highlighting substantial inequities in diabetes care. The escalating burden of T2DM among women aged 55 years or older reflects interactions between biological aging and metabolic, behavioral, and environmental risks. Age-targeted prevention, improved care quality, and mitigation of modifiable exposures are critical to reduce diabetes-related disability globally.
Diabetes mellitus (DM) is a significant driver of excess morbidity and premature mortality, though few contemporary or locally-derived data quantify this impact on New Zealanders, particularly Māori and Pacific Peoples. This prospective, national population study examines the life expectancy (LE) for New Zealanders with and without DM, and characterises mortality rates. Data from 01/01/2015 to 31/12/2019 housed in the Integrated Data Infrastructure, including the Virtual Diabetes Registry and Health New Zealand Mortality Collection, were linked. Estimated remaining LE years were calculated using abridged period life tables using the Chiang method for those with type 1 diabetes (T1D), type 2 diabetes (T2D), and without DM. Sub-group analysis by ethnicity was completed. Five-year cause-specific mortality rates per 100,000 people were compared by DM group. T1D and T2D prevalence was 0.4% and 5.5% in the overall sample (n = 4,505,478). Considerable ethnic differences in LE were evident, for example a 13-, 17.1-, and 24.5-year loss in remaining LE years was seen in men aged 0-19 years with T1D in the overall, Māori, and Pacific Peoples groups respectively compared to those without DM. An age-dependent reduction in remaining life expectancy years was also evident; for example an 8.6 (8.5-8.7) year reduction seen in females with DM aged 0-4, and 4.0 (4.0-4.1) year reduction for women with DM aged 65-69. Those with DM had higher cause-specific death rates. DM is associated with age-dependent reductions in LE across the entire lifespan, with disproportionately higher LE loss seen in Māori and Pacific Peoples.
Aboriginal and Torres Strait Islander adolescents living in rural communities do not have sufficient access to health promotion services. Community programs that respond to adolescent needs, highlight community strengths, and are locally tailored are needed. Set in Queensland (Australia), this study was cross-sectional and qualitative in design. Using implementation science and Aboriginal and Torres Strait Islander frameworks, this study aimed to identify community priorities for the co-design of a culturally appropriate, empowerment-focused nutrition program with rural Aboriginal and Torres Strait Islander adolescents. Through community yarning, the barriers, enablers, and opportunities for program implementation were explored within an Aboriginal and Torres Strait Islander community-controlled health organization. Ten adolescents, two parents/caregivers, eight healthcare staff, six community leaders, and four Elders participated. Thematic analysis identified six themes that outline community health priorities, contextualization to the local food environment, and the importance of cooking skills for empowerment and involving the family unit. Thematic analysis also explored community preferences for program evaluation. Themes were integrated with other knowledge sources to develop a program outline that is aligned with evidence-based practice and community voice. Implementation of the co-designed program is recommended and will be explored in partnership with the community through future research.
Diabetes-related foot disease (DFD) is a leading cause of disability worldwide. In Australia, DFD affects approximately half a million people and is the primary driver of diabetes-related hospitalisations, amputations and costs. Guideline-based multidisciplinary footcare can halve these rates and improve quality of life, yet access remains inequitable, particularly for rural and remote communities for whom DFD hospitalisation and amputation rates are persistently high. Geographic isolation, workforce shortages and fragmented service delivery are barriers to DFD care, with Aboriginal and Torres Strait Islander Peoples experiencing additional cultural and systemic challenges. Telehealth-enabled models of care offer a promising solution to reducing inequities in access without compromising effectiveness. Four 'Foot Hubs' have been established across Queensland (Australia) to deliver specialist multidisciplinary footcare via a hub-and-spoke model, combining telehealth, outreach, and local partnerships to improve access for people living with DFD in rural and remote areas. This commentary provides an introductory overview of these Foot Hub services and how implementation science (the scientific study of methods and strategies to promote the systematic and sustainable uptake of new practices) can support the uptake and sustainability of these new models of care.
In Australia, one in five adults experiences a mental disorder and 1.5 million individuals exercise with a personal trainer or coach. Consequently, personal trainers are likely exposed to individuals with mental health concerns, despite having minimal mental health training. This study aimed to explore personal trainers' exposure and responses to clients' mental health concerns. Australian personal trainers responded to an online survey which assessed how frequently personal trainers observed clients with mental health concerns and their responses to these concerns. Bivariate correlations, chi-square tests of independence and independent samples t-tests were used to assess relationships between variables. Of 56 personal trainers, almost all (96%) reported encountering mental health concerns from clients and 48% reported a frequency of at least weekly. Worry/anxiety (50%) and significant interpersonal stress (46%) were identified by the personal trainers as the most frequently observed client concerns. In response to client concerns, most personal trainers (89%) used listening skills, while those who had received mental health training were more likely to refer clients to mental health professionals. Despite a lack of formal training, personal trainers are frequently exposed to individuals with mental health concerns. There is a need for appropriate mental health training in this profession to allow for adequate referral pathways. SO WHAT?: Our findings indicate personal trainers play a role in mental health promotion. By providing personal trainers with adequate training, they can refer clients with mental health concerns to mental health professionals.
Managing multiple chronic conditions often requires people to make treatment decisions, particularly when faced with competing demands. This usually leads to condition prioritisation, where one condition is prioritised over the other. Considering that diabetes and hypertension are closely linked, prioritising medication for one condition over the other can have serious health implications. This study aimed to explore condition prioritisation in people with coexisting diabetes and hypertension, and its impact on medication adherence. A qualitative study was conducted with adults on medications to manage coexisting diabetes and hypertension, residing in Australia. Thirty participants were asked to indicate the condition they considered more important to manage and discuss their prioritisation. Thematic analysis was used to identify key factors influencing condition prioritisation. The Adherence to Refills and Medication Scale questionnaire was used to assess medication adherence for each condition. Medication adherence scores varied in most cases, with diabetes and hypertension scores ranging from 12 to 21 and 12 to 26, respectively. Participants who prioritised one condition over the other demonstrated better medication adherence for the condition they perceived as more important. The key themes influencing disease prioritisation emerged primarily as patient-related and condition-related factors. Most participants prioritised diabetes due to its immediate perceived risks, fear of complications and previous experience with the condition. Participants' perceptions of a condition and observed effects of the condition influenced condition prioritisation. This in turn influenced medication adherence, as participants were more vigilant in managing the condition they prioritised. These findings emphasise the need for tailored interventions that address the challenges of managing multiple conditions and medications. People living with diabetes and hypertension took part as study participants but were not involved in the design, analysis, or dissemination stages of this research. A lay summary of the results will be shared via email with participants who expressed interest in receiving the findings of the study.