搜索结果：Australian and New Zealand journal of public health

New Zealand's health system is under sustained pressure, with worsening access to primary and specialist care, widening inequities and declining public confidence. In this context, there is an emerging but largely unarticulated shift towards increased reliance on private provision and private financing. This editorial examines whether this represents privatisation by design, default or drift, and considers the likely consequences. Evidence from New Zealand and comparable health systems suggests that increased privatisation is associated with higher costs, reduced equity and no consistent improvement in outcomes. Rising private insurance costs, outsourcing of elective services and public-private partnerships risk undermining the sustainability of the public system while failing to address the fundamental drivers of demand, particularly chronic disease and unmet need in primary care. These trends disproportionately affect Māori, Pacific peoples and low-income populations, raising concerns regarding Te Tiriti o Waitangi obligations. An alternative approach is proposed, centred on sustained investment in primary care and prevention, a clearly defined core package of publicly funded services and a cross-party health accord to ensure policy stability. The future of New Zealand's health system will depend on deliberate choices about equity, access and the role of the public sector.

Efforts to address gambling harm often rely on narrow definitions of help seeking that focus on professional treatment. This approach overlooks the many other ways people seek support, use tools, or take action to reduce or control their gambling. This study aimed to examine the uptake of a broader range of help seeking and self-management approaches among people who gamble, across priority populations, including Māori, Pacific, Asian and Australian Aboriginal and Torres Strait Islander (ATSI), and among people experiencing different levels of gambling harm. A 58-item checklist on help seeking options contained three domains: People and Places (n = 33 items), Tools and Resources (n = 12 items) and Self-Help Strategies (n = 13 items). It was administered online to 514 adults in New Zealand and Australia, using quota sampling for ethnicity and gambling severity (75% past or current problems, 25% regular gamblers). Respondents indicated how often they had engaged in each help-seeking behaviour over the past 12 months. Overall, 97% of participants reported using at least one help-seeking option. People and Places were widely used (80.5%) with the most frequently endorsed items being partner, family member, or friend (62.3%), peers in social or cultural groups (44.9%), general practitioners (44.6%) and mental health counsellors (44.4%). Tools and Resources were used by 87.0% and included time-outs (64.8%), reading online information (63.0%), and spending limits (62.5%). Self-Help Strategies were used by 95.5% including lifestyle change (84.2%), setting time or money limits (83.3%), thinking differently about gambling (80.9%), and self-monitoring thoughts, feelings, or behaviours (77.0%). Priority populations had higher uptake of help-seeking options across each of the three domains than non-priority populations. Help seeking increased across levels of gambling severity. Eighty percent of people with no gambling problems reported using any option, compared with 97.9% at low risk and 100% among those with moderate risk or problem gambling. Help seeking extended well beyond specialist gambling services and included family, community and general health settings. This suggests that responses to gambling harm already occur across a wide range of everyday settings and highlights the need to better understand and strengthen these community responses. Future research should examine how different options connect to form pathways of support and how effective these pathways are over time.

In Aotearoa New Zealand, human papillomavirus (HPV) self-testing was introduced simultaneously with HPV primary screening in September 2023 to improve access and reduce inequities for priority populations, including Indigenous M&#x101;ori, Pacific and under-screened people. To contribute policy-relevant information, we implemented non-standard engagement and screening strategies, including text message invitation, mailed test kits, at-home self-testing, telehealth support and follow-up by a central nurse-led co-ordination team. We partnered with an Auckland primary health organisation (PHO) with high enrolment of priority populations. We invited people eligible for cervical screening aged 30-69&#xa0;years by text message to receive mailed test kits (April-October 2023); people who did not respond were re-invited (October-November 2023). Offering a financial incentive to return a sample (intervention group) was compared with no offer (control group) in a sub-group of eligible M&#x101;ori and Pacific who received a repeat mailed test kit in a nested randomised controlled trial (April-May 2024). Self-tested participants were invited by text message to an online survey. We invited 25,315 people and 24.0% opted in. Lower initial consent rates were increased after additional re-invitation reminders for M&#x101;ori (20.0% to 30.4%) and Pacific (13.7% to 24.9%), with the final consent rate in M&#x101;ori equal to European/Other (29.2%; p&#x2009;=&#x2009;0.284). Almost half (48.2%) of consenting participants returned a sample, giving a self-test uptake of 11.6% (n&#x2009;=&#x2009;2,925). Uptake was significantly lower (all p&#x2009;<&#x2009;0.001) for M&#x101;ori (12.7%) and Pacific (8.4%) vs. European/Other (19.0%), and for those under-screened (10.5%) vs. those overdue by&#x2009;<&#x2009;6&#xa0;months (19.4%). In the RCT, sample return rate did not differ significantly (p&#x2009;=&#x2009;0.704) between the intervention (7.9%) and control (8.5%) groups. HPV was detected in 7.7% of 3,018 valid results. Follow-up test rates were high (96.8% for cytology, 90.5% for colposcopy). Almost all survey respondents preferred a mailed at-home self-test for their next screen (91.9%; n&#x2009;=&#x2009;193 of 210). Invitation by text message to mailed at-home HPV self-testing engaged priority populations in cervical screening. Central co-ordination support achieved high rates of sample return and follow-up testing where required. A mailed at-home testing option, strongly preferred by survey respondents, warrants consideration in a broader programme to improve access to cervical screening, with additional targeted strategies to improve sample return rates for priority populations. While the overall study did not reach the ICJME or WHO criteria for clinical trial registration, the nested RCT was retrospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12625000798460) and World Health Organization (WHO UTN U1111-1324-8454).

BACKGROUND: Healthcare is a significant contributor to greenhouse gas emissions and solid waste. This study evaluated Australian healthcare workers&#x2019; knowledge, current behaviours and perceived barriers related to improving healthcare sustainability. METHODS: From November 2023 to January 2024, we conducted an online cross-sectional survey of employees at 12 healthcare organisations in Victoria, Australia. All employees of participating institutions at the time of the survey were considered eligible; students were excluded. The survey link was distributed to all employees via email, and participation was based on self-selection. Our survey included questions from the validated Climate Change Attitudes Survey and Climate and Health Tool, focusing on the domains of awareness, concern and behaviours at home and at work. We also developed original, non-validated questions to explore self-reported barriers to reducing healthcare-associated greenhouse gas emissions and waste, and perceived responsibility for action. Statistical analyses included logistic and linear regression models with cluster-robust standard errors, paired t-tests, Wilcoxon and McNemar tests to compare responses across groups. RESULTS: We received 2,040 complete and eligible responses. Most respondents were women (1,559, 76%), working in metropolitan locations (1,787, 88%) and employed in the public sector (1,937, 95%). Overall, concern regarding climate change (mean score: 3.29; 5-point Likert scale from 0 to 4) was slightly higher than awareness (mean score: 3.09). Respondents reported taking fewer sustainability actions at work compared to their personal lives (mean score 2.09 versus 2.48, p&#x2009;<&#x2009;0.001). Our original, exploratory questions demonstrated that the three most common barriers to reducing healthcare-associated waste and greenhouse gas emissions were identical: lack of knowledge (39% and 53%, respectively), busyness (26% and 20%) and perceived lack of support from superiors (26% and 19%). CONCLUSIONS: While respondents demonstrated high levels of climate awareness and concern, they faced numerous barriers to pursuing greater sustainability actions at work. The three most frequently reported barriers were a lack of knowledge, a lack of time, and a lack of support. Consistent with previous studies, employees struggled to transfer environmental sustainability practices from their personal lives to the workplace. Our findings offer practical insights into how employee perspectives can shape future strategies to enhance healthcare environmental sustainability.

Burns patients with recorded discharges against medical advice (DAMA) face potential medical and financial consequences associated with future readmissions. This study aimed to investigate the characteristics and outcomes of patients with recorded DAMA from burns services in Australia and New Zealand. In an observational study using data from individuals aged &#x2265;&#x202f;16 years captured by the Burns Registry of Australia and New Zealand with a burn-related admission between July 2009 and June 2022, 325 patients (1.4&#x202f;%) had recorded DAMA. A greater proportion of patients with recorded DAMA were aged 30-44 years, of Australian Aboriginal and Torres Strait Islander origin, from outer regional Australia, had pre-existing mental health conditions, with substance use, and sustained their injury through suspected assault or abuse. Injuries in patients with recorded DAMA were more severe. Compared to patients without DAMA, a greater proportion of patients with DAMA were readmitted within 28 days of discharge (13.8&#x202f;% versus 4.9&#x202f;%), with failed discharge processes (45.5&#x202f;%) and infection (18.2&#x202f;%) being the most frequently recorded reasons. They required readmission to the intensive care unit (20&#x202f;% versus 8.6&#x202f;%) with longer lengths of stay. Outcome findings remained similar in a matched cohort analysis between those with and without recorded DAMA. These findings highlight the consequences of DAMA, necessitating primary measures to address modifiable, cultural, and social factors preemptively to prevent DAMA among disadvantaged individuals, and secondary measures to minimize the impact of DAMA (e.g., adequate pain and wound discharge management, follow-up care, community-based treatments, etc.).

Debilitating Symptom Complexes Attributed to Ticks (DSCATT) is a chronic, debilitating illness associated with tick bites in Australia. DSCATT is of unknown aetiology, can impact emotional well-being and has no recognised treatments. The development and piloting of a novel psychotherapeutic adjunctive intervention for DSCATT that aimed to increase daily functioning, improve quality of life and reduce the impact of symptoms in people with DSCATT. This is a single-site, intervention development and acceptability study. The intervention was developed iteratively according to a Human-Centred Design (HCD) approach and manualised across four phases, with input from end users at each phase: qualitative interviews, development of the intervention, piloting, and revising and refining the intervention. Acceptability of the prototype intervention was evaluated through thematic template analysis of exit interviews. Self-report measures were completed before and after intervention delivery. Following qualitative interviews with 13 participants (11 females and 2 males; aged 35-70 years), the intervention was informed by an Acceptance and Commitment Therapy (ACT) model interwoven with cognitive and behavioural strategies that targeted DSCATT-specific difficulties. The manualised intervention consisted of 12 1-h weekly individual sessions, delivered by psychologists via Telehealth (video call or telephone). Modules addressed the six core psychological processes of ACT, alongside DSCATT-specific modules addressing cognitive function, sleep and social relationships. Pilot testing and follow-up interviews were conducted in a separate sample of six individuals with DSCATT (all females; aged 46-71 years). All participants reported that the approach benefited their emotional well-being and overall health and would recommend it to others with DSCATT. This is a novel and theoretically driven psychotherapeutic intervention for DSCATT, co-produced with patient involvement across four phases. Pilot testing suggested the manualised intervention was feasible and acceptable, supporting future evaluation of feasibility and treatment outcomes with randomised controlled trials. This study involved the engagement and participation of individuals with DSCATT across four stages of the project, according to an HCD approach-the choice of the intervention; the development of the intervention; the piloting of the intervention, and the assessment of the intervention. The pilot study component of this project was prospectively registered on the Australian and New Zealand Clinical Trial Registry (ANZCTR); trial ID: ACTRN12621001032842.

To identify and synthesise published literature on public health advocacy relating to influencing e-cigarette public policy outcomes and report the public health advocacy strategies and tactics employed by advocates and assess the effectiveness of these approaches in achieving the advocates' intended policy outcomes. A narrative review was undertaken of peer-reviewed journal articles that addressed public health advocacy relating to e-cigarettes. Several key themes emerged, which are as follows: (i) few studies have examined the effectiveness of e-cigarette public health advocacy strategies, (ii) a wide range of tactics is being used but tactic effectiveness has not been evaluated and (iii) diverse public health actors have engaged in e-cigarette advocacy, leading to differing views on regulation. The identified scarcity of research on effective public health advocacy for e-cigarettes appears to be a missed opportunity to share experiences and vital learnings. The findings highlight the need for greater evidence on effective public health advocacy strategies and tactics. Further research insights could strengthen the impact of e-cigarette advocacy among public health researchers, organisations, and practitioners that engage with this important public health issue.

Preschool wheeze and asthma are associated with substantial morbidity and impaired future lung function. Yet, wheeze is unreliably reported with high disagreement (>50%) between parental and physician observations. Objectively defining wheeze and its reversibility could enable an earlier asthma diagnosis and improve preschool wheeze management.Our primary aim is to determine in preschool children (aged 0.5-6 years) suspected of asthma whether adding WheezeScan to routine clinical assessment (vs assessment without WheezeScan) improves the diagnosis of asthma. Our primary hypothesis is that using WheezeScan in preschool children suspected of asthma is associated with increased definitive asthma diagnoses in this age group. Our secondary aims are to (a) examine the effect of using WheezeScan on patient-reported outcomes (PROs) and (b) healthcare costs. Our secondary hypothesis is that using WheezeScan in preschool children suspected of asthma is associated with improved quality of life without incurring additional healthcare costs. Our multicentre prospective cohort study involves recruiting 102 preschool children suspected of asthma. WheezeScan, a user-friendly digital device, incorporates artificial intelligence to objectively define wheeze and its response to bronchodilators. Over 6&#x2009;weeks, parents/caregivers use the WheezeScan two times per day and whenever wheezing is suspected. If wheeze is detected, an inhaled short-acting &#x3b2;2-agonist is administered and WheezeScan determines if wheeze resolves thereafter.Our primary endpoint is the proportion of children with a definitive asthma diagnosis, compared with baseline, based on the treating clinician's assessment using WheezeScan data. Our secondary outcomes are PROs, reflecting generic health-related quality-of-life and cough-specific (if chronic cough present) outcomes and health costs. The Children's Health Queensland Human Research Ethics Committee (HREC/23/QCHQ/100691) and the Queensland University of Technology Office of Research Ethics and Integrity approved the study. We will publish and share results with the academic and healthcare communities and relevant patient organisations. Australian New Zealand Clinical Trials Registry ACTRN12623000904673.

Older patients admitted under surgical care have longer length of stay (LOS) and are at risk of functional decline, hospital-acquired complications and geriatric syndromes. Embedded specialist geriatrician models within surgical care teams can reduce length of stay and perioperative complications. Evidence gaps remain regarding the implementation of these models of care and their impact on patient outcomes. This study aims to measure hospital, patient and implementation outcomes of an embedded perioperative geriatric service in a large Australian tertiary referral hospital. This hybrid type 1 effectiveness-implementation trial involves four services (emergency general, elective general, urology and vascular surgery), with a predicted reach of >2000 patients over 24 months. The intervention consists of a proactive geriatrician-led service providing a comprehensive geriatric assessment and ongoing review during the acute admission. Service evaluation will be via (1) traditional hospital outcomes (primary outcome LOS); (2) implementation outcomes; and (3) patient reported outcomes across three 6&#x2009;month phases: (1) prior to service implementation; (2) during service implementation and (3) continued service but without active implementation. Data analysis will include descriptive statistics of patient demographics, clinical characteristics and implementation outcomes; cost-effectiveness; univariate and multivariate analysis of outcomes against demographic and clinical characteristics and thematic analysis of qualitative data. This trial has been approved by the Hunter New England Research Ethics Committee (2024_ETH023259). The findings will be disseminated via peer-reviewed publications and conference presentations. The research team will facilitate adoption more broadly within the health service. Australian New Zealand Clinical Trials Registry (ACTRN12625000404426).

BACKGROUND: Indigenous peoples in high-income settler-colonial countries experience disproportionately high cervical cancer incidence and mortality compared to non-Indigenous populations, reflecting systemic inequities and barriers to culturally safe care. HPV self-collection offers a potential solution to overcoming inequities by enabling women and people with a cervix to collect their own sample, improving autonomy, privacy, and access, and supporting culturally responsive models of care. While self-collection is accurate, acceptable, and increases screening participation, evidence is needed on how best to support implementation to reach Indigenous women and people with a cervix. OBJECTIVES: This scoping review aimed to identify and describe implementation strategies, barriers, facilitators, and context-specific adaptations to HPV self-collection for cervical screening among Indigenous women and people with a cervix in high-income settler colonial countries. METHODS: Eligible sources included peer-reviewed and grey literature published between August 2013 and November 2025 that described barriers, facilitators, implementation strategies, or context-specific adaptations to HPV self-collection among Indigenous women and people with a cervix in Australia, Aotearoa New Zealand, Canada, or the United States of America (USA). Database (PubMed, SCOPUS, ProQuest CINAHL) and grey literature searches targeting Indigenous-specific organisations, government websites were conducted, using the broad search terms: cervical screening, HPV, self-collection, and Indigenous peoples. Data were extracted and mapped against the Health Equity Implementation Framework to identify barriers, facilitators, and strategies relevant to the implementation of HPV self-collection. RESULTS: 32 publications were included, comprising 28 academic publications and 4 from the grey literature. Identified facilitators included client health literacy and knowledge, flexible models of care, culturally responsive care, supportive data and systems, and strengths-based messaging. Indigenous-led solutions were central to enabling these facilitators. CONCLUSIONS: While evidence comparing the impact of individual strategies is not available, community-driven, multi-component strategies were recommended. The most effective strategies appeared to combine flexible delivery models, such as home-based or outreach approaches, with tailored education focusing on increasing knowledge and building trust. Indigenous-led approaches and the involvement of Indigenous health workers and community leaders were central to strategies.

Artificial intelligence (AI)-based algorithms are being implemented in breast screening to detect breast cancers on mammographic images. We aimed to apply an epidemiological approach to demonstrate how a cancer detection algorithm can be leveraged as an intermediate-term predictor of breast cancer (current and 4-year risk) to deliver greater risk-based personalisation in screening mammography. In this population cohort study, we used detection scores from an AI cancer detection algorithm (BRAIx AI Reader), which was calibrated using a training dataset of 397&#x2009;648 women aged 40 years to 97 years from women who screened at BreastScreen Victoria, Australia between Jan 1, 2016, and Dec 31, 2017, to create a woman-specific mammography-based score for breast cancer risk, the BRAIx risk score. Subsequently, the BRAIx risk score was evaluated on an independent test dataset of women from BreastScreen Victoria, Australia, comprising a random population cohort of 96&#x2009;348 women who screened from Jan 1, 2016, to Dec 31, 2017, aged 40 years to 74 years, and an independent, external dataset from woman screened at Karolinska University Hospital, Stockholm, Sweden. We applied logistic regression, using the BRAIx risk score to estimate risks of invasive breast cancers on the test dataset: (1) detected at cohort entry (n=525); and (2) for women given an all clear, diagnosed during the next 4 years either at future screens (n=790) or during intervals between screens (n=308). We also trained full multivariate risk models (logistic regression and elastic net) using the training dataset and evaluated their predictive performance on the test and external validation data, with assessment of familial aspects of the BRAIx risk score achieved with inference about causation from examining changes in regression coefficients in an innovative statistical analysis framework. In both Australian and Swedish test datasets, the BRAIx risk score predicted cancer detection at cohort entry and future cancer risk (all p<0&#xb7;0001). The BRAIx risk score was the strongest tested explanatory factor for cancer detection at cohort entry (odds ratio 13&#xb7;80 [95% CI 9&#xb7;54-20&#xb7;80] in Australian data; 8&#xb7;89 [3&#xb7;19-37&#xb7;49] in Swedish data) and for intermediate-term cancer risk (2&#xb7;29 [2&#xb7;13-2.47] in Australian data; 2&#xb7;15 [1&#xb7;85-2&#xb7;50] in Swedish data). We found that adding a thresholded binary version of the BRAIx risk score significantly improved model fit (p<2&#xb7;2&#x2009;&#xd7;&#x2009;10-16, Australian and Swedish data) and women with BRAIx risk scores of more than 2 were significantly at many-fold increased risk of intermediate-term cancer than women below that threshold (12&#xb7;34 [7&#xb7;33-20&#xb7;91], Australia; 44&#xb7;7 [11&#xb7;9-184&#xb7;9], Sweden; p<0&#xb7;0001). For the top 2% of women given an all clear with the highest BRAIx risk score, the probability of a cancer diagnosis within 4 years was 9&#xb7;7%. The BRAIx risk score explained 23% of why family history predicts 4-year risk (p<0&#xb7;0001). After fitting the BRAIx risk score in a multivariate model, mammographic density was no longer significantly associated with breast cancer risk in the Australian test data (p>0&#xb7;05) and became associated with lower risk for intermediate-term cancer in the external Swedish test dataset (0&#xb7;83 [0&#xb7;73-0&#xb7;95]). The BRAIx risk score is a strong intermediate-term predictor of breast cancer (current to 4-year risk). Calibrating the score on a training dataset produces population-specific probabilities for calculating individual-specific risk scores for screening clients based on their mammogram images. These risk scores enable future development of personalised screening pathways to transform population breast cancer screening and save lives. Identification of women given an all clear but at very high risk, similar to those carrying BRCA1 and BRCA2 mutations, could reveal insights into both familial and non-familial causes of breast cancer. Australian Government Medical Research Future Fund, the Ramaciotti Foundation, the National Breast Cancer Foundation, Cancer Australia, and the National Health and Medical Research Council.

In July 2022, Human Papillomavirus (HPV) self-collection became available as a choice to all participants in Australia's National Cervical Screening Program (NCSP). This policy change aims to facilitate equitable access to cervical screening; however, further evidence is needed to support its implementation and reach under-screened women and people with a cervix. This implementation study seeks&#xa0;to embed HPV self-collection into Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) and/or primary care organisations whose context is similar to that of an ACCHO. This will be achieved by co-designing, implementing, and evaluating models of care tailored to local needs. The aim is to increase cervical screening participation, particularly among under- and never-screened, Aboriginal and Torres Strait Islander women and people with a cervix. Ultimately the aim is to achieve equity in cervical cancer elimination. Screen Your Way will use a before-and-after study design to evaluate the effectiveness, acceptability and sustainability of implemented strategies on cervical screening participation among Aboriginal and Torres Strait Islander women and people with a cervix. The study will be guided by an Indigenist implementation research approach and will employ mixed methods. Ethical approval has been obtained from the Australian Institute of Aboriginal and Torres Strait Islander Studies Research Ethics Committee (REC-0092), Aboriginal Health and Medical Research Council of New South Wales Ethics Committee (2078/23), Australian National University Human Research Ethics Committee (H/2023/1103), Northern Territory Department of Health and Menzies School of Health Research (HREC2023-4557), and Metro South Human Research Ethics Committee (HREC/2025/QMS/115155). Additional approvals will be obtained in accordance with the locally nominated governance protocols of each participating service. This may include approvals from ACCHO Boards, Community Juries, or other designated decision-making bodies. The research team will work closely with each service to ensure all required processes are respected and adhered to prior to commencing any research activities. Findings will be disseminated via workshops, reports, evidence briefs and resource creation to assist with the evidence-based scale up of self-collection in the ACCHO setting. Further dissemination will occur via conferences and peer-reviewed publications in partnership with the Screen Your Way Aboriginal and Torres Strait Islander Caucus.

This systematic review investigated the impact of digital health interventions including videoconferencing, telephone counselling, remote radiology assessment models and wearable activity tracker on cancer diagnosis and treatment in rural and remote Australia. We systematically searched MEDLINE, CINAHL, EMBASE and PubMed from inception to 25 March 2025 to identify studies examining digital health interventions for cancer diagnosis and management among adults and children living in rural and remote Australia. Findings were synthesised using vote counting by digital health intervention type and outcome. Twenty studies were included. Of these, 12 were classified as beneficial and 8 showed a positive effect of digital health interventions for cancer diagnosis and management. Videoconferencing, telephone counselling and remote radiology assessment model improved access to care, reduced travel burden and costs and were generally associated with high patient satisfaction. However, communicating diagnostic results via telephone remained a persistent challenge. Digital health interventions were found to improve patient satisfaction and reduce travel and relocation burdens and enhance access to cancer care in rural areas. To enhance the effectiveness of digital health interventions, integration of psychosocial support services is recommended to better meet the emotional and psychosocial needs of cancer patients.

People are increasingly aware of climate change; however, little information exists regarding community understanding of the links between climate change and health. To examine Western Australians' perceptions of climate-related health risks. A cross-sectional online survey of 1,164 adults was conducted in July 2022. Items explored included perceptions of climate change, its health implications, responsibility for managing health impacts, and preferred communication channels. Chi-square and logistic regression analyses identified demographic predictors of awareness. Most respondents (87.5 %) believe climate change is happening, consider health extremely important (57.7 %), and are interested in climate-health co-benefits (85.9 %). However, fewer than half (46.4 %) think climate change will harm their own health within ten years, and 49.4 % had given little thought to health impacts. Only 44.7 % recalled recent climate-health information, and most felt poorly informed. Despite high climate awareness, understanding of its health impacts is limited. Many anticipate worsening environmental conditions but fail to connect these with health outcomes-e.g., concern about extreme heat without expecting more heat-related illness. This disconnect highlights the need for targeted communication to improve climate-health literacy and support adaptive public behaviours. Strategic public health messaging should address knowledge gaps and strengthen community resilience.

In Australia, early detection of melanoma relies on opportunistic skin checks, yet information on skin check behaviours in the general population is limited. We aimed to examine the prevalence and correlates of clinical skin checks in a large Australian cohort. The 45 and Up Study recruited 267,357 New South Wales residents between 2005 and 2009. We assessed self-reported clinical skin checks in the previous 12 months among 43,799 participants who responded to the 2020 follow-up survey (52.8% response). Multivariable multinomial logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between participant characteristics and skin checks, classified as whole-body, partial (part-body or specific mole/spot), and no skin check. Participants' mean age was 70.3 years (SD 8.3, range 56-103) and 55.9% were female. The prevalence of skin checks over the past 12 months was 43.2% for whole-body, 21.0% for partial, and 35.8% for no skin check; 21.8% of participants reported more than one skin check during the year. The highest odds of having a whole-body skin check were for participants with a personal history of melanoma (aOR=3.74, 95% CI: 3.39-4.13) or non-melanoma skin cancer (aOR=4.05, 95% CI: 3.83-4.29), many moles (aOR=3.26, 95% CI: 2.79-3.80 versus no moles), and very fair, fair or olive skin (aOR &#x2265;2.6 versus black/brown skin). Other factors significantly associated with whole-body skin checks included being male, age 70-79 years, Australia/New Zealand country of birth, university education, private health insurance, being retired, household income >&#x202f;$90,000, family history of melanoma, inability to tan, longer time spent outdoors, participation in other cancer screening programs, and frequent sunscreen use. There were some differences for the associations with partial skin checks. Our findings provide valuable insights into skin checking behaviours in older adults in New South Wales, Australia, highlighting associations with sociodemographic, personal risk, and behavioural factors.

Psychological distress is common among intensive care unit (ICU) patients, yet current pharmacological approaches carry risks. The aim of this study was to survey ICU clinicians' perceptions of psychological stressors affecting patients, their coping strategies, and the perceived feasibility, benefits, and challenges of implementing virtual reality (VR) interventions in ICU settings. A dual-method cross-sectional survey was distributed to ICU clinicians in Australia and New Zealand between March and May 2025. The survey comprised 5-point Likert-scale and open-ended questions exploring three domains: (i) perceived psychological stressors in ICU patients; (ii) current practices and perceived effectiveness of psychological support interventions, including VR; and (iii) perceived barriers and design recommendations for VR implementation in the ICU. Quantitative data were analysed descriptively; qualitative responses underwent thematic analysis using the NVivo software. Among 143 valid respondents (125 completed), 56.6% were female; 48.3 % were nurses, 46.9% doctors, and 4.8% allied health professionals. Lack of sleep (median: 5 [4-5]), isolation (median: 4 [3-4]), temporal disorientation (median: 4 [3.5-4]), and sensory overload (median: 4 [4-5]) were rated as key stressors. Pharmacological, family communication, and maintaining a calm environment were the most implemented and effective interventions (median: 4 [4-4]). Engagement activities were infrequent, but structured communication with family was rated important (median: 4 [4-5]). The interventions listening to music, watching family videos, and viewing nature scenes (median: 4 [3-4.5]) closely followed. VR was seen as moderately familiar (median: 3 [2-3]) and moderately beneficial (median: 3 [3-4]) but difficult to implement (median: 3 [3-4]). ICU clinicians recommended that the VR content should be personalised, simple, safe, and supporting both patients' emotional needs and ICU workflow integration. ICU clinicians acknowledge the perceived psychological burden of ICU environments and engagement activities were infrequent in ICU patients. They express cautious optimism towards VR as a supportive tool. However, successful implementation requires addressing significant logistical, clinical, and educational barriers.

To estimate the proportion of all healthcare expenses attributable to diagnosing and managing skin cancer in a large, population-based cohort, and identify characteristics of high users of skin cancer services. A prospective cohort study of 40,338 Queensland residents with linked healthcare data from the Medical Benefits Scheme (MBS), Pharmaceutical Benefits Scheme (PBS) and Queensland Hospital Admitted Patient Data Collection databases. We quantified the frequency of use and healthcare costs (out-of-pocket and government) for MBS services, PBS services and hospital admissions related to skin cancer. Over an average of 8.5 years follow-up, 71% (n=28,498) of participants used 245,919 skin cancer services, costing the government approximately $43.1 million (2.4% of all health service costs). In total, 51% (n=20,548) of participants had &#x2265;1 skin biopsy, 36% (n=14,458) had &#x2265;1 keratinocyte cancer excision and 8% (n=3,226) had hospital admissions. Out of the total government or out-of-pocket costs for skin cancer services, 44% and 41% were for keratinocyte cancer excisions, respectively. Services for diagnosing and treating skin cancer accounted for 2.4% of all direct health service costs in this Queensland cohort. As skin cancer is largely preventable, investing in enhanced primary prevention efforts may mitigate these significant burdens.

OBJECTIVE: To establish the cost of implementation, as well as the social return-on-investment, when scaling the Seniors Exercise Park program across multiple local government areas. METHODS: Seniors Exercise Parks are an age-friendly active space. Implementation requires both creating and activating the park (i.e., running community programs that require leader training, community engagement, resource development and marketing). For the Social return on investment (SROI) analysis, the cost of implementation data (purchase, installation, programs) for six Seniors Exercise Parks in Victoria, Australia, was collected continually from the participating councils, over a 15-month time horizon (3-month baseline period; and 12-month intervention and maintenance period). Social return data was based on the difference in health and social care utilisation, as well as quality of life, leisure and work participation, in park users before (baseline period) and after (maintenance period) implementation of the six Seniors Exercise Parks. The cost of implementation was compared to the social return, to determine the SROI for the Seniors Exercise Parks establishment and activation per participant. The SROI analysis took a societal perspective and costs are presented in AUD$2024 with earlier costs inflated. RESULTS: Over 15 months the cost of implementation for the six Seniors Exercise Parks was $1,191,704, representing an average cost of $198,617 (SD $86,551) per park. The total investment cost ($1,191,704) was divided by the total number of older people who participated in a Seniors Exercise Park program over 12-months (n&#x2009;=&#x2009;883) to give an average investment cost of $1,350 per person. Over the first 12-months of Seniors Exercise Park programs, the per participant social return was $3,394; the investment was $1,350; indicating a SROI of $2.50 for every $1.00 spent. CONCLUSION: From a broad societal perspective, state-based scaling of the Seniors Exercise Park program, incorporating the creation and activation of age-friendly active spaces across multiple local government areas, may provide a strong return on investment. TRIAL REGISTRATION: This economic evaluation was prospectively registered with the Australian New Zealand Clinical Trials Registry. Trial number ACTRN12622001256763. Date registered 20/09/2022.

To describe the perspectives of Aboriginal and Torres Strait Islander peoples and health care workers on genomics in cancer care to inform the National Framework for Genomics in Cancer Control (the Framework). A total of 37 Aboriginal and Torres Strait Islander community members, health care workers, researchers, and Aboriginal community-controlled health sector representatives participated in five in-person workshops around Australia. Data were audio recorded, transcribed and analysed using reflexive thematic analysis. Discussions of genomics in cancer control yielded six themes. Culture describes the cultural considerations for genomics. Self-determination describes the need for informed decision making in genomic healthcare and research. Capacity building identifies areas for improving education and awareness. Workforce identifies specific roles needed to support Aboriginal access to genomics. Access describes the barriers and enablers for genomics in cancer control. Suggested actions for integrating genomics into cancer care outlines participants' call to action. Equitable access to precision medicine for cancer control will be strengthened by co-design with and for Aboriginal and Torres Strait Islander peoples. The findings from this study informed the development of the Framework, which will guide Australia's cancer control sector in the use of genomics.